leadership and management chapter 28

what are the two responses to stress?

(1) the classic general adaption syndrome (GAS) and (2) a withdrawing reaction, in which the person pulls back to conserve energy.

psychological hardiness 2 reasons

(1)dampers the effects of stress by challenging the perception of the situation and (2) decreases the negative impact of a situation by moderating both cognitive appraisal and coping.

Job-related challenges

(eustress), which motivate us to learn new skills, master our jobs, and manage new situations, differs from distress, which can lead to symptoms in a range from fatigue to exhaustion, feelings of inadequacy, and failure, or even, complete burnout

what do acute stressors do to the body

(very short-term) "revved up" the immune system, preparing for infection or injury. Short-term stressors, such as difficult exams, tended to suppress cellular immunity while preserving humoral immunity.

procrastination

- identify the reason for procrastinatin -make that task your highest priority the next day -Reward yourself after you finish the task - select the least attractive element of the task to do first, and the rest will seem easy -break the task down into manageable pieces and plan rewards for accomplishing each of the smaller tasks -program evaluation and review technique (PERT) chart or a Gantt chart- outline how you approach project -technology as a tool or time-waster

psychological hardiness

- individual's ability to deal with stress - is a composite of commitment, control, and challenge.

time- management: organization

- neat workstation -file management not pile management •Plan where things should go: your desk or your disk •Keep a clean workspace •Create a "to do" folder •Create a "to be filed" folder for any papers •Schedule time to work your way through the folders - have materials ready for the next day

General Adaptation Syndrome: key ideas

-"stress response" is an adrenocortical reaction to stressors that is accompanied by psychological changes and physiologic alterations that follow a pattern of fight or flight. -The general adaptation syndrome includes an alarm, resistance, and adaptation or exhaustion

time- management: time tools

-Ask others around you if your lack of planning has a negative impact upon their work day. - If you do not plan the day, you may be responding to events rather than prioritized goals. -Each nurse must devise a method for tracking care and organizing time, as well as delegating and monitoring care provided by others. -computer and tablets (PDA)

Classification of Time-Management Techniques: organizations: -purpose -actions

-Designed to promote efficiency and productivity -Organize and systematize things, tasks, and people, use basic time management skills

three characteristics of burnout

-First, a feeling of physical, mental, and emotional exhaustion can be recognized. -second characteristic of burnout is depersonalization, a state characterized by distancing oneself from the work itself and developing negative attitudes toward work in general -third a decreased sense of professional accomplishment and competence; low efficacy and cynicism

Classification of Time-Management Techniques: keep focused on goals: -purpose -actions

-Focuses on goal achievement -Assemble a prioritized "to do" list daily, based on goals.

Classification of Time-Management Techniques: time management plan -purpose -actions

-Helps to refocus, to gain control, and to use information -Develop a personal time-management plan appropriately.

too much information

-Information overload, or "data smog," occurs when you are overwhelmed by too much information, too fast, and too often and do not have the skills to interpret the data as useful information. -information literacy- developing data and information gathering, receiving, and sending skills can greatly reduce stress and improve efficiency and productivity -knowledge management- being able to manage flow of information

important and urgency grid

-Making shift assignments is an A task because it is both important to the work to be accomplished and commonly urgent because a time frame is specified during which data about patients and qualifications of staff can be matched. -The real key to setting priorities is to attend to the B tasks, those that are important but not urgent. Examples of B activities are reviewing the organization's strategic plan or participating on organizational committees -Even if something is urgent but not important (cell C), it contributes minimally to productivity and goal achievement. An example of a C activity might be responding to a memo that has a specific time line but is not important to goal attainment -neither important nor urgent (cell D), it may be considered a waste of time, at least in terms of personal goals. An example of a D activity might be reading "junk" e-mail.

common characteristics of burnout

-Physical exhaustion -Mental exhaustion -Emotional exhaustion: Cynicism, Somatization, Depersonalization

Classification of Time-Management Techniques: tool usage -purpose -actions

-Uses the right tool for planning and preparation -Use tools such as a smartphone.

PERT chart

-assist in complex projects that require a series of activities, some of which must be performed sequentially and others that can be performed in parallel with other activities. -Envisioned as a network diagram, a PERT chart indicates dependent activities that must be completed before a new activity is undertaken

appropriate delegation

-be willing to give/accept delegation -only when the delegator trusts the delegatee to accomplish the task and to report findings back to the delegator. -give delegates sufficient responsibility and authority -convey expectations and clearly -require delegatee to be accountable -debrief: what worked? what did not? what will you both try to do differently next time?

stress

-consequence or response to an event or stimulus. -continuum ranging from eustress to distress the key is to not reach either extreme

four types of meetings

-daily check - daily or weekly tactical meeting - monthly strategic meeting - quarterly off-site review

stress management

-does not necessarily mean stress reduction or elimination -emotional and behavioral control, perseverance, and a sense of challenge in the face of stressful events.

time- management: managing information

-first step in managing information is to assess the source then you will have better idea with how to deal with the information -Track incoming information for a few days. Patterns will begin to emerge and will give clues as to how to deal with it. You can generally predict that, using the Pareto principle, 80% of your incoming data comes from approximately 20% of your sources, and that 80% of useful information comes from 20% of information receive -discard uneeded data -Be able to build the big picture from the masses of data you receive. -Finally, recognize when you have enough information to act - information-sending skills. - Remember, if your e-mail message is more than a few sentences in length, your message probably warrants a phone call instead

time- management: goal setting

-first steps in time management are goal setting and developing a plan to reach the goals -set goals that are reasonable and achievable -give yourself time to meet the goals -develop short-term goals within a long term goal-sense of achievement -write your goals, date the entry, keep it handy, and refer to it often to give yourself a progress report -goals reviewed during annual evaluation

disorganization to organization

-guiding principle is that organization is a process rather than the product - You can spend so much time organizing that you will never get to the task at hand (procrastination). - guidelines include eliminating clutter, keeping everything in its place, and doing similar tasks together. -disorder not always bad; allows spontaneous ideas

dpersonalization and becoming completely oppositional to the organization were indirect predictors of active or passive counter productive work behaviors examples

-harming elders or deliberately bypassing handwashing -taking longer breaks off the unit, or calling in sick on a busy weekend

doing too much

-if you think you are doing too much, you probably are -fewer projects running simultaneously - concentrate your efforts on one thing at a time. -the first step is to be realistic and limit major commitments, and then give each activity your full and undivided attention -completing one task before starting another -prioritizing goals or activities for the day - what must be done v. what would be nice to do

time- management: setting priorities

-once goals are set can work on priorities -Knowing what your goals and priorities are helps shape the "to do" list. -organize work may depend on geographic considerations, patient acuity, or some other schema. -placing the elements of importance and urgency in a grid ex. cell A most important then so on cell

burnout

-prolonged response to chronic, emotional, and interpersonal stressors on the job -sources: environmental, individual, interaction -not objective phenomenon -perception of stressors, how they are mediated, and level of adaption to the individual are important

Tips for Managing Meetings Effectively

-schedule meetings right before lunch or at the end of the day- people will want to stick to schedule -avoid meetings longer than 2 hours -seating arrangement: near the door, so they can easily slip out of earshot and handle emergencies as needed -requesting a "no texting while meeting" agreement. -create agreement on how group will interact - provide a written agenda to each member in advance of the meeting. -make goal of meeting known - rules of order to facilitate meetings: time limit on discussion and order of priorities to deal with concern -Keep minutes and distribute them to participants. - planning in advance

how to stop complaining

-stop and ask yourself what would be the ideal solution and then take the risk to act on it -take the time to talk with the person and get the problem out in the open or write a letter or an e-mail to the person discussing your point of view (stop short of pushing "send," because this is an effective technique even if you do not mail it) -within the workplace, rethink the problem, generate some possible solutions, and then talk to your manager. simple or out of box solutions

inability to say "no" or "not now"

-stop and consider the request -Do you want to do the task now or sometime in the future?- if not say no - If you wish to do the task but simply do not have the time, consider delegation - be honest -negotiate -accepting assignments never be able to complete puts you in a bad light

perfectionism

-tendency to never finish anything because it is not yet perfect - tends to consume much time when your expected outcome is not attainable -does not mean that you should do less than your best -occasionally need to give yourself permission to do slightly less than a perfect job, such as buying a carryout dinner rather than preparing a home-cooked meal

Maslow's Hierarchy of Needs: application to practice

-wages should be enough to provide shelter and food -job security and a social environment that rewards and recognizes nurse performance are important

Interruptions

. Most interruptions are integral to the positions that you hold, but others can be controlled. - numerous small interruptions by individuals who want just a "minute of your time" and take much longer than that getting to the point -resume "doing it now" so that an interruption does not destroy your schedule and to maintain the attitude that whatever the interruption, it is a part of your responsibility; more energy to maintain a positive perspective and to move projects forward

quarterly off-site review

1-2 days designed to analyze progress and to develop the team. It is uncommon to find that many organizations provide this frequency and intensity except at higher levels in the organization

Some stressors, in fact, can be ignored or minimized by posing three questions:

1.Is this event or situation important? Stressors are not all equally significant. Do not waste energy on little stressors. 2.Does this stressor affect me or my unit? Although some situations that produce distress are institution-wide and need group action, others target specific units or activities. Do not borrow stressors from another unit. Individuals can "cross-pollinate" stressors by spreading gossip about the misfortunes of other units' team members. 3.Can I change this situation? If not, then find a way to cope with it, or if the situation is intolerable, make plans to change positions or employers. This decision may require gaining added credentials that may produce long-term career benefits or contacting a search firm to simply discover "what's out there."

daily check- in meeting

5 minutes check schedules and activities. "touch base" or huddle meeting to ensure that everyone is progressing as planned and that no patient care issues are unattended.

define efficacy

Efficacy is one's belief in his or her capabilities to organize and execute goal-oriented activities. Nurses are more inclined to take on a task if they believe they can succeed. -Low efficacy can lead nurses to believe tasks are harder than they actually are

structured agenda

If a topic is particularly controversial, consider the expectation that requires any negative comment to be preceded by a positive one.

theories applicable to self-management

Maslow's Hierarchy of Needs, General adoption syndrome, complex adaptive systems, and Pareto principles

complex adaptive systems: application to practice

Nurse engagement in self-managed groups and teams allows organizations to shape their environment through controlled "experimentation" using the rapid-cycle plan-do-study-act improvement method.

what has a direct effect on the amount of one's stress

Poor and unhealthy lifestyle choices, such as the use of caffeine, lack of exercise, a fat-ridden diet, inadequate sleep and leisure time, and cigarette smoking,

resolution of stress

Social support, professional organization/specialty association involvement, counseling mentorship, conferences, leadership and management

Pareto principle: application to practice

The 80-20 rule can be applied to many aspects of health care today. For example, 80% of healthcare expenditures are on 20% of the population, and 80% of personnel problems come from 20% of the staff. In quality improvement, 80% of improvement can be expected by removing 20% of the causes of unacceptable quality or performance. A nurse can also expect that 80% of patient-care time will be spent working with 20% of his or her patient assignment.

Complexity compression

The intensity of increasing functions and expectations without a change in resources, including time

employee assistance programs (EAPs).

They are a source of free, voluntary, confidential, short-term professional counseling, and other services for employees either via in-house staff or through a contract with a separate mental health agency.

complex adaptive systems: key ideas

This theory of unpredictable interactions between interdependent people and activities emphasizes the importance of innovation and rapid information sharing to improve performance.

signs of stress

accidents, poor physical or emotional health, unhealthy coping mechanisms, absenteeism, turnover, decreased quality care, diminished productivity, increasing health care costs

define time management

appropriate use of tools, techniques, and principles to control time spent on low-priority needs and to ensure that time is invested in activities leading toward achieving desired, high-priority goal

where does your time go?

are you doing too much? inability to say "no" or "not yet"? do you procrastinate? do you spend time compiling rather than acting? are you a perfectionist? are you organized? do you have a minute (interruptions)?

external stress: change

cannot easily balance caring and clinical expectations with business and administrative demands

General Adaptation Syndrome: application to practice

change, lack of control, and excessive work load are common stressors that evoke psychological and physiological distress among nurses

external sources:

change, social factors, position (overworking) and roles, gender

conclusion: time management

clock-oriented

time agenda

consider setting a specific amount of time to be dedicated to each item on the agenda. If you stick to the schedule, discussion will stay focused and you will be more likely to make it through the agenda. However, setting realistic times is critical to the success of this strategy.

Gantt chart

consists of a table of project task information and a bar chart that graphically displays the project schedule. This method of tracking project activities in relation to time is often used in planning and project management.

conclusion: stress management

control of external and internal stressors.

define burnout

describe the effects of prolonged emotional and physical exhaustion and diminished interest caused by an unrelenting workload, without relief -feel as though their resources are depleted to the point that their well-being is at risk.

define depersonalization

described as a feeling of being outside one's body, feeling as if one is a machine or robot, an "unreal" feeling that one is in a dream or that one "is on automatic pilot." -others may view this as "callousness"

managing meetings

designed to solve problems, disseminate information, seek input, inspire the group, delegate work or authority, or create or maintain a formal power base. -not effective if poorly managed

what is effective way to deal with stress

determine and manage its source. -step back and look at the big picture. By identifying daily stressors, the nurse can then develop a plan of action for management of the stress. - plan may include eliminating the stressor, modifying the stressor, or changing the perception of the stressor

example of counseling

employee assistance programs (EAPs).

managing stress and time

everyone has 24 hours. successful people know how to use time effectively for themselves, their career, loved-ones, and work

two categories of job related stressors

external (working conditions) and internal (worker characteristics), dynamics of job stress

prevention of stress

find the right workplace, identification of daily stressors, change perception of stressor, obtain assistance with problem solving, ask: "how am I doing frequently, insist on equipment that prevents physical stress, enjoy a hobby develop expertise in

define stress

gap between how we would like our life to be v. how it actually is

subtle signs of stress

headache, fatigue, apathy, disruptive behaviors

examples of external stress

increasing workload, rotating shifts, high patient acuity, inadequate staffing, ethical conflicts, dealing with acute illness and death, role ambiguity, the multiple, complex, and continually growing number of responsibilities, constant multitasking, work relationships, and job insecurity

time-management: stress and time relationship

is one method of stress prevention or reduction. Stress can decrease productivity and lead to poor use of time. Time management can be considered a preventive action to help reduce the elements of stress in a nurse's life

psychological hardiness: commitment attitude

led the individuals to be actively involved in the changes that decreased isolation.

psychological hardiness: challenge attitude

led them to believe that the stressful events were opportunities for new learning.

psychological hardiness: control attitude

led them to try to influence outcomes rather than sink into powerlessness and passivity

what are two key time management strategies

managing meetings and delegating,

meeting management

managing meetings, agendas, delegating

conclusion: Self-management

means to achieve a balance between work and personal life, as well as a way of life to achieve personal goals within self-imposed priorities and deadlines.

distress

negative attributes or perceptions of stress

two choices when managing time

organize or "go with the flow."

Job stress

physical and emotional responses that arise when the job requirements do not match the abilities, resources, or needs of the worker

Stoppler top five stressors

poor calendar habits, clutter, perfectionism, self-treatment, following other's expectations

eustress

positive attributes or preceptions of stress

management of stress

prevention, symptoms, burnout

Pareto principle: key ideas

refers to a universal observation of "vital few, trivial many." This concept of disproportion. study showed 80% of wealth controlled by 20% of the population

Maslow's Hierarchy of Needs: key ideas

shows the five levels are not always present or in order, it is reasonable that unmet needs motivate most employees most of the time.

self-management

stress, time, and meeting management

types of agendas

structures, time, and action

Complaining

the act of expressing dissatisfaction or annoyance with persons, places, things, and

what immune systems are more prone to stress-related immune system changes

those who are older or already sick

what are the implications of stress management in the workplace

to low absenteeism rates, improved quality, and increased productivity

where do internal stressors stem from

unrealistic self-beliefs (unrealistic expectations, taking things personally, all-or-nothing thinking, exaggerating, or rigid thinking), perfectionism, or the type A personality.

monthly strategic meeting

used to address big issues that have longer-term implications. These meetings are frequently standing committees of the organization on which staff serve and include reports from subgroups. An example of this meeting can be illustrated by unit based councils, often found in Magnet™ organizations where shared governance provides opportunities for staff decision making at the unit level.

daily or weekly tactical meeting

used to resolve issues. This type would be reflective of what the unit staff needs to address to ensure that it has the resources to achieve what it needs to do for patients.

Physical illnesses linked to stress

visceral adiposity (body fat), type II diabetes, cardiovascular disease (hypertension, heart attack, stroke), musculoskeletal disorders, psychological disorders (anxiety, depression), workplace injury, neuromuscular disorders (multiple sclerosis), suicide, cancer, ulcers, asthma, and rheumatoid arthritis. Stress can even cause life-threatening sympathetic stimulation

physical stress-management strategies

• Accept physical limitations • Modify nutrition: moderate carbohydrate, moderate protein, high in fruits and vegetables, low caffeine, low sugar • Exercise: participate in an enjoyable activity five times a week for 30 minutes • Make your physical health a priority • Nurture yourself by taking time for breaks and lunch • Sleep: get enough in quantity and quality • Relax: use meditation, massage, yoga, or biofeedback

Tips to Prevent Interruptions and Work More Effectively

• Ask people to put their comments in writing in an e-mail—do not let them catch you "on the run." On the same note, do not use others as you would a Post-it note! • Let the office/unit secretary know what information you need immediately. • Conduct a conversation in the hall to help keep it short or in a separate room to keep from being interrupted. • Be comfortable saying "no" and "not yet." • When involved in a long procedure or home visit, ask someone else to cover your other responsibilities. • Break projects into small, manageable pieces. • Get yourself organized. • Minimize interruptions—for example, allow voice mail to pick up the phone; shut the door. • Keep your work surface clear. Have available only those documents needed for the task at hand. • Keep your manager informed of your goals. • Plan to accomplish high-priority or difficult tasks early in the day. • Develop a plan for the day and stick to it. Remember to schedule in some time for interruptions. • Schedule time to meet regularly throughout the shift with staff members for whom you are responsible. • Make an effort to round with the night and weekend team; conduct early morning breakfasts so that night staff can meet with you away from their unit. • Recognize that crises and interruptions are part of the position. • Be cognizant of your personal time-wasting habits, and try to avoid them.

controlling interruptions

• Be organized • Focus on the urgent and important tasks- what is important to your boss? • Use some method of time organization • Use delegation effectively • Ask for information in writing

mental stress-management strategies

• Learn to say "no"! • Use cognitive restructuring and self-talk • Use imagery • Develop hobbies or activities • Plan vacations • Learn about the system and how problems are handled • Learn communication, conflict resolution, and time-management skills • Take continuing education courses

time management strategies

• Setting priorities • Being organized • Using time tools • Dealing with tempting time wasters • Devising a personal time management system • Dealing effectively with information and information over load

emotional/spiritual stress-management strategies

• Use meditation • Seek solace in prayer • Seek professional counseling • Participate in support groups • Participate in networking • Communicate feelings • Identify and acquire a mentor • Ask for feedback and clarification