DiversityNursing Blog

The holidays are a joyful time but also a stressful time for many people. The pandemic has also added an extra layer to the holiday blues. So here are some tips for managing this season's stressors.

According to Psychology.org, common symptoms of the Holiday Blues are:

Symptoms often begin in November and last until the start of the new year.

Triggers of stress vary for each person but many common themes arise this time of year such as finances, family gatherings, isolation and loneliness.

The thought of holiday spending is unquestionably stressful, but with a little planning, you may be able to alleviate some of that stress.

Budget - creating a budget is most important. Understand what you have for resources and then prioritize. For example, make a list of the people you need to buy gifts for, figure out how much money you have to work with, then allocate your resources in order of priority.

Plan and shop early. It's usually a good idea to start buying gifts earlier in the year. When you see that certain item on sale months before the holidays, grab it. It can be overwhelming hunting down limited items and spending a lot in a short amount of time.

Also don't stress about cutting back on pricey gifts. The important people in your life will recognize that, ultimately, it's still the thought that counts.

For many people, the pandemic is adding to the typical holiday stress of navigating how to approach family gatherings.

Discussing family plans in advance is always a good idea. If you're feeling stressed about attendees being vaccinated or not, try keeping the gathering immediate family only and utilize facetime tools to include those who couldn't be there this year.

If traveling to see loved ones is stressing you out, consider inviting them to your home.

Are there family members who are choosing to skip the full-fledged family gathering? Try spending time with them on other days throughout the holiday season or meet for a meal or some other meaningful activity.

Sending greeting cards to your loved ones during this time of year is another great way to let them know you are thinking of them.

People who don't have the opportunity to gather with loved ones this year may be feeling bouts of loneliness and isolation.

Try taking some extra special care of yourself. It may not completely erase feelings of loneliness, but self-care can help you feel better. Whether you take a relaxing bath, read a good book, practice your favorite hobby, or learn something new, doing something for yourself is important during stressful times.

Volunteer – it’s a great way to beat loneliness. Spend time volunteering at local shelters, fundraisers, and even animal shelters. There are plenty of charities that could use an extra hand during this busy season of giving.

In addition to the stress and anxiety caused by the holidays, many people suffer from seasonal affective disorder (SAD).

According to the National Institute of Mental Health (NIMH), SAD is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. People who suffer from SAD typically see the onset of symptoms annually, coinciding with the same time we roll our clocks back.

Treatments are available that can help many people with SAD. They fall into four main categories that may be used alone or in combination:

• Light therapy
• Talk therapy
• Medications
• Vitamin D

Talk to your health care provider about which treatment, or combination of treatments, is best for you. With these tips, hopefully you’ll have a happy and less stressful holiday season!

It's no secret Nursing is a stressful and physically demanding career. High stress levels can affect your health and well-being. However, there are ways to manage your stress. Consider some of these techniques.

Try keeping a journal, or note times when you don't feel your best and jot down what might be contributing to that feeling. For example, if you're running low on energy it could be from lack of proper sleep or nutritional foods in your diet. 

Some breathing techniques developed to reduce stress include:

• 4-7-8 technique: Breathe in for four seconds with the nose, hold for seven, and breathe out for eight through the mouth.
• Belly breathing: Place one hand on the belly and one on the chest, feeling the belly move and the chest remain still while breathing in through the nose and out through the mouth.
• Breath focus: Use a picture or phrase to aid in relaxation, such as picturing the air as calmness.
• Equal time: Count the breaths in equal time, such as five seconds, for inhaling and exhaling.
• Modified lion’s breath: Breathe in through the nose, and out through a wide open mouth with a “ha” sound.
• Progressive muscle relaxation: Tense and relax muscle groups in succession while breathing in and out.

Calm the mind. Mediation goes hand in hand with deep breathing. One of the biggest barriers to meditation is that people don’t know where to begin. Start with small goals like 2 minutes every day for a week, then increase your time slowly from there. 

Find a quiet space, get comfortable, then set your timer. Focus on your breathing or chosen mantra. A mantra is a word, phrase, or sound repeated it in your mind continuously. 

Thoughts will float in and out of your mind. Acknowledge them then let them go. The goal of meditation is to keep your focus on one thing. 

If you have trouble practicing on your own, there are many guided mediation apps and online videos to help. 

Recharge your batteries. As you know, lack of sleep is a major stress factor. To achieve better sleep, try the deep breathing and meditation exercises mentioned above, right before bed, as well as these suggestions:

• Don't consume caffeine, alcohol, or food for at least 3 hours before bedtime.
• Establish a consistent sleep schedule/routine.
• Avoid electronics for at least 1 hour before bedtime.
• Try rubbing lavender essential oils on your temples or pillowcases. 

Get your blood pumping. Almost any form of exercise or movement can increase your fitness level while decreasing your stress. The most important thing is to pick an activity that you enjoy. Exercise boosts your endorphins and helps release physical tension.

Enjoy A New Hobby. Hobbies are a great way to relieve stress because it shifts your focus on to something that makes you happy. It doesn't have to be time consuming. It could be watching a funny movie/tv series, reading a book, or knitting. 

Seek Help. If the stress is becoming too much for you to handle on you own, it's okay to seek advice or counsel from a loved one or a trusted mental health professional.

Because you are a Nurse, you often care for others without stopping to care for yourself. This ideology needs to change. It's extremely difficult to provide quality care for others when your own mental health is suffering. Be sure to take care of YOU too!

Frontline healthcare workers face stressors during normal times, but especially now during a pandemic and hospitals are finding new ways to help their staff cope. 

Recently, University Hospitals in Ohio announced they would be trying out a 10-month pilot program that provides sleep pods for their teams. Doctors, Nurses and staff in the UH Cleveland Medical Center Emergency Department will have access to two HOHM units as a space to safely recharge.

Each 43.5 square-foot pod is designed to block out sound and features a twin-sized bed, a privacy and sound-blocking curtain, charging stations, and a tablet to control reservations. 

“Our UH Cleveland Medical Center Emergency Department frontline caregivers have been working tirelessly for months to combat the COVID-19 pandemic,” said Robyn Strosaker, MD,, University Hospitals Cleveland Medical Center Chief Operating Officer. “In the midst of all this trauma and stress, we’ve continuously looked for new ways to support our team, and HOHM sleep pods are a way we can help address their wellbeing.”

Some hospitals are making design changes to their break rooms as a way to try and help healthcare workers manage their stress throughout the day. 

Nurses may be reluctant to take breaks especially during times of crisis. But taking breaks during your shift can help prevent burnout. So when a Nurse does decide to take a break, there should be a space where they can fully decompress and have time to gather their thoughts and recharge. 

Research has found strong evidence between exposure to natural environments and recovery from physiological stress and mental fatigue. Break rooms are becoming a green space with plants and images on the walls of natural landscapes. Create a sitting space with cushioned chairs or ottomans by windows that have a nice view outside. Offer the option of listening to calming music or nature sounds inside the break room. 

Hospitals are also offering time for their staff to spend with support animals. 

Nonprofit organization Canine Companions for Independence provided Jordy, a lab/golden retriever cross to help frontline workers at Santa Rosa Memorial Hospital. 

“The science confirms what we already know, pets provide comfort and support during hard times,” said Jessica Lacanlale, MSN, Trauma Program Manager at Santa Rosa Memorial Hospital. “The stress of caring for patients and working long hours is intense; but spending a little time with Jordy lifts my spirits and helps me get through the long days.”

Health Systems like Yale New Haven Health are offering confidential well-being check-in programs. This offers employees an opportunity to meet with an expert social worker or clinician one-on-one to discuss their needs and access resources to manage stress and improve well-being.

“People often downplay their own needs, saying ‘I’m OK’ when asked how they are doing,” said Javi Alvarado, YNHHS’ director of social work and co-chair of the WELD Council. “These visits create an opportunity to be better than ‘OK’ and truly grow from recent challenges.” 

During this pandemic, it is critical hospitals and health systems recognize what stress looks like and takes steps to help their staff cope with it. Equally as important is that healthcare workers know where they can go for help. This means internal communications to staff is key to express your awareness of the stress and the assistance being offered.

In order for a healthcare system to be successful in having high engagement, job satisfaction and retention, the Nursing workforce should be able to combat the stressors of the job and burnout.

Nurses can better accomplish this by having help from peer support groups and mindfulness programs.

According to a report from the National Academy of Medicine (NAM), between 35% and 54% of Nurses and Doctors experience burnout. Among medical students and residents, it is as high as 60%.

Symptoms, the NAM report said, include emotional exhaustion, cynicism, loss of enthusiasm and joy in their work and increasing detachment from their patients and the patients’ ailments. The problem has been linked to higher rates of depression, substance abuse and suicide.

Many institutions are implementing stress management and self-care programs to provide caregivers with easy-to-use tools and resources to build their resilience and help them cope.

The Cleveland Clinic Abu Dhabi implemented a new mindfulness program known as the ‘Compassionate Intension Program.’ The sessions introduce caregivers to mindfulness as a wellness tool they can utilize in both their workplace and personal lives. Currently, there are three sessions in place:

• In Tune Tuesdays: Held biweekly, ‘In Tune Tuesdays’ are 20-minute classes designed to further educate attendees on mindfulness and how to improve mindfulness in their work environment. The classes are held at three different times to accommodate caregiver schedules.
• Mindfulness Rounding: Also a biweekly activity, ‘Mindfulness Rounding’ features a team of mindfulness experts who visit clinical units. The experts conduct learning huddles and one-on-one conversations with caregivers, sharing quick tips. Their pocket cards or guides offer information on easy-to-implement mindfulness techniques.
• Introduction to Mindfulness Workshop: This 8-week workshop, featuring 1-hour weekly sessions, was developed around the evidence-based standards of mindfulness experts, including, Jon Kabit-Zinn, PhD, of the University of Massachusetts Medical School, Center for Mindfulness, and Richard Davidson, PhD, of the University of Wisconsin’s Center for Healthy Minds and Oxford University’s Mindfulness Center. It offers a deeper dive into various mindfulness techniques.

Johns Hopkins Hospital, Pediatric Nurse, Cheryl Connors, RN, MS, created a peer program to provide immediate support for health providers affected by stressful cases.

The Resilience in Stressful Events (RISE) program was developed with a Pediatric Chaplain, a Patient Safety Director, a Doctoral Student, and General Internist Albert Wu, MD, FACP.

According to the American College of Physicians, the RISE program provides a team of 39 peer responders who volunteer their time to support those who call the service. RISE team members include Nurses, Doctors, Nurse Practitioners, Respiratory Therapists, Pastoral Caregivers, and Social Workers. They undergo didactic, video-based, and role-playing training.

The team has been called by more than 700 Johns Hopkins employees. The hospital previously had a program offering free professional counseling but, Ms. Connors said, “They actually prefer somebody who knows what they're going through—another health caregiver who can relate—and when they need it, not a week later.”

As supporters of patients and their families, Nurses deal with a lot of stress. Health systems can help their Nurses by surrounding them with support and offering them the tools to overcome and cope with stress so they can provide the best care for their patients and for themselves.