Research Paper on "Stress Management in the Caregiver"

Research Paper 13 pages (4668 words) Sources: 8

[EXCERPT] . . . .

A study published by the Nuffield Trust (Williams et al. 1998) highlighted what had long been a subject of interest in the caregiver media: the levels of stress, sickness, absenteeism and burnout among professional caregivers. This report, from an authoritative and reputable organisation, brought together much of the prevailing evidence about the alarming state of the government funded workforce, which, despite a growing independent sector, is still responsible for giving over 90% of health caregiver. The report states that 'for the sake of good management and from simple compassion, both we and the Government should view these findings with due alarm, and accept shared responsibility for working quickly together to develop a program for action.

Studies highlighting stress and burnout in professional caregivers continue to mount. Kapur et al. (2009) demonstrated continuing high levels of stress among consultants and junior doctors, and a report by Sarah Boseley (2010) raised further alarms about stress among medical staff and the connection with high levels of drug and alcohol abuse. The Professions Allied to Medicine (1998), which includes radiographers, chiropodists, physiotherapists and dieticians, have also recently reported exceptional low morale and high stress levels among a survey of 1800 members. A further report (Borril et al. 1998) took account of the views of 11-000 government funded nursing staff. More than one-quarter were suffering from significant levels of stress, with nurses being 40% more likely to suffer stress than other groups of technical and professional workers with whom they were compared.

Stress Management for the Caregiver Givers

<br />As awareness of the effects of stress upon caregivers has grown, an increasing number of steps have been taken to counter the problem. Lay caregivers may find that there is access to respite or counseling facilities to aid them in their work, and many voluntary associations offer help through mutual support groups. Organizations have tried to introduce measures which give more direct support to the staff and produce more staff-friendly managerial cultures. Other organizations and consulting agencies have been set up to research and advise on stress management. Books and papers on the subject fill the library shelves and occupy the attentions of countless program planners and educators. A scan through the literature suggests that a huge range of options have been attempted. These include devising policies to involve staff more in decisions at work, introducing staff counseling services, improving pay and conditions of service, monitoring workloads and reducing them where excessive, teaching stress management, assertiveness and even relaxation skills. Other options to have been implemented in the healthcare setting for stress management are introducing exercise and healthy eating programs, access to occupational health services, better training in interpersonal skills, developing and implementing anti-bullying and anti-discrimination policies at work, introducing personal development plans. Stress management has also been tackled through development of clinical supervision and debriefing groups among staff to provide professional support, introducing family-friendly policies (e.g. opportunities for caregivers breaks, job sharing, flexible hours, creche facilities), taking steps to reduce violence in the workplace, giving staff more control over their own work and developing stress management groups. Developing 'listening groups' (teams of staff who collect information about staff experiences to identify causes of stress and make recommendations) are often coupled with programs such as team building, opportunities for time out, access to continuing education and better job-related training, better caregivers counseling.

All of these and more have been implemented with varying degrees of success in a wide variety of organizations. Attempts to help staff feel valued and cared for are legion and each can contribute to making the caregiver's workplace or home a more supportive place. An incremental approach, where the more options that are in place, the better the possible outcomes, would seem to be logical. However, it is not our intention to discuss all these approaches in detail. Each has its part to play and we would not wish to question the usefulness of any of them.

The solutions often run the risk of 'fire fighting' -- dealing with the problem after it has arisen rather than preventing it in the first place. Doing the latter requires a wholesale commitment to examine and change the organizational culture, the way in which people work together, and the ways that individuals participate in that culture. While it is important to examine workplace conditions and organizational systems and cultures, and to effect changes that may help staff to cope with stress and make the workplace a better place to be, there are other issues operating. The evidence cited so far tends to skirt around these. What are these issues? We get some clues from the common concern of caregivers that relationships are not working - relationships with employers, with work colleagues, with patients - that something doesn't seem right. The 'something' appears to be not just decent rates of pay, stress reduction techniques or better working conditions - laudable as it is to address such matters. Even when these issues are rectified, the problems seem to persist. Something more is amiss, and it is the 'something more' that this paper will seek to explore.

Some hints as to the deeper nature of the problem can be found. Dossey (2005), for example, argues that 'At the core of the problem is the truth that we, as a civilization, have turned our communal back on healing ... ignoring the role of consciousness, soul, spirit, and meaning - stock items in the arsenal of authentic healers - we have birthed a malaise that permeates not just the healing profession, but our entire society'. Can it be that the alarming list of difficulties so far discussed that many caregivers face is only part of the story? Can it be that other factors are at work which seeks to undermine effective caring relationships? If the answer to both of these questions is 'yes', then we need to examine what is going on in the caring relationship in a little more detail. Workloads and working conditions undoubtedly have a part to play in causing stress in caring, yet there are other factors too. It is worth noting that problems with relationships are often mentioned as a stress factor, and attempts to deal with these include team-building work. Perhaps there are other areas where the quality of a relationship is having an impact upon a caregiver's performance. As we seek to change the system and its culture we have to remember that these are not disembodied entities with a life of their own 'out there': we are the culture, we are the system. Who we are, each and every one of us, counts - each of us brings our own particular building block to add to the whole.

Prevention and Treatment. Everyone is exposed to environmental and personal stressors. The question is, How does one reduce the long-term neuroendocrine disturbances induced by stress and emotional arousal? There are thought to be three modes: (1) conservation / withdrawal, (2) relatedness, and (3) relaxation. In the face of major stress an individual uses conservation/withdrawal mechanisms such as shock, projection, displacement, repression, rationalization, and depression. All these help allow time for the psyche to move toward a realistic appraisal of the situation and to move outward to connect with interpersonal supports. This outward movement of coping can then be followed by the relaxation so essential to maintenance of neuroendocrine regulatory mechanisms and protection from disease-producing disturbance. Forsythe and Compas (1987) believe efficacy in management of stressors immunizes the individual against emotional disruption. Individuals with more personal and environmental resources use more active coping strategies when encountering difficulties (Holahan and Moos, 2002). A core set of attitudes, including optimism, self-efficacy, a sense of control, connectedness and coherence, and life sources of happiness and pleasure, resulted in positive outcomes (Sobel, 2008).

The Harvard Community Health Plan found educational materials, relaxation-response training, and awareness training were all helpful in coping with stress (Sobel, 1995). Life experience in successful stress management may be the most important resource elders have. In the future, nursing research should address personality impact, control, social supports, life experience, types of stressors, and gender differences in stress management. All of these and other unidentified factors may be significant, and as yet we do not know what combination is most effective in mediating stress in the lives of elders. We do know that 80% of health and stress management is self-initiated, so it is important to provide elders with an array of self-caregiver tools. Teaching the elderly stress reduction often begins with progressive muscle relaxation (PMR). This has several benefits in addition to stress reduction because it facilitates awareness of muscle groups and those that are weak, tight, stressed, or inactive. Weinberger (1991) found, in reviewing the literature, that elders given PMR training had beneficial results in stress reduction and enhanced immune function and memory. The procedure for teaching progressive muscle relaxation and the sequential order of proceeding from one… READ MORE

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