Cumulative stress is a common experience for people who work in chronically stressful situations. It results from an accumulation of various stress factors such as heavy workload, poor communications, multiple frustrations, coping with situations in which you feel powerless, and the inability to rest or relax. Cumulative stress progresses through three phases:
Early warning symptoms
Apathy
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Depression
Emotional fatigue
Vague anxiety
Mild symptoms
Frequent headaches, colds, and stomach problems
Intensified physical and emotional fatigue
Intensifying depression
Irritability
More frequent loss of emotional control
Muscle aches
Sleep disturbances
Withdrawal from contact with others
Ingrained symptoms
Elevated blood pressure and cardiac problems
General physical and emotional fatigue
Increased alcohol use
Increased smoking
Intense depression
Intense irritability
Loss of sexual desire
Migraine headaches
Poor appetite
Relationship problems
Skin rashes
Ulcers
Use of nonprescription drugs
(Source: Mitchell J, Bray G. Emergency Services Stress: Guidelines on Preserving the Health and Careers of Emergency Services Personnel. Upper Saddle River, NJ: Prentice Hall; 1990.)
· Be gentle with yourself
· Remind yourself that you are a catalyst, not a magician. We cannot change anyone else; we can only change how we relate to them.
· Find a hermit spot. Use it daily.
· Give support, encouragement, and praise to peers. Learn to accept it graciously in return.
· Remember that in light of all the pain we see, we are bound to feel helpless at times. Admit this without shame. Caring and being there are sometimes more important than doing.
· Change your routine often, and change your tasks when you can.
· Learn to recognize the difference between complaining that relieves and complaining that reinforces negative stress.
· On the way home, focus on a good thing that happened during the day.
· Be a resource to yourself. Get creative, try new approaches. Be an artist as well as a technician.
· Use supervision or the buddy system regularly as a source of support, assurance, and redirection.
· Avoid shop-talk during breaks and when socializing with colleagues.
· Say “I choose” rather than “I should,” “I ought to,” or “I have to.” Say “I won’t” rather than “I can’t.”
· Aloofness and indifference are far more harmful than admitting an inability to do more.
—Gail Noller, MA, LP
Kerstin McSteen is a palliative care clinical nurse specialist at Abbott Northwestern Hospital, Minneapolis, Minnesota, and department editor of The Total Nurse section on OncologyNurseAdvisor.com.
