Nursing and Anxiety / Stress
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Stress During Nursing Training
Stress from many sources has been reported for some time by student nurses. Academic sources of stress include examinations, long hours of study, assignments and grades, lack of free time, faculty response to student need and lack of timely feedback (Beck & Srivastava 1991). Specific elements of the academic programme, e.g. palliative care experiential workshops (Lawrence et al. 1985), produce stress reactions in students.
Clinical sources of stress include working with dying patients, interpersonal conflict with other nurses, insecurity about personal clinical competence, fear of failure, interpersonal problems with patients, work overload and concerns about nursing care given to patients (Parkes 1985). Learning psychomotor skills, e.g. administering injections (Speck 1990) and performing female catheterization (Bell 1991), have been associated with high levels of anxiety, and a perceived lack of practical skills is a common worry for many students (Hamill 1995).
The atmosphere created by clinical faculty, patient care responsibilities, working with HIV/AIDs (Mueller et al. 1992) and supernumery status itself (Wilson-Barnett et al. 1995) are all clinical sources of stress.
The setting in which student nurses are placed may also have an impact on affective well-being. Initial ward placements produce greater anxiety for students than for any other period in the early part of training, regardless of whether the experience is in a male/female, or a medical/surgical placement (Parkes 1982). Changes in ward allocation have also been shown to be a source of stress for student nurses (Jack 1992).
Examples of this three-level approach can be summarised as follows:
- Stress reduction - personal stress profile feedback, time management training, career and training consultations, assertiveness training, communication skills development and psycho-education.
- Stress management - health lifestyle promotion, reflection, clinical supervision, mentorship, buddy systems, relaxation and home/work interface.
- Stress treatment - counselling, psychotherapy, occupational health interventions and physical wellness: diet, exercise, addictions, lifestyle work.
- Stress reduction - team building, team role analysis and boundary clarification.
- Stress management - group development diagnosis and intervention, clinical team supervision, dependency/skill mix and workload analysis and review.
- Stress treatment - therapeutic remedial team work and work group role negotiation.
Sources: Jones, M.C. & Johnston, D.W. Distress, Stress and Coping in First-Year Student Nurses. Journal of Advanced Nursing. 1997 and Cottrell, S. Occupational Stress and Job Satisfaction in Mental Health Nursing: Focussed Interventions Via Evidence-Based Assessment. The Journal of Psychiatric and Mental Health Nursing. 2000.
Many students will feel anxious when asked to give a formal talk or presentation, especially for the first time. There could be many reasons for this anxiety which may include any or all of the following:
- Unfamiliar situation: because most people speak formally only rarely to an audience, the novelty of the situation is a cause of apprehension.
- Lack of Confidence: this stems often from a feeling that others will be better speakers than us, or that they will know more about the topic in question.
- Sense of Isolation: the speaker is alone, the centre of attention, and therefore vulnerable.
- Self-Consciousness: about our accents, grammar, voice and image generally.
- Fear of Looking Foolish: students may be worried that they will forget what they want to say, or will stumble over words, will say the wrong thing, etc.
- Fear of the Consequences: e.g. being judged by others, particularly tutors, as lacking in ability or insight because of a poor public presentation. At least with an essay, mistakes can be made in private!
There are a number of signs of anxiety that can affect students if they are feeling anxious about a presentation: increased heart and breathing rates, increased adrenaline, over-rapid reactions, and tension in the shoulder and neck area. These bodily changes can also affect the voice, making it sound tremulous, or disjointed by over-rapid breathing.
Students should be encouraged to overcome anxiety by planning and preparing presentations and thinking about what they want to say and how they want to say it. By encouraging students to adopt the following strategies, they can learn to prepare for presentations and therefore build confidence:
- This involves setting objectives; considering the purpose of the presentation and the message that the student is trying to get across to the audience.
- Knowing the audience: How many people will the student be speaking to? Why will they be there? What is their prior knowledge? What are their expectations?
- Brainstorming to get ideas down onto paper and selecting and ordering the points that they want to make.
- Considering the time that has been allocated and how much can be reasonably said in the time.
Decide how the presentation will be structured:
- The first four minutes are the time when the student is likely to have the full attention of the audience, it is important that they use this time to make an impact.
- Making notes: unless students will be reading a speech or a paper, notes should consist of only key words and phrases. Just enough to jog the memory and remind them of key points they want to make. They can be encouraged to use cue cards, mind maps or ordinary notes on paper depending on preference.
- Students will need to prepare any visual aids they will want to use well in advance.
- Ensure any equipment is available and that students are familiar with using it.
- Check the venue and ensure that students are familiar with the surroundings.
- Encourage students to practice the presentation out loud, either alone or in front of peers and invite feedback.
- Use a tape recorder to listen back to presentations. This will identify how much students will need to vary the tone of voice, any areas where they will need to add emphasis and the amount of enthusiasm they need to project into the presentation.
- Encourage students to practice in front of the mirror to identify any mannerisms or gestures they might want to add or change.
- Practice smiling to convey the message that students are pleased to be speaking to the audience and are enjoying the presentation. This will affect how the student relates to the audience as well as help them to build confidence.