Skills help you cope with change
Simple exercises keep stress in check
The health care delivery system looks nothing like it did during the dawn of case management in the 1970s, when fee-for-service ruled supreme. Managed care dictates that case managers learn to do more with less and still maintain quality of care. And trying to do a good job in this new environment is causing case managers a great deal of stress, says Priscilla A. Bright, MPH, founder and director of Bright Initiatives in Oceanport, NJ.
"To reduce or combat stress, you need to have simple techniques you can use every day throughout your life. How many resolutions to take better care of yourself have fizzled because they were too elaborate and you couldn’t work them into your daily routine?"
The stress case managers experience comes when their desire to try to fix everything collides with the knowledge that they can’t, Bright says. "That problem is complicated by the fact that case managers, like most caregivers, are much better at taking care of others than taking care of themselves."
Most stress comes from either an event in the day just past or anticipation of an event in the future, Bright says.
The first step in managing stress is to understand your reactions to it, she explains. "Each person has an individual profile of how they experience stress. You must become aware of your own personal reactions in order to manage them effectively," she says.
The body’s physiological reaction to stress includes increases in blood pressure, breathing rate, heart rate, metabolism, and muscle tension, Bright says.
Also, these warning signs may indicate you’re living with too much stress:
• chronic fatigue;
• frequent colds or flu;
• headaches;
• indigestion;
• lower back pain;
• ringing in the ears;
• restlessness;
• problems sleeping;
• racing heart;
• anger;
• anxiety;
• crying;
• boredom;
• feeling of powerlessness;
• feeling trapped;
• frequent worry;
• mood swings;
• unhappiness.
Case managers also may exhibit behaviors that indicate they are under stress. Bright says those behaviors include:
• accident proneness;
• avoiding responsibilities previously enjoyed;
• constant striving for perfection;
• frequent forgetfulness;
• inability to make decisions;
• neglecting appearance.
"Case managers have strong intuitive abilities to heal or care for others. What case managers must learn to do is use some of those marvelous, healing, nurturing, intuitive senses for themselves," Bright says.
When it comes to successful stress management, the key is to stay focused on the present and physically connected to yourself, she says. "Mindfulness is a healthy exercise for dealing with daily stress. It involves being fully aware of the present moment and letting go of all other distractions. The present rarely has stress in it. And even if the moment is stressful, if there is a difficult client in the room with you or on the phone, blocking out distractions, such as family or co-workers, and focusing on the moment will help you deal with that stress more effectively," she says.
Other simple techniques Bright suggests case managers practice include breathing relaxation and progressive muscle relaxation. "With practice you can reach a relaxed state in a matter of minutes and practice these exercises all day long to reduce your stress," she says. "You can do these exercises in the elevator, in your car in the parking lot, on while you sit at your desk."
Her breathing relaxation exercise takes one minute and includes the following steps:
• Sit with your feet flat on the floor. (This also can be done standing.)
• Close your eyes.
• Inhale to the count of four, breathing in through your nose, and expand first your lower abdomen, and then your chest.
• Hold your breath for a count of four.
• Exhale through your mouth to a count of eight, making a blowing sound.
• Repeat three times.
• Sit quietly, feeling the relaxation. When ready, open your eyes slowly.
Progressive muscle relaxation is more involved and takes about three minutes to achieve, Bright says. The steps include:
• Place your feet flat on the floor.
• Close your eyes.
• Feel the soles of your feet on the floor and the weight of your body in the chair.
• Tense the muscles in your feet for five seconds, then release the muscles as you breathe out. Allow the feeling of relaxation to flow into the muscles as you exhale. Take two breaths before moving on to the next muscle group.
• Repeat the same process for each muscle groups, including the calves, thighs, abdomen, shoulders, hands, and face.
• When finished, sit comfortably with your eyes closed and become aware of the feeling of relaxation in your body.
These exercises are simple enough that with practice, you can use them in many situations, Bright says. For example, if dealing with clients’ families is stressful, spend a moment before you talk with them to center yourself with a breathing exercise, she suggests.
"If dealing with your children at the end of a long day at work is stressful, take a moment to sit in your car and do the muscle relaxation exercise in the parking lot before you drive home. It will help you feel a bit refreshed before you get home. Relaxation is a very healing feeling, and as you practice relaxing, it will become easier and faster for you to relax."
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