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.