All 3 sections in this workbook must be answered correctly to receive a satisfactory grade for this assessment. You must achieve a satisfactory result for each question in the workbook and include referencing requirements to achieve a satisfactory result for this assessment.
This workbook is to be completed in your own time using available reliable sources such as the course text books provided to you at orientation, credible internet sources such as the department of health and other text and online journals available to you through the online library service offered to all students and discussed at orientation.
It is important that you reference all sources of information that you use to obtain information used in your answers. Referencing must be included and failure to adhere to this requirement will result in a not satisfactory outcome for the assessment.
You are required to develop a personal stress management. It involves 3 sections:
Section 1 – Reflection and identification of a stressor and development of personal management plan
Section 2 – Implementation of the strategies in your management plan to assess their effectiveness using two case scenarios
Section 3 – Evaluation of strategies from your management plan using the case scenarios.
This assessment is divided into sections which focus on the different legislative, policy and industrial requirements for fulfilling competency in this unit
Within each section all questions must be answered.
Ensure you answer each part of the question with required amount of details.
Section 1 – Development of Personal Stress Management Plan
This assignment is for you to develop a personal stress management plan to cope with identified triggers and stressors involved in the nursing environment. You are to reflect on issues that arose while you were on clinical placement that caused you to experience stress. You will pick one issue that will be used to then develop your personal stress management plan. These issues may have included but not limited to:
In this section you must address all the questions
Please note: The space below is not indicative to the required length of the response; you are to ensure that you thoroughly answer the question.
As a Student Enrolled Nurse in the clinical environment, I encountered several sources of stress, the most disturbing one being delivering care to clients and patients. There were stressful working conditions brought about by the understaffed institution and the larger than normal client admissions. An overcrowded institution often means minimal resources. Clients and patients issues, for example mental illness, aged clients who don’t know how to carry themselves also affected the way to deliver care to them. Some are stubborn and disobedient. They had constant demands that were difficult to respond to owing to the fact that they were many clients to tend to. The multiple tasks that were impossible to combine made it difficult to deliver proper care to the client at hand. With very poor supervisory support, there was no one to turn to with some issues or problems experienced, and this led to frustration from the clients as they could not understand the situation at hand or why they didn’t get a delegated nurse to themselves. There was low input into decision-making, especially with lack of supervision. Hence, more often than not, some duties were left undone or not completed and some clients failed to receive constant care, leading to major frustration, pressure and stress on my part.
Triggers included the overcrowded state of the environment, leading to understaffed personnel. This meant overload in the amount of work. Weariness, lack of support were also causes that lead to major source of stress. Uncertainty in waiting for a particular outcome in various situations and circumstances also acted as triggers.
My physical responses included fatigue and exhaustion, nausea, headaches appetite change, insomnia, and overactivity and underactivity in some situations.
Cognitive responses included constant worrying about outcomes, feeling light headed, confusion, forgetfulness, overwhelming feelings, negative thoughts and attitudes and concentration issues.
Behavioural responses were, constant withdrawal from colleagues due to the pressure, poor relationships with those I interacted with, feeling lonely, pacing and failing to relax especially when waiting for an outcome, avoiding other people, decreased sex drive, and absenteeism.
Emotional responses were sadness when something failed to turn out as I wanted it to, frustration, anxiety, guilt, sudden excitement or anger, apathy, helplessness and burnout.
Trainer comments: S NYS
From a study by Elizabeth Scott, quick stress relievers like breathing exercises are helpful in reducing stress. I practiced these breathing exercises, that basically involve breathing at a certain pace while counting. This eventually calmed me down and felt better enough to think straight. [ Elizabeth Scott, An overview of stress management, (2018)]
By adapting to the stressor and changing myself. A study by Lawrence Robinson suggests focusing on the positive and adjusting your attitude towards a stressful situation. I implemented this strategy looked the bigger picture in the situation at hand. I used the policy, ‘If it won’t matter in 5 years, don’t spend 5 minutes thinking or stressing about it.’[ L Robinson, et al, Stress Management : Using SelfHelp Techniques for Dealing with Stress ( Published under Helpguide.org, 2018)
By changing myself too, I set realistic standards, and even what I expected from clients and patients changed because I then understood that with some patience needed to be practiced. Perfectionism in itself can be a major source of stress. Hence I became more realistic with my goals and standards and adjusted them to fit into every situation.[ L Robinson (n4)]
I learnt to accept things not changeable and the importance of it, as the study by Robinson suggests as well. I found out that, the sooner I accept and adjust, the sooner things work out for the better. Especially when it comes to clients and patients who need different kinds and ways of help. I had to accept them as they are, as well as accepting their situations and find a way to deliver care to them effectively and efficiently.[ L Robinson (n5)]
From the study by Lawrence Robinson, avoiding unnecessary stress is a good way to prevent it.[ L Robinson (n3)]Shchuka Aljona’s study suggests this as an important way, because when one knows stress and the causes of it, there are more chances of him or her to prevent its appearing.[ Aljona Shchuka, Stress work :Stress Management, (2018)] I took this into action and practiced staying away from people who brought unnecessary extra stress baggage for the moment. And by taking charge of my environment, I found my stress levels reducing and I was able to prevent more stress .
I adjusted my nutrition. A study by Christian Nordqvist showed that having a healthy balanced diet helps maintain the immune system in stressful times. Poor nutrition will eventually add on to your stress and lead to ill-health. By adjusting my diet and including lots of fruits and vegetables, I realised that I gradually became stress resilient.[ Christian Nordqvist, Why stress happens and how to manage it, ( Medical News Today, 2017)]
Internal sources that could be used are sharing my issues/triggers/problems with my relatives or colleagues. As Gerard Lebel suggests in his article sharing problems is important because a defined problem is a problem half solved. My colleagues, friends or family might have also gone through a similar situation as you are, and might help me get through the stressful period. [ Gerard Lebel, Self guide for stress management, (2011).]
Another internal source of could be relaxation. Finding time for self-improvement is important as it enables individuals take control over their behaviours. Taking breaks and utilizing them to relax and recharge. [ S Giga, et al, Development of a framework for a comprehensive approach to stress management interventions at work, (2003).]
External sources could be finding your own destressor. Christian Nordqvist suggests that people should turn to helpful and healthy strategies that help them relax, for example jogging, reading a book, going to the gym or going for walks. This activities help in relaxing and eventually they reduce, prevent and manage stress and stress levels. [ Christian Nordqvist, Why stress happens and how to manage it, (Medical News Today, 2017)]
Another external source includes sleep Ensuring that you get enough sleep and rest is important and is necessary for proper functioning of a human being. Gerard, in his article, provides rules for good sleep hygiene. [ Gerard (n61)]
Trainer comments: S NYS
Stressors
Aspects of delivering care to clients. This included the minimal resources available, stressful working conditions, patient’s issues, for example, mental illness or aged patients. Stubborn and disobedient clients made it difficult for me to deliver proper care to them. Poor supervisory support, low input into decision-making, many tasks at hand and constant demands by patients.
Overcrowded institution
Understaffed personnel
Overload of work.
Tiredness
Lack of support
Uncertainty or waitings for important outcomes.
My response
Physical: fatigue, nausea, headaches, insomnia, overactivity and underactivity, apettite change.
Cognitive: constant worrying, dizziness, confusion, forgetfulness, feeling overwhelmed, negative thoughts and attitudes, concentration issues.
Behavioural: withdrawal from friends, decreased libido, poor relationships, feeling lonely, pacing and failing to relax, absenteeism, avoiding others.
Emotional: burnout, feeling overworked, sadness, frustration, sudden excitement or anger, apathy, helplessness, anxiety, guilt, fear.
Many responses to stress are further discussed in Steve Bressert’s study. [ Steve Bressert, The Impact of Stress, (2016)]
Strategies to use
From a study by Elizabeth Scott, quick stress relievers like breathing exercises are helpful in reducing stress. I practiced these breathing exercises that basically involve breathing at a certain pace while counting. This eventually calmed me down and I felt better enough to think straight.
By adapting to the stressor and changing myself. A study by Helpguide.org suggests focusing on the positive and adjusting your attitude towards a stressful situation. I implemented this strategy and looked at the bigger picture in the situation at hand. As is said, ‘If it won’t matter in 5 years, don’t spend 5 minutes thinking or stressing about it.
By changing myself too. I set realistic standards and goals and my expectations from clients and patients changed because I then understood that with some patience needed to be practiced. Perfectionism in itself can be a major source of stress. Hence I became more realistic with my goals and standards and adjusted them to fit into every situation.
By accepting things not changeable, as the study by Helpguide.org suggests. I found out that the sooner accept and adjust, the sooner things work out for the better. Especially when it comes to clients and patients who need different kinds and ways of help. I had to accept them as they are and their situation as it is and find a way to deliver care to them effectively and efficiently.
By avoiding unnecessary stress, as a study by shows. I practiced staying away from people who brought unnecessary extra stress baggage for the moment. And by taking charge of my environment, I found my stress levels reducing and I was able to prevent more stress.
I adjusted my nutrition. A study by Christian Nordqvist showed that having a healthy balanced diet helps maintain the immune system in stressful times. Poor nutrition will eventually add on to my stress and lead to ill-health. By adjusting my diet, including a lot of fruits and vegetables, I realised that I gradually became stress resilient.
Section 2a – Implement stress management strategies
Case Scenario 1
You are working on a busy general medical unit. In the past week there have been four unexpected deaths and an extraordinarily busy unit resulting from larger than normal client admissions. Staffing has been a constant struggle of ensuring that there is a safe nurse-patient ratio, and a large number of shifts have been worked short-staffed. Your manager has asked you on several occasions to work extra shifts and you have agreed as your partner has just lost his job.
In the course of one shift that you worked, two clients died. Of the clients, one was a young male, Jason Thomas, 32, who recently became a father. Jason presented to emergency for chest pain and was sent to your unit for observation. Jason had pressed his call button for assistance and when the nursing staff arrived (yourself and Vanessa, a RN), he was found to be clutching his chest in pain, pale, diaphoretic and very short of breath. A MET was called, and despite resuscitation, Jason died an hour later. You were very distressed after this event as it reminded you of a personal tragedy and went to take your tea break.
Since Jason’s death, you have been sick for most of your shifts. When you are at work you are at times abrupt and some relatives have complained about your ‘attitude’ to the Nursing Unit Manager. The staff members who have been working with you for more than 6 months and know that this is not your normal behaviour. They have tried approaching you and asked if you are ok, but you brush their comments away or do not respond at all, and walk away from the area.
To investigate the complaint, the Nursing Unit Manager is questioning staff members who were working alongside you on the day of the complaint as well as the patient’s family.
Quick stress relievers, as suggested by Elizabeth Scott would help in calming me down whenver I feel sick or anxious.
Acceptance of things I can’t change. Jason’s death is something that is irreversible, therefore, although it might take time, accepting his death, and accepting that death is normal and natural could help in reducing stress.
Sharing the issues/triggers/problems with my relatives or colleagues who I’m comfortable around as Gerard suggests in his article. A problem shared is a problem half solved. They might also have experienced a similar problem a I am and might help me get through the stressful period. [ Gerard (n40)]
Adapting to the situation as fast as possible will help in changing your attitude towards it. Deal with the issues at hand head on, as the study by studentconduct.eku.edu suggests. Take the bull by the horns.
Finding my own destressor could also help in reducing my stress levels. For example, I could go for walks as a way to de-stress.
To ensure enough rest, sleep, and following rules for good sleep hygiene could be of help to enable proper functioning of the body as suggested by Gerard’s article [ Gerard (n61)]
Trainer comments: S NYS
Having a schedule for each day. This ensures avoidance of stress, as and keeping track of your life and ensuring I perform each task that is delegated to each day to the fullest leading to achieving balance.
By setting my priorities straight. Being assertive and knowing your limits and when to take a step back.
By accepting help if any is offered to me by my colleagues.
What are three (3) or more adjustments that could be made to your plan if your identified strategies are not meeting the desired outcome to prevent, reduce and manage stress
Evaluation of self. Resetting and re-establishing my goals.
Having realistic standards and goals, so as to adapt to the stressor at hand.
Meditation, which studies have shown can help promote resilience, if done regularly on a long term basis.[ Elizabeth Scott,, An overview of stress management, (2018)]
By rating my personal stress levels. For example, on a scale of 1 to 5, how stressed am I currently?
By monitoring myself. Having a stress journal, where you indicate what or who triggered your stress.
Monitoring your reactions to your triggers or sources of stress.
Checking your stress levels at specific times, for example in the morning or reflection of your day during breaks or in the evenings.
State two more adjustments could you make if your strategies are not meeting the desired outcomes.
Being proactive. This is anticipating and taking action to prevent stressful situations as Gerard suggests in his article. [ Gerard (n110)]
Acquire resources that allow you to face it life, for example, money and networks.
Trainer comments: S NYS
What are two additional internal or external sources could you seek for additional support to meet the desired outcomes of the stress management plan. (You must have 2 internal and 2 external sources)
Internal sources of support I could seek are mentors. Having people in the same field who I look up to could help me meet my desired outcome.
Another internal source of support is including my supervisors and reaching out to them whenever I encounter situations with stressors or triggers that are too ‘difficult ‘ to manage.
External sources of support I could seek are exercise. Studies have shown that exercise is beneficial for the cardiovascular system and if practiced routinely, can help develop a process that results in resilience to stress and protection from physical and mental health effects. [ S. Giga, et, al, Development of a framework for a comprehensive approach to stress management interventions at work, (2003)]
Another external support I could seek is medication. When it is used in the right way, as prescribed by a physician after examination, medication can help in reducing and managing stress levels. [ Gerard (130).]
Trainer comments: S NYS
Implement stress management strategies
You are an EN on the floor working in an aged care facility. There is a resident, who is a very demented lady (Mrs R). Mrs R was a sweet lady, but now hissed at everyone walking past, spat in your hair when you were putting on her shoes, and lashed out at you if you came near her.
When attending to the wound on her arm when she grabbed the keys from round your neck and began choking you. Another staff member was walking past and saw you trying to pull away. Your fear of hurting Mrs R left you blue and breathless from her choking you. The staff member released Mrs R’s grip from your keys and set you free. You left the room with a sore neck and a bruised area from the lanyard
Explain how the strategies in your personal management plan could address the personal triggers and stressors in the above scenario.
The breathing exercises suggested by Elizabeth Scott would help in calming me down.
Adjusting my standards, especially according to the kind of patients or clients I am dealing with, like Mrs R. Being realistic about my expectations from her, as she is aged, would help me manage.
Having my own destressor, for example reading a book or taking a walk could help in reducing stress in that situation, as suggested by Christian Nordqvist.
Sharing the issue with colleagues and friends could help in address triggers in the situation and understanding the people involved, as shown in Gerard’s study. These people, as shown in another study by Diana and Janis, will act as your support network for you and will help in considering and developing new positive ways to cope with everything.[ D Ballesteros, Janis Whitlock, Cornell Research Program : Self Injury and Recovery, (2012)]
Learning how to be open-minded in certain situations and being willing to compromise when a certain group of people like Mrs R are involved could help in managing the situation. Studies have shown that practicing patience and being understanding in situations is helpful.
By adapting to the stressor, as studies shown, who in this case is Mrs R and her actions towards me. Practicing the policy, that if it won’t matter in 5 years, don’t spend 5 minutes thinking or stressing about it.
Name three ways could you organise your own workload to minimise stress and inform relevant personnel of any variations and difficulties affecting work requirements. (These must be different from your previous answers).
By considering a change in your working time, especially if your workload at a certain time affects other plans at hand or your personal time.
Combining tasks when necessary. This is from of multitasking, which eventually savea time for me.
Being willino to compromise in certain situations.
Identify and adopt 4 or more strategies to balance work/life priorities.
Having mentors and watching how they work.
Timeshifting, which requires mindfulness. Eva defines it as ‘Cultivating awareness of our thoughts and sensations in the present moment ‘. This helps in ‘slowing down time ‘. It therefore gives room for happiness and efficiency. [ E Chittenden and C Ritchie, Work-life balancing: Challenges and strategies, (2011)]
Having goals. Studies have shown that setting goals and having a personal vision and mission statement helps in balancing work and life priorities. Keeping your long term and short term goals clear, and keeping track of your performance in achieving them.
Taking good care of yourself by realising that physical health is important and is often a low priority in many people’s lives. Lack of exercise and poor eating habits leads to poor health and a poor life eventually.
State 4 ways you will know that your stress management strategies are effective? (These must be different from your previous answers).
There is more organization in my life and how I handle myself in certain circumstances and situations.
Opening up to people more. I’ll find myself opening up to people more, sharing about my life’s occurences and even delegating tasks that I might find overwhelmed by.
I’ll realise that I’m becoming more self aware and my priorities are more informed than before.
My journey to a healthier I would be productive. Implementing exercise, proper rest and correct nutrition and eating habits will be a routine in my life and if I’m trying to achieve a set goal in my life that alines with this habits, I’ll be on my way to achieving them. [ www.webmd.com, Health and balance: Stress Management (2016).]
State two adjustments could you make if your strategies are not meeting the desired outcomes. (These must be different from your previous answers).
Getting a mentor or a supervisor.
Develop thought stopping techniques, which involves dwelling or concentrating on unwanted thoughts for a short time, then suddenly stopping and emptying the mind through command and word, for example, ‘STOP!’ or even a loud noise. This ends up interrupting the unpleasant thoughts that bring stress and anxiety. [ Klinic Community Centre, Stress and Stress Management, (Jan 2010).]
Trainer comments: S NYS
What are three additional internal or external options could you seek for additional support to meet the desired outcomes of the stress management plan. (These must be different from your previous answers).
Internal sources of support I could seek are participating in the making of laws, policies and shifts periods at work. Generally participating and voicing my thoughts will help me explain myself more and not bottle everything up and hence have an input in the management.
Another internal source I could seek is discovering if my organization or manager or employer has a service set in place for employee welfare, and if it exists, then I turn to it. Studies have shown that the skills taught here mobilize support and participation in problem solving and decision making. Thus more positive and supportive feedback is reported and I and others will feel more able to cope and work better. [ S Michie, Causes and Management of Stress at Work, (2002).]
External sources I could seek are professional counselling services Many regions have governmental counseling services.
Another external source I could seek is making a gratification list, listing down my qualities, strengths, accomplishments, assests and successes, hence outline how I can use them to make my life easier. [ Gerard (n145).]
Reference list
Scott E, An Overview of stress management, (2018)
Robinson L, Smith M, M.A, Segal R, Stress Management: Using Self Help Techniques for dealing with stress, (Helpguide.org 2018)
A Shchuka, Stress at work: Stress Management (2010)
Nordqvist C, Why stress happens and how to manage it, (Medical News Today 2017)
Lebel G, Self help guide for stress management, (2011)
Giga S, Copper C, Faragher B, Development of a framework for a comprehensive approach to stress management interventions at work, (2003)
Chittenden E, Ritchie C, Work-life balancing: Challenges and strategies (2011).
www.webmd.com, Health and balance and stress management- Your stress management checklist, https://www.webmd.com/balance/stress-management/stress-busting-checklist (Reviewed by Joseph Goldberg 2018) (Accessed 31/08/18).
Bressert S, the Impact of Stress (2016)
Ballesteros D, Whitlock J, Cornell Research Program on Self-injury and Recovery (2012)
S Michie, Causes and Management of Stress at Work (2002)
Klinic Community Health Centre, Stress and Stress Management, (2010)
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