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May/June 2014
Resilience Strategies for Geriatric Care TeamsBy Annita Kerr D’Amico, EdD A nurse at an assisted-living facility recently shared her assessment and perceptions of her professional and personal experiences in her workplace: “My workday begins at 8 AM sharp and lasts through a 10-hour shift; this has been my daily schedule for the past five years. A typical morning shift begins the moment I arrive, with barely time to hang up my jacket before the night shift shares the evening report. “The night team often hurries through the details, exhausted and ready to head home. Their report outlines the conditions of residents who have been up all night, some showing signs of skin irritations. And frequently one or more residents have fallen and spent the night in the emergency department. These individuals usually return to the facility during the morning shift. “Many residents’ needs are chronic in a medical care world built and trained for more acute needs. I wonder whether this is one of the reasons the care staff rarely enjoys the feeling of closure when we have successfully handled a crisis. I feel I have been trained to manage and promote cures, but as members of long term care teams, we manage problems to which we often have no answers. “Our challenges are not limited to resident care. By the end of our shift, several members of our team frequently seem distracted and on edge, making our efforts as a care team strained and less productive. “I love what I do, but it seems that I don’t start out the day with the same energy I used to. At the end of my 10-hour shift, the day’s events have become a blur of complex care needs. It seems today’s residents are sicker, suffer with more pain, experience more severe cognitive impairment issues, and encounter deeper psychological valleys of loneliness and depression. “After a typical shift, I arrive home with very little energy left for my family and myself. I feel the crushing burden of daily stress tipping me toward burnout, and I am not sure how to prevent it.” A Real Threat Today it is common to find professional caregivers describe their lives as being stuck in 24/7 work mode. It is not only difficult for them to unplug from work but even more difficult to find opportunities to recharge physical and emotional banks. Care team members respond to workload stress in different ways. Certain members excel in the midst of intense stress, while others crash and burn out. Although stress is a normal occurrence in life, unmitigated chronic stress impacts energy and motivation levels, influencing the ability to effectively negotiate workloads and maintain social skills. Stress was labeled as an occupational hazard in the 1950s, and the term “compassion fatigue” began to be used around this time to diagnose a type of stress specific to nurses. In 1974, psychologist Herbert Freudenberger, PhD, coined the term “burnout,” which describes long-term exhaustion and a decreased interest in work. Researchers in the field of occupational stress study its impact in the workplace. Their research concerns include how stress negatively influences the health and emotional stability of professional caregivers and their ability to provide quality patient care. Strategies to alleviate the negative impact of stress must consider complex variables that mediate or exacerbate stress in the workplace. These variables are influenced by individual and team interpretations and include shift length, generational expectations, sex, family-work conflict, personality, management styles, and workload expectations and perceptions. Interpretations of stress overload affect the mind first, altering an individual’s perceptions of situations. Perceptions of extreme stress cause the brain to rewire to survival mode, shifting the focus of concentration away from the executive system of logic and reason to emotional response centers. The emotional centers then send out chemical alarms that alert the body to potential danger. Chronic stress keeps the mind and body on high alert, exhausting and disturbing its natural chemical balance for well-being. Maintaining this chemical imbalance on a regular basis negatively impacts the body, mind, emotions, and behaviors in multiple ways. Experiencing excessive and/or chronic stress affects the entire body. Red Flags The psychological perspective examines stress and how an individual evaluates work demands that exceed personal resources. Professionals who experience symptoms of stress or perceive diminished effectiveness in their daily discharge of professional duties can utilize tools to help define their stress levels. The Maslach Burnout Inventory measures burnout levels, dividing them into three components: emotional exhaustion, depersonalization, and reduced perceptions of personal accomplishment. Several stress and compassion fatigue evaluation tools are available online, including MindTools.com, which provides a free informal self-test for assessing personal burnout risk. A Question of Resources Job stressors that deplete personal resources and profoundly impact emotional resilience include work overload, emotional demands, role ambiguity or uncertainty, and lack of autonomy.6 Stressful environments can function as emotional and physical sinkholes. Individuals who feel their work is ineffective or unappreciated and experience a driven, critical management style may perceive the environment as toxic, aggressive, and offensive. In contrast, researchers have found that promoting engagement at work helped to build energy levels, mental resilience, and a sense of meaning and pride. This engagement involved enhancing personal strengths rather than simply decreasing environmental stressors within care providers’ settings. Strategies included helping individuals develop more optimistic views, maximizing emotional competencies (ie, awareness of others’ emotions, verbal expressions of emotions, empathy), and gaining knowledge of strong personality skills.7 Personal Resource Strategies In my wellness practice, clients work through a stress risk management and refuel chart. They are challenged to examine a stressful event, evaluate emotional and physical risks created by the event, explore ways to refuel, and then develop strategies to think and behave differently using personal resources. The table below is an example of a stress management chart. The chart is designed for use with additional strategies for managing lifestyle changes and easily can be modified for a care team or single individual. Regroup and Rethink Tips • Practice a positive view of situations. Focus on people’s positive qualities and avoid criticism. Notice small improvements in job performance and reward yourself and others. • Practice forgiveness and tolerance. Evaluate what is important and let go of minor issues. Try to understand family members and colleagues, and exercise greater acceptance of differences. This includes self-kindness. • Recognize and accept limits. Establish realistic expectations. Set aside time for physical and emotional renewal. Arrange for a day off every week. • Make plans. Control your schedule and develop time management strategies that plan for daily needs and work deadlines. • Learn how to play. Have fun, laugh, take breaks, and enjoy family and others. Find a pastime or hobby that is fun and relaxing. Learning to advocate for personal needs is a powerful life tool. High levels of acute and chronic stress do not have to result in starve-out as we develop and manage our personal, social, and emotional resources. Each generation that learns how to balance and manage its gifts, resources, and responsibilities is healthier and happier and provides leadership to the next generation’s workers to care for themselves as well. — Annita Kerr D’Amico, EdD, is an educational psychologist and certified wellness coach in private practice at Cornerstone Medicine Group in Franklin, Tennessee. She speaks, writes, and trains on stress management and personal care strategies.
Stress Management Chart
References 2. Selye H. The Stress of Life. New York, NY: McGraw Hill; 1956. 3. Lazarus RS, Folkman S. Stress, Apraisal, and Coping. New York, NY: Springer; 1984. 4. Bakker AB, Demerouti E. The Job Demands-Resources model: state of the art. J Manag Psychol. 2007;22(3):309-328. 5. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. A model of burnout and life satisfaction amongst nurses. J Adv Nurs. 2000;32(2):454-464. 6. Jawahar IM, Stone TH, Kisamore JL. Role conflict and burnout: the direct and moderating effects of political skill and perceived organizational support on burnout dimensions. Int J Stress Manag. 2007;14(2):142-159. 7. Garrosa E, Moreno-Jiménez B, Rodriguez-Muñoz A, Rodriguez-Carvajal R. Role stress and personal resources in nursing: a cross-sectional study of burnout and engagement. Int J Nurs Stud. 2011;48(4):479-489.
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