Unrelieved stress in a high proportion of workers results in a department with low morale and high staff turnover. To prevent this, each stressor should be looked at and methods of coping and alleviating the stress should be used. Interpersonal communications can be improved by encouraging staff to attend courses that include interpersonal skills and assertiveness training. Talking about stress-related problems with colleagues, family, partners, or friends may also be an effective coping mechanism. Problems about communicating with awake patients who cannot speak may be reduced by open discussions with other members of the team looking after the patient.
Certain patients are very demanding and different nurses should look after them. This allows nurses to alternate between periods of emotional demand and more relaxed times. It may be useful for staff to meet shortly after having to deal with a difficult patient so that coping mechanisms can be discussed and perhaps the way that staff deal with difficult situations can be improved. Similarly, a meeting after the death of a patient allows the obvious stress to be talked about. Indeed, many American hospitals allow staff to take 'time-out' for informal and confidential discussion to take place. These are usually under the control of a facilitator who was not involved in the death. This results in at least one person being objective.
It is essential that management attempt to minimize staff turnover so that the morale of the remaining staff is maintained. The theory is that if individuals are happy and stimulated within an environment, the decision to leave will not be made. Ways of maintaining job satisfaction have been suggested ( A.k.er.m..a.n...1..99.3), including the following:
1. encouraging effective communication between all members of the multidisciplinary team;
2. providing opportunities for the staff to advance both professionally and academically with sufficient study leave and funding;
3. arranging research and teaching sessions and encouraging all staff to participate in the running of the ICU.
If workload continues to increase, ways of reducing the immediate problem should be sought by either employing agency nurses or closing beds until it is resolved. If this is not done, the quality of safe consistent care will decrease and nursing staff will attempt to prevent this by working overtime, thus precipitating occupational stress.
If workers are feeling under stress, it is important for them to isolate those stressors that they control themselves from those controlled by senior staff or management. Nurses have used team-building and attempts to control the number of stressors acting at any one time to reduce stress. Self-assessment questionnaires may be useful in the hope that staff can deduce which areas are causing stress and start a self-care strategy ( FoxaN eL§L 1990). Methods of preventing stress should be sought before staff start in the ICU. This may include preparing staff for what they may expect and what stressors they may face, establishing peer group support, and teaching techniques to improve interaction with fellow professionals and with patients and their relatives.
If a worker is suffering from symptoms of stress, this should not be ignored but ways of minimizing stress should be sought. These may range from advice about relaxation, to adequate leave for those unable to cope so that they have a period of adjustment, to the availability of professional counselors based either locally or regionally.
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