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Stress Management Program for Health Workers

Introduction

Health workers face considerably high-stress levels due to work-related factors. Occupational stress refers to harmful reactions due to work demands or undue pressure. According to Bhui et al. (2016), approximately 9.9 million working days have been lost due to occupational stress. Studies further demonstrate several occupational stress effects, including physical and mental illness, psychological distress, and disrupted parenting (Bhui et al., 2016; Ruotsalainen et al., 2015). While all medical practitioners are at risk of mental health problems, research shows that some practitioners have a higher risk of psychological distress than others. For example, a systematic review conducted by Dutheil et al. (2019) revealed that psychiatrists, general practitioners (nurses and physicians), surgeons, and anesthesiologists are more likely to commit suicide than other healthcare workers. Unfortunately, a healthcare worker’s occupational stress not only affects the individual workers but also their patients’ safety.

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Essentially, work-related stress may be caused by exposure to various work stressors. Dutheil et al. (2019) attributed mental health issues among physicians to heavy workload and burnout, moral loneliness, lack of social support, long working hours with sleep deprivation, unhealthy work-life balance, administrative constraints, and high patient expectations. Dutheil et al. (2019) also revealed that medical practitioners, especially physicians, rarely seek help due to the medical education culture. Given that most physicians are in frequent contact with suffering patients, death, and illnesses in the workplace, they are most likely to experience stress, anxiety, and depression. Dutheil et al. (2019) further argue that these occupational factors lead to decreased job satisfaction and poor mental health. Therefore, understanding the causes or sources of occupational stress can help healthcare practitioners to improve their health and wellbeing.

Given the implications of work-related stress, it is critical that the problem is adequately addressed. This presentation describes the proposed stress management program aimed at reducing occupational stress among healthcare providers. It delineates the initiative’s format, applicable techniques, and a summary of the importance of stress management. The presentation also addresses the potential barriers to the project’s implementations and the solutions to overcoming these hurdles.

Description of the Program

The proposed stress management program for the target population is the Mindfulness-Based Stress Reduction (MBSR) technique; this strategy will help improve the organization’s workers’ cognitive/mental, behavioral, and physical health. MBSR is a stress-reduction program which involves the utilization of relaxation techniques to reduce patients’ distress levels. Relaxation techniques are therapeutic interventions that can reduce anxiety, physical tension, and psychological tension. This viewpoint is supported by a randomized control study conducted by Ruotsalainen et al. (2015), which revealed the above-mentioned approach’s efficacy in reducing occupational stress among healthcare workers. Findings from this research demonstrated that mental and physical relaxation could minimize distress levels by up to 23% (Ruotsalainen et al., 2015). It involves conducting therapeutic exercises to increase calmness and reduce anxiety, somatic and subjective emotional experience, muscle tension, and other stressful symptoms (Ruotsalainen et al., 2015). Examples of activities included under this technique include yoga, mindfulness meditation, breathing exercises, guided imagery, and progressive muscle relaxation exercises.

The technique to be used for this stress management program is diaphragmatic breathing. Diaphragmatic breathing exercises, commonly identified as ‘deep breathing,’ are among the most crucial relaxation techniques that can help individuals manage their stress levels effectively (Dutheil et al., 2019). This breathing exercise can be conducted during, before, or after a stressful experience. The technique is mainly used during yoga or meditation to improve emotional balance and reduce tension. Findings from a recent study conducted by Ma et al. (2017) indicated that a one-day diaphragmatic breathing exercise could eliminate emotional fatigue caused by job burnout. The survey further revealed that conducting this breathing exercise daily for five minutes for 30 sessions significantly reduced anxiety levels (Ma et al., 2017). Furthermore, according to Ma et al. (2017), a seven-day intensive yoga program involving the diaphragmatic breathing exercise reduced depression and anxiety in patients with low back pain. Apart from reducing mental stress, this breathing exercise has been shown to reduce sleep disorders, improve focused attention, reduce fatigue, and stress-related physical disorders (Ma et al., 2017).

The diaphragmatic breathing exercise’s mechanism is linked to its effects on the cortisol hormone. Cortisol is a steroid hormone that is released during high-stress situations. High levels of cortisol hormone have been associated with stress, depression, anxiety, and negative emotions (Ma et al., 2017). The hormone is sensitive to hypothalamic-pituitary–adrenaline (HPA) activity activated by CO2 inhalation (Ma et al., 2017). The diaphragmatic breathing technique causes the diaphragm to contract, the belly to expand, consequently decreasing the frequency of respiration and increase of blood gases. Therefore, because the diaphragmatic breathing exercise involves deep inhalation and holding of gases, HPA activity is activated, which, in turn, reduces the levels of cortisol hormone and its effects on an individual.

Design of the Program

Target Population

The target populations for this program are frontline workers working in all units in the healthcare facility. As indicated by research, frontline workers such as nurses and physicians are among the high-risk populations for mental health problems, including suicide (Dutheil et al., 2019). There are approximately eight physicians and thirty-four nurses in the work setting.

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Room and Sitting Arrangement

The program will be conducted in a sunny, open-air room that is soundproof or with minimal noise interference. The participants will sit on chairs, spaced out throughout the entire room. The breathing sessions will be conducted either at the beginning or at the cessation of each working shift. The timing of the sessions will be adjusted to meet individual preferences or needs. This program is designed to reduce the staff’s occupational stress and improve their physical and mental wellbeing.

Format of the Breathing Exercise

The program’s participants will be taught how to perform diaphragmatic breathing to familiarize themselves with deep breathing exercise correctly. They will breathe in as deeply as possible and then slowly exhale the air in a controlled and rhythmic manner.

  • Phase 1: Workers will inhale air via the nose for four seconds.
  • Phase 2: Hold the breath for four seconds.
  • Phase 3: Exhale air via the nose for four seconds
  • Phase 4: Hold the breath for four seconds

Repeat this breathing technique for 20 minutes during each session

All the participants will focus on their breathing movements and sensations created by their bodies during the exercise. This exercise will be performed while the participants are sitting on a comfortable chair with closed eyes. An experienced coach will guide them through the exercise to ensure that all participants use the right breathing technique. The trainer will provide the participants with verbal guidance at the beginning of the session and facilitate their active involvement throughout the process. According to Ma et al. (2017), the coach must speak at a slow speed to allow the participants to be more involved in the exercise. Each session will include a ten-minute resting breathing session and 10-minute diaphragmatic breathing. This program will be conducted for eight weeks with a total of 20 sessions.

This program’s design and length of the sessions have been adopted from the controlled randomized trial conducted by Ma et al. (2017). The research demonstrated that this diaphragmatic breathing program has significant positive effects on stress (Ma et al., 2017). By the end of the twenty sessions, the participants exhibited significant cognitive and mental performance (Ma et al., 2017). The survey also illustrated that the diaphragmatic breathing technique reduced adverse physiological effects on stress in healthy adults. From this study’s outcomes, it can be surmised that the healthcare facility’s selected population will have improved mental health and stress management skills by the end of the stress management program. With recurrent practice, the participants will also learn and expand their knowledge on effectively responding to stress and subjective emotions through diaphragmatic breathing techniques.

Possible Obstacles to the Successful Implementation of the Program

The successful implementation of this program heavily depends on the availability and cooperation of staff. According to a study by Tappen et al. (2017), the significant barriers to effective implementation of a change program include competing demands, stakeholder resistance, unstable leadership, the complexity of the change, and technical problems. In this context, the potential hurdles to the program’s success include competing demands and stakeholder resistance. The staff might be reluctant to participate in the program due to fatigue caused by long shifts and heavy workloads.

The practitioners might also lack interest or commitment in the program due to ignorance/lack of awareness or a negative attitude towards sudden change. Tappen et al. (2017) indicated that resistance to change is a common barrier due to employees being accustomed to the status quo. The authors suggested that employees always have to be pushed to use new tools or programs (Tappen et al., 2017). Requiring a workforce that is already burdened with time constraints and heavy workloads to dedicate more of their time to the organization might invoke resistance. Given that most healthcare professionals have unpredictable work shifts, it is also difficult to schedule a fixed time to conduct the program. Additionally, the staff may not always be available for the session at the end of their shifts due to extensions in working shifts.

Possible Solutions

To address the problem related to participants’ lack of interest and commitment, I would educate the practitioners on the program’s importance and the initiative’s potential benefits. The study by Tappen et al. (2017) revealed that training individuals on the need for change serves as a primary facilitator for the successful implementation of an improvement project. Training prepares employees for a culture change and also changes their mindset and attitudes towards the proposed program. Therefore, I will first train the target population on the program’s essence before implementing the program. Creating awareness on the effects of occupational stress on physical, social, mental wellbeing might positively influence the practitioners’ attitude towards the programs. I will also clarify what the program is designed to solve and build a consensus with employees.

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Regarding the time constraints and unpredictable working shifts, I will try to individualize the program as much as possible. In collaboration with the target population, we will schedule the program to meet their preferences and needs. According to Tappen et al. (2017), stakeholder collaboration can lead to the successful implementation of a program in a health setting. Tappen et al. (2017) argued that it was essential to get organizational-wide support and involve all the participants to ensure the initiative’s positive results. Therefore, I will use my leadership skills to influence the target population and other stakeholders to support my team’s vision. Selecting an experienced in-house coach might give me an upper hand in the successful implementation of the program. An in-house trainer understands the institution’s culture and the organization’s staff model; hence, he/she has a better chance of creating meaningful relationships and positively influencing the target population.

Conclusion

Stress management programs are mainly designed to prevent the causes of stress in the workplace, alleviate or minimize the symptoms, or rehabilitate a patient. Diaphragmatic breathing is a guided stress management technique that can significantly reduce the effects of stress and improve the participants’ physical, cognitive, and mental health. Additionally, the participants can acquire the skills needed to respond to stressful situations in the future effectively.

References

Bhui, K., Dinos, S., Galant-Miecznikowska, M., De Jongh, B., & Stansfeld, S. (2016). Perceptions of work stress causes and effective interventions in employees working in public, private and non-governmental organisations: a qualitative study. BJPsych Bulletin, 40(6), 318–325. Web.

Dutheil, F., Aubert, C., Pereira, B., Dambrun, M., Moustafa, F., Mermillod, M., Baker, J. S., Trousselard, M., Lesage, F., & Navel, V. (2019). Suicide among physicians and healthcare workers: A systematic review and meta-analysis. PLOS ONE, 14(12), 1–28. Web.

Ma, X., Yue, Z.-Q., Gong, Z.-Q., Zhang, H., Duan, N.-Y., Shi, Y.-T., Wei, G.-X., & Li, Y.-F. (2017). The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in Psychology, 8(874), 1–12. Web.

Ruotsalainen, J. H., Verbeek, J. H., Mariné, A., & Serra, C. (2015). Preventing occupational stress in healthcare workers. Cochrane Database of Systematic Reviews, 2015(4), 1–127. Web.

Tappen, R. M., Wolf, D. G., Rahemi, Z., Engstrom, G., Rojido, C., Shutes, J. M., & Ouslander, J. G. (2017). Barriers and facilitators to implementing a change initiative in long-term care using the INTERACT® quality improvement program. The Health Care Manager, 36(3), 219–230. Web.

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