Stress as Healthcare Issue and Its Management

Management Issues and Stress as Healthcare

Stress Management,Nursing Research on Interventions and Coping Strategies,Effects of Stress Management,Outcomes of Strategies,Nursing Research and Future Expectations.

Stress Management

    Stress management is a broad term that encompasses a wide range of methods intended to prevent stress or effectively manage it as evidenced by low levels of stress emotions and improved coping abilities. “Stress management interventions are deliberate actions taught to patients to help achieve outcomes” (Synder, 2000, p. 179). 

    Coping strategies are actions self-initiated by a person to manage stress. Coping strategies are typically categorized as direct action/problem focused aimed at alleviating or decreasing the intensity of perceived threat, or palliative/emotion focused aimed at decreasing or keeping in check the intensity of stress emotions experienced (Lazarus & Fokman, 1984).

Nursing Research on Interventions and Coping Strategies

    Nurse researchers have studied stress management interventions and coping strategies in various groups of people including nurses, student nurses, and patients. It is interesting to note that the majority of these studies have been conducted by nurse researchers in European and Asian countries. 

    Some of the coping strategies frequently used by nurses to manage stress include taking action, drawing on past experiences, using problem solving techniques, using humor, talking over problems with coworkers, accepting the situation, taking breaks (escaping from the situation), using diversions , using relaxation, and exercise (Lewis, DJ, & Robinson, 1986; Petermann, Springer, & Farnsworth, 1995). 

    Coping strategies taken to prevent stress involve balancing demands and resources, focusing on the positive in difficult situations, maintaining perceived choice and sense of personal control, building social support, and viewing difficult situations as challenges that can bring gain or benefit through learning (Dionne Proulz & Pepin, 1993;Lyon, 1996).

Effects of Stress Management

    Nursing research studies on the effects of stress management interventions with various patient population groups have yielded equivocal results. M Snyder (1993) critically reviewed all 54 stress related intervention studies appearing in the nursing literature from 1980 through 1990. 

    The types of stress management interventions used included relaxation strategies (eg, progressive muscle relaxation, imagery, meditation, breathing techniques, massage, music), educational strategies, and use of social support groups. 

    A major flaw of most of the intervention studies was an inadequate description of the intervention used, and there was a lack of attempts to explain the theoretical link between the intervention and outcome measures. Manipulation checks as a way to assure that subjects mastered the intervention also were lacking in the intervention studies. 

    Studies using sensation information (eg, Johnson, JE, Rice, Fuller, & Endress, 1978) and studies using progressive relaxation techniques (e.gPender, 1985) have demonstrated positive effects on health related outcomes such as less anxiety and an increased sense of well-being. 

Outcomes of Strategies

    Since 1995 there has been little theoretical knowledge gained through nursing research about the effectiveness of stress management interventions or coping strategies. Two com non findings, consistent with Lazarus (1966) and Lazarus and Folkman (1984), are that: 

(a) direct action or problem focused coping strategies and cognitive restructuring strategies are related to decreased stress related outcomes such as anxiety, other negative mood states, and an increased sense of well-being

(b) palliative or emotion focused strategies are related to increased anxiety, other negative mood states, and distress. The most common theme is that stress is a subjective phenomenon that is experienced differently by each person. The most common outcomes measured as dependent variables have been stress emotions such as anxiety, other negatively toned mood states, and depression.

Nursing Research and Future Expectations

    Future directions for nursing research. should focus on identifying patterns of appraisal, emotions, and coping that result in health-related outcomes. 

    Additionally, for the discipline's research efforts to mean- fully contribute to knowledge generation, it is imperative that nurse researchers clearly define and delineate stress management interventions and offer testable theoretical formulations that explain how the interventions affect outcome variables within specified person and environment contexts. 

    It is also essential that the researcher incorporate manipulation checks into the methodology to verify that the intervention “took. For example, when using a progressive muscle relaxation or autogenic relaxation strategy it is important to verify that the participant experienced a sense of “relaxation.” 

    Likewise, it is equally important for the researcher to verify that participants implement coping strategies correctly following a psychoeducational intervention. Results must be able to demonstrate that the intervention actually altered the target variable as proposed in the theoretical formulation. 

    Furthermore, research designed to contribute to knowledge generation offers little meaning if the researcher does not reflect on the meaning of the findings in relation to proposed theoretical formulations.

    Current developments in testing “ABC” codes (Alternative Link, 2004) representing non-pharmacological interventions and complementary and alternative therapies offering nursing the opportunity to demonstrate effectiveness of stress management interventions in assisting patients to achieve desired health related outcomes (Lyon, 2000) . 

    The latter half of this decade will offer unprecedented opportunities for nurse scientists to demonstrate the cost-effectiveness of stress management interventions in nursing practice.