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Dealing With Stress

The adaptive responses to demands or the adaptive condition of unsatisfied needs. Stress is an imbalance or disharmony in the natural orderliness we seek. It results in behavioral and/or physiological symptoms that may impair one's functioning and possibly lead to inappropriate behavior such as abuse.

The kind of stress healthcare professionals need to be attentive to is the stress resulting from an ongoing problem. Temporary stress, while unpleasant, usually can be handled well by the individual. If not resolved, situational stress may mushroom from a temporary condition to a long-term problem. Ongoing stress is different because there is no relief from it. As it continues day after day, the individuals ability to cope diminishes to the point where he loses sense of control. It is much like the tales told of the ancient Chinese water torture test. One, two, three slow drops of water in a pattern an individual can deal with, but 1000, 5000, even 10000 will cause anyone to breakdown emotionally. Each individual has a limit to their coping abilities.

Recognizing the symptoms of stress is essential to resolving the problem. One or two symptoms may not indicate serious stress. Stress can be situational; that is a response to a specific situation that will shortly go away. The person may be just having a bad day because of physical discomfort. Do not immediately come to the conclusion that the individual is experiencing stress that requires intervention. The easy course of action for a supervisor or anyone would be to ignore the problem, rationalizing it as the individuals private concern. But that is not an acceptable view because the individual is an employee whose behavior affects his coworkers and the healthcare center's patients. There can be serious job performance problems. 

Behavioral Symptoms of Stress

Personal Behaviors Work-Related Behaviors

Irritability, anger - Taking more sick time

Inappropriate laughter - More frequent tardiness

Depression - Increased absenteeism

Impatience, agitation Sarcasm, - bad attitude

Anxiety - Decreased productivity

Moodiness - Unwillingness to help others

Inaction - Patient abuse

Decreased self-esteem - Lack of discretion in public relations

Increased drinking - Forgetfulness

Blaming others - Lack of attention to details 

Physiological Symptoms of Stress

Lump in throat, Insomnia

Tightness in chest, Poor appetite

Shortness of breath, Hypertension

Upset stomach, ulcers Fatigue

Headaches, Nervousness

Increased heart rate, Diarrhea

Nausea and/or vomiting, Accident prone

Contributing Factors of Stress

1.      Personal Stress Factors: circumstances unique to the individual.

Personal problems like poor health, family problems with spouse, children or relatives, financial concerns, death of a close friend or relative, a divorce, move to a new home, and having too much to do and not enough time to do it are common sources of personal stress. For some individuals personal resources and social supports are enough to help them deal with their problems. For others, professional intervention/counseling is required.


2.      Self-generated Stress Factors: individual perceptional problems.

Two kinds of chronic perceptional problems lead to stress: negative personal interpretations (nobody likes me) and misinterpretations (always assuming the worst based on incomplete knowledge). It takes a very mature, insightful person to recognize that they have a perceptional problem that contributes to their stress. Professional help is usually required.


3.      System-generated Stress Factors: from the environment.

In a health care setting there are many factors that can create stress. These include: emotional demands working with the elderly and chronically ill, personnel shortages that increase the work load for those present at their jobs and an increase in demands for working overtime, the physical demands of the job, change in personnel or management, and unpleasant personal relationships at work.  Supportive management is the key for dealing with this type of stress. 

a)      Communicate any type of changes so the employee understands what is happening and why.

b)      Introduce new employees, orient them to the facility, and make sure they possess the skills and knowledge to do their jobs effectively.

c)      Conduct exit interviews routinely to determine if terminating employees are leaving because of work related stress.

d)      In scheduling, make sure the patient care load is distributed fairly, so that each employee has a mix of easy-to-care-for and more demanding patients. Make sure each employee is aware of this process so that no employee sees himself or herself as unfairly assigned or is, in fact, given an unfair workload.

e)      Encourage employees to express their concerns before they grow into larger problems.

f)        Evaluate alternative ways to schedule and assign work, such as split shifts or CNA's assigned to specialize in certain tasks or duties.

g)      Consider floating assignments when employees are having difficulty caring for a specific group of patients, such as the terminally ill, unusually demanding, or physically abusive. This allows all employees an equal break from the emotional and physical demands of caring for these types of patients.

h)      Seek job satisfaction information through periodic, anonymous employee surveys. Identify responses that indicate areas that may lead to or are causing employee stress.

i)        Promote personal development to all employees. 


Job Stress

A cluster of symptoms, including emotional exhaustion, depersonalization, or a desire to withdraw from people, and reduced accomplishment (working harder and harder while accomplishing less and less). Job stress is effected by other significant factors including obsessive-compulsive or perfectionistic personality traits and bitterness or unresolved anger.


Warning Signs that an Individual is Approaching Job Stress

The individual:

  •         gripes more and more and enjoys it less and less;

  •         can't stand people;

  •         withdraws;

  •         feels like the school bus driver who said, "I love my bus; I like my route, but I hate every single student who rides my bus";

  •         has trouble separating people from their performance, especially if no one's performance matches up to their rigorous standards;

  •         is experiencing drug or alcohol abuse;

  •         has had a major blowup---yelling at people or collapsing in tears;

  •         or has felt paralyzed when you needed to take action.


Warning Signs that an Individual is Experiencing Acute Job Stress

The individual:

  •         has experienced a coronary or other serious physical problem;

  •         is experiencing an emotional breakdown or suicidal feelings;

  •        is involved in acting-out behavior---an affair, an arrest for driving while intoxicated;

  •         indicates they are completely overcome by exhaustion or uncontrollable anger.


Warning Signs that an Individual is Facing Chronic Job Stress

The individual:

  •         continually withdraws physically from their job;

  •        has trouble maintaining contact with people---even eye contact or verbal communication;

  •         lacks the emotional energy to handle the daily hassles of family life;

  •         refuses to discuss their problems or acknowledge a need for help;

  •         quits their job without good reason.

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