Care for the Caregiver
Nursing Students Learn to Mange Stress in a Demanding Profession
Every day Ashleigh Tondo juggles the daily challenges of school, work and a social life. She
goes to class up to five hours a day two days a week, and works twelve hours at the hospital
one day a week. Somewhere amongst all the chaos, she needs to find time to spend with her
family and friends. Her life is anything but easy. Stress is a constant feeling. She strives to
be the best of the best, for the word ‘average’ is not in her vocabulary.
Tondo is an accelerated master’s nursing student. The expectations she and her fellow
classmates are held to are unlike those of any other student. Her work ethic and dedication
is what got her to where she is today. Tondo is living her ultimate dream working as a
nurse, and only wishes to pursue her career further. She is put under a lot of pressure
caring for her patients. Being responsible for another person’s life can get over whelming.
As a nurse it’s in her nature to put her patients before herself. But what happens when the
caregivers forget to care for themselves? Nurses need to eat well, make exercise a priority,
get adequate sleep and make time to relax as much as everyone else, possibly even more so
due to the nature of their work.
Because of the inherent stresses in the nursing profession, many leave the health care field
all together, creating vacancies in hospitals that could cost up to $64,000 annually per
nurse in turnover costs. This, in the midst of a looming nursing shortage, retaining trained
nurses has never been more important.
Blazing the Trail
Kent State University’s College of Nursing recognizes the dire need to attract qualified
people to the nursing profession and to do all it can to help retention rates. It is committed
to making a change to sustain the field of nursing, and its nurses, through education. The
College of Nursing is blazing the trail with research and innovative training for its nursing
students with the stress-management techniques of Urban Zen – a project of Donna Karen,
of Donna Karen New York (DKNY). Urban Zen combines the techniques of Reiki, a Japanese
method of massage, yoga and breathing techniques. Losing her husband, Steven, and a close
friend, Anne Klein, to cancer moved Karen to start Urban Zen. To Karen, these techniques
served as powerful alternative therapies that brought solace, comfort and stress relief to
her loved ones.
In her journey as a caregiver, Karen recognized the difficulty and anxiety involved in trying
to care for oneself while caring for others. This is where the College of Nursing’s Care for
the Caregiver Program enters for students in the Accelerated Bachelor’s of Science in
Nursing (ABSN) program at Kent State. These students already possess a bachelor’s degree
and are pursing nursing as a second degree in the ABSN Accelerated BSN program. This
group represent non-traditional students in that they already have worked a professional
job, are juggling families and continue to work full-time in professions such as sports
medicine, nutrition, biology, all while working toward their nursing degree. This is the
group of nursing students selected to pilot the Care for the Caregiver Program and the first
to be taught the skills and practice of Urban Zen.
Tondo was one of those students who were able to participate in the program.
“I got a lot out of those classes,” said tondo. “ It focuses a lot on yourself which most of us
forget to do sometimes.”
Tondo said she didn’t realize how important it was for her to take care of herself until she
participated in Urban Zen.
“As a nurse you can get over whelmed with five different patients, different medications,
doctors orders and if you make one wrong move you can kill someone,” said Tondo. “You
need to be able to take care of yourself in order to take care of patients.”
Now, in the research study’s second year, the Urban Zen Integrative Therapies will be
shared with nursing students at Cleveland State and Ursuline College to expand the
College’s research base and understanding of the effects of teaching self-care and wellness
strategies to nursing students.
Stress Management Through Mindfulness The self-care practice is about learning to be
aware or “mindful” in order to focus, clear one’s mind and be present in the situation you
are in. Being “present” is about focusing one’s mind on nothing but the situation and task at
hand. Tracey Motter, senior undergraduate program director, coined it as: “Learning to live
for the moment and let go of the baggage.”
But Motter and the College of Nursing realize that for many nurses, letting go is not as easy
as it sounds. However, the researchers recognize the College’s unique opportunity to lead
the way in nursing education with an innovative approach to practice that deems stress
management skills equally as important as the skills required to inject their first shot.
Last year was the first phase of a three-part research project by the College of Nursing. The
goal of the first phase of research was to expose 30 accelerated nursing students to the
techniques of self-care and wellness using Urban Zen techniques to identify the effect on
their perceived stress level, or the students’ self-assessment of the intensity of their own
stress. Motter based the study on the mindfulness awareness scale. The Mindfulness
Awareness Attention Scale Developed by Brown and Ryan measures if the student's ability
to be mindful "focus on the moment" is increased practicing the self-care modalities of
meditation, body scanning, yoga, Reiki, and/or aroma therapy.
The results of the initial phase of research showed that for the students that received selfcare training, perceived stress remained the same. However, for students in the control
group who did not receive the training, perceived stress increased. The students trained by
the Urban Zen Integrative Therapists used the techniques to manage stressful situations
and maintained the same level of stress throughout the semester, rather than allowing
their stress to increase.
The second phase of research, conducted this past academic year, incorporated students
from both Cleveland State University and Ursuline College nursing programs using the
same measures on a wider range of students from public and private local universities. The
third and final phase of the research will be conducted in the 2012-013 academic year.
Hard biological data of students’ stress levels in simulated clinical settings will be collected
and analyzed. In each phase of this research study the aim is to see if students with
training in the Urban Zen practice employ the techniques and if, as a result, have lower
stress levels in clinical situations by measuring pulse rate and blood pressure after
simulated clinical settings.
Nurses who understand the benefit of self-care and wellness strategies will care for
themselves and their patients better. Breathing techniques and an increased focus on the
situation at hand means that nurses will make less mistakes, according to Motter.
Micheal Dota, another accelerated nursing student who also experienced Urban Zen,
understands the importance of being ”mindful” when taking care of a patient.
“Your patients feed off your emotions,” said Dota. “They can tell if you’re in a bad mood,
they can tell when you’re happy and they can tell when you want to take care of them,
which means they can tell if you’re taking care of yourself too.”
At this point self-care strategies require evidence-based research in order for these
practices to be incorporated in curriculum. Motter explaines that the research will need to
measure the effectiveness of teaching self-care, outcomes for students, and sustainability.
“Burnout is a pervasive issue in nursing,” Motter said. “We realize we can only educate as
many nurses as we have room for and even though we educate them, if they all stop
working because of burnout in 20 years, its not doing us any good. So how do we help
nurses deal with every day stress?”
Motter believes a holistic approach of self-care strategies will aptly prepare students to
handle both the emotional, physical and mental stress of their careers as nurses and their
lives outside of practice. Kent State nursing students found the practice useful to their
nursing practice. One student said, “I work on a medical surgery floor, caring for a total of
23 patients when the floor is full. It is often stressful do to the load. I practice breath
awareness – deep breathing as I am walking down our hallway and while I am
inputting information into our computer systems. I probably did this a dozen times on
each shift over the last week… it helps.”