STRESS

MANAGEMENT
PRESENTED BY :-
MS. NEHA MALIK
 Introduction
 Right from the time of birth till the last breath drawn, an individual is invariably exposed
to various stressful situations. The modern world which is said to be a world of
achievement is also a world of stress and has been called the – Age of Anxiety and Stress.

 Stress has been defined in many different ways over the years. The word stress is derived
from English word. Originally it was used in physics and it meant an external pressure,
tension, load of an object (Newhouse and Treven, 2005). It was conceived as pressure
from the environment, then as strain within the person.
 The term stress was introduced in medicine in 1949 by Canadian
endocrinologist – Hans Selye. To him, stress is described as the body’s
adjustment to a new circumstance, and the body’s stereotypical and non-
specific response to environmental stimuli that disrupt a personal balance,
and described also as a psychosomatic mechanism to regulate and balance
the tensions, which means the perception and preparation of the body to the
specific loads.
 About one-third of workers reports high level of stress and high level of
stress are associated with the substantial increase in health service
utilization.
 Additionally, periods of disability due to job stress tends to
be much longer then disability periods for other
occupational injuries and illness.
 Stress affecting the nurse across the globe has been
convincingly documented in the literature for more than 40
years, (Lazarus RS).
 Nurse’s environment includes an enclosed atmosphere,
time pressure, excessive noises, no second chance,
unpleasant sights and sounds, and long standing hours.
 Definition Of Stress: -
According to Selyle (1956), ―Stress is defined
as the pressure experienced by a person in
response to life demands. These demands are
referred to as stressors and include a range of
life events, physical factors (e.g.: cold, hunger,
hemorrhage, pain), environmental conditions
and personal thoughts.
 According to Selye (1976) Stress is a process of adjusting to or
dealing with circumstances that disrupt or threaten to disrupt a
person’s physical or psychological functioning.
 Stress is tension, strain, or pressure from a situation that requires us
to use, adapt, or develop new coping skills.
 STRESSOR
 Stressor is any person or situation that produces
anxiety response to the body. A stressor is a
chemical or biological agent, environmental
condition, external stimulus or an event that causes
stress to an individual.
 Stressor
is the stimuli proceeding or precipitating a
change. It may be internal (fear, guilt) or external
(trauma, peer pressure, etc).
 Types of stressor
Physiological stressors:
Chemical agents
Physical agents Illness, injuries, hormonal fluctuations, inadequate sleep or
nutrition
Infectious agent
Nutrition imbalances
Genetic or immune disorders
 Psychological stressor:
 Accidents can cause stress for the victim, the person who caused the accident
and the families of both

 Stressful experiences of family members and friends

 Fear of aggression or mutilation from others such as murder, rape,

terrorist and attacks.

 Events that we see on T.V. such as war, earthquake, violence

 Developmental and life events• Rapid changes in our world, including economic
and political structures and technology
 SOURCES OF STRESS
There are many sources of stress, these are broadly classified as:
 Internal stressors: they originate within a person e.g.: cancer, feeling of depression.
 External stressors: it originates outside the individual e.g.: moving to another city, death
in a family.
 Developmental stressors: it occurs at predictable times throughout an individual ‘s life.
e.g.: child- beginning of school.
 Situational stressors: they are unpredictable and occur at any time during life. It may be
positive or negative. e.g.: death of family member, marriage/ divorce.
 Organizational factors
 Workload :- due to shortage of staff or time pressure , increasing
responsibilities, non nursing work, can lead to emotional exhaustion
among the nurses .
 Inadequate staffing :- shortage of staff in shift duties leads to extra
work among nurses and there will be time pressure to complete the
work: that can be the cause of stress and burn out among nurses
 Job content :- unpleasant tasks and works of low social value can
lead to frustration among the staff and also nurses working in the
hazardous environment have the fear being exposed to infections.
Working hours :- long unsocial, strict and
inflexible duty hours.
Shift duty pattern :- Frequent shift duty pattern of
odd hours especially the night duties change the
lifestyle and behavior of the nurses.
Role Ambiguity and Role Conflict :-Lack of
clarity about tasks, unit and organization is also one
of the predictor of stress as reported by the nurses.
Lack of Task Autonomy , Accountability and Feedback:-
Accountability without autonomy at times become the
source of stress among nurse administrators and
supervisors.
Lack of Career Development:- Job insecurity, lack of
promotional avenues, lack of opportunity of growth,
advancement, can cause stress among nurses.
Physical Facilities/Environment:- Inadequate, unpleasant
or dangerous physical facilities, e.g. poor ventilation,
lighting, temperature, crowding , noise, air pollution, or
ergonomic problems are the stressors at the work place.
Social Environment:- Lack of support from the nurse
administrators, lack of family-friendly policies, poor
interpersonal relationship with co-workers, doctors,
nurse administrators and other team members, lack of
staff support, autocratic behavior of the supervisors,
conflict with doctors are the predictors of psychological
stress among nurses.
Ineffective Communication :- Stress can result from a
lack of communication or from a lack of the right kind
of communication at the right time.
 Nature of Profession
The nature of nursing is not free from stress. It is considered
one of the stressful occupations.
Caring for Suffering and Death and Dying Patients:-The
patients suffering with pain, disability, long term and
acutely ill, death and dying can be the source of stress for
nurses.
Difficult Patients and their Family Members :- At times,
the nurses are experiencing difficult and demanding patients
and their family members can be source of stress for nurses.
Working with Psychiatry Patients:- Nurses may face
emotional exhaustion in working with aggressive
patients especially with suicidal and violent incidence of
patients.
Exposure to Occupational Hazards:- The nurses are
working in the environment susceptible to expose to
various biological, physical, reproductive, chemical,
mechanical, psychological and occupational cancers.
Working in such an environment will be stressful for
them.
Exposure to biological hazard :-the prevalence
of stress, anxiety and depression within front-line
healthcare workers caring for COVID-19 patients
is high. Therefore, the health policy-makers
should take measures to control and prevent
mental disorders in the Hospital staff.
 Personal Characteristics
Demographic Characteristic:- The empirical evidences
revealed that age, gender, length of tenure in the job, job area
of individual nurses are associated with their level of stress.
Personality:- Personality and interpersonal behavior of
individual nurses are associated with various dimensions of
stress.
Belief in External Locus of Control:-The nurses who believe
that outside forces are controlling their fate in the job
environment are more stressful than other nurses who believe
that they can control potential adverse forces in their job.
Competency :-The nurses if not competent, may be
scared and not confident to handle the situations will
be under stress.
Lack of Preparation:- One of the greatest sources
for nurses, stress is the their lack of preparation in
handling the emotional needs of patients which
causes anxiety within the nursing staff. Nurses who
are not emotionally mature can have high level of
stress to deal with the patients.
 TYPES OF STRESS:
Stress is the ‘wear and tear’ our bodies experiences as we adjust to
our continually changing environment. It has physical and emotional
effects on us and can create positive and negative feelings.

There are actually two types of stress;

 A.Eustress

 B.Distress
A. Eustress:
o Eustress is the positive stress that stimulates a person to function better.
This is called as friendly stress or positive stress.
o It has a good influence on human in terms of physical and mental ability.
o It acts in a positive for the individual and the organization.
o It also provides the sense of urgency and alertness needed to survival
when confronting threating situation.
 B. Distress
o Distress is a negative stress that may cause illness.
o This is also called as harmful stress.
o Negative stress could be also described as a burning out.
o It is a contributory factor in minor condition such as
headaches, insomnia, ulcers, etc
 CLASSIFICATION OF
STRESS :

Stress can be classified as;

 Short term (acute) stress
 Long term (chronic) stress
 Short term (acute) stress :

 Acute stress is the reaction to an immediate threat, commonly

known as fight or flight response.
 The threat can be any situation that is experienced, even
subconsciously or falsely as a danger.
 Common acute stress includes – noise, crowding, isolation, hunger,
danger, infection, etc.
 Long term (chronic) stress:
In day-to-day life persons faces different stressful situations, which are not
short, lived. The stress becomes chronic when an individual tries to suppress it.
Common chronic stressor includes;

 Ongoing highly pressured work

 long term relationship problems

 Loneliness
 EFFECTS OF STRESS:
Short term effects of stress:
1.Physical changes:
 Physical symptoms are usually triggered by arousal of autonomic nervous
system and includes increase in heart rate and blood pressure

2. Psychological changes: -
 It includes lack of concentration, Muscle ache, Headache, and Insomnia, Loss
of memory, iinability to make decision, Forgetfulness, and Confusion,Faster
breathing,
3. Emotional changes: - Emotional response may
include :-Anxiety, Nervousness, Frustration, Anger,
Irritability

4. Behavioral symptoms: Impact of stress also affects

the behavior and present as pacing, Fidgety movement,
Nail biting, - Smoking, Drinking, and Throwing things
Long term effects of stress:
Behavioral changes: The affected person becomes victim of serious
behavioral disorder like. Fearfulness, Obesity. Alcoholism ,Drugs addiction

Cardiovascular disease :-many studies suggest that psychologically

demanding jobs that allow employees little control over the work process
increasing the risk of cardiovascular disease
Endocrine system:- Stress alone
doesn't cause diabetes. But there is some
evidence that there may be a link
between stress and the risk of type
2 diabetes. Our researchers think that high
levels of stress hormones might stop insulin-
producing cells in the pancreas from working
properly and reduce the amount of insulin
they make.
Musculoskeletal disorder:- on the basis of research by
NIOSH and many other organizations, it is widely
believed that job stress increase the risk for
development of back and upper extremity
musculoskeletal disorder.
Mental problems :- occupational stress and its
consequences on nurses behaviour can create mental
problems such as anxiety , depression, insomnia and
feeling of inadequacy
Substance abuse and suicide
Emotional changes: Chronic anxiety ,Depression.
 The affected person become victim of serious Emotional
disorder, like Fear and phobia ,Personality changes ,Mental
disorder
Cognitive changes: - The affected person become victim of
serious Cognitive disorder, like Memory problem
,Obsessive thoughts ,Sleep disorder
 STAGES OF STRESS
Hans Selye explained stress through GAS (General Adaptation
Syndrome), a way that the body tries to keep balance. The GAS stages
are;
1.The alarm reaction stage.
2.Stage of resistance.
3.Stage of exhaustion.
 The alarm reaction stage :

 Alarm is the first stag When the stressor is

identified or realized, the body’s stress
response is a state of alarm.
 During this stage, adrenaline will be
produced in order to bring about the fight
or flight responses.
Stage of resistance
 Resistance is the second stage, If the stressor
persists, it become necessary to attempt some
means of coping with the stress.
 Although the body begins to try to adapt to the
strains or demands of the environment, the body
cannot keep this up indefinitely, so its resources
are gradually depleted.
 Stage of exhaustion
 Exhaustion is the third stage and final stage in the
GAS model, at this point, all the body’s resources
are eventually depleted and body is unable to
maintain normal function.
 If stage three is extended, long term damage may
result as the capacity of gland, especially the
adrenal gland.
 STRESS MANAGEMENT:
Stress management involves the use of the coping strategies in
response to stressful situations. Coping strategies are adaptive
when they protect the individual from harm or strengthen the
individual’s ability to meet challenging situation.
To manage job related stress two types of approaches are there
Individual coping strategies
Organisational coping strategies
 Individual coping strategies
 Awareness; - The initial step in managing stress in awareness- to become aware of the factors that create
stress and the feeling associated with a stressful response. As one can becomes aware of stressors, he or
she can omit, avoid, or accept them.

 Got organized; - Coping with stress is all about planning. You can plan to fall or plan to succussed.
Organized time for work, family, hobbies, spiritual time, time with friends and time alone, time for
exercise and time for relaxation

 Visualized the best outcome; Coping with stress knows how to deal with a stressful situation before it
occurs. Rehearse how you are going to handle it. Picture yourself being successful in coping with stress
 Time management
 Relaxation/meditation
 Don’t postpone action; - One of the best strategies for coping with stress
is not to put off actions until tomorrow if you can do it today. Coping with
stress become more difficult when you defer. Do your least favorite chores
first, followed by rewards.
 Be realistic; - Set realistic goals. Emphasize quality over quantity. Work
at a leisurely pace, taking breaks often.
 Sleep, eat, and exercise; - Coping with stress is all about treating your
body properly. Eat food that nourish you, exercise and get plenty of sleep.
Organizational coping strategies
 Organizational
developmental programme
 UNHEALTHY WAYS OF COPING
WITH STRESS
1. Smoking

2. Drinking too much

3. Over eating or under eating

4. Using pills or drugs to relax

5. Sleeping to much

6. Withdrawing from friends, family, and activities

7. Zoning out for hours in front of the T.V or computer.

8. Taking your stress out on others (lashing out, angry outbursts, physical violence)
 NURSE MANAGER’S ROLE IN
STRESS MANAGEMENT:
 Ensure that the workload is in line with nurses’ capabilities and resources.

 Clearly define the nurse’s role and responsibility.

 Planned orientation programmers for the newly joined staff.

 Give nurses the opportunities to participate in decision making and actions in

patients care.

 Improve the communications and provide supportive environment

 Provide opportunities for social interaction among the nurses.

 Organize group meeting to solve the problems.

RESEARCH ARTICLES ON STRESS MANAGEMENT
1. A Study On Stress Management Among The Employees Of Nationalized Banks
- Harish Shukla and Ms. Rachita Garg (12/2013)

ABSTRACT

Banking, like other services, has become one of the highly competitive sectors in India. The banking organizations, since the
beginning of this decade, have been facing greater challenges in terms of technological revolution, service diversification and
global banking. Stress is unavoidable on the part of the employees as the systems, procedures; techniques are getting
complicated with the use of advance technology. Every employee cannot cope with such rapid Changes taking place in the jobs.

This will lead to arising of stress among employees. An attempt has been made through this research paper to know the reasons
of stress among the bank employees and the ways used by employees to cope with the stress generated at workplace. It is found
that maximum number of employees in banks remains in stress. Majority of the employees try to find solution to relieve them
from stress.

Also, the measures are also suggested in the paper to overcome stress that affects their physical and mental health.
 Findings and Conclusion
Most of the employees fear with the fact that lack quality in their work puts stress on them. It is found
that maximum number of employees in banks remains in stress. 50% employees feel that they are
overloaded with work.

44% employees feel tensed due to their non- achievement of their target of work. 38% employees
accepted that they will obey the order of their boss by sacrificing their important domestic function. It
indicates fear and stress among employees. 24% employees feel stress due to their family related
problems.

Half of the employees accepted that there is conflict among the employees. It is a concern for top
management. Only 48% employees feel that strategies used by banks to manage stress of employees
are effective. Majority of the employees try to find solution to relieve them from stress.50% employees
use YOGA or other ways to relieve them from stress. In spite of stress, majority of the employee’s