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From the various literature gathered, it is quite evident that the effects of stress have tremendous demands on the individual. The demands that stress places on individuals exhibit negative effects (Black et al., 2001). Omdahl and O�Donnell (1999) state that stress affects the well being of health, and stress is identified as the reason nurses leave the profession. Not only does stress have direct effects on an individual�s health and well being, stress and burnout leads to high economic costs in the form of high absenteeism, labour turnover, industrial relations difficulties, and poor quality control (Omdahl & O�Donnell). Black et al. identify three types of responses to stress: emotional, behavioural, and physical. This framework will be utilized to identify the effects of stress on the individual.
Emotional Response
Nurses are frequently exposed to stressors that may be difficult to handle, therefore the nurse experiences a flood of emotions which may be overpowering (Laws and Hawkins, 1995). Black et al. (2001) describes examples of emotional responses, which include depression, anger, decreased self-esteem, apathy, and impatience. A study conducted by Cole, Slocumb, and Mastey (2001) identify high levels of stress in the occupation of critical care nurses which carries negative emotions, such as frustration, anger, guilt, resentment, professional failure, personal loss, helplessness, powerlessness, sorrow, and burnout. Laws and Hawkins state that many nurses suffer from emotional burnout and leave the nursing profession resulting in a shortage of experienced nurses.
Behavioural Response
Black et al. (2001) describes examples of behavioural responses to stress, which include decreased ability to think clearly and function, increased tobacco and alcohol use, overeating, and disrupted sleep patterns. Cox and Ferguson (as cited in Healey, 2000) associated stress with mood changes, which includes feelings of tension, anxiety, fatigue, and depression.
Physical Response
Black et al. (2001) provides examples of physical responses to stress can include tight, sore neck and shoulder muscles, increased blood pressure and heart rate, palpitations, chest discomfort, headaches, gastrointestinal upset, and fatigue. Kiecolt-Glaser and Marucha (1995) identify how psychological stress adversely affects the immune system. Stress having an effect on the immune system may directly explain why stress causes nurses to have high absentee rates in the workplace.
There were many stress relieving strategies found in the literature. Some of the stress buffering strategies were aimed towards nurses and some were directed towards any individual as effective tactics in counteracting stress. Black et al. (2001) define three components of stress management: resistance, cognitive reappraisal, and coping skills. This framework will be utilized to present a framework which describes the stress relieving strategies retrieved from various literature.
Resistance
Stress resistance involves �decreasing the body�s response to stress, healthy eating and activity, and relaxation techniques� (Black et al., 2001, p. 35). Brown (1991) mentions how physical fitness plays a significant role in promoting and maintaining health. Brown states that one benefit of fitness is its �ability to moderate the negative effects of stress� ( 2). Several studies indicate that �high-fit people evidence less physiological reactivity to stress than those who are less fit� (Brown, 2); although this has been proven in several studies, Brown also mentions that several factors need to be addressed with this issue. Brown states that factors such as other variables may be responsible for the stress buffering effects other than physical exercise.
Cognitive Reappraisal
Black et al. (2001) describe the goal of cognitive reappraisal is to �change the perception or interpretation of events as stressors� (p. 36). Therefore, the individual experiencing stress may decrease their stress experience by changing their perception or interpretation of these events as stressors. Healey (2000) describes how there are many studies which suggests humour as a type of coping activity and as a possible stress buffer. Dixon describes humour to be an �adaptive coping strategy because it enables individuals to reappraise stressful events as being less threatening and thus reduces their negative emotions� (as cited in Healey, 2000, 7). Black et al. also propose the use of guided imagery as a form of relaxation and cognitive reappraisal. Guided imagery occurs when a trained therapist assists the client to visualize a stressful event and the situation is reworked or switched to a relaxing event so the stressful event is perceived as not so stressful (Black et al.). Lachman (1983) promotes the use of relaxation and visual imagery to decrease stress. Lachman mentions that creating relaxation images in the mind, combined with muscle relaxation and deep breathing exercise may decrease stress in the individual.
Coping Skills
Black et al. (2001) characterize effective coping skills as involving �recognition of the problem causing stress and, through problem-solving skills, development and implementation of an effective strategy to cope with or solve the problem� (p. 36). Black et al. mention that effective coping skills may include time management, assertiveness, solution-oriented therapy, and development of a support system. Laws and Hawkins (1995) state that when a formal support structure is absent in a nurse�s work environment, nurses traditionally have dealt with stressful experiences through informal discussion with peers. Laws and Hawkins describe this type of support as ineffective and harmful because peers may contribute judgmental personal values towards the stress incident. In contrast, Hopkinson et al. (1998) performed a study on occupational stress experienced by community psychiatric nurses and concluded that positive relationships at work, such as informal peer support networks were used regularly and the nurses found that this type of support reduced their stress. Hopkinson et al. also add that because this type of support is significant to nurses experiencing stress, team leaders and managers may want to consider strategies to facilitate these meetings formally in the workplace.
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