SMART PP

Nakia Thomas

Prof. Sandra Griffi n

NUR: 495 Capstone Project

Capstone Facilitator:

Annamarie Broich MSN, RN

November 12, 2014

S.M.A.R.TStress Management, Adversity & Resiliency Training Program

S.M.A.R.T Stress Management, Adversity & Resiliency Training Program Honesty Statement

• The student name indicated on this title page signifies that the author has read and understands the IWU Honesty Policy as outlined in the Student Handbook and IWU Catalog. Affixing this statement to the title page certifies that no cheating or dishonest use of information has occurred in completing this assignment. The work submitted is original work specific for this course. If cheating and/or plagiarism are discovered in this paper, it is acknowledged that the university policy will be followed, and may result in dismissal of the student from Indiana Wesleyan University.

Objectives Define stress

Define adversity

Define burnout

Psychological and physical manifestations of stress/burnout

Concept of resiliency

Concept of self-care

The importance of now in building resiliency

Stress What is Stress?

The brains response to any demand Can be positive and/or negative Short and /or long-term Major and /or minor Anxieties can lead to stress The body responds to each type of stress

similarly Different people handle and respond to stress

differently

(National Institute of Mental Health, n.d.)

Types of Stress

Routine Stress: You have a full-time job, home, and family responsibilities to juggle (National Institute of Mental Health, n.d)

Acute: You are almost hit by a bus while crossing the street

Chronic Stress: You are in a stressful relationship, you have a very sick parent, and you hate your boss

(Sapolsky, 2004; Trauma Talk: JD Sexton, PhD)

Stress ManagementRoutine stress

Stress trends are more constant and body changes are more difficult to notice compared to others types of stress

Body gets no clear signals to return to normal function Stress and continuous strain on the body from this type

of stress can lead to serious health problems such as: Diabetes Heart Disease High B/P Depression Anxiety Disorders Other Illnesses

(

National Institute of Mental Health, n.d.)

Stress Management

Acute stress Known as the fight –or-flight response; the body’s immediate

reaction to a perceived threat, challenge or scare Immediate and intense and in certain circumstances can be

thrilling Severe acute stress can cause mental health problems such as:

Post Traumatic Stress Disorder (PTSD) Physical difficulties like a heart attack (Mayo Foundation for Medical Education and Research, 2014)

Chronic stress Is constant and continuous Suppresses functions that are needed for immediate survival. Immunity is lowered digestive, excretory, and reproductive systems

stop working normally Severe viral infections (flu, common cold) Vaccines less effective (National Institute of

Mental Health, n.d.)

Stress Management

Physical responses to stress Brain uses more oxygen Headaches Increased Heart rate Increased Respiratory rate Muscle tension Fatigue / sleeplessness

(National Institute

of Mental Health, n.d.)

Stress Management Psychological responses to stress

Depressed mood Anger Irritability Emotional exhaustion /compassion fatigue (Zander & Hutton, 2010)

Social responses to stress Negative interactions with others Conflict Withdrawal Isolation

(Chesak, 2013; Guadalupe & Ayala, 2011; Jackson; Firtko, & Edenborough, 2007; National Institute of Mental Health,

n.d.; Mealer, et al., 2021; Zander & Hutton, 2010)

Adversity Adversity is a state of hardship or suffering associated with: Misfortune Trauma Distress Difficulty Tragic event

Workplace adversity is viewed as any negative, stressful, traumatic or difficult situation or episode of hardship that is encountered in an occupational setting.

(Jackson, Firtko, & Edenborough, 2007; p. 3)

Types of Adversities Limited and/ or shortage in resources

Staffing Scheduling Supplies

Workload Lack of support Difficult, negative and /or challenging relationships Intrapersonal and /or intraprofessional relationships Difficult and complex patients / families Time management /constraints Skills and procedures Emotional annoyance and exhaustion)

(Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008; Jackson, Firtko, & Edenborough, 2007; Mealer, et al., 2012 National Institute of Mental Health, n.d.; Pipe, et al., 2012; Zander & Hutton, 2010

Stress + Adversities= Burnout

BurnoutBurnout is a state of physical and mental exhaustion, emotional annoyance and exhaustion combined with personal and professional self-efficacy doubts.

Causes of Burnout Lack of control Unclear job expectation Dysfunctional workplace dynamics Mismatch in values Poor job fit Extremes of activities/ monotonous to chaotic Fatigue Lack of support No work life balance Trying to be everything to everyone

(Mayo Foundation for Medical Education

and Research, 2014)

Burnout Quiz

You try to be everything to everyone You get to the end of a hard day at work, and feel like you

have not made a meaningful difference You feel like the work you are doing is not recognized You identify so strongly with work that you lack a

reasonable balance between work and your personal life Your job varies between monotony and chaos You feel you have little or no control over your work You work in healthcare

Burnout Physical signs and symptoms of burnout

Unexplained Headaches Backaches Body aches Other physical complaints

Psychological signs and symptoms of burnout Depression, Post traumatic stress disorder (PTSD)

Drag self to work and have trouble getting started Lack of energy to be consistently productive Irritable or impatient with co-workers, clients, and patients Cynical, or critical at work /negative thoughts and mood Lack of satisfaction from your achievements Changes in sleep habits and appetite Using food, drugs or alcohol to feel better, or to simply not feel (Mayo Foundation for Medical Education and Research, 2014)

Outcomes of Stress, Adversities, & Burnout Work

Job dissatisfaction Patient dissatisfaction Work errors and performance decline Needle stick injuries Decline in quality decision-making Pt. safety issues Risk for negligence Role conflict and ambiguity

Relationships Negative spillover into personal and professional relationship and

life

(Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008; Jackson, Firtko, & Edenborough, 2007; Jones, 2013; Lombardo & Eyre, 2011; Mayo Foundation for Medical Education and Research, 2014; Mayo Foundation for Medical Education and Research, 2014; Mealer, et al., 2012; National Institute of Mental Health, n.d.; Pipe, et al., 2012; Zander & Hutton, 2010)

Outcomes of Stress, Adversities, & Burnout

Excessive stress Fatigue Headaches and /or Migraines Muscle tension Insomnia Depression Post traumatic stress disorder

(PTSD) Anxiety

Heart disease High cholesterol Type 2 Diabetes Metillus (esp. in

women) Stroke Obesity Alcohol and substance abuse Vulnerability to other illness and

health issue

(Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008; Jackson, Firtko, & Edenborough, 2007; Jones, 2013; Lombardo & Eyre, 2011; Mayo Foundation for Medical Education and Research, 2014; Mayo Foundation for Medical Education and Research, 2014; Mealer, et al., 2012; National Institute of Mental Health, n.d.; Pipe, et al., 2012; Zander & Hutton, 2010)Push, listen, scratch and

sniff

Resiliency

A function of your ability to cope (person), and the availability of resources (situation) related to health and well being.

(Sapolsky, 2004; Trauma Talk: JD Sexton, PhD)

Resiliency

Resiliency What is Resiliency?

The ability of an individual to adjust to adversity Maintains equilibrium Retain some sense of control over their

environment, and to continue to move on in a positive manner

Not a trait and can be learned The ability to undergo personal change enabling

the person to thrive and survive An active process Reduces vulnerability to stress and burnout


Resiliency Interventions Hardiness

Transforming critical positive and negative experiences; learning from those experiences and applying them to nursing practice

Being committed Feeling in control Having positive views toward challenges Increases sense of personal accomplishment Decreases impact of emotional exhaustion Assists in overcoming negative emotions

Thought sharing of stress, vulnerability, adversity, and resilience

Story exchange Sharing confidence within team Emotional expression /seeking assistance if needed Problem solving /not dwelling on problems


Resiliency Interventions Promoting positivity Creating and having supportive, nurturing, and validating

relationships (in and outside of work) Doing three good deeds for others (nothing major as simple as opening

the door for others)

Reflecting on work and situations to overcome negative situation, thinking, and attitudes

Searching for greater meaning and /or good Expressive /reflective writing /journaling (personal and professional

life and situations)

Mindfulness /self-awareness Awareness of strengths

Interest, skills, and passion Achievements / personal and professional

Awareness of limitations Emotional Seek help /assistance when needed


Resiliency Interventions Self-care

Scheduling relaxing time and activities Healthy activities that are physically, emotionally, and spiritually

nurturing Relaxation techniques Mediation Yoga Tia chi

Taking breaks and lunches At least 15-30mins uninterrupted Eating healthy to meet bodies needs /requirements

Work life balance Personal and professional boundaries


Resiliency Interventions Self-care cont. Managing stressors Know what coping strategies will help and when they are

needed Weigh achievements against emotional exhaustion Mindful of posture /body position

Resources (which people provide the best support)

Counselor /Resiliency coach (Tiasha Rojas-Parker MBA, MS) S.M.A.R.T Champions (unit based) Mentor /preceptor Co-workers BMT Leadership team


Outcomes of Resiliency Are able to find meaning and purpose in life in the

face of loss and trauma Ability to emerge stronger in ones’ ability to face

adversity Experience less stress and negative emotions and

work related problems than others Lifelong coping skill Able to recognize and transform stress from a more balanced perspective Optimism /positive outlook Having a sense of humor /laughter

Improved physical, mental, and social health Protective against burnout Prevents PTSD Broaden perspective mindfulness /self-awareness When to seek assistance / use resources


Outcomes of Resiliency Improved immune system

Lower stress hormone levels Reduce inflammation response to stress Lower B/P Reduce pain Better sleep

Job satisfaction Commitment /reduce turnover Productive work environment Decrease in work errors Improved ability in decision-making and information processing

Improved listening

Quality patient care and outcomesEmpowerment of patients Improved patient safety Improved patient satisfaction Perceived as more caring


Outcomes of Resiliency Positive intrapersonal and intraprofessional relationships

Improve unit moralCommunicationTeamworkMentoring

Promotes self-care enhancementPersonal and professionalHaving a sense of humor /LaughterImproves ability to want to take on challenges/ desire for learningIncreases use of resources knowledge and resources

Improve personal and professional self-efficacyHopeControlCompetenceCoping Appropriate regulation of negative emotionsEffective conflict management /problem solving Increases thought action inventory in the face of adversityPromotes personal and professional goals setting and achievement


Summary

Stress is the brains response to any demand and can be routine, acute, or chronic. People handle and respond to stress differently, but all stress effects the body similarly.

Adversity is a state of hardship or suffering associated with misfortune, trauma, distress, difficulty, or tragic event.

Burnout is a state of physical and mental exhaustion, emotional annoyance and exhaustion combined with personal and professional self-efficacy doubts.

Effects of stress, adversity and burnout can be manifested psychologically and physically.

Resiliency is a function of your ability to cope (person), and the availability of resources (situation) related to health and well being

Self-care involves healthy activities that are physically, emotionally, and spiritually nurturing.

Resiliency and you, today and tomorrow and the day after that…

Post Test & Survey• Thank you for reviewing the resiliency education

• Please click on or copy and paste the following link to complete the Resiliency Post Test & Survey

https://www.surveymonkey.com/s/MSD57LJ

• It should take 5-10 minutes to complete



References• Chesak, S. (2013, December). Integration and impact of stress management and resiliency training (Smart) in a Nurse

Residency Program: A feasibility study. Retrieved October 16, 2014, from University of Wisconsin Milwaukee UWM Digital Commons: http://dc.uwm.edu/cgi/viewcontent.cgi?article=1352&context=etd

• Google. (n.d.). Stress, resiliency, and adversity. Retrieved November 14, 2014, from Google images: https://www.google.com/search?q=stress&biw=702&bih=529&source=lnms&tbm=isch&sa=X&ei=0PFrVM39CMOdgwTUnYK4BA&ved=0CAcQ_AUoAg#imgdii=_

• Guadalupe, G. M., & Ayala, C. J. (2011). Emotional exhaustion of nursing staff: Influence of emotional annoyance and resilience. International Nursing Review, 59(1), 101-107. Retrieved October 18, 2014, from DOI: 10.1111/j.1466-7657.2011.00927.x

• Hodges, H. F., Keeley, A. C., & Troyan, P. J. (2008). Professional resilience in Baccalaureate-prepared acute care nurses: First steps. Nursing Education Perspectives , 29(2), 80-89. doi:10.1043/1094-2831

• Jackson, D., Firtko, A., & Edenborough, M. (2007, October ). Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: A literature review. Journal of Advance Nursing, 60(1), 1 -9. doi:10.1111/j.1365-2648.2007.04412.x

• Jones, B. (2013). Compassion Fatigue and the Challenge of Developing Resilience . Retrieved October 17, 2014, from Oncology Nursing News: http://nursing.onclive.com/publications/oncology-nurse/2013/June-2013/Compassion-Fatigue-and-the-Challenge-of-Developing-Resilience

• Lombardo, B., & Eyre, C. (2011). Compassion Fatigue: A nurse's primer. Online Journal of Issues in Nursing, 16(1). Retrieved October 16, 2014, from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No1-Jan-2011/Compassion-Fatigue-A-Nurses-Primer.html

• Mayo Foundation for Medical Education and Research. (2014). Healthy lifestyle adult health: Job burnout: How to spot it and take action. Retrieved October 20, 2014, from Mayo Clinic: http://www.mayoclinic.org/healthy-living/adult-health/in-depth/burnout/art-20046642

• Mayo Foundation for Medical Education and Research. (2014). Healthy lifestyle stress management: Know your triggers . Retrieved November 12, 2014, from Mayo Clinic: http://www.mayoclinic.org/healthy-living/stress-management/in-depth/stress-management/art-20044151

• Mealer, M., Jones, J., Newman, J., McFann, K. K., Rothbaum, B., & Moss, M. (2012). The presence of resilience is associated with a healthier psychological profile in ICU nurses: Results of a national survey. International Journal of Nursing Studies , 49(3), 292-299. doi:10.1016/j.ijnurstu.2011.09.015

• National Institute of Mental Health. (n.d.). Fact Sheet on Stress. Retrieved October 20, 2014, from National Institute of Mental Health: http://www.nimh.nih.gov/health/publications/stress/index.shtml

• Pipe, T. B., Buchda, V. L., Launder, S., Hudak, B., Hulvey, L., Karns, K. E., & Pendergast, D. (2012). Building personal and professional resources of resilience and agility in the healthcare workplace. Stress and Health, 28(1), 11-22. doi:10.1002/smi.1396.

• Sexton, B., & Sexton, J. (2013). Enhancing caregiver resilience: Burnout and quality improvement. Duke University Healthcare Systems Patient Care Center, (pp. 1-42). Durham. Retrieved October 15, 2014

• Zander, M., & Hutton, A. (2010). Coping and resilience factors in Pediatric Oncology Nurses. Journal of Pediatric Oncology Nursing, 27(2), 94-108. doi:10.1177/1043454209350154

SMART PP

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