Stress Reduction Techniques for Nurses

By Jillian Crimmins-Bartsch, RN

Goal

• The goal of this presentation is to provide nurses with tools that can be used during the workday or at home to reduce occupational stress that can lead to burnout

In this presentation

• We will first discuss the physical and psychological manifestations of stress
• There will be an opportunity to assess your stress with a quiz
• There will be an introduction and discussion of relevance, followed by a video demonstration of the following techniques:
• Mindfulness Meditation
• Progressive Muscle Relaxation
• Deep Breathing Relaxation
• Finally, there will be some tips for including mindfulness into the workday

How to recognize when you are stressed

(American Institute of Stress, n.d.)

Nurses experience a high level of occupational stress due to factors such as long work hours, workplace hazards, and poor communication. Stress can negatively impact the way that the nurse views their role as well as their job performance. (Sharma et al., 2014)

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Stress can manifest itself in many ways. It is important to recognize and address stress before it becomes a chronic issue leading to long term physical and psychological conditions as well as problems in the workplace.

Assess your own stress

If you would like to take a few minutes to assess whether you are stressed, follow the link below.

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Stress and Anxiety Quiz

Evidence Based techniques for stress reduction

• In this section, for each of the following techniques; I will first provide an introduction, then describe the supporting evidence, and finally, I will present an instructional video so that you can participate in these stress reduction techniques
• Mindfulness Based Stress Reduction
• Progressive Muscle Relaxation
• Deep Breathing

Mindfulness Meditation

• Mindfulness involves bringing attention to the present moment
• This awareness can help to train our minds over time to become more relaxed despite our surroundings
• The goal is to free the mind from negative thoughts
• (Moore, 2021)

Mindfulness Meditation

(Lee et al., 2020)

Mindfulness Based Stress Reduction is a particularly well studied mindfulness program involving 8 weeks of classes that teach mindfulness meditation. It has been shown to reduce stress, anxiety, depression, and pain. (American Psychological Association, 2019)

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The figure shown here describes a study which demonstrates the effects of Mindfulness Based Stress Reduction on blood pressure, a common physical symptom of stress.

Mindfulness Meditation

(Great Meditation, 2021)

Progressive Muscle Relaxation

• Progressive muscle relaxation is a technique first described by Dr. Edmund Jacobson in the 1920’s. It is accomplished by tensing and relaxing each muscle group in the body
• It is thought that this exercise helps the participant to notice the difference between the two states and then they begin to understand when stress has contributed to muscle tension
• The thought behind this intervention, is that addressing the physical manifestations of stress and anxiety can also help to reduce the psychological manifestations
• (Healthline, 2020)

Progressive Muscle Relaxation

• A study by Pelit-Aksu et al. (2020) looked into the effect of Progressive Muscle Relaxation on the stress experienced by student nurse interns. They found that students who implemented Progressive Muscle Relaxation at least four times a week for 3 weeks experienced reduced stress when compared with the control group

Progressive Muscle Relaxation

(Mason, 2020)

Deep Breathing Relaxation

• Deep breathing is a relaxation technique that can be used as part of a meditative practice to reduce stress (National Center for Complementary and Integrative Health, 2020)
• There are many different ways to practice this technique, but most involve expanding the belly with each breath and improving the efficiency of each exhalation (also called diaphragmatic breathing) (National Center for Complementary and Integrative Health, 2021)

Deep Breathing Relaxation

• A study by Chen et al. (2016) demonstrated that study participants who completed an 8-week trainer-led course on diaphragmatic breathing relaxation, experienced significantly reduced anxiety. Their results were based on physiological indicators such as skin conductivity, heart rate, respiratory rate, as well as the Beck Anxiety Inventory.

Deep Breathing Relaxation

(MassGeneralHospital, 2019)

Ways to incorporate mindful practices during the workday

• Use handwashing time to recite positive affirmations
• Use your breaks to read or listen to something positive
• Take a walk around your unit and incorporate a breathing exercise
• Breathe in for 4 counts
• Hold for 7 counts
• Breathe out for 8 counts

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(American Nurse, 2020)

References

American Institute of Stress. (n.d.). How stress affects your body [Infographic]. https://www.stress.org/how-stress-affects-your-body

American Nurse. (2020, June 7). ANA Enterprise works to support the mental health, well-being, and resilience of nurses. https://www.myamericannurse.com/ana-enterprise-works-to-support-the-mental-health-well-being-and-resilience-of-nurses/

American Psychological Association. (2019, October 30). Mindfulness meditation: A research-proven way to reduce stress. https://www.apa.org/topics/mindfulness/meditation

Chen, Y-F., Huang, X-Y., Chien, C-H., & Cheng, J-F. (2016). The effectiveness of diaphragmatic breathing relaxation training for reducing anxiety. Perspectives in Psychiatric Care, 53(4), 329-336. https://doi-org.ezproxy.emich.edu/10.1111/ppc.12184

Great Meditation. (2021, March 7). 5 minute mindfulness meditation [Video]. YouTube. https://www.youtube.com/watch?v=ssss7V1_eyA&t=35s

Healthline. (2020, July 21). What is Jacobson’s relaxation technique. https://www.healthline.com/health/what-is-jacobson-relaxation-technique

Lee, E.K.P., Yeung, N.C.Y., Xu, Z., Yu, C-P., & Wong, S.Y.S. (2020). Effect and acceptability of mindfulness-based stress reduction program on patients with elevated blood pressure or hypertension. American Heart Association Journal, 76(6), 1992-2001. https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16160

Mason, V. (2020, October 20). Progressive muscle relaxation [Video]. YouTube. https://www.youtube.com/watch?v=QOhGBaiA4CU

MassGeneralHospital. (2019, October 7). Focused deep breathing meditation [Video]. YouTube. https://doi-org.ezproxy.emich.edu/10.1111/ppc.12184

Moore, C. (2021, June 12). What is mindfulness? Definition + benefits (incl. psychology). PositivePsychology. https://positivepsychology.com/what-is-mindfulness/

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References Continued

Moore, C. (2021, June 12). What is mindfulness? Definition + benefits (incl. psychology). PositivePsychology. https://positivepsychology.com/what-is-mindfulness/

National Center for Complementary and Integrative Health. (2020, January). Stress. https://www.nccih.nih.gov/health/stress

National Center for Complementary and Integrative Health. (2021, June). Relaxation Techniques: What you need to know. https://www.nccih.nih.gov/health/relaxation-techniques-what-you-need-to-know

Pelit-Aksu, S., Ozkan-Sat, S., Yaman-Sozbir, S., & Senturk-Erenel, A. (2020). Effect of progressive muscle relaxation exercise on clinical stress and burnout in student nurse interns, 57(3), 1095-1102. https://doi.org/10.1111/ppc.12662

Sharma, P., Davey, A., Davey, S., Shukla. A., Shrivastava, K., & Bansal, R. (2014). Occupational stress among staff nurses: Controlling the risk to health. Indian J Occup Environ Med, 18(2), 52-56. https://doi.org/10.4103/0019-5278.146890

Stress and Anxiety Quiz. (n.d.). The Greater Good Science Center at the University of California, Berkeley. https://greatergood.berkeley.edu/quizzes/take_quiz/stress_and_anxiety

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