Lesson 2 of 1
In Progress

Tame Your Stress: Stress Management

October 2, 2014

Here is a brief power point presentation on Stress Management for this course.

Please watch this optional but interesting National Geographic video called “The Science of Stress”



You are running late to pick up your child from preschool and traffic is hardly moving. The last time you were late picking her up the day care owner was very upset with you and charged extra late fees which you can hardly afford. You glance at the mail that you had picked up on the post office and see a letter from the IRS. Your heart start racing and you can feel the blood shoot into your face. You are now sweating and feels like you need to pee. Suddenly, a police car pulls up behind you. You start wondering if you had been speeding and now your heart is just fluttering. You are in panic mode and you can’t breathe. You feel like you are having a heart attack and want to throw up…….Sounds familiar?

Hello Stress

Stress is basically a feeling of emotional or physical tension. Stress describes a person’s physical or emotional response to demands or pressures that they may experience from time to time. When we sense danger, whether it’s real or imagined, our bodies’ defenses kick into high gear in a rapid, automatic process known as the “fight-or-flight” reaction, or the stress response. When we perceive a threat, our nervous system responds by releasing a flood of stress hormones, including adrenaline and cortisol which rouses our bodies for emergency action. The subsequent events involves our hearts pounding fast, muscles tightening, elevated blood pressure, hyperventilation, and our senses becoming sharper. These physical changes increase our strength and stamina, speed up our reaction time, and enhance our focus—preparing us to either fight or flee from the perceived danger.

Anxiety and stress are interrelated because anxiety is a normal response to stress. Anxiety is an apprehensive state characterized by feelings of dread in response to internal or external stimuli. Over time, anxiety can lead to depression.

The American Psychological Association describes 3 different types of stress;

Acute: This is the most common type of stress and is short term, such as hurrying to meet a deadline, and if it occurs infrequently causes little problem. However, if acute stress happens frequently, it can cause psychological and physical distress.

Episodic acute: This is repetitive short-term acute stress, such as the person who always runs late for work and appointments or never completes assignments or tasks on time. These people are in a constant state of arousal and anxiety.

Chronic: This type of stress lacks the ups and downs of emotions associated with more acute stress, but it is a constant weight that burdens people and results in anxiety and depression and difficulty coping.


Everyone experiences anxiety at some point and a little dose of anxiety may actually serve a useful purpose in motivating people to act but chronic anxiety can lead to stress

Mild: People may have sharpened senses with a wide perceptual field, increased motivation, and effective problem-solving and learning ability but may also experience irritability, restlessness, “butterflies,” insomnia, and hypersensitivity to noise.

Moderate: People have more difficulty focusing attention as perceptual field narrows to immediate task and attention is selective. People may have difficulty concentrating and may react automatically. Symptoms associated with the sympathetic nervous system (muscle tension, palpitations, dry mouth, GI upset, frequent urination, headache, diaphoresis) occur.

Severe: People may be able to concentrate on only one or scattered details and cannot complete tasks or solve problems effectively. They may not be able to redirect attention and behavior is often directed toward relieving anxiety, but is usually not successful. People may appear in awe, dread, or horror and may cry out or carry out ritualistic behavior.  Physical symptoms become more severe and may resemble a panic attack with severe headache, nausea, vomiting, diarrhea, trembling, rigidity, vertigo, pallor, tachycardia, and chest pain.

Panic: The perceptual field focuses only on the self as environmental stimuli cannot be processed. Perceptions are distorted, and people cannot think rationally and cannot always recognize potential danger or communicate verbally. Some people may experience delusions or hallucinations and may become suicidal. People may react by bolting and running or becoming immobile and mute. The fight-flight-or-freeze response is primary.

BURNOUT for the Nurse Assistant

“Can you get some ice water for Room”? “I need the Vitals for Room 18, and Room 13 is still waiting to be fed”. Another RN will also quip; “Can you get Room 5 out of the bedpan”? Sounds familiar?

Certified Nurse Assistants work in a difficult, fast-paced, and often thankless job. They provide a majority of the direct patient care and spend more time with the patient that anybody else. Sometimes they encounter difficulty patients or very critically sick patients who are at the end of their lives. These patients are dealing with all sorts of losses especially the loss of independence and adjusting to being dependant on someone else. They are sad that this is where they are, and the nursing assistant who is with them each day has to be able to deal with this emotional issue and sometimes angry outbursts.

Even though Nurse Assistants started a career as a caregiver to help others, they soon find their minds and bodies suffering from burnout. There is alot of demands and responsibilities which can make a CNA feel like they can’t meet their work requirements. They become completely drained and exhausted due to overwhelming demands. One of the biggest complaints from them is that they have too much to do, and not enough time to get it their tasks done. This feeling of always feeling overwhelmed eventually escalates to burnout. Burnout is dangerous because it affects individuals emotionally, physically, and mentally and can ultimately lead to stress.

Burnout in the Nurse Assistant is commonly due to being overworked, unappreciated, lack of job security and unreasonable work expectations. Many Nurse Assistants do not feel their pay is sufficient for the amount of duties that they are required to perform on an ongoing basis. Nurse Assistants need to understand and be able to recognize burnout before it takes an emotional toil on them. To avoid burnout, they need to take care of themselves physically and emotionally.

Stress Management

stress 1

The signs and symptoms of stress overload can be almost anything. Stress affects the mind, body, and behavior in many ways, and everyone experiences stress differently. Not only can overwhelming stress lead to serious mental and physical health problems, it can also take a huge and  devastating toll on your relationships at home, work, and  in your relationships.

Stress management means trying to control and reduce the tension that occurs in such stressful situations. This is done by making emotional and physical changes. The degree of stress and the desire to make the changes will determine how much improvement takes place.

Signs and Symptoms

Uncontrolled stress can cause a number of psychological and physical symptoms. Psychological symptoms of stress can include;

  • Sleep disturbances
  • Difficulty concentrating
  • Lack of confidence
  • Depression
  • Difficulty relaxing
  • Difficulty with decision making


Physical symptoms of stress can include;

  • Muscle tension and pain
  • Low energy
  • Headaches
  • Changes in appetite
  • Decreased sexual function
  • Shortness of breath or difficulty breathing.


Long term, uncontrolled stress is associated with the development of a number of different medical conditions. Primarily these occur as the result of biochemical imbalances that can weaken the immune system and over-stimulate the part of the nervous system that regulates heart rate, blood pressure and digestion.


Medical conditions that can occur as a result of long term stress include;

  • Hair loss (alopecia)
  • Heart palpitations
  • Hyperventilation
  • Gastrointestinal problems (eg: indigestion, heartburn, stomach ulcers and irritable bowel syndrome)
  • Worsening skin conditions (eg: eczema, dermatitis)
  • Elevated blood pressure
  • Recurrent colds and ‘flu.


As a CNA, you should know that how you deal with stress is influenced by a number of factors that include;

  •  Your support network – A strong network of supportive friends and family members can be an enormous buffer against life’s stressors. On the flip side, the more lonely and isolated you are, the greater your vulnerability to stress.
  • Your sense of control – It may be easier to take stress in your stride if you have confidence in yourself and your ability to influence events and persevere through challenges. If you feel like things are out of your control, you’re likely to have less tolerance for stress.
  • Your attitude and outlook – Optimistic people are often more stress-hardy. They tend to embrace challenges, have a strong sense of humor, and accept that change is a part of life.
  • Your ability to deal with your emotions – You’re extremely vulnerable to stress if you don’t know how to calm and soothe yourself when you’re feeling sad, angry, or overwhelmed by a situation. The ability to bring your emotions into balance helps you bounce back from adversity and is a skill that can be learned at any age.
  • Your knowledge and preparation – The more you know about a stressful situation, the more prepared you will be and the more easier it is to cope.


How to De-stress

Nursing Assistants have to prioritize, so sometimes helping someone who has fallen is more important than giving the patient a shower on time. Think about safety and basic needs when prioritizing. Once you master how to prioritize, you will not feel so overwhelmed and rushed. Learn to anticipate your patients’ needs. If you are taking Mr B back to his room after a walk, perhaps you can grab that pitcher of ice water for him on your way so he will not be calling when you are helping Mrs C across the hallway. Be familiar with the care plan of each of your patient which will help you anticipate their needs. Talk to your nurse and request to get a verbal report and discuss with the nurse the plan of care for the day.

There is a need for support from Department Managers and a supportive organization for reducing nurse assistants work-related stress, which in turn can create a positive caring climate where the nurse assistants are able to provide high quality care.

The Nurse Assistant should be open and honest with his or her supervisor regarding scheduling conflicts or personal issues that can affect her job. For example, if you can’t get to work in time a certain day because you have a kid’s event at school, perhaps you can request to have the day off.  Talk to your supervisor about schedule conflicts, baby sitting issues, weekend family obligations etc…Most employees who get the schedule they are comfortable with are less likely to call in sick.

Treatment approaches

There is no magic bullet for dealing with stress at your workplace. Stress management often requires a number of different approaches, based on individual needs. A healthy lifestyle can provide a buffer against the impact of stressors.

Adequate sleep: Sleep deprivation is a major stressor and can cause irrational thinking. Always make sure you have adequate sleep and are well rested before the starting your shift.

Breaks: Nurse Assistants should take regular breaks at work. Take a few minutes break even if it is just to stretch. Coordinate with your charge nurse and other co-workers for break coverage so your patients are taken care of when you are on break.

Nutrition: Nurse Assistants should try to eat a healthy well-balanced diet, avoiding high carbohydrate foods, which further increase glucose levels, and caffeine, which is a stimulant that can increase stress. They should not skip meals and should eat at regular times at least 3 times daily. Overeating, which is sometimes a response to stress, should be avoided. Avoid taking that doughnut that has been in the break room all day. Well-nourished bodies are better prepared to cope with stress. Start your day with a healthy breakfast, reduce your caffeine and sugar intake, and cut back on alcohol and nicotine.

Take your vacation time. As much as tempting signing up for that extra shift is, it is much better for your health if you take time off from work to do something you like.  Taking vacations  even if its just to stay with your family or hang out with friends for a movie will de-stress your body.

Relaxation Techniques. Relaxation techniques such as yoga, meditation, and deep breathing activate the body’s relaxation response, a state of restfulness that is the opposite of the stress response.

StressExercise regularly. Physical activity plays a key role in reducing and preventing the effects of stress. Nothing beats aerobic exercise for releasing pent-up stress and tension.   Exercise helps to release built up tension and increases fitness  which, in turn, increases the body’s ability to deal with stress and helps to avoid the damage to our health that prolonged stress can cause. It is recommended that exercise be undertaken at least three times per week to be of most benefit.



Discussing concerns with an impartial person may assist with recognizing stressors and deciding upon strategies to deal with them.  Most employers in healthcare have an Employee Assistant Program (EAP) where any employee can speak to a therapist privately. This program is offered free by the employer so you do not need to pay a penny but many people are either unaware of it or do not take advantage of it. Whether you are having work related stress or personal issues like marital or relationship problems, this is a good option of seeking help and can alleviate stress and help resolve many issues. The process of discussing a concern is enough to alleviate the stress it is causing. Asking for help should not be seen as a sign of weakness. Knowing when to ask for help may be one of the changes necessary in order to deal with stress more appropriately.





Burnout as a Nursing Assistant. (n.d.). Retrieved October 4, 2014, from http://nursingschool.org/burnout-as-a-nursing-assistant/

Stress management: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved October 4, 2014, from http://www.nlm.nih.gov/medlineplus/ency/article/001942.htm

Stress Symptoms, Signs, and Causes. (n.d.). Retrieved October 4, 2014, from http://www.helpguide.org/mental/stress_signs.htm

Stress -causes, symptoms, diagnosis. (n.d.). Retrieved October 4, 2014, from https://www.southerncross.co.nz/AboutTheGroup/HealthResources/MedicalLibrary/tabid/178/vw/1/ItemID/115/Stress-causes-symptoms-diagnosis.aspx