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Stress Management: Effective StrategiesJessica A. Stewart & Tonya ThompsonFerris State UniversityAbstractThis paper serves as a reference for Registered Nurses who are experiencing stress in the work place and outside of the work place. It includes statistics on work related stress for health care, and psychological changes associated with stress. Effective strategies for stress management are discussed. Specifically, relaxation techniques such as diaphragmatic breathing and Progressive Muscle Relaxation (PMR) are explained. Exercise is also discussed including walking, yoga, and Tai chi. All of these interventions can help nurses to manage and decrease stress.Stress ManagementThe Emergency Room was chaotic and the patient load increased, filling every room and crevice of the hallway as the staff rushed to keep up with the growing demand in front of them. The Registered Nurse (RN) worked diligently, and stress that was common place in this job setting began to take hold of her. This situation is like many others that occur in the workplace, as well as in everyday life. According to a survey conducted by the American Nurses Association in 2001, “70.5% of nurses cited that acute and chronic effects of stress and overwork were among their top three health and safety concerns” (American Holistic Nurses Association, 2011, para. 4). Furthermore, a survey conducted by the American Psychological Association in 2007 showed that 40% of employees working in health services (as well as education) reported “experiencing extreme levels of stress” (See Appendix A). The management of stress in the work environment and in the personal lives of RNs is essential in decreasing this health and safety concern. This paper will outline effective techniques for managing stress in order to promote healthy living and prevent stress overload.Relaxation Techniques“A person experiences stress when a demand exceeds his or her coping abilities, resulting in disturbances of cognition, emotions and behaviors that can adversely affect well-being” (Collins, 2011, Dis-Ease, para. 2). Relaxation techniques may be used to manage stress in order for the RN to perform essential job functions. Muscle relaxation and breathing exercises are beneficial to stress management by allowing the parasympathetic nervous system to overtake the physical symptoms associated with the sympathetic nervous system’s fight-or-flight response. Increased heart rate and blood pressure associated with the fight-or-flight response during stress are reduced as relaxation techniques are used. Diaphragmatic BreathingDiaphragmatic breathing “is an excellent tool to stimulate the relaxation response that results in less tension and an overall sense of well-being” (Stress Group, 2011, para. 3). This can be performed by placing one hand on the chest and another on the abdomen while breathing. The individual should inhale slowly through the mouth and contract the abdomen with exhalation for a period twice as long as inhalation until all air is expelled from the lungs (Stress Group, 2009) This air exchange should last a total of about 15 seconds (Stress Group, 2009). In abdominal breathing, the abdomen should rise farther than the chest, which allows proper exchange of oxygen and carbon dioxide (See Appendix B). This cycle should be repeated four more times. This technique can be enhanced by incorporating words such as “relaxation” with inhalation and “stress or anger” with exhalation with breathing (Stress Group, 2009, para. 4). Diaphragmatic breathing may be used by RNs in the work place during or after stressful situations to help reduce stress.Progressive Muscle Relaxation“Progressive Muscle Relaxation (PMR), developed by Edmund Jacobson in 1938, involves decreasing voluntary muscle and sympathetic nervous system activity while increasing parasympathetic functioning” (Pender, 2011, p. 207). This form of muscle relaxation begins with focused breathing, followed by tightening and relaxing of each muscle group individually starting from the head and moving towards the feet (Harvard Special Health Report, 2006). Each muscle group should be tightened for a period of about eight seconds (Pender, 2011). PMR should last more than 20 minutes (Harvard Special Health Report, 2006). “Positive outcomes have been documented when PMR is used for stress reduction either as the prescribed therapy or as an adjunct therapy” (Pender, 2011, p. 207). ExercisePhysical exercise, from dancing to Pilates, and mind-body disciplines, such as yoga and meditation, are excellent stress reduction techniques outside the hospital for nurses (Collins, 2011, The Power of Touch, para. 4). Exercise is a fantastic approach to lowering stress levels. Elizabeth Scott, M.S., is a wellness coach and helps people deal with stress in everyday life in the area of health psychology. According to Scott, “exercise can decrease ‘stress hormones' like cortisol, and increase endorphins, your body's ‘feel-good’ chemicals, giving your mood a natural boost” (2011a, para. 3). Endorphins are chemicals in the brain that can help counteract stress. By exercising at least five days a week, an individual can produce more endorphins which aids in combatting high stress levels (Federal Occupational Health, 2008). Physical activity such as walking, yoga, and tai chi, can be very beneficial in reducing stress (Scott, 2011a).Walking Walking is a gentle, low-impact exercise that can aid in decreasing stress (Mayo Clinic, 2011). This activity can be completed during breaks at work in most clinical settings, allowing the nurse to reenergize and calm the mind during or after stressful situations. According to Maggie Spilner, “a brisk 20- to 30- minute walk can have the same calming effect as a mild tranquilizer” (2004, para. 2). It is important for the RN to walk in an area separate from the work environment—this change in scenery can enhance mood and aid in the calming effect of walking. Other benefits of walking include: decreasing blood pressure, decreasing low-density lipoprotein cholesterol (LDL), increasing high-density lipoprotein cholesterol (HDL), and reducing the risk or managing Diabetes Type II (Mayo Clinic, 2011). Yoga “Yoga, which derives its name from the word, “yoke”—to bring together—does just that, bringing together the mind, body and spirit” (Scott, 2011, para. 3). Not only is yoga a physical activity, but it also combines breathing control and meditation that are essential in reducing stress levels (Scott, 2011b, para. 1). Janice Kiecolt-Glaser of Ohio State University conducted research of 50 women who incorporate yoga into daily living, both beginners and experts in yoga. She concluded that yoga is a type of physical activity that is beneficial in decreasing stress (U.S. Department of Health & Human Services, 2011). There are numerous positive effects of yoga, including: reducing cortisol levels, lowering heart rate, sense of well-being, increased strength and flexibility, and sleeping more soundly (Scott, 2011b). Although yoga cannot be performed in the workplace due to the time required to complete the session, nurses can benefit from this activity as a way to wind down and re-energize after a stressful day of work. Furthermore, by participating in yoga, the RN will have the tools for controlled breathing and meditation which can be beneficial while at work. Tai ChiTai Chi is a martial art that consists of slow, graceful, circular motions (Harvard Special Health Report, 2006). It is similar to yoga because it too promotes balance control, regulates breathing, improves strength and flexibility, and promotes meditation. All of these components are helpful in reducing stress. Tai Chi “facilitates the flow of chi (“life energy”) through the body by dissolving blockages both within the body and between the body and the environment” (Collingwood, 2011, “Tai Chi”, para. 2). This form of exercise is low-impact, making it especially beneficial for older RNs. ConclusionWorking conditions for RNs can often lead to increased stress. It is vital for nurses to find an outlet for this stress in order to avoid burnout and potentially dangerous situations such as medication errors. By utilizing relaxation techniques such as diaphragmatic breathing and PMR both in and away from the work place, the fight-or-flight response can be taken over by the parasympathetic nervous system. Furthermore, exercise such as walking, yoga, and tai chi can be used to decrease cortisol and increase endorphins, resulting in stress relief. ReferencesAmerican Holistic Nurses Association. (2011). Holistic stress management for nurses. Retrieved from Psychological Association. (2007, October 24). Stress in America. Retrieved from , J. (2011). Using Exercise to Beat Stress. In Everyday Health, Inc.. Retrieved July 17, 2011, from , S. (2011). From ‘Distress’ to ‘De-Stress’ with stress management. Retrieved from Occupational Health. (2008). Let’s Talk. U.S. Department of Health and Human Services. Retrieved from Special Health Report. (2006). How to Prevent and Manage Stress. Retrieved from Clinic. (2010). Walking: Trim your waistline, improve your health. Retrieved from , N. J., Murdaugh, C. L., Parsons, M. A., (2011). Health Promotion in Nursing Practice (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.Scott, E. (2011a). Exercise and Stress Relief: Using Exercise as a Stress Management Tool. : Stress Management. Retrieved from , E. (2011b). The Benefits of Yoga for Stress Management. In : Stress Management. Retrieved from , M. (2004). Prevention. Reduce Stress with Walking & Exercise Discover how to optimize stress busting benefits of walking. Retrieved July 19, 2011, from Group. (2009). Breathing exercises: Deep breathing techniques to help relieve stress, tension, anxiety. Retrieved from . Department of Health & Human Services. (2010). HHS Healthbeat: Yoga versus stress. Retrieved from A-37465013779500Appendix B ................
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