Self-Care and Stress Management

Stressor

Any event that activates the stress response systems: "any demand, situation, internal stimulus or circumstance that threatens an individual's personal security or integrity" (Mallette & Yonge). Can be internal or external, actual or perceived, and is very individual.

Stress

A normal response to life events; in small doses can be motivating. May be described as fear, unease and worry with emotional and physiological responses (CMHA).

Stress response: physiological steps

Brain perceives a threat → HPA axis stimulated (hypothalamic-pituitary-adrenal) → adrenals release adrenalin and cortisol → energy is mobilized and must leave the body. "Fight, flight or freeze" (Lupien).

The 4 Fs of stress responses

Fight, flight, freeze, fawn.

General adaptation syndrome (Selye)

Body's physiological response to stress in 3 stages: alarm reaction, resistance, exhaustion.

GAS: alarm reaction stage

Awareness of the stressor; physiological changes occur.

GAS: resistance stage

Body reacts to fight the stressor.

GAS: exhaustion stage

Body becomes overwhelmed.

Prolonged exposure to the stress response may result in...

Lack of recognition of the stressors/response (may seem "normal"); lack of control over stressors (real or perceived); chronic exhaustion (energy resources used up); illness; insomnia, errors in judgement.

Stress response and illness

Chronic triggering of the stress response without resolution may lead to harm and permanent damage, e.g. illness (Mate, 2004).

Approaches to understanding stress

Physiological: GAS, fight or flight. Cognitive: role of perceptions and appraisal in stress responses.

Primary vs secondary appraisal

Primary appraisal: deciding whether an event is a threat/stressor (is it relevant to me?). Secondary appraisal: assessing whether you have the resources/ability to cope with it.

Coping

Efforts (thoughts and behaviours) used to manage the demands of a stressor and reduce its physiological and psychological effects.

Crisis

Occurs when a person cannot overcome obstacles with usual problem-solving and adaptation methods.

Why do people appraise stressors differently?

Factors influencing response: characteristics of the individual (age, gender, culture; social supports; perceived control; sense of competence; cognitive appraisal); aspects of the stressor (intensity, duration, scope; number and nature of other stressors; expected vs unpredictable); past exposure to serious stressors.

Stress management strategies (4 broad)

1) Remove the stressor or yourself

2) Reduce or avoid stress-producing situations

3) Increase your resistance to stressors

4) Learn strategies to decrease physiological and psychological responses to stress (Lupien; Pender)

Stress management: problem solving, support, body

Use problem-solving methods (increases sense of control); seek support from others; use your body effectively (e.g. exercise to move energy); get to know your stressors.

Using the body to decrease mobilized energy

Deep abdominal breathing; move (exercise, dance, walk, yoga, tai chi); laugh; practise mindfulness.

Mental strategies for stress

Mindfulness, imagery, visualization, meditation; think of pleasant experiences/people; journal (put feelings into words); hobbies; identify, solve and/or talk about problems; reframe thoughts (Baier & Hegadoren).

Cognitive distortions (6 types)

"All or nothing" thinking; overgeneralizing; mind reading and fortune telling; personalizing; acting on "should" and "ought to"; "awfulizing".

Cognitive restructuring

Teaching clients to question automatic beliefs, assumptions and predictions that lead to negative emotions and replace negative thinking with more realistic and positive beliefs. Looks at difficult situations from a broader perspective and counteracts cognitive distortions: "Don't believe everything you think".

Self-talk (reframing negativity)

Become aware of negative thoughts and replace them with positive ones. Track down the event that led to the negative thought and reframe it. Develop a mantra to repeat when a negative thought arises, e.g. "I can do this."

Chronic stress in nursing: consequences

Physical and mental illness; increased risk of substance abuse; interference with care relationships; errors/safety violations; leaving the profession; high nursing turnover.

Causes of compassion fatigue/burnout

Inability to maintain personal or professional boundaries; neglecting self-care; shortage or lack of personal/professional support; workplace factors (Peters, 2018).

Compassion fatigue

A state of exhaustion that limits the ability to engage in caring relationships (Nolte). Removes empathy and caring, which are essential to trust in the nurse-patient relationship: nurses withdraw from patients/families, focus on technical aspects, and become more pessimistic about positive change.

Secondary traumatic stress (vicarious trauma)

May develop from hearing about a traumatic event or caring for someone who has experienced one (van Mol).

Burnout

Emotional and behavioural impairment from exposure to high levels of occupational stress. Combination of 3 factors: emotional exhaustion, depersonalization, personal accomplishment (Schaufeli & Bakker).

Signs of compassion fatigue/burnout (4 domains)

Physical: exhaustion/fatigue, insomnia, headaches, muscle aches, frequent illness.

Behavioural: avoiding clients, compromised care, impaired decisions, absenteeism, attrition, anger/irritability, increased drug/alcohol use, relationship problems.

Psychological/emotional: sadness, apathy, mood swings, frustration, anger, helplessness, confusion, poor concentration/judgement, forgetfulness.

Spiritual: disconnection, questioning meaning in work, anger at God.

Strategies to build resilience and prevent compassion fatigue (Mathieu)

Prioritize self-care; mindfulness-based stress reduction; recognize warning signs; build a support network; set boundaries; seek supervision/debriefing at work; find healthy ways to decompress; advocate for change; reduce trauma inputs.

Self-care (WHO)

The ability of individuals, families and communities to promote health, prevent disease, maintain health and cope with illness and disability, with or without a health care provider. About forming healthy habits, not just "improving" or "treating" yourself (Healthline).

Daily self-check

Attend to current "in the moment" responses; self-examine to evaluate your stress level each day.

Balanced lifestyle

Care for mind, body and spirit and develop effective coping skills.

Mindfulness (Kabat-Zinn)

"Paying attention in a particular way, on purpose, in the present moment, non-judgmentally." Also paying attention with openness, curiosity and flexibility (Harris). A form of meditation rooted in Buddhism.

Benefits of mindfulness (Myers, 2017)

Reduced symptoms linked to conditions like cardiovascular disease and cancer; decreased stress and depression; increased memory and learning capacity; healthier living and eating; increased capacity for deeper empathy and compassion.

Mindfulness practices (4)

Gratitude, letting go, finding focus, sustaining positivity.

Self-compassion

Kindness directed toward the self (Klinik).