Stress and Nursing Practice

Although the medical field level may differ from the type of specialty, the American Holistic Nursing Association reveals that workplace stress is more common in nurses than in other professionals in the medical field ( Jordan et al., 2016) . The rate of stress is also higher in the nursing field compared to other professions. The most significant intrinsic triggers to these stresses are decision making, change, taking responsibility, and availing competent and professional patient care while the external forces causing stress include difficulty in maintaining a home and workplace balance of responsibilities, physical demands, the inadequacy of resources, and management issues ( Jordan et al., 2016) . The issue cannot be oversimplified due to dire impacts like poor decision making, apathy, demotivation, losing concentration, and anxiety that often result in uncharacteristic errors and performance impairment ( Jordan et al., 2016) . This paper aims to present a personal nursing experience that defined me as a nurse and the impact and significance of my current operations. It also highlights the relevant efforts that have played a part in overcoming the stressful event. The second part entails the debriefing process and its significance in the workplace. 

Initially, patient care and vital signs resulting in sleepless nights were the main ideas that crossed my mind as a nurse. However, having spent months in nursing, it finally dawned on realizing that nursing was more of empathy, compassion, sensitivity, and patience. The defining moment dates back to eight months ago before the COVID-19 crisis became rampant. At the moment, I was assigned a nursing care role on a 78-year-old man who has Alzheimer's disease. Five years ago, the patient had been diagnosed with the condition but was still able to live alone with constant help from his sister Abby. As the disease progressed, the patient was increasingly in need of 24-hour care, which was eventually assigned to me. Few weeks before his demise, the patient had refused to eat and continued to become increasingly unresponsive. To me, the process of dying was a new experience, especially a slow death filled with pain and suffering. Although the rest of the family wanted the patient to receive IV feeding and oxygen, his sister wanted him to pass in their traditional way, the natural way. Abby had spent most of the time with her brother in the ailing time and might have had some knowledge about his final wishes. 

The dilemma caused by the family and Abby was vast, but more importantly, I had to be ethical and responsible. As the patient’s condition worsed, the family argument increased, especially on matters of advance directives. Among all participants in healthcare intervention, no one wanted the patient to suffer unnecessarily. Through close association with Abby, I was able to understand their culture. According to Abby, the semiconscious state needed to be respected; therefore, owing to her the plea to conduct traditional dying rituals on his brother, I was compelled to seek the relevant higher authority. The move was approved for the ritual. Abby's request comprised an empty room, which she cleansed with sage and sweetgrass. The patient was washed with cedar, and tobacco was offered for reasons I do not understand later. Abby cradled his brother, singing and speaking their native language as the culture required. The idea that Abby had visions of his brother crossing over to the spiritual world was absurdly irrelevant until the day she requested that all family members report the next day. It was at dawn when the deeply spiritual phenomenon took part. I had never seen the patient so peaceful since the onset of 24-hour care. As we witnessed the patient take her final breath, I felt that I had taken a step to beauty and peace. 

Ways in Which The Case Affects Me and My Practice 

Over the years, I had never experienced such exhaustion, fatigue, and detachment from other personal activities. It is no doubt that thoughts of quitting the profession had begun crossing my mind at least twice. Although the majority of the nurses seemed reluctant to the calling, the entire experience was a phenomenon. From experience, I was able to appreciate the essence of professional vigilance and patience. Through our experience, intelligence, and compassion as nurses, our patients are our priority, especially in desperate times. Therefore, nursing is not merely a job my care and trust through dignity, integrity, and respect for human culture—it all about selflessness. 

Steps Undertaken to Overcome The Stressful Event 

The initial stages of overcoming the event to part in the course of the patient's care. Since rational decision making is a crucial element in the medical field, I always consulted with the chief physician in dilemmas. At the moment, the interaction was more of a therapeutic vent session and was very helpful on how to relate with the patient's family and improve things. Often, I participated in vigorous exercise at the end of the shift to reduce cortisol and adrenaline levels accumulated during the day. Through medical journals, I adopted deep breathing exercises as a simple way to reduce stress. According to Roberts & Grubb (2014) , deep breathing is an effective method to relieve stress by driving more oxygen to the brain and stimulating the parasympathetic nervous system, thus reducing stress. 

Debriefing and Its Significance 

Debriefing aims to discuss actions and thought processes experienced in a particular patient care incident. The process is a crucial element of identifying aspects of team performance that were successfully integrated and failed. It allows health care practitioners to reflect on actions and thought processes. Therefore, it is an essential strategy for identifying chances of opportunity to incorporate improvement for better future performance (Patient Safety Network, 2019). Debriefing provides support to emergency response outcomes, resuscitation, and team performance. Although it is often challenging to implement the strategy, it is an effective method for quality improvement, clinical education, and systems learning. 

Withing the healthcare settings, time pressures have always been an issue of significant concern; thus, the most variable facilitation is experience and skills. Therefore, it is often challenging to implement real-time debriefing due to uncertainty about the nature of the activity to be debriefed and its time of occurrence. In the workplace, most debriefing practices have occurred during emergencies (Patient Safety Network, 2019). Despite been quick, the strategies have proven substantially effective. Most of the debriefing has taken part in the emergency rooms or intensive care units to evaluate whether the situation awareness was maintained, whether the work was equally distributed, whether an explicit demonstration of responsibility was evident or whether the errors present were timely mitigated or corrected. 

The components of a debriefing involve setting the stage in a manner that supports learning. Since the list of the debriefing is not to assign blames or identify errors. Still, to identify why individual decisions or actions were relevant in a clinical task, a team leader who maintains other participant's psychological safety would take charge (Patient Safety Network, 2019). Debriefing requires facilitators with the ability to select evaluation measures and support the engagement of all the staff. Therefore, the leader must have experience in inquiry strategies or reflective inquiry strategies. Debriefings are possible within the work environment and would help to serve as simulation activities. (Patient Safety Network, 2019)Although most healthcare professionals disregard their significance, educational research reveals that debriefing is an effective mechanism for enhancing team performance and promoting adult learning. 

Conclusion 

Although nurses are well educated and receive adequate training, it is wrong to assume that their health and behavior will be similar to the general population after work experiences. Past researches show that most nurses are not physically and psychologically healthy. The competing demand in their personal lives demands their attention, time, and energy, thus exacerbating the risk of work-family conflicts, unhealthy practices, and chronic stress. For instance, due to the COVID-19, the few past months have been dramatic and extremely stressful for most nurses who have had to work for long shifts. To meet patients' needs in overcrowded quarantine centers, most home-care-based nurses have been relocated to hospitals; hence overburdening the few remaining in-home care settings. Therefore, together with the health care sectors, the government needs to formulate and implement lasting solutions to these problems by increasing the number of nurses to reduce the shifts subsequently. Health care sectors might also create stress management programs exclusively meant for nurses. 

References 

Jordan, T. R., Khubchandani, J., & Wiblishauser, M. (2016). The impact of perceived stress and coping adequacy on the health of nurses: A pilot investigation.  Nursing research and practice ,  2016 . https://www.hindawi.com/journals/nrp/2016/5843256/ 

Patient Safety Network. (2019, September 7). Debriefing for Clinical Learning . Retrieved from PS Net: https://psnet.ahrq.gov/primer/debriefing-clinical-learning#:~:text=Debriefing%20is%20defined%20as%20a,incorporate%20improvement%20into%20future%20performance. 

Roberts, R. K., & Grubb, P. L. (2014). The consequences of nursing stress and the need for integrated solutions. Rehabilitation Nursing ,  39 (2), 62-69. https://dx.doi.org/10.1002%2Frnj.97