Essentials of Nursing Leadership and Management, 5th Edition

chapter 13 | Work-Related Stress and Burnout 199

She was afraid that she would miss something

important and that the patient would die during

the admission. The more experienced nurses

seemed to handle each admission with ease, even

when the patient’s physical condition was severely

compromised.

Selye also differentiated between “good” stress and
“bad” stress. In 1974, Selye stated: “Stress is the
spice of life. Since stress is associated with all
types of activity, we could not avoid most of it
only by never doing anything” (Lenson, 2001,
p. 5). Good stress can push people to perform bet-
ter and accomplish more. What makes an event

“good stress” or “bad stress”? Lenson identified

seven factors:

1.People can exert a high level of control over the

outcomes of good stresses. With bad stresses,

there is little or no control.

2.Positive feelings are experienced in processing

good stress. With bad stress, negative or

ambivalent feelings occur.

3.Good stress helps achieve positive goals. No

desirable outcomes occur with bad stress.

4.There is a feeling of eagerness when anticipat-

ing the work that needs to be done to process

the good stressors.

table 13-1

Stress Continuum

Eustress Distress Severe Distress

Psychological

Physiological

Individual response

Adapted from Martin, K. (May 1993). To cope with stress.Nursing 93, 39–41, with permission; Goliszek, A. (1992). Sixty-Six Second Stress Management: The

Quickest Way to Relax and Ease Anxiety.Far Hills, N.J.: New Horizon; and McVicar, A. (2003). Workplace stress in nursing: A literature review.Journal of

Advanced Nursing, 44(6), 633–642.

Fear/excitement

Autonomic nervous system

response: increased blood

pressure/heart rate;

increased metabolic rate;

release of cortisol; quicker

reaction times

Adaptive

Increased alertness

Focus totally on the situation

Able to respond to changes

quickly

Callousness

Energized for fight or flight

preparation

Feelings of uneasiness, appre-

hension, sadness, depression,

pessimism, listlessness

Lack of self-esteem

Increased level of arousal/

mental acuity

Negative attitude

Increased use of alcohol/

smoking/drugs

Decreased interest in sexual

activity

Procrastination/unable to

complete tasks

Prolonged elevated blood

pressure/pulse

Indigestion

Bowel disturbances

Weight gain or loss

Reduced immunity

Fatigue/low energy

Poor sleep habits

Headache

Trembling hands, fingers, body

Dry mouth and throat

Varies among individuals but

usually maladaptive

Absenteeism

Apathy

Cynicism

Defensiveness

Burnout

Emotional exhaustion/

depersonalization and

disengagement

Isolation

Clinical hypertension

Coronary artery disease

Gastric disorders

Menstrual problems

Varies among individuals but

usually severely maladaptive,

possible life-threatening