Academic Skills for Nursing Practice E-Portfolio (NUR017-1)

This e-portfolio, created for the Academic Skills for Nursing Practice (NUR017-1) module, presents a comprehensive exploration of stress management within the nursing profession. It begins with a literature search, detailing the methodology used to identify relevant research on the impact of stress management interventions on job-related stress among nurses. The search strategy includes the selection of databases (CINAHL and PubMed), the development of search terms, and the application of inclusion and exclusion criteria. An annotated bibliography follows, summarizing and critically evaluating five key research articles on stress management programs, web-based interventions, stress management training for students, mindfulness-based interventions, and the effects of stress management on the quality of nursing care. The portfolio also includes a reflective account of a practice visit, analyzing a personal experience in an aged care residential home where the student encountered a patient with dementia. The reflection uses Gibbs' reflective cycle to examine the student's actions, identify mistakes, and outline plans for future professional development, particularly in managing aggressive patients. The portfolio demonstrates the student's ability to apply academic skills, including literature review, critical analysis, and reflective practice to nursing practice.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Literature search on the nursing topic
Nursing is an occupation that is associated with a high level of stress and paying attention
to stress management intervention is crucial as stress impairs the provision of quality care and
efficiency in care delivery. Stress contributes to burnout, high rate of absenteeism as well as high
nursing turnover. Hence, identifying the degree to which stress management programs can
reduce stress, promote the well-being of nurses and maintain an adequate nurse-patient ratio is
important. The literature review aims to identify the impact of stress management on job-related
stress among nurses and the literature search will focus on identifying the best literature that
fulfils this aim. Any research process starts with the formulation of a good research question and
a good research question is narrowly focused. Framing research question is important to guide
data collection or literature search process too. Thus, the research question for this literature
review is ‘What is the impact of stress management on job-related stress among nurses?'.
A search strategy is a structured and well-thought-out process to search for relevant research
literature and the search process starts with the selection of database and development of search
terms (Anthopoulos 2015). The search for literature will be done in CINAHL and PubMed and
the main rationale for choosing these two databases is that they both publish peer-reviewed
papers from the field of nursing. The search terms were created by taking cues from the research
question. The primary search terms include 'nurse', 'stress' and 'stress management'. Apart from
this primary search terms, several other synonyms were used to broaden the search process and
get more relevant papers. For example, synonyms used for stress included 'occupation stress' and
'job-related stress'. In addition, in place of stress management, other keywords like 'stress
management intervention', 'stress reduction techniques' and 'stress management program' were
also used.

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Apart from the basic search, advanced search filters were also used to get specific papers
relevant to the research question. For example, a publication date filter was used to select the
date from 2010 to 2019 and the language of the article was set to English. In addition, the
Boolean operators like 'AND' were used to combine two search terms so that only those papers
were retrieved which had both the keywords in the search process. Some examples of the
Boolean search included 'Stress management intervention' AND 'job stress' AND 'Nurse'.
Similarly, the 'Stress management program' AND 'reduction in stress in nursing was used'.
To ensure that unnecessary articles in the search process are excluded and the most
relevant papers related to the research question are retrieved, inclusion and exclusion criteria for
article selection were also developed. The following is the inclusion and exclusion criteria for
article selection:
 Only those articles were selected which reported about stress management interventions
 The search population for all the studies must be nursing staffs or nursing student
 All the studies must report about outcomes after implementation of the stress
management program
 No other employees other than nurses will be included in the review
 All articles must be published within the past 10 years
 Only articles published in English will be included
The paper retrieved after entering the search terms will be screened based on the above
inclusion and exclusion criteria and papers will be confirmed for this literature review after
full-text review of each article.
Annotated bibliography on the nursing topic

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This section provides an annotated bibliography of the five sources of evidence which is
relevant to the research question:
Hersch, R.K., Cook, R.F., Deitz, D.K., Kaplan, S., Hughes, D., Friesen, M.A. and Vezina, M.,
2016. Reducing nurses' stress: A randomized controlled trial of a web-based stress management
program for nurses. Applied nursing research, 32, pp.18-25.
Hersch et al. (2016) reported a web-based stress management program using a
randomized controlled trial method. The primary outcome measure in this study included
perceived nursing-related stress and secondary measures included job satisfaction, symptoms of
stress and use of the substance. The study revealed a significant reduction in stress for program
group participants compared to control groups. The significance of the program was that it
included cognitive-behavioral techniques as well as relaxation strategies. The study gives the
implication that the cognitive restructuring technique can be successful in replacing
dysfunctional thinking patterns and promoting positive coping among nurses. This intervention
holds promise in improving nurse's skills in managements of stressors in nursing.
Salem, A., Kaabi, A., Al Shehri, B., and Sufyani, R., 2018. Stress management training program
for nursing students in Saudi Arabia. International Research Journal of Medicine and Medical
Sciences Vol. 6(3), pp. 85-90, S
Salem et al. (2018) gave evidence for the outcome of a stress management training
program implemented for nursing students in Saudi Arabia. Utilizing a quasi-experimental study,
the researchers calculated the level of stress before training and after training. The results of the
study revealed that the stress level was high for those nurses who did not take part in the
interventional program. In contrast, nursing students who regularly took part in the stress

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management sessions reported a reduction in stress levels. The findings suggest the significance
of arranging stress management programs for nursing students too so that they become
competent in managing stress. As there is a lack of studies on stress management techniques in-
class setting, this could be the subject of future research investigation.
Nowrouzi, B., Lightfoot, N., Larivière, M., Carter, L., Rukholm, E., Schinke, R. and Belanger-
Gardner, D., 2015. Occupational stress management and burnout interventions in nursing and
their implications for healthy work environments: a literature review. Workplace health &
safety, 63(7), pp.308-315.
A literature review by Nowrouzi et al. (2015) investigating occupational stress
management in nursing and by analysis of many articles, the study suggested mindfulness-based
stress reduction and meditation-based intervention as effective in preventing stress. Some of the
studies were limited by small sample size, however, the evidence gave strong points to prove the
impact of occupational stress on controlling hostility, aggression, and absenteeism due to stress.
These findings have many policy and practice-based implications as it strongly suggests the need
for nurses and employers to work together to foster career advancement and job satisfaction.
Ratanasiripong, P., Park, J.F., Ratanasiripong, N. and Kathalae, D., 2015. Stress and anxiety
management in nursing students: Biofeedback and mindfulness meditation. Journal of Nursing
Education, 54(9), pp.520-524.
Ratanasiripong et al. (2015) gave an idea about two interventions for stress and anxiety
management among nursing students. The interventions included mindfulness moment
meditation and biofeedback. Mindfulness involved focusing on present feelings and avoiding
destructive thoughts and feelings. In addition, biofeedback included a non-invasive intervention

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where feedback was given on physiological responses from a mechanical device and the
individual learns to modify their behavior accordingly. By the comparison of the impact of the
two interventions, the study revealed that biofeedback could improve anxiety levels and
mindfulness decreases both anxiety and stress. Nurse educators must focus on integrating such
intervention programs into the educational curriculum so that nursing students can positively
overcome stress.
Pahlavanzadeh, S., Asgari, Z., and Alimohammadi, N. 2016. Effects of stress management
program on the quality of nursing care and intensive care unit nurses. Iranian journal of nursing
and midwifery research, 21(3), 213–218.
The significance of the randomized controlled trial by Pahlavanzadeh, S., Asgari, Z., and
Alimohammadi (2016) is that it gave robust evidence for the efficacy of stress management
program on the quality nursing care of the ICU nurses. The intervention group received 10
sessions of stress management intervention and the control group received placebo sessions.
After the collection and analysis of data related to the Quality Patient Care Scale, the study
demonstrated a high quality of care among the intervention group. Apart from the reduction in
stress, as this evidence shows the impact of stress management on quality of care, it is
recommended that nursing leaders take additional efforts to integrate stress management
programs for ICU nurses in professional development activities.
A reflective account of learning from practice visit:
What?
In nursing practice, I have learned many important nursing lessons on a practice visit. As
part of my nursing placement, I had to go to an aged care residential home for the care of a

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person with dementia. I was given the responsibility to conduct a mental assessment of the client
and orient the patient to her environment because she had a memory problem. Based on my
knowledge regarding various scale for mental assessment, I completed this process and the
process was completed smoothly. However, to ensure comfort for the student and assure that the
patient gets a comfortable environment, I tried to introduce the patient to other patients in the
ward. This particular behavior of mine triggered violent aggression and the patient started crying
and pushing everyone away. As I had no experience in managing aggressive patients, I was
startled and controlling the patient initially became a daunting task for me. I managed to make
the patient calm after taking advice from my senior colleagues.
So what?
On looking back at the experience, I feel that my action was not appropriate at many
points. The first and foremost mistake was that I did not take the patient's permission before
attempting to start a conversation with other people in the ward. This is important because as per
the NMC standards of practice for registered nurses, it is crucial for them to take consent from
the patient before treatment and address any personal and external factors that could influence
planning intervention for the patient (NMC 2018). Hence, with this mistake, I developed the
understanding that no matter how minor an activity, I should always take permission from the
patient before starting any treatment.
After encountering the aggression of the patient, I also came to learn about factors that increase
the aggression of staff. I tried to distract the patient from cognitive disturbance by engaging the
patient in conversation. However, my judgment was wrong because I did not go through the
medical history of the patient. I assumed that memory loss and behavioral change was the only

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change in such a patient. I was not aware that the patient was aggressive during social situations
and preferred staying alone. Post the event, I searched for factors contributing to aggression in
dementia patient and I learned that no single factor determines this behavior. Dementia patients
can be aggressive because of pain and also because of unmet psychological needs such as
hunger, sleep, and thirst. They may also get agitated because of the long period of withdrawal
from social activities and lack of access to familiar people (Morgan et al., 2012). Hence, the
lesson for me was that since the patient avoided social gathering, I should have considered the
past medical history before engaging in such initiative. I also learned unfamiliarity with the other
patient made her aggressive too.
Now what?
Since I failed in controlling the aggression of the patient and my seniors had to intervene
to control the aggression of patients, I have planned to develop my skills in this area. I have
decided to take in continuous professional development training for aggression management in
mentally ill patients and learn more about ways to deal with aggressive patients in the ward.

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References:
Anthopoulos, L.G., 2015. Understanding the smart city domain: A literature review.
In Transforming city governments for successful smart cities (pp. 9-21). Springer, Cham.
Hersch, R.K., Cook, R.F., Deitz, D.K., Kaplan, S., Hughes, D., Friesen, M.A. and Vezina, M.,
2016. Reducing nurses' stress: A randomized controlled trial of a web-based stress management
program for nurses. Applied nursing research, 32, pp.18-25.
Morgan, R.O., Sail, K.R., Snow, A.L., Davila, J.A., Fouladi, N.N. and Kunik, M.E., 2012.
Modeling causes of aggressive behavior in patients with dementia. The Gerontologist, 53(5),
pp.738-747.
NMC 2018. Future nurse: Standards of proficiency for registered nurses. Retrieved from:
https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-
proficiencies.pdf
Nowrouzi, B., Lightfoot, N., Larivière, M., Carter, L., Rukholm, E., Schinke, R. and Belanger-
Gardner, D., 2015. Occupational stress management and burnout interventions in nursing and
their implications for healthy work environments: a literature review. Workplace health &
safety, 63(7), pp.308-315.
Pahlavanzadeh, S., Asgari, Z., and Alimohammadi, N. 2016. Effects of stress management
program on the quality of nursing care and intensive care unit nurses. Iranian journal of nursing
and midwifery research, 21(3), 213–218.

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Ratanasiripong, P., Park, J.F., Ratanasiripong, N. and Kathalae, D., 2015. Stress and anxiety
management in nursing students: Biofeedback and mindfulness meditation. Journal of Nursing
Education, 54(9), pp.520-524.