Yes, it's stressful, but what can you do?
Yes, it’s stressful, but what can you do?
Experts offer ideas for solving the problem
It’s a scenario that’s quite familiar: The nurse walks into the patient’s home to check the blood sugar level, and she finds the patient has wet the bed.
Her training and instinct tell her to clean up the patient. But she won’t be paid for it, and she really doesn’t have enough time for this additional task. So what does she do?
One thing is certain. Whether she satisfies her conscience and cleans the patient or yields to managed-care restraints on her time, she will feel stress.
She faces an unpalatable choice of either getting behind in her work or feeling guilty for not helping someone in need.
This is why psychologists and other experts say stress management is both an individual and group problem. An agency needs to do more than hand out coping tips, they say.
Home care nurses have very real problems, and these need to be addressed and changed where possible, says Susan Brace, RN, PhD, PSY.D, a Los Angeles psychologist who con-sults with home care agencies about stress management.
A home care agency can address this in a variety of ways, including through education and group problem-solving sessions, says Arthur Nezu, PhD, chairman of the department of clinical and health psychology for Allegheny University of the Health Sciences in Philadelphia.
Brace and Nezu say agencies can take these actions to reduce staff stress:
Form an action-oriented therapy group.
This differs from traditional group therapy because it focuses as much on solutions as on the problems. Brace says the session would combine group psychotherapy with brainstorming.
Ideally, agencies would hire a psychologist or other expert to work with the group, Brace says. But where that isn’t feasible, a nurse manager trained in psychology could lead the group. "This group needs to be a place where feelings can be divulged and explored," Brace says. "Problems need to be identified, and solutions need to be offered."
The group leader’s role is to provide some safety when the emotions fly. "In my groups, anger is always welcome, and it’s gotten pretty hairy sometimes where someone says, You did this to me, and I’m really angry,’" Brace explains.
"I don’t think you can let a person stay there and inhabit that anger, but you need to accept it."
When the entire group is angry about something, it is time to teach a little problem solving and assertiveness training, she adds.
Brainstorm for creative solutions.
Nezu suggests the group simply accept every single idea, no matter how ridiculous. "One principle is quantity breeds quality, so keep thinking of more and more ideas and defer judgment."
The group could begin the brainstorming session with an exercise that stimulates their creative juices.
Nezu offers this exercise: Ask the group to think about a single brick and come up with numerous uses for that brick. Give the participants some categories from which to create uses. These might include:
• use in construction;
• use as a weapon;
• use as jewelry;
• use as an art form;
• use in a garden.
"We’ve had groups where you come up with 40 to 100 ideas, and each idea might be a modification of another idea," Nezu says.
"We use the brick exercise to show there’s never any one solution," he adds.
Give employees an excuse to relax.
"I believe in mental health days," Brace says. "I think you should be able to call up and say, I still haven’t gotten over my patient Pete who died, and I can’t do it yet.’"
Other suggestions include:
• Hold a company retreat where employees can play and brainstorm. This could be in an attractive setting, such as a cabin in the woods. "This gives people a tremendous feeling of being valued," Brace says.
• Create opportunities for team building. A home care manager could plan after-work gatherings such as a dinner out or a party because these increase the feelings of belonging to a team.
• Allow employees to use work time occasionally to do something relaxing. For example, some hospices allow employees to go to a movie while on the clock. It’s a way of recognizing their continuous stress in dealing with dying patients. "Make sure you structure and systemize fun activities," Nezu says.
• Recognize employees’ good ideas.
Good ideas need to be rewarded or at least recognized.
Brace suggests that home care employees keep an idea book in which to write down some techniques or ideas that have worked for them and how they fixed problems.
This information can be shared with managers and other employees and can be used to determine who receives recognition. Give a monthly reward of a dinner out or movie for two to someone on staff who has done something exceptional.
Brace says this is especially important because it attacks one of the chief causes of stress: believing you "are not being recognized and valued, then feeling like you are helpless to effect any change within your organization or with your patients," she says.
Sometimes the only recognition necessary is taking time to listen to an employee’s concerns. A manager can listen to employees and accept that employees sometimes need to gripe to one another, Brace says.
"Maybe you can’t solve the problems, but at least you can complain about them," she says. "It helps bleed off steam that builds up."
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