In May 2017, the American Nurses Association (ANA) launched The Healthy Nurse, Healthy Nation Grand Challenge, an ongoing movement designed to transform the health of the nation by improving the health of our 3.6 million RNs. ANA research shows that nurses are less healthy than the average American, have more stress, get less sleep, and are more overweight. Because nurses are the largest and most trusted healthcare profession today, the aim of the healthy nurse challenge is to encourage nurses to increase their personal wellness and patients may follow their example. The ANA also initiated an RN survey that identified the acute and chronic effects of stress as one of the top health and safety concerns for nurses. The impact of long-term stress on health can include higher incidences of hypertension, reduced immunity, digestive problems, headaches, diabetes, and stroke.
Due to the rigors of nursing school, nursing students endure stress when managing studies, work commitments, social activities, and family obligations. Nursing students care for acutely ill patients and are exposed to the same type of stress identified by RNs in the ANA survey.
What's all the stress about stress?
Stress is defined as the psychological and physical response of the body that occurs whenever a person must adapt to changing conditions, whether those conditions be real or perceived, positive or negative. There are two types of stress: distress and eustress.
Distress is a negative, draining energy that results in anxiety, depression, confusion, and fatigue. Some examples of distress include the death of a family member or friend, financial overload, or work/school load demands.
Eustress is a positive, beneficial energy that's motivational and results in feelings of happiness, hopefulness, and purposeful movement. Eustress is different from distress because it has a positive influence on overall well-being. In general adaptation syndrome—the three stages the body goes through when reacting to stress—eustress releases endorphins that help improve mood. Endorphins are also beneficial to those who may have depression or low energy. Examples of eustress are a much-needed vacation, a new challenge, a new job, or playing a favorite sport.
In both types of stress, the same physiologic responses are expressed and can strain a person's system. So downtime apart from every day routine is important to keep stress in check.
To help reduce our nursing students' stress levels, we designed a “stress buster session” during their final exam week. During the stress buster sessions, we offered the following modalities:
- hand massage with a variety of lightly scented/unscented lotions and essential oils
- foot soaks with Epsom salt using a whirlpool foot bath basin
- upper body Reiki
- auricular massage
- auricular acupuncture/acupressure using needles or beads.
Station 1: Hand massage with lotions and essential oils
This station was set up to be self-appointed with a partner or by oneself. Seats were arranged across for each other at a long table. An assortment of scented and unscented lotions and oils were placed on the table so students could choose which they wanted to use. Of the lightly scented lotions and oils, lavender was chosen because it's a scent that's thought to decrease stress and anxiety. Lavender was the scent most widely used by the students. Most students paired with a partner and performed hand massages on each other. While giving hand massages, students engaged in casual conversations about the challenges of nursing school and other topics. The advantages of hand massage include that it's quick, can be done with or without a partner, and has immediate results. Benefits include enhanced circulation and feelings of overall relaxation.
Station 2: Foot soaks with Epsom salt
This station was set up in the same room as the hand massages and equipped with lavender scented or unscented Epsom salt, a chair, a heated whirlpool foot soak appliance, and disposable towels. Students were instructed to empty the water from the foot soak appliance after using it, clean it with a disinfectant wipe, and thoroughly rinse it with water in preparation for the next student's use. Foot soaks with Epsom salt soothe aching feet. Sitting in the chair while soaking one's feet also requires a time-out from the daily routine, promotes relaxation, and helps reduce anxiety. Benefits of a foot soak include increased overall relaxation/stress reduction and reduced feelings of anxiety; it may also influence endorphin release, leading to a feeling of peacefulness.
Station 3: Reiki
This station was in a separate room from the hand massages and foot soaks. Chairs were placed around a conference table and we asked students to limit conversations when in the room. We played instrumental music and nature sounds at low volume to provide a soothing background. Reiki is a Japanese technique done to help reduce stress, promote relaxation, enhance a sense of well-being, and improve healing. Reiki is administered by laying of hands to move energy through the body. Both of us performed Reiki on students who asked to participate in the session; one of us is a certified level one Reiki practitioner. We used an upper body modified approach for whole body Reiki. Attendees noted that this station was beneficial. Reiki may help the body release stress and tension by creating total relaxation. It also calms the mind and can improve emotional well-being.
Station 4: Auricular massage and acupuncture
This station was held in the same room as the Reiki treatments. A short in-service was given to nursing students who wanted to participate in this session. A consent form was signed by those who wanted to experience auricular acupuncture with needles. Those who wanted to experience a bead placement instead of a needle didn't need to sign a consent form. Brief auricular massage therapy was also taught so students could use the technique at any time. We focused on the Shen Men point—located at the apex of the triangular fossa in the ear—as the main auricular point in these sessions. The Shen Men point is one of the most recognized auricular points in the acupuncture world and is known to decrease anxiety when a fine acupuncture needle is inserted into the point, a bead (or seed) is placed on the point, or the point is massaged by oneself or another person. Benefits include a boost to the immune system, improvement in overall health, and increased energy. The self-massage technique is accomplished best by using a cotton swab to massage the Shen Men point.
The stress buster sessions were well attended, with excellent feedback from the students. Those who attended requested that this become a regular event. We'll be offering more sessions throughout the year in addition to the sessions during midterms and final exams.
Additional ways for nursing students and nurses to manage stress during demanding times include the following:
- Understand how you experience stress. How do you know you're stressed? How are your thoughts and behaviors different when you're stressed than when you aren't stressed?
- Identify your sources of stress. What events or situations trigger stressful feelings?
- Learn your own stress signals. You may have a hard time concentrating or making decisions, notice feelings of anger or irritability, or experience headaches, muscle tension, or low energy.
- Recognize how you deal with stress. Do you use unhealthy ways to cope, such as smoking, drinking alcohol, or over/under eating?
- Find healthy ways to manage stress. Consider healthy stress-reducing activities, such as meditation, exercise, or talking things over with friends or family. Change one unhealthy behavior at a time.
- Take care of yourself, both in mind and body. Eat right, get enough sleep, drink plenty of water, and engage in regular physical activity. Do yoga, play a sport, go for a walk, read a book, or listen to music. Remember to take a break and make time for yourself.
- Reach out for support. Accepting help from family or friends can help you improve your ability to manage stress. If you're totally overwhelmed, you may need to reach out for help from a professional.
A healthy routine
Stress can be positive or negative, but if not kept in check, it can lead to health problems. It's important for nurses to maintain overall good health, not only for themselves, but also so they're more prepared to care for patients. Daily routines should include downtime, even if it's just a pause for a few minutes a few times a day. Your daily routine should also include managing stress in a healthy way. Leave work at work and, once off duty, engage in enjoyable activities and spend quality time with family and friends. If out socially with friends from work, agree to leave work-related topics out of the discussion. Taking care of yourself should be a priority and making sure you have downtime is important to keeping stress in check. Remember that healthy nurses promote better patient outcomes and contribute to a healthy work environment.
did you know?
Nurses can teach similar stress reduction techniques to patients. Encourage patients to:
- identify their stress and know stress signals
- recognize how they deal with stress
- find healthy ways to deal with stress
- drink plenty of water (unless contraindicated) and eat healthy
- get good sleep and exercise each day
- reach out for help if stress is overwhelming.
- Nurses have high levels of stress due to the nature of our work.
- There are two types of stress: eustress (positive) and distress (negative).
- When bad stress (distress) is high, health is impacted, including headaches, high BP, weight gain, gastrointestinal upset, and possible stroke.
- Good stress (eustress) helps boost endorphin release, improving well-being.
- Engaging in routine, constructive ways to manage stress will help give your immune system a boost and keep you healthy.
Managing stress at work
- Take breaks and eat meals off the unit.
- Eat healthy and drink plenty of water.
- Go for a quick walk or allow for quiet time to relax.
- Leave work at work, don't include it in your social or home life.