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           STRESS MANAGEMENT         


   Feeling Burned Out?                                                                 



Nursing is both a demanding and rewarding profession.

Often our greatest challenge is showing love and patience in the face of adversity, suffering, and pain.

The emotional demands of nursing, coupled by inadequate staffing ratios, increasingly medically complex patients, coupled with risks to staff and client safety, are a perfect environment for nurse burnout and moral fatigue.  



 AHNA developed a Holistic evidence based guide to target the root causes of Nurse burn-out: lack of time for self-care & self-compassion.  

        Holistic Self-Care Strategies for Nurses        

Click Here to Download This Entire Holistic Stress Management Page as a PDF You Can Print

Click the images below to download a PDF of the Holistic Nursing Self-Care Strategies  

AHNA Holistic Nursing Self-Care Strategies637215376660107441 AHNA Holistic Nursing Self-Care Strategies2637212713974770650

Click Here for References

The stress response can be an asset for raising levels of performance during critical events such as a sports activity, an important meeting, or in situations of actual danger or crisis. However, if stress becomes persistent, all parts of the body's stress management system (the brain, heart, lungs, vessels, adrenals and muscles) become chronically over-activated. Over time, this produces physical and/or psychological damage.

Many nurses “accept” health problems that come from the physical and emotional stress of caring for others by not giving equal care to themselves. This is not necessary when we practice holistic self-care.

Causes of stress are categorized as external or internal and acute or chronic:

  • External stressors are adverse physical, mental, emotional, or spiritual conditions around you, such as high-pressure working conditions, noise or abuse.
  • Internal stressors are adverse physical, mental, emotional or spiritual conditions when you, such as your attitudes beliefs and illnesses. Studies show that internal psychological stressors are rare or absent in most animals except humans.
  • Acute stress is the reaction to an immediate threat commonly known as the "fight, flight or freeze" response. The threat can be any situation that is experienced as a threat or danger, even subconsciously or falsely. Common acute stressors include noise, crowding, isolation, hunger, infection and imagining or recalling threatening events.
  • Chronic stress happens when the acute stressors continue without resolution. The instinct to fight, flee or freeze becomes suppressed and/or exhausted.

Studies suggest that the psychological effects of stress include:

  • The onset of depression or anxiety
  • Diminished quality of life
  • Difficulty in sleeping
  • Emotional instability
  • Disruption of social and family life
  • Increased use of cigarettes, alcohol, and drugs
  • Poor attitude towards work
  • Difficulties in communicating with patients
  • Difficulty maintaining pleasant relations with coworkers
  • Difficulty judging the seriousness of a potential emergency

As you know, our mental, emotional, physical and social/relational aspects are intertwined and interconnected, so what affects one aspect of yourself will influence all other aspects. For instance:

  • The way you care for your body has a profound effect on your thoughts, your emotions and your relationships
  • Your thoughts affect your emotions and your emotions affect every cell of your body
  • Likewise, the types and nature of your relationships affect your physical health, emotional health, mental clarity and sense of well-being

The wonderful thing about this is that when you create health in one area of your life the positive effects spill into all other areas of your life!

A very small proportion of people, when they first attempt to enter a state of deep relaxation, have a paradoxical reaction and feel extremely uneasy and anxious, and may have increased respiration and racing thoughts. If this happens to you, be assured that this is not abnormal! If the more “quiet” forms of relaxation leave you feeling anxious, begin your relaxation training with progressive muscle relaxation.

The following links offer evidence-based Stress Management Tools you can begin using today.

Disclaimer: The information, facts and opinions provided here are not intended to be a substitute for professional advice. Always consult your primary healthcare provider for any medical advice, diagnosis, or treatment and before undertaking a new diet or exercise plan.

Holistic Stress Management
uses the tools of Self-Reflection and Self-Care

Self-Reflection and Self-Care are based in Holistic Theory and are Core Values of Holistic Nursing.

The Holistic Nursing: Scope and Standards of Practice defines self-reflection as:

“Self-reflection: Turning inward to examine one’s thoughts, values, beliefs, experiences, behaviors and inner wisdom. Self-reflection enhances self-awareness and understanding. The nurse’s self-reflection, self-assessment, self-care, healing and personal development are necessary for service to others, growth/change in the nurse’s own well-being and understanding of the nurse’s own personal journey. The nurse values herself/himself and her/his calling to holistic nursing as a life purpose.” (Holistic Nursing: Scope and Standards of Practice, 2nd edition (2013), page 8.)

Holistic Nursing: Scope and Standards of Practice goes on to say that “Self-reflection and self-care, as well as personal awareness of and continuous focus on being an instrument of healing, are significant requirements for holistic nurses. Self-reflection is both a self-care strategy and a professional practice integrating critical thinking of the mind and compassion of the heart.

Holistic nurses reflect on action to become aware of values, beliefs, feelings, sensations, perceptions, and judgments that may affect their actions, and reflect on their experience to obtain insight for future practice. Self-reflection allows one to know oneself more fully in order to become more authentic and mindful.” (Holistic Nursing: Scope and Standards of Practice, 2nd edition (2013), Core Value 5, page 20.)


Holistic nursing views everything as inseparable and interrelated – our mental, emotional, physical and social/relational aspects are intertwined and interconnected. The wonderful thing about this is that when we create health in one area of our life the positive effects spill into all other areas of life!

However, many studies show that nurses are experiencing stress at higher rates, and are less healthy, than the average adults in their communities. 

A synthesis of 187 international studies on nurse health conducted by Fronteira and Ferrinho (2011) found that nurses experience more musculoskeletal disorders, are at greater risk of acquiring tuberculosis and blood-borne pathogen infections and have more occupational allergies than the general public. 

In another study, hospital-employed bedside nurses were found to have a depression rate of 17% compared to the national rate of only 9% (Letvak, Ruhm & McCoy, 2012). Nurses’ shift work has also been found to increase health problems. For example, a longitudinal study of nurses found that night work and job stress were associated with sleep deficiency, lack of exercise, and increased cardiometabolic risk (Jacobsen, et al., 2014).

Enjoy this 5-Minute Video on "How to Meditate in a Moment"


Balevre, P.S., Cassells, J., & Buzaianu, E. (2012). Professional nursing burnout and irrational thinking: A replication study. Journal for Nurses in Staff Development, 28, 2-8.

Cuneo, C.L., Curtis Cooper, M. R., Drew, C. S., Naoum-Heffernan, C., Sherman, T., Walz, K., & Weinberg, J. (2011). The effect of Reiki on work-related stress of the registered nurse. Journal of Holistic Nursing, 29, 33-43.

Fronteira, I. & Ferrinho, P. (2011). Do nurses have a different physical health profile? A systematic review of experimental and observational studies on nurses' physical health. Journal of Clinical Nursing, 20(17-18), 2404-24.

Gonzalez, R., Pizzi, J., Thomas, S., Cooper, K., & Clyne, M. (2013). Tranquility room study: Caring perspectives. International Journal for Human Caring, 17(4), 15-19.

Jacobsen, H. B., Reme, S. E., Sembajwe, G., Hopcia, K., Stiles, T. C., Sorensen, G., Porter, J. H., & Marino, M., Buxton, O. M. (2014). Work stress, sleep deficiency, and predicted 10-year cardiometabolic risk in a female patient care worker population. American Journal of Industrial Medicine, 57(8):940-9.

Letvak, S., Ruhm, C. J., & McCoy, T. (2012). Depression in hospital-employed nurses. Clinical Nurse Specialist, 26(3), 177-82.

Organopoulou, M., Tsironi, M., Malliarou, M., Alikari, V., & Zyga, S. (2014). Investigation of anxiety and burn-out in medical and nursing staff of public hospitals of Peloponnese. International Journal of Caring Sciences, 7, 799-808.

Orme-Johnson, D. W., Barnes, V. A. (2013). Effects of the Transcendental Meditation technique on trait anxiety: A meta-analysis of randomized controlled trials. Journal of Alternative Complementary Medicine, 19(0), 1-12.