Self Care for Staff

Working in Stroke Services• As a member of the stroke team you

may have experienced assisting a patient through an emotive inpatient stay, to enable them to live independently in the community.

• You may have provided a valuable space for a patient to talk about their difficulties, helping them to adjust and adapt to their life post-stroke.

• However, working within a busy ward, caring for patients and their families with a high level of physical and psychological need, can contribute to stress or burnout in staff.

What is Stress?• “I just don’t get a task finished any more before I move on to

the next thing. I keep forgetting where I’m up to, I have 20 things on the go at once and I’m not getting anywhere with any of them ....”

• “I keep meaning to get a little time for myself but I never manage to. Someone always asks me to help out and I never have the heart to say no, but I end up feeling really tired and irritable ...”

• “It just seems to be one crisis after the next in my life. I’ve got a constant headache and stomach problems, I keep expecting something else to go wrong, I’m at the end of my tether ...”

What Causes Stress?• Causes of stress or psychological

distress in care-giving include:

• Work environment – high levels of noise, multiple demands on time, inadequate breaks, inadequate facilities to have a break from the ward.

•Difficult interactions (abusive interactions) with relatives or care-givers.•Work-related illness or injury.•Verbal or physical abuse from patients.•Little or no control over your work.•Little or no recognition for the good work done.•Bullying or harassment by other staff members.

Other Causes of Stress in Stroke

• Working in stroke brings with it some unique causes of stress, which you would not necessarily come up against in other working environments. For example:

• Challenging behaviour; particularly repetitious behaviours, verbal and physical abuse.

• High levels of expressed emotion in patients and relatives.• Physical demands in coping with patients with high levels of

physical disability.• It is not unusual to experience all of the above stresses from just

one patient, so it is no wonder that working with many individuals who have had a stroke can be extremely stressful.

• Signs of stress can include:

• Over-engagement in activities.• Overactive emotions.• Feeling unable to manage multiple demands. Working more to

try and meet the demands, often foregoing breaks.• Finding it hard to switch off and relax.• Poor sleep characterised by being wakeful at night, finding it

hard to switch off or feeling tired although sleeping more than usual.

• Using food, alcohol or drugs to suppress anxiety.

Signs of Stress

Activity• Think of a time when you have

experienced a high level of stress in your life, what changes in yourself did you notice?

• Were there any signs/symptoms of your stress that friends or family pointed out to you, which you perhaps hadn’t noticed yourself?

• At what point did you realise that you were very stressed, and at what point did you do something about it?

• Grab a pen and paper and write down your thoughts.

Signs of Burnout• Stress that is prolonged and/or

unmanaged can lead to burnout. Burnout is characterised by:

• Disengagement, a loss of interest.• Blunted emotions.• A feeling of hopelessness and

helplessness that anything can make the situation better.

• Exhaustion.• A feeling that everyday is a bad day.

How to Tackle Stress• Below are some strategies for managing stress : • Sharing our thoughts and emotions. • Making sure that breaks are taken regularly and in a quiet environment.• Plan for breaks and holidays from work.• Being realistic about what you can manage at work.• Prioritise, and praise yourself for a job well done.• Eat well.• Exercise regularly.• Have regular leisure or relaxation time.

• Managing stress can be tricky within a high-pressured environment. Sometimes factors that are out of our control (e.g. bereavement or loss, illness, finance, childcare) can influence our stress levels and subsequently our ability to work. A first step is recognising the signs and symptoms of stress.

Other strategies…• If you feel able, talk to your line manager. It may be

possible to reduce some of the work stressors e.g. inadequate breaks.

• Talk through some of the stressors at work. A particular patient might be very difficult to manage, discussing with others may help to generate potential solutions.

• Making action plans. Write a list of the things that are causing you stress and potential solutions. Make a plan for each problem.

• Try relaxation techniques. These can be used discretely at work. Try taking up a new leisure activity out of work to increase your relaxation time.

• Getting additional support. Professional help may be appropriate if stress is still problematic after trying these things.

Activity• Think about what you need when you feel stressed, what kind

of strategies help you to cope?• You may be unable to use some of these strategies while you

are at work, but can you think of a way you could adapt them to make them “work friendly”?

• Perhaps you like to sit down with a glass of wine and a bar of chocolate when you get home at night, at work you could take a break and have a cup of tea with a biscuit. Perhaps you like to go shopping to ease stress, instead you could take a break and write up a shopping list for the weekend, or browse some shops online. If you would normally watch or play football, could you catch up with the latest sports news or tweak your fantasy football team?

• Grab a pen and paper and write down some ideas.

Summary• Working in health care generally can be very

stressful, but working in stroke services poses many unique challenges and circumstances.

• It is important to look after yourself as well as your patients, as a stressed or burnt out nurse (or other health professional) is never going to be able to fulfill their role to the best of their ability.

• If you are feeling stressed, talk to someone about it and seek help. Don’t wait until you’re burnt out and it starts to affect all areas of your life.

• Look after yourself with as much care and attention as you would give to a patient.