Stressed about Stress by Amanda Taka

Stress is one of those words that has become intrinsic in our everyday vocabulary: we’ve all heard ourselves moaning “I’m so stressed!” What is it and how can we manage it?

Stress is defined in different ways by different organisations, but the common thread seems to be that stress is “feeling under pressure”. A small amount of stress is good for us: it keeps us motivated and helps us to do our best. However, when we are living with stress all the time, it can lead to a myriad of unpleasant feelings and physical symptoms can follow.

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Often we are quick to identify stress in others, but would we recognise it in ourselves? Symptoms associated with stress are wide ranging and initially we might not associate the physical symptoms as related to our mental wellbeing. There has been a tradition to separate mental and physical health, but evidence shows the link is greater than we previously may have understood. The jury is still out as to whether stress itself causes disease, but there’s lots of evidence to show that the unhealthy habits we rely on when we’re stressed contribute to many conditions.

Physical symptoms can include:

  • Sleep problems
  • Dizziness
  • Chest pain, palpitations
  • Dry mouth, lump in the throat, shaky hands
  • Lack of appetite, or conversely, comfort eating
  • Repetitive tic
  • Headaches
  • Diarrhoea or constipation
  • Loss of libido
  • Tearfulness/depression/anxiety
  • Worsening symptoms of long term conditions

Additionally:

  • Poor concentration
  • Difficulty making decisions
  • Irritability
  • A feeling that things are hanging over you
  • Excessive intake of caffeine, cigarettes or alcohol
  • Low self esteem/lack of confidence

This list is not exhaustive!

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What causes stress?

Here’s the tricky bit. We’re all different, so we all have different triggers. For example, one nurse would struggle to cope with the incessant physical and emotional demands of working in the Emergency Department, whereas that environment is perfect for a different nurse.

Acknowledged triggers of stress are as follows:

  • Work pressures, job instability, fear of redundancy
  • Parenting, family and relationship difficulties
  • Financial pressures
  • Bullying and discrimination
  • Loneliness and isolation
  • Living with a long term condition
  • Caring responsibilities

And one more for us workaholics:

  • Taking on too much responsibility and feeling you don’t have enough time to do everything!

OK, so it looks like life itself is stressful.

If you’re feeling like stress is starting to impact on the quality of your life then the first thing would be to get it down on paper. Spotting stress in its early stages can help prevent things from getting worse. Things to include in your “stress diary”:

  • Date, time and place of the incident
  • What you were doing, before, during and after
  • Who you were with
  • What were your feelings, before, during and after
  • Any physical sensations
  • Give the event a “stress rating” e.g 0 = no stress, 10 = the most stressed you could possibly feel.

Making a stress diary is helpful because it aids our ability to make connections between the context and the symptoms. Ideally, a stress diary should be continued for at least 2 weeks. This helps us to see things in perspective. Additionally, this is a vital piece of evidence to discuss with your GP if you’re feeling overwhelmed and unable to cope.

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Quick Fix

When I searched ‘wellbeing’ in Amazon at the beginning of the year, I was astounded at the number of different products that claim to enhance one’s wellbeing: necklaces, crystals and orthotic sandals sat alongside the list of ‘new age’ literature that was available. I’m not sure it’s something that can be bought. There’s certainly no single ‘cure all’ solution. Therefore it’s worth trying, or combining, a number of different approaches until you succeed. Most research shows the following are a good place to start:

  • Physical activity – doesn’t need to be a gym membership, incorporating 30 minutes of activity can help boost mood and clear the mind (remember it can be in blocks of 10 minutes)

 

 

  • Relaxation techniques such as mindfulness and breathing exercises are evidence based ways of reducing stress. Courses are available across the region, check the local press or http://www.uws.ac.uk/wellnessandrecoverycollege for details.

Nursing is acknowledged to be a stressful profession. In our profession, we tend to put everyone before ourselves, but who looks after the caring professions? I passionately believe that we need to give ourselves the time and effort to look after our own mental wellbeing, and being aware of our stress levels is intrinsic to this.

Further self help resources to try:

  • Living Life telephone self help service and online programme for people with mild to moderate feelings of anxiety and depression using Cognitive Based Therapy. See http://www.llttf.com/ for more info

 

  • Breathing space – confidential helpline that describes itself as a ‘first stop’ service which aims to listen and provide emotional support. http://breathingspace.scot

 

 

  • Steps to Deal with Stress – you may have noticed the little square booklets floating around NHS D&G, pick one up, they have great common sense tips to help with stress busting. More info at http://www.stepsforstress.org/

A last word

If you or someone you know is struggling and self help techniques haven’t worked, you may need to seek expert help. For some people a combination of medication, talking therapy alongside some of the techniques outlined above are appropriate. Also, it’s worth remembering that the Samaritans have changed their number to 116 123. Further helplines can be found at http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/mental-health-helplines.aspx

And remember… “taking on too many commitments” may lead to feelings of stress!

Amanda Taka is a Keep Well Nurse at NHS Dumfries and Galloway

Let’s Get Physical by Amanda Taka

With the festive season looming towards us, the last thing you want to be told is to get physical right? However with 8 weeks to Christmas, we still have plenty of time before we carve the turkey. The Physical Activity Guidelines for adults recommend that we build up to 30 minutes of moderate intensity activity 5 days out of 7. But how do we fit this in to our busy working lives? And is it worth the effort?

We’ve all heard of the benefits of exercising, but here’s a recap:

Regular exercise:

  • reduces the risk of many diseases such as type 2 diabetes, coronary heart disease and stroke
  • helps us to maintain a healthy weight
  • improves our self esteem
  • promotes a sense of wellbeing
  • reduces symptoms of depression and anxiety

Working in the NHS we can’t fail to be reminded of what we should be doing and why. However, being ready, willing and able to make those lifestyle changes can be another matter.

Amanda 1And before you write me off as one of those typical fitness fanatics, let me tell you a bit of my story. At school I was always the last to be picked for team games, I didn’t learn to swim until I was 16 because I was frightened to put my head under water, I hated PE and used to hide in the Geography block toilets to avoid detection. My Mum and Dad told me to stay as I was because playing squash and golf gave you a heart attack. My Dad’s motto was ‘built for comfort not for speed’. They were both overweight and although I wasn’t, I always knew I would be too because that’s what happened to us in our family. And so it would have gone on if I hadn’t returned to Uni and trained to be a nurse.

Anyone who has trained to be a nurse knows that it changes you. It changes the way you look at people, the way to speak to people and the way you react to people. Furthermore, it challenges hard held beliefs and preconceptions. Studying at UWS under the influence of Julie Orr and her colleagues, I began to see that getting older doesn’t need to mean that we inevitably get bigger and slower. I realised that the ability to change was within me and additionally I had the power to influence my young daughters’ long term health.

This Eureka moment happened to me in the middle of one lecture towards the end of my training. Julie was telling us about when she was doing her Masters and how she fitted it into family life “and I still went to the gym three times a week” was the phrase that hit home for me. Like a bolt of lightning I realised that I needed to make physical activity a priority for me. I started to take up yoga again – something that I hadn’t done regularly since I’d had my children. Slowly I began to build physical activity into my day, feeling very smug about it too thank-you very much.

After qualifying, I got a job on a fast paced 22 bedded respiratory ward. Working full time was enough to achieve my 30 minutes a day. Life doesn’t stay static though, and I moved to a 6 bedded Coronary Care Unit. My daily steps dropped, my waistband started to feel a bit tighter and I put half a stone on. I realised that I had to change tactics. I began to walk into town on my days off, I got myself a Fitbit and tried to do 10,000 steps a day, challenging nurses on other wards inspired my competitive streak. Obviously when you put physical activity first, other things slide. I won’t be winning any Good Housekeeping awards imminently and I don’t have time to watch TV. But as I see it, the benefits outweigh the costs.

Then earlier this year I left Coronary Care and moved to the Keep Well project here in Dumfries and Galloway. Keep Well is an anticipatory person-centred service that aims to reduce health inequalities. Part of this role involves delivering brief interventions for physical activity. I started to see that the guidelines weren’t going to be achievable for everyone – like the 64 year old lady who had to use a wheelchair because of her COPD. In that case, the message is do what you can, keep doing it and try and build on what you can do. Most of my clients with long term conditions are very aware of their limitations and they know better than I do, what is achievable for them.

Amanda 2Changing from a shift based work life to a ‘normal’ 8.30 to 4.30 job required further readjustment to my physical activity routine. Covering the whole of D&G has found me spending large amounts of time in the car. But the advantage is that I now have my weekends free and I make sure I do something active with my children. But I was struggling to do something on week days. So I started a 90 day Yoga challenge – 30 minutes of aerobic yoga for 90 days. The only time of the day I could fit this in was before everyone else got up. I found that I was so used to getting up at 5am to go to Carlisle that doing yoga at 6.30am was achievable for me. In all honesty, I haven’t made it onto my yoga mat every single day because sometimes life gets in the way, but I didn’t beat myself up because I knew that tomorrow was another day.

Now I realise that getting up at 6am to exercise isn’t going to work for everyone. So, I suppose the main message I’m trying to share is

  • Find an activity that you enjoy
  • Small changes really make the difference if you do them often enough
  • Give yourself permission to exercise – no one else can do it for you
  • Don’t give up if you miss a few days/weeks/months. Life gets busy and big events sometimes engulf us.
  • Set a SMART goal, running the London marathon next April is not appropriate for everyone. Parking the car as far away from the office 3 days a week could be more achievable.

As the largest occupational group in Scotland, we nurses are in an incredible position to reach a huge number of people. If we start with ourselves, this will ripple out to our families, our communities and ultimately to the Scottish population.

Lesley Fightmaster Yoga Fix 90 – 90 day to build a healthy habit https://www.youtube.com/watch?v=ArZDT5zXSR0

Amanda Taka is a Keep Well Nurse based in Public Health, Crichton Royal Hospital and a Coronary Care Nurse with North Cumbria University Hospitals NHS Trust.

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