H.A.L.T.!

Relaxation skills are tools for effective stress management that are a part of a proactive approach to taking responsibility for coming to your work strong and feeling emotionally and physically well. Resilience is the ability to adjust to change, to “bounce back.” Relaxation strategies work best when you are not totally depleted. H.A.L.T. is an acronym for Hungry, Angry, Lonely, and Tired, introduced in Alcoholics Anonymous, to remind us of vulnerabilities that make us less resilient (Friedmann et al, 2003). To make the best use of relaxation skills, pay attention to your own self-care needs. Choose nutritious foods. Go off the unit to take lunch times and breaks, which are your allotted time to refresh yourself. Deal with fear, frustration, and hurt, which are emotions that lead to anger (Herring, 2011). Nurture relationships with others by scheduling time to be together, recognizing that although we may be connected electronically, we may become isolated. Interesting research about women is referred to as “tend and befriend,” which addresses the differences in how women respond to stress. Men’s response to stress is known as “fight or flight.” Women tend to nurture their children and seek out companionship, especially with other women; this is related to the hormone oxytocin (Taylor et al, 2000). Women often eliminate time with other women friends, putting it at the bottom of their list of priorities. Commit to getting 8 hours of sleep when possible and allow yourself time to just rest!

Importance of relaxing your body

As a student in nursing, balancing a full life with your academic responsibilities, you likely have experienced the unwanted effects of stress. As a graduate you balance a different set of stressors. There is no quick-fix to manage stress, because stress is a result of “an interaction between a negative environment, unhealthy lifestyles, and self-defeating attitudes and beliefs” (Micozzi, 2010). Exposure to noise and artificial light can be stressors for nurses and contribute to job dissatisfaction (Applebaum et al, 2010). Interruptions in the work environment of nurses can have a significant impact on client safety (McGillis Hall et al, 2010). Injuries can occur when we are “just not thinking.” Consider a time when you were driving and suddenly realized that your mind was not on your driving and you don’t remember how you got from one place to another. Geller (2010) uses mindfulness exercises in his work with job safety analysis (JSA) to promote prompt reaction to prevent industrial accidents. This chapter encourages you to take charge of your reactions to stressful situations in the workplace and develop a habit of daily relaxation, a letting-go technique, to eliminate the negative build-up of stress in your body. When you engage in relaxation practices you become more focused and alert, promoting safety for clients and for yourself. Other chapters help you prepare your mind for communicating effectively in your interpersonal encounters with clients and colleagues. This chapter focuses on preparing your body to relax during your workplace interactions. Worry can trigger tension in your muscles, resulting in soreness, headaches, or digestive upsets. In turn, bodily tension is an aggravating signal to your mind that you are not at peace and that something is “eating away at you.” If you allow these physical symptoms of stress to build up, you are in danger of eventually damaging your body. In contrast, relaxation is “a state of consciousness characterized by feelings of peace and release from tension, anxiety and fear” (Ryman and Rankin-Box, 2001) that contributes to your general sense of well-being (Spencer and Jacobs, 2003).

Chronic tightened muscles, tension headaches, or digestive disturbances reflect your “disease” and register diminished well-being. Built-up stress reactions steal valuable energy and put you at risk of holding back or closing off in your interpersonal relationships. In a study of high school students who received relaxation training, state (transient) anxiety scores were reduced. This is important, too, for nursing students, because high anxiety adversely affects learning (Rasid and Parish, 1998). You can see that it is assertive to learn to minimize your tension and expand your relaxation response in the workplace. Your own self-caring strategies, meditation, and relaxation practices help you build self-awareness and resiliency in times of personal stress and illness (Anselmo, 2005; Tusaie and Edds, 2009; Irving et al, 2009). There are benefits for you, as well as for your clients and colleagues, when you are more relaxed.

Stress of nursing as an occupation

Occupational stress is a major health issue leading to anxiety, short-term and long-term physical problems, and counterproductive behavior at work (Spector, 2002). As a nurse, you navigate several organizational structures to ensure client well-being: the nursing hierarchy, the medical hierarchy, and the agency’s bureaucracy. To survive this organizational maze, you need effective interpersonal communication techniques and efficient management skills. Increased acuteness of clients’ conditions and a shortage of personnel contribute to increased stress.

Not only do nurses require a sound knowledge in their own areas of expertise, but to be effective in helping clients, they need to know the roles and functions of other healthcare professionals, how to communicate clearly with other members of the healthcare team, and how to coordinate the work efforts of all these disciplines. The changing exposure to different personnel demands that you quickly size up how to relate to colleagues effectively, which adds one more level of stress to an already complex working environment.

One of the most frequently cited sources of stress in nursing is the excessive workload, which gives nurses the feeling that they are always in a hurry, as if in a race with time. This factor is intensified by nurses’ day-to-day encounters with distressing and anxiety-provoking situations, as well as insufficient resources in these times of healthcare restraint. As helping professionals, each of you has a vision of what your workplace, colleagues, and clients will be like, and these images may not prepare you for the reality you encounter. This chapter invites you to empower yourself by taking charge of your individual resourcefulness for increasing your relaxation response.

Part of your health teaching with any client is reviewing the basics of health promotion, such as eating nutritiously, exercising regularly, securing adequate sleep, engaging in supportive social encounters, and making time for solitude and/or spiritual contemplation. Your knowledge of the benefits of taking care of yourself physically, emotionally, socially, and spiritually is sound. With the investment you have in health, you likely try to incorporate these health behaviors in your own daily life. The return on your investment is an enhanced feeling of well-being and a readiness to handle the stress of working as a nurse. This chapter invites you to add three practices to help you relax and prepare for stress in your interpersonal relationships with clients and colleagues: daily meditation, progressive relaxation, and on-the-spot relaxation exercises. These techniques are designed to relax your body, putting it in a state in which the fight-or-flight response or the defense-alarm syndrome of arousal is greatly diminished or eliminated, so that your energy is available for communicating effectively (Luskin and Pelletier, 2005).

Meditation as a way to augment your relaxation response

Meditation is a “mind body practice with many methods and variations . . . grounded in the silence and stillness of compassionate, nonjudgmental present-moment awareness. Although contemplative meditation practices are largely rooted in the world’s spiritual traditions, the practice of meditation does not require belief in any particular religious or cultural system” (Fortney and Taylor, 2010, p. 81). Meditation has become a general term that includes a variety of practices to relax the body and still the mind. The word “meditation” comes from the root word meditari, which means to “consider” or to “pay attention to something” (Fontaine, 2010). Meditation is an experiential exercise you do by yourself and for yourself to benefit from the subjective sense of deep relaxation of the body’s musculature; an added benefit is that you may possibly come to know yourself more fully. Meditation is psychologically and physically refreshing and energy restoring (Luskin and Pelletier, 2005).

Empirical study has confirmed that the meditative process relieves nervous system stress more efficiently than either dreaming or sleeping. It has been proven that marked physiological alterations accompany meditation: a reduction of the metabolic rate, a reduction of the breathing rate to 4 to 6 breaths per minute, an increase in the number of alpha waves in the brain (waves of 8 to 12 cycles per second), the appearance of theta waves in the brain (waves of 5 to 8 cycles per second), and a 20% reduction in the blood pressure of hypertensive patients (Luskin and Pelletier, 2005).

The regenerating effects of meditation are experienced during the meditation itself and have a carryover effect into your daily activities (Luskin and Pelletier, 2005). Once you have learned the low arousal effect during the meditation practice, you can maintain this state of neurophysiological functioning in response to stressful situations. It is impossible to be relaxed and tense at the same time, and your enhanced ability to maintain relaxation during the day in the face of stressful interpersonal situations is what will help to minimize the effects of stress on you. With practice you will be able to call upon your low arousal state as needed during your working day. By itself this mechanism is helpful, and your heightened feelings of being able to cope with the pressures of everyday life will augment your good feelings (Luskin and Pelletier, 2005). When you learn to diminish your reaction to stressors, you free yourself to deal with aspects of the interpersonal situation more worthy of your energy. Being able to shift focus from being tight or nervous to feeling calm and in charge allows you to communicate more effectively with your clients and colleagues.

Mindfulness is an aspect of meditation that “reflects the basic and fundamental human capacity to attend to relevant aspects of experience in a nonjudgmental and nonreactive way, which in turn cultivates clear thinking, equanimity (composure under stress), compassion, and openheartedness” (Fortney and Taylor, 2010, p. 81). Mindfulness, which is developed through meditation, enables you to maintain a fluid awareness in a moment-by-moment experiential process that helps you disengage from a strong attachment of beliefs, thoughts, or emotions; this results in a greater sense of emotional balance and well-being. This evidenced-based practice holds the potential for many health benefits, including challenges such as increasing healthcare costs, chronic lifestyle-induced illness, healthcare provider burnout, client dissatisfaction, and stress in clients and caregivers (Fortney and Taylor, 2010; Ludwig and Kabat-Zinn, 2008; Deyo et al, 2009; Paul-Labrador et al, 2006; McCray et al, 2008; Eckleberry-Hunt et al, 2009; Chiesa and Serretti, 2009). Meditation teaches you to fix your attention firmly upon a given task for increasingly protracted periods of time, overcoming the habit of flitting from one subject to another. A chaplain working in a hospice setting made this remark about meditation: “When you are trying to still the mind, if a thought comes into your head, you need not invite it to tea.”

Once you have truly tried to quiet your mind or to allow images to run through it without letting any particular one become distracting, you will understand why practice and perseverance are necessary if you are to be successful. Have you noticed how your thoughts seem to wander or race? It is not easy to still the mental chatter. When you attempt to become quiet, your mind may jump from one thought or concern to another. This is expected. Think “Oh well, a thought,” and let it go. Begin with 10 minutes of meditation and increase it to 20 minutes at a time. Experiment to determine the best approach for you. You will find it gets easier to be still and be present for yourself. At this point, the subtle benefits of meditation become more pronounced (Luskin and Pelletier, 2005).

Guidelines for beginning to practice meditation

The following guidelines are for a nonreligious form of meditation. It has a very simple form, requiring that you sit comfortably in a quiet place, that you focus your attention on the word “one,” and that you adopt an accepting and unconcerned attitude. These conditions will help you experience what is called the relaxation response, a state that research shows is associated with reduced physiological activity. That means the heart rate will become slower and the blood pressure will fall. You’ll notice that you feel calmer than usual and the whole sensation will be a pleasant one. At no time will you lose consciousness or be controlled by an outside force. The state you reach is one that you will have induced in yourself (Payne and Donaghy, 2010; Benson and Proctor, 2010). There are other forms of meditation, and you may wish to read about them or even take a course or individualized instruction in meditation.

Develop a passive attitude

Distracting thoughts are likely to occur during your meditation, especially at first when you are learning to focus. Let these thoughts pass without becoming worried about their intrusion or your ability to meditate.

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