This booklet was written by Scott Brunero, cnc, Liaison Mental Health Nursing



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Stress

Stress


Management

Management 

for Nurses



This booklet was written by Scott Brunero, CNC, Liaison Mental Health Nursing, 

Prince of Wales Hospital, Sydney; Darrin Cowan, CNC Liaison Mental Health 

Nursing, Greater Southern Area Health Service; Alan Grochulski, CNC, Mental 

Health Northern Sydney and Central Coast Health Service; and Angela Garvey, 

Professional Offi cer, NSW Nurses’ Association.

authors


We wish to thank the following people for their help and support in the production 

and editing of this booklet:

 

Marianne Goodwin, Peter Newman, Terry Joyce, Ben Neilson, Salih Ozghul,  



 

Patricia McDermott, Beverley Raphael, and the many nurses who shared 

 their 

stories.


Copyright © 2006 

New South Wales Nurses’ Association

PO Box 40, Camperdown 1450

New South Wales. Australia

Telephone: 02 8595 1234

Facsimile: 02 9550 3667

Email: gensec@nswnurses.asn.au

Web: http://www.nswnurses.asn.au/

Stress Management for Nurses

ISBN: 0-646-45849-3

1. Nurses - Job stress.  2. Stress management.  I. Garvey Angela.  

II. N.S.W Nurses’ Association.

363.11961073

Illustrations by:  Scratch! Media, info@scratch.com.au

Design by:  jacstar design, jacstar@swiftdsl.com.au

Printed by:  No Time to Lose, info@notimetolose.com.au

This work was funded by the NSW Department of Health under the 

Mental Health Nursing Enhancement Fund.

All rights reserved.  No part of this publication may be reproduced, stored 

in a retrieval system, or transmitted in any form or by any means, electronic, 

mechanical, photocopying, recording or otherwise, without prior written permission 

of the copyright owner.

acknowledgements



stress

management 

for nurses

This booklet is intended to heighten 

awareness of the mental health 

needs of nurses and provide useful 

exercises to assist nurses to 

manage stress at work

(Disclaimer)

This book is not designed to be a substitute 

for professional advice. It should be used in 

conjunction with specifi c health advice from 

your health care provider.



4

While your union and others are working 

hard to achieve improvements in nurses’ 

employment conditions, it remains a fact 

of life for nurses that we will frequently 

encounter situations at work that are 

physically and emotionally demanding.  

We also know that chronic exposure to 

stress can sometimes have very real and 

signifi cant implications for our health and 

wellbeing.      

While there are a number of mechanisms 

already in place to assist nurses, such 

as occupational health and safety and 

employee assistance programs, it is 

also important that every nurse has the 

awareness and skills to take care of their 

own mental health needs.  

It is hoped that this booklet will be a 

reminder for nurses about the need to care 

for ourselves, be mindful of the impact of 

the stressors and strains they encounter at 

work, to encourage nurses to seek support 

and assistance if needed.

Brett Holmes

forward



Introduction 4

What is Stress? 

8

Occupational Health & Safety 



11

Employee Assistance Programs 

15

Coping Strategies 



17

Relaxation Techniques 

27

10 Things Every Nurse Should Do 



29

Useful Contacts 

30

Recommended Reading 



32

contents



This booklet has been written by 

nurses for nurses to help promote 

awareness and understanding of 

our own mental health needs. 

It is widely recognised that nurses, 

like many others in the caring 

professions, have mastered the 

art of anticipating and attending to 

the physical and emotional needs 

of others. Unfortunately, nurses 

tend to forget how to take care 

of themselves and each other.

While there is no doubt that 

nursing is a wonderful career with 

many challenges and intensely 

rewarding experiences, it is also a 

fact that in their daily work nurses 

confront emotional and professional 

demands that are unimaginable 

to the wider community.  Let’s 

face it: spending your working 

life taking responsibility for the 

quality of people’s lives and their 

deaths is a heavy burden, even 

for the broadest of shoulders.

Nurses have a habit of putting the 

needs of our patients ahead of 

our own.  The community regards 

us as tough, able to cope in all 

situations, resilient, always caring, 

loyal to our patients, dedicated, 

introduction

4



committed, the list goes on. These 

expectations are put on us by 

society, managers, organisations 

and sometimes ourselves.  How 

do we as nurses react to these 

demands, what choices do we have 

and how do we put ourselves fi rst?

In the same way as mental health 

issues have struggled to make 

it on the broader social agenda, 

they’re also struggling to make 

it on the agenda at work.  The 

profession has made a lot of 

progress in managing many of 

the physical risks associated 

with our work:  we use safe lifting 

techniques, we’ve adopted universal 

precautions and many other 

practices to ensure our physical 

safety at work.  Unfortunately, we 

haven’t made the same level of 

progress where hazards to our 

mental health are concerned.

One of the most signifi cant risks 

nurses are exposed to in their work 

is stress.  This booklet will highlight 

some of the signs and symptoms 

that indicate when stress might be 

becoming a problem. It offers some 

skills and strategies to assist you 

to overcome some of the pressures 

associated with nursing work.

Inevitably nurses fi nd themselves 

in situations where the source of 

their stress is diffi cult to eliminate, 

like fi nding that extra nurse to 

cover the shift, stopping that extra 

patient turning up on the ward, or 

not having enough experienced staff 

rostered on the shift.  Frustrating 

as it may be, there are some 

sources of stress that we have 

limited ability to change, and this 

can lead to people feeling stressed, 

anxious, angry and depressed.

The coping strategies and relaxation 

techniques explained in this book 

have been evaluated and they work.  

They are simple, effective and 

helpful in managing anxiety levels, 

anger and depressed feelings.

However, it is critical that we all 

recognise that individual stress 

management is only part of the 

answer to looking after nurses’ 

mental health.  When we consider 

workplace mental health, we must 

adopt the same approach that we 

have adopted for the management 

of other occupational health and 

safety concerns.  That is, with a risk 

management approach that focuses 

on prevention.  For this reason, we 

have included a brief overview of 

5



the occupational health and safety 

laws in NSW and the obligations 

of both employers and employees 

to work together to maintain safe 

and healthy systems of work.

It is also important that all nurses 

are aware of NSW Health’s 

commitment to the mental health 

and wellbeing of staff at work in 

public hospitals.  A confi dential 

employee assistance program (EAP) 

has been available to all public 

sector nurses for some time.  Many 

of the nurses who provided personal 

insights for this project reported a 

high level of satisfaction with the 

service provided by local EAPs.

It is hoped that nurses who read 

this book will benefi t, not only 

from practising the strategies and 

exercises, but also by developing 

a better awareness of our own 

mental health needs and those of 

our colleagues.  Most of all, it is 

important that we accept that there 

is no shame in acknowledging that, 

at times, the demands placed on us 

at work can become overwhelming 

and that the best thing we can do 

for ourselves, our families and our 

patients is to take care of ourselves 

and seek help if we need it.

introduction

6



7


You would think that defi ning 

stress would be relatively easy. 

Yet those who have spent most of 

their professional lives studying 

it still have trouble defi ning the 

term. Despite efforts over the 

last half-century to defi ne the 

term, no satisfactory defi nition 

of stress exists. Defi ning stress 

is much like defi ning happiness. 

Everyone knows what it is, but no 

one can agree on a defi nition.  

Essentially, stress is the emotional 

and physical response you 

experience when you perceive an 

imbalance between demands placed 

on you and your resources at a 

time when coping is important.

What this means is that you 

experience stress whenever you 

are faced with an event or situation 

that you perceive as challenging to 

your ability to cope.  If you see the 

what is stress?

8



event or situation as only mildly 

challenging, you will probably feel 

only a little stress; however, if you 

perceive the situation or event as 

threatening or overwhelming your 

coping abilities, you will probably 

feel a lot of stress.  Importantly, 

your perception of how negative an 

outcome could be will signifi cantly 

determine what degree of stress 

you experience.  So, having to 

wait for a bus when you have 

all the time in the world triggers 

only a little stress.  Waiting for 

that same bus when you are 

running late for an appointment 

triggers much more stress.

The difference between the 

demands of the situation and 

your perception of how well you 

can cope with that situation 

is what determines how 

much stress you will feel.

What are the signs and 

symptoms of stress?

The signs and symptoms of stress 

can range from a major physical 

crisis like a heart attack, to more 

minor symptoms like tiredness 

and disrupted sleep patterns.  

The more serious stress-related 

problems usually emerge in the 

context of prolonged periods of 

exposure to intense stress.  It 

is important therefore to be 

able to recognise and manage 

the early signs and symptoms 

of stress, in order to avoid the 

more serious effects of stress 

on your health and well-being.

Think about how you have been 

feeling in the last few months.  

How many of the physical and 

psychological signs of stress 

listed on the following page 

have you experienced?

9



•  tiredness, fatigue, disrupted sleep patterns 

____________________

•  increased pulse rate and blood pressure 

____________________

•  shallow, rapid respirations 

____________________

• muscular tension 

____________________

•  loss of appetite, overeating, indigestion 

____________________

• constipation, diarrhoea 

____________________

dry mouth 

____________________

•  excessive perspiration, clamminess 

____________________

• nausea 

____________________

• decreased libido 

____________________

• nail-biting 

____________________

•  increased use of alcohol or other drugs 

____________________

•  irritability and impatience 

____________________

•  frequent worry and anxiety 

____________________

•  moodiness, feeling sad or upset 

____________________

•  loss of sense of humour 

____________________

•  poor concentration, memory lapses 

____________________

• ambivalence 

____________________

•  feeling overwhelmed by even minor problems 

____________________

 

signs and symptons of stress:



1

10



Nurses confront a range of 

occupational health and safety 

(OHS) risks in their roles providing 

care and comfort to the sick and 

aged.  While much has been 

done to identify and control the 

physical risks associated with 

nursing work, such as manual 

handling, ergonomics, chemical 

and biological hazards, we have 

been less successful in recognising 

the very real psychological risks 

encountered by nurses.

There is a growing recognition 

among employers and many 

employees that the effects of the 

workplace stress that many nurses 

experience may constitute a mental 

or psychological disorder due to 

exposure to risks in the workplace.   

Recent WorkCover NSW

3

 statistics 



indicate that stress is among 

the most common workplace 

hazards for nurses, along with 

manual handling injuries, physical 

injuries from acts of aggression 

or violence and the consequences 

of chemical exposures.

occupational 

health & safety

2

11




While OHS legislation provides a 

framework for the health, community 

and aged care industries to develop 

strategies to minimise the risk of 

injury to nurses, it takes more than 

legislation for a safety culture to 

develop and become the foundation 

for nursing practice.  All nurses, at 

all levels, need to embrace safety, 

including psychological safety, and 

consider it integral to the way work 

is planned, resourced, performed, 

monitored and evaluated.

The NSW Occupational Health 

and Safety Act 2000 (OHS Act) 

is the key legislative instrument 

that provides for the health, safety 

and welfare of all people at a 

workplace including employees, 

agency nurses, patients, 

contractors and visitors.

Section 8 of the OHS Act places the 

prime responsibility for occupational 

health and safety on the employer.  

Employers are required to:

•  ensure the health, safety 

and welfare at work of 

all employees, and

•  ensure that people (other 

than employees) are not 

exposed to risks to their 

health and safety arising from 

the employer’s activities.

This means that employers must:

•  ensure that the work 

environment is safe

•  provide and maintain 

safe systems of work, 

eg work conditions

•  ensure that everything 

used at the workplace is 

safe when used properly, 

eg equipment, chemicals

• provide information, 

instruction and training

•  establish and maintain 

effective consultation

• provide supervision 

suffi cient to ensure safety

•  provide adequate facilities 

for the welfare of employees, 

eg toilets, facilities for hand 

washing and meal rooms

•  provide for the safety of 

patients, visitors, sub-

contractors and others who 

visit or work in the workplace.

occupational health & safety

12



13


Section 26 of the OHS Act extends 

the employer’s responsibilities to 

all levels of management.  Directors 

and managers are responsible for 

OHS within their areas of control 

and infl uence.  They are the 

employer’s representatives and 

have the responsibility, authority 

and delegation for resourcing, 

developing, implementing and 

reviewing policies and procedures.

All nurses in management or 

supervisor positions have a 

responsibility for the health and 

safety of all staff reporting to 

them.  This responsibility is limited 

to the scope of their control, 

authority or infl uence.  In some 

circumstances, supervisors 

are regarded as employees.

Section 20 of the OHS Act 

outlines your responsibilities 

as an employee.  Specifi cally, 

you are required to:

•  cooperate with the employer 

in their efforts to provide a 

safe and healthy workplace, 

i.e. follow safe systems 

of work, use equipment 

according to procedure, 

participate in training, and 

report any risks or injuries

•  take reasonable care not 

to endanger anyone else by 

what you do (actions) or what 

you fail to do (omissions).

Employees are also obliged by 

the OHS Regulation (clause 28) 

to report anything that could 

reduce the employer’s ability to 

comply with the OHS Act.  This 

could include reporting:

• hazards

•  an injury or accident

• faulty equipment

•  unsafe work practices, or 

work practices that employees 

are unable to comply with 

– either of these situation 

could increase the risk to 

the employee, colleagues 

or others in the workplace, 

eg patients or residents.

As always, nurses with OHS 

concerns can contact the 

NSW Nurses’ Association for 

advice and assistance.

occupational health & safety

14



Compliance with the NSW Health 

policy for Employee Assistance 

Programs is mandatory for all 

public health organisations in NSW.   

The policy defi nes an employee 

assistance program (EAP) as a 



“work-based, early intervention 

strategy which provides appropriate, 

timely, professional and confi dential 

counselling and referral services 

for staff (and their families) in 

order to assist them to identify 

and resolve professional, personal, 

health or work-related issues.”

4

While EAP has been available for 



some time, generally it is under-

utilised by nurses.  Indeed, many of 

the nurses who contributed to the 

development of this book by sharing 

their advice and insights into mental 

health issues at work, expressed 

concerns about the confi dentiality of 

employee 

assistance 

programs


15


this type of work-based counselling.  

However, it is very important to 

recognise that the EAPs available to 

nurses in the NSW public sector are 

governed by the same privacy rules 

and regulations that apply to all 

other health information in NSW, i.e. 

the Privacy and Personal Information 



Protection Act 1998 and the Health 

Records Information Protection Act 

2002.  Nurses who access EAP can 

do so with the same expectations 

in relation to privacy that they have 

of any other health care agency.

The rationale for the provision 

of EAP is quite simple: levels of 

psychological distress among staff 

contribute to lower productivity 

and studies have shown that 

workplace counselling helps 

reduce psychological distress.     

Nursing staff can access EAP 

for any issue that may have an 

impact on the health and safety 

of staff at work, including:

• relationship problems 

at home or at work;

• mental health issues;

• organisational change;

• substance abuse;

• gambling problems;

• workplace confl ict;

•  health concerns;   

•  fi nancial problems.  

16

employee assistance programs




“Grant me the courage to 

change the things I can change, 

the serenity to accept those 

that I cannot change and the 

wisdom to know the difference” 

Reinhold Niebuhr

This famous quote from philosopher 

Reinhold Niebuhr has been the 

inspiration for many people who 

have successfully managed to turn 

their lives around by consciously 

challenging many of their thoughts 

and assumptions in order to 

change the way they think and 

feel about their situations.  

With the level of day-to-day pressure 

faced by many nurses, it is easy 

for us to fall into negative patterns 

of thinking that have a big impact 

on how we feel at work and at 

home.  The trick is to recognise 

negative thinking patterns and 

work towards changing them.

The nursing literature suggests that 

there are a range of interventions to 

help you reduce stress in nursing.  

A recent review

5

 suggests that 



cognitive behavioural interventions 

and relaxation/meditation 

coping strategies

17



strategies are effective in reducing 

your personal levels of stress.

Cognitive-behavioural interventions 

are designed to help people live 

longer, feel better and avoid having 

self-defeating thoughts.  They assist 

people to understand themselves 

so that they may live a more 

fulfi lling and happier existence.

6

Developed in the 1950s by Aaron 



Beck and Albert Ellis, these 

interventions are designed to 

increase your emotional self-

management to allow you to change 

the things you can change and 

accept (though not like) those 

things you cannot change.

This type of intervention targets 

the individual thoughts as a 

cognitive (thinking) process. It is 

based on the theory that changes 

in our emotions and behaviours 

are determined by our thoughts 

about events that occur.  People 

are often disturbed by their view 

or perception of events rather 

than the events themselves. By 

being able to change the way 

that you think about things you 

then are able to change the way 

that you also feel about them. 

By identifying and then modifying 

those thoughts which produce 

negative feelings, you are then 

able to reach your goals and 

make changes in the way that 

you perceive and feel about life 

situations.  It sounds easy but this 

takes some practice to change 

the way you react to situations.

7

The model is as easy 



to use as A.B.C.

A = Activating event (what 

happened) An occurrence, 

which triggers an emotional 

consequence. 

Eg: My bus is running late, I 

won’t make it in time for work

B = Belief (what you are thinking, 

self talk) An evaluation and 

judgement about the demands 

on your self, demands about 

others and demands about 

the world or life conditions. 

These may be rational and 

realistic or irrational.

Eg:  People will look down on me 

for being late.  They will think 

I’m stupid and unreliable 

coping strategies

18



C= Consequence (outcome) an 

emotional and/or physical 

consequence linked to a belief.

Eg:  Anxiety

It is easier to work out the 

Activating event (problem) and 

Consequences (outcome) fi rst, as 

the Beliefs (what you are thinking) 

are not always so obvious to us. 

To help us resolve a problematic 

situation we can use these steps.

Activating Event (A) Write down a 

problem which has happened 

or may happen in the future, 

which leads you to perform 

ineffectively and/or experience 

a negative emotional reaction.

Consequences (C) Write down 

your behaviour and your 

negative emotional stress 

reactions/feelings, which 

regularly occur in the face of 

the above activating event (A).

Beliefs (B) Write down your beliefs, 

thoughts, attitudes and self 

talk about the activating event 

(A), which are irrational, not 

true or useful that lead to your 

self defeating behaviour.

Goals Write down how you would 

like to behave and feel about 

the Activating Event (A) the next 

time a similar problem occurs.

19



Step 1:  Think of an activating event  (A)

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

Step 2:  Identify your feelings/reactions (C)

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

Step 3:  Identify beliefs (B) that lead to negative outcomes 

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

Step 4:  Write down the same event (A)

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

Step 5: How would you like to feel and behave (C) the next time the same 

event occurs?

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

now apply these steps to a real example from your 

own life:

20



21


Examples of negative thoughts 

and stressful thinking

Our thoughts or types of thinking (B 

- beliefs) directly affect our feelings.  

Some of our thoughts are healthy 

while some are not benefi cial to 

us.  By addressing and changing our 

thinking we can then infl uence and 

change our emotions and physical 

wellbeing.

Some examples of errors 

in thinking are:  

1. Black & white thinking

Some times we see things in 

extremes. No middle ground. Eg: 

good or bad, success or failure, 

perfect verses useless or moral 

verses immoral. When we do this 

we forget that things are rarely one 

way or the other but usually some 

where in between.  Another name 

for this is “All or nothing thinking”.



Eg:  “If I am not perfect 

then I am useless.”  

2. Filtering

You tend to see all the things 

that are wrong, but ignore 

the positives and take all 

the positives for granted.



Eg:  “I forgot how to set up for the 

catheterisation.  Then I panicked.  I 

can’t do anything right.  I’m a failure.”

3. Overgeneralising

When people build up one 

thing about themselves or their 

circumstances and end up thinking 

that it represents the whole 

situation or happens all the time or 

is part of a never ending pattern.



Eg:  “No-one here knows 

what they are doing.”

4. Mind reading 

Where we jump to conclusions 

without enough evidence or where 

we make guesses about what other 

people are thinking about us.



Eg:  “I wasn’t given the 

shifts I asked for because 

she doesn’t like me.”  

5. Fortune telling

When you predict the future 

in a totally negative way.



Eg:  “It will be another 

shift I can’t handle.”

6. Personalising

When you jump to a conclusion 

that something is directly 

connected to you. 

Eg:  “Every one knows I’ve been 

off work because I can’t cope.”

coping strategies

22



Challenging negative and 

unhelpful thinking

How do we do this?  The fi rst 

step is to become more aware of 

your emotional stress reactions 

and understand that they 

are not helpful in you getting 

what you want and need. 

Try this:  On a piece of paper 

draw two columns. In the fi rst 

column write down an irrational 

belief; one that caused you to 

become overly upset about a 

situation, person, or task. In 

the second column, write down 

the more realistic response that 

would make you feel better about 

the situation.  The table below 

includes some common examples.

Automatic Thoughts

Realistic Responses

My performance was terrible – 

I’ll never be any good at this.

(black & white thinking)

It’s awful not feeling completely 

confi dent about my skills but I know 

I’m learning and that things will 

gradually get better.

I can’t fi nd anything I like about 

working here.  Nothing goes right. 

(fi ltering)

There are some good days and bad 

days in every job. Today is one of 

the bad days, but not all my days 

are bad.

Nothing goes right for me.  

(overgeneralising)

Things don’t always go perfectly 

but then again they don’t always 

go wrong.

I know everyone in the team thinks 

I’m an idiot.

(mind reading)

No one has said that I am useless.  

Everyone is actually really friendly 

and supportive.

Things are only going to get worse.   

(fortune telling)

No one knows the future but I know 

I have coped with worse things in 

the past.

I haven’t been given the shifts I 

asked for because she hates me.  

(personalising)

Sometimes I get the roster I ask 

for, so maybe she doesn’t hate me 

afterall.

 

23




Step 1:  My irrational belief/thought (ie an irrational or unreasonable 

response to a situation):

____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________

Step 2:  Prove it. Where’s the evidence that my belief is true?   

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________

Step 3:  Is there evidence that my belief is false?

____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________

Step 4:  Write down what you did (how did you behave or feel following your 

irrational thoughts/beliefs?)

____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________

now try this:

24



Step 5:  Now answer the following questions.

Did your behaviour solve the problem in the short term? 

Yes

________________________



 No

________________________

Did your behaviour solve the problem in the long term?

Yes


________________________

 No


________________________

Did your feelings help you to think clearly. 

Yes

________________________



 No

________________________

Did your feelings help you to deal with the upsetting event?

Yes


________________________

 No


________________________

Are your emotions and behaviours helping you or hurting you?

Yes

________________________



 No

________________________

Step 6:  What good things will happen to me if I give up my belief?

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

By developing emotional self-management, you will be more able to 

handle stressful situations and think more clearly about your problems.

1. Activating event (A) – What is the problem, be specifi c

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

2. Consequences (C) – Negative behaviours and stress emotions/feelings 

(eg anxious, depressed) 

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

25



3. Beliefs (B) – Irrational, false thoughts – the things you said to 

yourself following the activating event (A) (eg: Everything is so unfair.)

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

4. Goals – How I would like to feel and behave

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

5. Rational beliefs – Sensible and true statements

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________

Reinforce your preferred beliefs.  With practice, make them 

part of you. Do this regularly and ask yourself: 

•  What truth is there in my thinking?

•  What is the evidence?

•  Will thinking like this help me?

•  How else could I think about this?

•  Where is it written that it must be so?

•  Is my belief desirable or essential?

•  What is the worst thing that could happen to me?

•  What can I do if that happens?

26



Relaxation is a skill. With frequent 

practice you will improve these 

skills to control your emotions and 

improve your physical well being.   

These techniques can be practiced 

either day or night to assist you to 

relax and feel in control.  It is really 

important to practice regularly.  

Slow breathing technique

This is useful if you start to over 

breath and when you are feeling the 

fi rst signs of anxiety or stress.   You 

are required to do the following:

1.   STOP what you are 

doing and sit down. 

2.   Hold your breath and 

count to 10.

3.   When you count to 10 

breathe out and say the 

word “relax” to your self in 

a calm soothing manner.

4.   Breathe in and out through your 

mouth, focus on your breathing. 

Breathe in for 3 seconds and 

relaxation 

techniques

27



out for 3 seconds. Repeat 

saying “relax” to your self 

every time you breathe out.

5.   At the end of each minute hold 

your breath for 10 seconds 

and then continue the 6-

second breathing cycle.

6.   Continue doing this breathing 

cycle until all of your 

symptoms of over breathing 

are gone and you feel relaxed 

and back in control.

Muscle relaxation technique

This technique involves you using 

your slow breathing technique 

in conjunction with muscle 

relaxation. This can be practiced 

any time. The more you practice 

the easier it will be to achieve 

total relaxation and also the 

duration of feeling relaxed and 

being stress free will last longer. 

1.   Sit down in a comfortable chair 

in a quiet location without 

disruption or distraction. 

2.   Make sure your body, feet and 

arms are supported, feet in 

front of you, arms by your sides.

3.   Focus on the tension in 

your body or muscles.

4.   Breathe in and out slowly 

and deeply, at your own 

pace until you settle.  If you 

feel your anxiety rise start 

again by holding your breath, 

focus on your breathing.

5.   Breathe in for 3 seconds 

and out for 3 seconds. In 

through your nose, out through 

your mouth saying “relax” 

to your self-every time you 

breath out. As you say the 

word relax allow the tension 

go from your muscles.  

6.   Close your eyes. Continue 

breathing in through your nose 

and out through your mouth 

saying “relax” to your self-

every time you breath out.   

7.   Repeat this process until 

you feel relaxed and practice 

it a few times a day. 

28

relaxation techniques




Although we cannot avoid stress, we 

can learn to deal with it effi ciently, 

adjust and live with it, rather 

than letting stress overwhelm us 

and effect our quality of life.

Try to:


1.   Keep things in 

perspective, prioritise

2.   Share your worries with 

family and friends

3.   Increased knowledge helps to 

alleviate fears – clear up any 

misconceptions and give yourself 

the tools and resources to cope.

4.   Don’t be too hard on yourself

5.   Worry does not solve anything, 

try to confront your problems 

and make plans to solve them.

6.   Set realistic goals

7.   Exercise regularly and eat 

healthily

8.   Practice relaxation techniques

9.   Have fun with your family 

and friends, think positive 

and enjoy new experiences

10. Remember: it is normal 

to have setbacks – they 

can be overcome.

10 things every 

nurse should do 

29



Employee Assistance Programs

Every Area Health Service has 

an EAP program available free of 

charge to its employees.  Many 

of these services provide free 

access to external providers.  

Contact your Area administration 

offi ce for contact details.

General Practitioner

Maintain regular contact with your 

GP and be sure to discuss any 

concerns you may have with your 

doctor. Your doctor will also be able 

make appropriate referrals to assist 

you with your recovery such as:

• Anxiety Clinics

• Counselling Services

• Relaxation and Stress 

management Courses

•  Health Promotion Units

useful contacts

30



There are also now a number of 

allied health services covered by 

Medicare.  Your GP may be able to 

refer you to a health professional for 

sessions rebatable under Medicare.

Local Community Health Centre

Contact your local community 

health centre (white pages, 

under “community health”)

Alcohol & Drug Information 

Service (ADIS) 

24 hr advice

1800 422 599

Beyond Blue

www.beyondblue.org.au/index.aspx

beyondblue is a national, 

independent, not-for-profi t 

organisation working to address 

issues associated with depression, 

anxiety and related substance 

misuse disorders in Australia. 

Black Dog Institute

www.blackdoginstitute.org.au

Welcome to the Black Dog 

Institute, a clinical, research 

and educational body dedicated 

to improving understanding, 

diagnosis and treatment of 

depression and bipolar disorder

Bush Crisis Line 

www.bcl.org.au

1800 805 391

A 24 hour crisis line that provides 

confi dential telephone support 

and debriefi ng services to rural 

and remote practitioners.

Centre for Cognitive Behaviour 

Therapy


www.ccbt.com.au

DepressioNET

www.depressionet.com.au 

Information, help and support for 

people who have Depression 

St. Vincent’s Anxiety 

Disorders Clinic

www.crufad.org

New South Wales 

Nurses Association

www.nswnurses.asn.au

1300367962

8595 1234

31



From Thought to Action: 

A self-help manual, (2nd ed) 

– Dr Antony Kidman, 2001

Feeling Better: A Guide to 

Mood Management 

– Dr Antony Kidman, 1999

Change Your Thinking 

– Sarah Edelman, 2003

Three minute Therapy: Change 

your thinking, change your life 

– Michael R. Edelstein, 1997  

What you can change and 

what you can’t 

– Martin EP Seligman, 1994

A New Guide to Rational Living 

– Albert Ellis and Robert 

A. Harper, 1975.

Wellness At Work – Building 

Resilience To Job Stress 

– Valerie 0’Hara, 1995

recommended 

reading


32


1  Stress Management for Dummies (1999) Allen 

Elkin, IDG Books Worldwide Inc, California.

2  This section adapted with permission from Occupational 

Health and Safety Essentials for Nurses, WorkCover 

NSW, NSW Nurses’ Association, 2004.

3  Statistical Bulletin 2000, WorkCover 

NSW, www.workover.nsw.gov.au

4  Employee Assistance Programs: NSW Health Policy 

and Better Practice, NSW Health, March 2005.

5  Mimura C & Griffi ths P (2003) The effectiveness of current 

approaches to workplace stress management in the 

nursing profession: an evidence based literature review, 

Occupational and Environmental Medicine, Jan (60)1.

6  Kirkness, A & Grochulski, A (2001) “Living with an Implantable 

cardioverter defi brillator” Royal North Shore Hospital and 

Community services (Reproduced in part with permission).

7  The RET resource book for Practitioners. Michael. 

E Bernard and Janet Wolfe, editors. New York, N.Y: 

Institute for Rational Emotive Therapy, 1993.

33



notes


35


notes



Stress

Management




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