Right from our first encounter, I could tell Mr. James was under enormous stress. As a Nursing officer on duty that night, I had resumed with checking of inpatient folders as part of taking over the shift from the afternoon nursing team; when I noticed a man in his late forties, talking to himself and pacing back and forth between the cash point and the nurses office.
I walked up to him cautiously, trying not to startle him.
“Good evening Sir”, I greeted calmly. He could barely notice me, so I stretched out my hand and touched him by the shoulder. Suddenly he snapped back into consciousness and turned in my direction.
“My name is Nurse Umoh”, I said with a smile, “may I offer you a seat? He quickly obliged and entered the well air conditioned Nurses station and sank into a comfortable chair across the table.
He blasted off another circuitous round of words for the next 30minutes. I sat patiently listening, while scanning through his wife’s medical records. I was nodding empathetically without interrupting him, understanding every atom of his stressful situation.
He was angry at the hospital for the seemingly outrageous bill he was presented with, as fee for his wifes treatment. His wife, a 28-year-old unemployed mother of four boys, (ages between 2 and 8 years), was 32 weeks pregnant with the fifth boy. She had been hospitalized for the second time that month and this time, according to laboratory investigations, she had malaria and anemia in pregnancy.
She had been duly managed and discharged, but yet to settle a pending thirty-three thousand naira (N33,000.00) hospital bill. From what I could gather, Mr. James had earlier had a row with his wife at the pharmacy. He had screamed at his wife, accusing her of defying his orders and gone ahead to seek medical care at the hospital. She was supposed to have waited till her next antenatal visit. But in actual sense, she had made the right decision. It wasn’t her fault that she had been sick, her young body was worn out. Mr. James on the other hand didnt want any form of birth control. He said his culture didnt permit him to indulge in the practice. This decision was obviously taking a toll on his family and his finances.
It was January, time to pay house rent, school fees, prepare for child birth, pay electricity bills, tend to demands from extended family members, buy food stuff, queries for absenteeism at work; and for Mr. James an average employee working in a private firm in town, the stress on him and his finances, was overwhelming.
I offered to check his blood pressure, and found it elevated. So I explained to him what was going on in his body, how stress can affect all the systems of the body and eventually every aspect of our lives, including our emotions, behaviors, thinking ability, and physical health. No part of the body is spared. But, because people handle stress differently, symptoms of stress can vary significantly.
According to www.webmd.com an online medical journal, “Stress is the body’s reaction to harmful situations, whether they’re real or perceived”.
When our bodies feel vulnerable, a chemical reaction occurs in our bodies that allows us to act in a way to prevent injury. This reaction is known as “fight-or-flight” or the “stress” response.
Symptoms most times are elusive, poorly understood and may be the same as those caused by medical conditions, hence, grossly misinterpreted. Some people may become easily agitated, frustrated and moody. The feelings could be overwhelming, like losing control or need to take control when in a difficult situation. In some extreme cases, it contributes to low self-esteem, loneliness, worthlessness, and depression which can lead to avoiding others and eventually suicide.
According to www.mayoclinic.org, “stress consumes our energy; causes headaches; upsets the stomach with symptoms like diarrhea, constipation and nausea; instinctively our bodies experience aches, pains, tense muscles, chest pain and rapid heartbeat.”
The body gradually loses sleep, subjected to frequent colds and becomes susceptible to infection; loss of sexual desire and/or ability; nervousness and shaking, coupled with all these symptoms.
www.mind.org.uk posits that, “our minds are constantly worried, racing thoughts, forgetfulness, disorganization and inability to focus, poor judgment, being pessimistic or seeing only the negative side further impedes our problem solving abilities.”
As time passes there are changes in appetite, either not eating or eating too much, procrastinating and avoiding responsibilities increased use of alcohol, drugs, or cigarettes exhibiting more nervous behaviors, such as; fidgeting and pacing etc.
Agreeing with www.gostress.com, sources of stress can be grouped into six including;
significant events stress.
Mr. James’ situation was a combination of little portions of all the sources of stress. However, a healthy life doesnt necessarily mean the absence of stress but implementation of an effective coping mechanism. Whatever the source of stress, there are certain steps to managing it.
How then can we manage activities of daily living and avoid a full blown stressful situation? here are a few tips to observe. However, in managing stress, one must understand the sources of stress (stressors).
1. TAKE CONTROL OF YOUR LIFE
Stress can be prompted by problems that naturally seem impossible to solve. Mr. James’ case was compounded by culture and religion. According to him, birth control is a taboo where he comes from. Hitherto, his wife put to birth after every year. No solid family planning or proper child spacing. With regards to the current economic situation of the country, producing four children, within a period of eight years, is overwhelming, even for the rich. Proper family planning would have averted his current situation.
However, learning how to find solutions to his problems would help him feel more in control, thereby lowering his stress level. Planning is a key ingredient in taking control of activities of daily living. Lifes situation can be grouped into events and activities. One problem-solving technique involves writing down the problem and coming up with as many possible solutions as one can. Decide on the pros and cons of each one and select the best solution. Write down each step that you need to take as part of the solution: what will be done, how will it be done, when will it be done, who is involved and where will it take place.
2. MANAGE YOUR TIME WELL
According to www.mentalhelp.net, Sometimes, we all feel overburdened by our To Do list and this is a common cause of stress. In as much as diarizing your task is a way of keeping track, you have to also accept that you cannot do everything at once and all by yourself. This is where prioritizing and delegating would come in. Compose a log of all the things that you need to accomplish and arrange them in order of honest importance. Be mindful of what tasks you need to do personally and what can be delegated to others to do. Record which tasks need to be done straightaway, subsequently or when time allows.
By elimination what started out as an overpowering and insurmountable task list, will be broken down into a series of smaller, more manageable tasks spread out over a longer time frame, with some tasks removed from the list entirely through delegation or using the concept of a micro economic theory, the opportunity cost.
Think of creating buffer times to attend to unexpected and emergency tasks, and to include time for your own relaxation and well-being as well.
3. EAT HEALTHY AND LEAD A HEALTHY LIFESTYLE
I suppose “You’re what you eat, might not literally be true, but our nutrition provides energy and protection to our bodies. Mr. James wife was already anaemic, which tells a lot about the nutritional status of the family. To make matters worse, he consumed a lot of alcohol, in an attempt to wade off the stressful situation and enjoy the temporary euphoria. Unknown to him to effectively tackle stress, avoiding or at least reducing consumption of alcohol, caffeine and nicotine would help. Life style modification is a must in stress management. That’s the only way to prevent relapsing.
Consuming products that contain nervous system stimulants, would only increase your level of stress rather than reduce it. Alcoholic drinks depress the system when consumed in large quantities, but it arouses the central nervous system in smaller quantities. Therefore, using alcohol as a way to alleviate stress is not ultimately helpful.
Avoid deteriorating the situation, take decaffeinated coffee, nonalcoholic drinks, water, herbal teas, or diluted natural fruit juices with the intention to keep yourself well hydrated as this will enable your body to survive better during stress. Reducing your intake of refined sugars – contained in many processed foods – will help, as energy boost linked with it will make you to feel tired and irritable. Take fresh fruits and lots of vegetables instead. Generally, try to eat a healthy, well balanced and nutritious diet.
4. DO MORE PHYSICAL ACTIVITIES/EXERCISE
Our bodies release massive amount of stress hormones, such as, adrenaline and cortisol during stress. As said earlier, these are “fight or flight chemicals. but as humans, we have evolved. Stress in the modern age is rarely resolved by a fight or flight response. For an average worker in the city, like Mr. James, time to exercise is a luxury. Physical exercise can help our bodies to breakdown these excessive stress chemicals produced by our bodies during stress and restore our bodies and mind to a calmer and more relaxed state.
During an acute phase of stress, going for a brisk walk for fresh air or joining a local football team could help. Mr. James flippantly shrugged I walk through traffic every day, then I climb the stairs to my office when at work, do I still need exercise? Yes, was my answer. Try to incorporate some physical activities into your daily routine on a regular basis, either before or after work, or at lunchtime; considering there is a big difference between passive and active exercise. Consistent physical activity will also enhance the quality of your sleep.
5. SLEEP DEEPLY AND FOR MORE HOURS
To a large extent, poor sleep causes stress. Conversely, stress also prevents our bodies from good sleep as thoughts keep spiraling through our heads, stopping us from relaxing enough to fall asleep. Mr. James resorted to medication (sleeping pills). That was a poor solution as the use of medication to induce sleep, may lead to drug dependence. Aim to maximize your relaxation before going to sleep. Make sure the environment is conducive and devoid of other stressors.
How can you get a good sleep listening to the groaning sounds made by a neighbor’s generating set (I pass my neighbor)? The use of a headset is recommended. Listen to a cool soothing music instead. Stop any brainstorming activities several hours to bedtime so that you’ll give your brain time to settle.
Try taking a warm bath, then, read a calming and undemanding book for a few minutes. This will relax your body. Resting your eyes, focusing your attention will help you relax. It will help forget about the things that worry you. According to www.webmd.com, sleep experts suggest, “going to bed at roughly the same time each day, helps our minds and bodies get used to a predictable bedtime routine”.
6. TALK TO SOMEONE ABOUT YOUR STRESS
In the big cities nobody seems to care about the other person’s predicament. Talking to someone might be difficult but it works, even if the person is a stranger. Simply expressing your feelings can be helpful. It doesn’t necessarily mitigate the problem immediately, but its a step in the right direction. Like the popular saying goes, a problem shared is half solved.”
Talking can work by either distracting you from your stressful thoughts or releasing some of the built-up tension by discussing it. Talking, gives you more insight about your stressors or stressful event, thereby helping you understand the situation more. However, stress can put a veil on your judgement and prevent you from seeing things clearly. Talking things through with a close friend, colleague, or even a trained professional, can help you find solutions to your stress by putting your problems into perspective.
7. LEARN TO SAY NO AND AVOID ADDITIONAL STRESSORS
A mutual cause of overwhelming stress is having too much to do and too little time to accomplish it. Atypically, Mr. James would agree to take on additional responsibilities. Learning to say No, to additional or unimportant requests will help to reduce your level of stress, and may also help you develop more self-confidence.
Learning to say No in our clime might be difficult. Its cultural in Africa to cater for members of your extended family, some connections lengthening into generations of family ties and therefore further compounding the problem. Many people like Mr. James find it hard to say No because they want to help and are trying to be nice and to be liked. For others, it is a fear of conflict or rejection. Not being able to say no is self-inflicted. Practice to say no when necessary, itll cut down your stress levels and improve health.
8. TAKE A SICK LEAVE AND REST IF YOU ARE ILL
Finally, if you are feeling unwell, with or without symptoms, do not feel that you have to carry on regardless. Momentarily, rest will enable the body to recuperate faster. Don’t take those little activities of daily living for granted, allowing stressful activities to pile up isn’t healthy. Take time out to face life’s challenges head on and avoid an overwhelming stressful situation.
Stress is just the way our bodies respond to Lifes ups and downs. Just like the reading of the ECG machine, it indicates the presence of life. Stressors are drawn from our environment, be it social, financial, organizational, physiological or psychological. As a nurse, my task is to care for others in need. The task in itself is stressful; but thanks to nursing education and increasing knowledge through practice, I have the right problem solving tools to cope. To some it may not sound so noble, but helping those in need, is not particular to just nursing. Helping others in need comes with a boost to ones mood and a profound feeling of accomplishment.
Conversely, helping others in obvious stressful situation does not require a Registered Nurse Certificate or a nursing degree. To reduce the burden of stress in our society, we need to be sympathetic, sensitive and show empathy to others. Coping with stress is entirely dependent on effective stress management. Taking charge of your life, managing your time well, eating a healthy balanced diet, leading a healthy lifestyle, more physical exercise, good sleep, talking to someone, adequate rest and learning to say no, cannot be over emphasized.
Mr. Jamess case could actually progress into depression if his stress coping mechanism fails. Clinical depression is more serious and long-lasting than stress, the resultant effect being an increase in the number of suicides recorded in Nigerian today.
Written By UMOH UKEME ELIJAH