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Conflict can generate stress, lots of stress. Stress itself has been labeled the disease of the 90's and is certain to continue into the next millennium. The concept of stress can manifest itself in individuals, in the work setting and be carried into the home setting and personal relationships. It further comes as no surprise in these times of reorganization, and a tight and often difficult job market, that stress has been identified as a contributing factor to many health and emotional problems.

But what actually do you know about stress? The following true/false test will shed light on some common misconceptions about stress. Review the ten statements and decide if the answer is true or false. There will not be a score at the end, but explanations will be given for the correct answers.

What Do You Know About Stress?

Answer each statement as true or false.

1. Stress is caused by bad things that happen to you.

2. Nervous tension and stress are the same thing.

3. Stress should be avoided.

4. People who feel stressed are nervous anyway.

5. You always know when you're under stress.

6. Stress is only in the mind; it's not physical.

7. Stress can be eliminated if you know how to do it.

8. Stress can be controlled with medication.

9. Stress can make you miserable, but it can't kill you.

10. The best way to control stress is by avoiding conflict.

Answers

1. False. Stress is not always bad, nor is it always caused by negative events and conflict. Some of the same physical stress responses that are triggered by negative events can be triggered by positive events. For example, making a job change can be very stressful and can trigger all the same responses that a negative life event triggers.

2. False. Stress is not nervous tension. Nervous tension, such as the feeling one gets before one takes a test or makes a presentation in front of a group, is frequently confused with stress, but they are not the same.

3. False. Too little stress can be as counterproductive as too much stress.

4. False. Anyone can experience stress.

5. False. Sometime stress is mild and subtle, so you may not be aware of it, until the symptoms make you aware.

6. False. Stress can lead to many physical problems such as sleeplessness, fatigue, headaches, chest pain and ulcers.

7. False. Stress can be controlled, but not completely eliminated. There is no way to control every stress-inducing event.

8. False. Medication can control some of the symptoms of stress, but it cannot control stress.

9. False. Stress can raise blood cholesterol levels, thereby increasing a person's risk for cardiovascular disease and heart disease. Stress can also contribute to reducing the body's immune system that may result in increased susceptibility to infection.

10. False. Conflict is a fact of life and cannot be avoided. The important thing to remember is how you react to the conflict.

Surprised by all the answers that are false? There are many myths and misconceptions regarding stress, not only in individuals but in the workplace, as well.

Body's Response

The body can respond to stress in many different ways. A few are mentioned below:

„ Hormones and adrenaline are released to increase your energy to ensure faster response.

„ The digestive process shuts down to divert the blood flow to the muscles and brain.

„ Breathing becomes more rapid to send more oxygen to the brain.

„ Increased heart rate and blood pressure ensure that cells have sufficient blood supply.

„ Pupils dilate to let more light enter the eye.

„ Muscle tension increases for readiness to run or fight.

The "fight or flight" syndrome serves an important function in emergency situations that require quick, physical responses. Day-to-day stress and conflict does not trigger a dramatic fight or flight response, but it does affect us in other ways.

Not all stress is caused by emergencies. There are many other kinds of stress events that happen all the time. They range from small stressors like accidentally leaving your brief case in the car to more serious stressors, like backing your car into a tree. The amount of stress we experience depends on the kind of stress event, its duration, and its frequency.

Short stress duration is a category that includes the small inconveniences that we all face daily that make us feel annoyed and mildly stressed. Things like being stuck in traffic, sitting next to a crying baby, or waiting in long checkout lines are considered short duration stressors. These events typically last for a few minutes to a few hours at most. Short duration stressors will not cause serious stress unless they occur continuously over a long period of time.

Moderate duration stress usually lasts from several hours to several days. Some examples might include ongoing disagreements with colleagues or conflict with a co-worker. This category is worth paying attention to because it can lead to stress-related fatigue and precipitate emotional and physical problems later on.

Long duration stressors are ongoing, chronic situations that may last up to several months or years. Examples may include serious illness, financial problems, legal battles and being laid off from your job. This level of stress can be a direct contributor to emotional and health problems.

Just about everyone can make it through a single crisis situation. The crisis may cause stress, but if you take time to refuel and recover after the crisis, you will return to a state of equilibrium and be ready to tackle the next crisis when it arises. However, if you go from one crisis to the next, without time to recover and rejuvenate, you will soon find yourself in an escalating stress spiral that leads to unhealthy stress exhaustion.

Stress also can manifest itself by displaying numerous physical problems as well. Take a look at the list below:

    •     aches and pains

    •     palpitations and dizziness

    •     loss of appetite or compulsive eating

    •     digestive problems

    •     insomnia and breathing problems

    •     feeling tired

    •     frequent infections

Stress can make you unhappy, and may cause depression attacks. There can be feelings of anxiety, pessimism, anxiety attacks and dissatisfaction with life that all appear to be part of the picture. It can further make you difficult to live with because people under stress often are irritable, irrational, and hostile. It can affect your work performance. You may become forgetful, lethargic, unable to concentrate or make decisions. It certainly diminishes your opportunity for success, and possibly even promotions.

As a nurse, it is important to your personal and professional long term success to integrate stress management skills into your life. It is critical to achieve and maintain balance. We can all be more productive if we feel our lives are in balance and we feel a sense of control so we can make a difference in others' lives. Find out if conflict has taken a toll on your stress and thrown you off balance by completing the following exercise to measure your stress level.

Stress Test

Directions: Decide how the statements apply to you; then on a scale of 1-4, circle the response that best describes how you feel. The key is as follows:

Key:

4 = all the time

3 = often

2 = sometimes

1 = never

1. I am regularly exhausted by daily conflicts at work. 4 3 2 1

2. No matter how hard I try, some conflicts are unresolved. 4 3 2 1

3. I am dissatisfied with my personal relationships. 4 3 2 1

4. I stew in my anger rather than express it. 4 3 2 1

5. I do not trust that things will work out. 4 3 2 1

6. I feel responsible for the unhappiness of people around me. 4 3 2 1

7. My stress is caused by outside forces beyond my control. 4 3 2 1

8. I do not know what I want out of life. 4 3 2 1

9. I feel as if I do not have anyone to turn to for help. 4 3 2 1

10. I feel that management does nothing to resolve conflict. 4 3 2 1

Scoring: 40-35 Life for you has become one struggle after another.

34-25 Your opinions are clouded and you feel trapped.

24-15 You have an awareness that life is in your hands.

14-10 You are your own best ally with a high degree of self-control, self-esteem and positive identity with problem-solving skills

Personality Traits and Stress

Have you ever noticed that some people seem to be always seriously stressed about something or some conflict, and others seem relaxed and calm no matter what? There are, in fact, some people who, because of certain personality traits, tend to succumb to stress situations. Let's take a look at some of the personality traits and their relation to stress.

Tolerance/intolerance for ambiguity. People who have a low tolerance for ambiguity (where there are more questions than answers) are more prone to stress than others. These people require a lot of order and structure. They need to know exactly what is expected, when it is due, and how to do it. They prefer predictable, established routines and, therefore, do not function well when unanticipated problems arise. They also feel insecure when organizational details have not been addressed. And herein lies the problem. Because so much of life is unpredictable, people who cannot tolerate ambiguity frequently experience more stress than those who can cope with ambiguity, surprise, and change.

Locus of control: internal/external. Locus of control refers to how a person perceives his or her control over the environment and life events. If a person believes that he or she has a lot of control, the person is known as internal. If, on the other hand, a person believes that things happen to him or her and that there is little control over life events, that person is considered external.

Externals are prone to experience high degrees of stress as a result of their feelings of helplessness to control what happens to them. Internals, on the other hand, see a direct cause and effect relationship between what they do and the outcomes; therefore, they feel in control, they take action and as a result experience less stress overall. An example of external control and internal control is demonstrated in the scenario with Phil and Sam below:

Phil is external. He has several pressing deadlines; his supervisor just asked him to work two extra overtime shifts this week on short notice; last night his wife announced an unexpected visit from her parents; and two physicians are demanding explanations for incident reports on their patients at the same time. As an external, Phil will feel the pressure of each and every demand.

Then there is Sam. He is an internal in a similar situation. He has pressing deadlines, unexpected visitors and questioning physicians too. Sam, however, knows how to cope. He will figure out ways to prioritize, delegate, or ask for help to reduce the pressure of the demands he faces.

Type A. These individuals are usually characterized by behavior that is emotional, aggressive, intense, perfectionist, competitive and often impatient. They display drive, ambition and passion in everything they do.

Type B. These individuals are not, as sometimes thought to be, the flip side of Type A. Type B's can be equally ambitious and aggressive, but they differ from Type A's in their ability to accomplish goals without subjecting themselves to psychological and physical havoc.

Type B's are able to adjust their pace to suit the situation, and they seem to be able to relax and catch their breath between chaotic periods and conflict situations. High performing Type B's can avoid burnouts without sacrificing performance.

It is valuable to know if you have personality traits that make you prone to negative stress experiences. If this is the case, it will give you an opportunity to take action and correct it.

Negative Self-Talk

Negative self-talk can be a conflict stress generator. In addition to all the external events that induce stress, there is the stress we create for ourselves through negative, self-defeating attitudes. When we adopt a "can't-do" attitude, we quickly become our own worst enemy. Stop and think for a moment about some of the things you are likely to say to yourself in these situations:

    - on your way to a job interview

    - dealing with a difficult boss or colleague

    - when a co-worker is criticizing you

    - when a patient or family member is difficult to communicate with

If you are like most people, each one of these situations can trigger a fleeting negative or fearful thought, such as "I can't handle this," or "Maybe I was wrong in the situation my co-worker criticized me." Such negative thoughts have a negative impact on behavior. By telling ourselves we are not capable or good enough, we undermine our ability to perform. Take the case of Steve, for example.

Scenario on Steve: The Cycle of Pessimism

Steve is a very well-educated, capable nursing graduate. As a student, he won a competitive internship, working on a project grant in the mental health clinic of a large teaching hospital. Following graduation, he was hired under temporary contract to complete his project. Now he is waiting to be interviewed for a permanent job with another hospital of similar size and reputation. While waiting, Steve finds that he is quite nervous.

Rather than mentally reviewing his recent accomplishments he begins to think about the stiff competition for this job, and he remembers how difficult it was to get the internship. By the time it is his turn to be interviewed, he has made himself a nervous wreck. Consequently, he can't think straight and finds it difficult to formulate clear, concise answers to the interview questions. Steve leaves the interview knowing that he did not make a good impression. The rejection letter he received the next week confirmed his belief.

What happened to Steve could happen to anyone. Put simply, he told himself he would do poorly; as a result he lost confidence and performed poorly. We all experience self-talk like Steve's. Self-talk is the tape we play over and over in our heads. Sometimes our messages are positive, and that's great because positive messages are like personal pep-talks. But when self-talk messages are negative, they destroy confidence and increase anxiety.

Unfortunately, the prophecy of doom we predict with negative self-talk often comes true because we believe the self-defeating message and act accordingly. And each time the negative message is reinforced we're more convinced that we can't do "it," or whatever "it" is.

Look at Steve's interview situation, for example. While he was waiting to be interviewed, Steve was feeling nervous. At that point Steve could have benefited from the shot of adrenaline his body was producing, given himself a pep-talk, then gone into his interview with confidence. Instead, Steve played an old negative tape in his head, made himself more nervous, predicted a poor performance, then performed poorly. There is little doubt that the next time Steve is in a similar interview situation, the same thing will happen now that his negative self-talk has proven correct.

Negative self-talk is a habit. The good news is that we can break the habit by applying a strategy called cognitive restructuring. It means, be smart about the way you talk to yourself so you can avoid a buildup of negative feelings that might lead to self-defeating actions and attitudes. Use positive self-talk instead.

Here are three simple steps to rewriting your negative scripts.

Step #1: Catch yourself in the act of negative self-talk and stop the tape.

Step #2: Do a reality check by asking yourself a few questions to help you analyze the situation objectively. For example, ask yourself, "What's good about this?" "What's right about this?" or "What skills do I bring to this situation?"

Step #3: Replace your message with a more accurate one.

Here is an example. You think: "My proposal won't be accepted. The committee will think I'm crazy to ask for so much time and money for this project."

Do a reality check: "What's wrong with asking for something I think that I need to do the job right?"

Replace the irrational thought with: "The committee might think this proposal is too ambitious. If they do, there are several modifications I can suggest."

Negative self-talk in its extreme form can cause us to give up before we begin. The way to overcome negative self-talk is to catch yourself doing it, do a reality check, then convert negative thoughts into more accurate ones.

Managing Stress That Conflict Creates

You might ask. If I can't prevent stress situation and crisis from happening, how can I control my level of stress? How can I accept the fact that conflict will arise, disagreements will take place and there are unhappy colleagues and bosses in every work arena. One approach is the three A's: learn to accept, alter, and avoid.

Accept: Rule number one is to manage the stress, don't fight it. Stress escalates when we fail to accept the situation we're in. Accept does not mean give up or stop trying. It means, make the best of the hand you've been dealt. An example could be described in the scenario below.

Kenneth was upset when his coworker, Janice, became his supervisor. Her promotion over him was a bitter pill to swallow, so he became angry and resentful. As a result, work became unpleasant. He and Janice fought over every decision. Finally, the daily struggle became unbearable and Kenneth's work performance began to suffer. Poor performance lead to more stress and bigger problems. If, instead of fighting, Kenneth had accepted the situation, he would have been spared the anger and stress it caused. He then could have made a conscious decision to stay or explore opportunities elsewhere.

Alter: Sometimes you can avoid or reduce stress by altering some aspect of your work or life to allow time to relax and refuel. Altering may mean changing deadlines, setting priorities, or delegating work. Sometimes a very simple adjustment in a schedule can give you just the time you need to function better overall.

Karen is a good example of how a simple schedule change can reduce stress. Karen had an 8:30 to 5:00 day job and two young children to shuttle to and from day care and school. Her mornings were hectic. Karen was often late for work because of rush hour traffic, which she couldn't avoid because of her children's school schedules. Karen usually arrived at work in a frenzied state, and toward the end of the day she became distracted by the need to leave in order to pick up her children on time.

Karen decided that something had to change, so she asked her boss to help her overcome the daily traffic stress by allowing her to work from 8:45 to 4:45 four days a week, and to work longer hours on Mondays to make up for the shorter days Tuesday through Friday. At the same time, she arranged to have a friend drive her children to and from school on Mondays so she could work longer hours. The change was magical. Karen's stress level decreased and her work production increased.

Avoid: Sometimes it is best to avoid a potentially stressful situation. That may mean saying "no" when you're asked to chair a committee or work overtime when you know that your home commitments make it difficult. In other words, if you know that saying "yes" to such requests will lead to stress down the road, avoid the stress by saying "no."

If you know that certain situations are stressful for you, then learn how to graciously turn down those obligations. "Avoid" should not be used as an excuse to procrastinate or to get out of doing things that you don't want to do. Rather, this strategy should be used judiciously for those situations that you know, based on past experience, will lead to moderate or high levels of stress.

Herbert Benson, a noted author, feels that it is important to respond by using the coping and relaxing strategies available to you, which include:

Coping strategies:

Distraction. Putting the problem on hold until you can deal with it.

Direct action. Dealing with it now.

Reframing. Looking at events from a different perspective.

Affirmations. Positive thoughts or phrases, repeated often.

Constructive self-talk. This is a mind game that takes practice, lots of practice.

Communication. Verbal as well as non-verbal through body language and eye contact. If you communicate well, people will respond to you in ways that improve your relationships and help you cope with difficult situations.

Relaxing Strategies:

Keep a stress diary. Describe situations and difficult colleagues that you have conflict with, or those that make you anxious. Ask yourself why you were so distressed. What were your concerns? How might you think or act differently in the future to help you cope more effectively? List the pros and cons of possible responses to assess your options.

Breathe effectively. Slow breathing from the diaphragm is one of the most effective ways of managing stress. Quick-fix breathing can release tension in a difficult situation. Calm and control your breathing by taking several deep, slow breaths. Return to normal breathing, then repeat.

Learn to relax. You've read it countless times, but have you practiced it? Relaxing will lower blood pressure and it slows breathing, metabolic and heart rates, and allows your body to recover its equilibrium. It only takes 15 minutes. Lie on your back on a firm bed or mat. Let your feet flop outward and your hands rest by your sides. Close your eyes and sigh to release tension. Breathe slowly, pausing after each exhalation.

Release tension in your toes, feet, and legs. Then do the same with your fingertips, arms, and neck. Ease tension in your shoulders by lowering them. Mentally smooth the muscles of your face. Be aware of the relaxation in your muscles. When you're ready, slowly open your eyes and stretch. Bend your knees and roll on your side before slowly getting up.

Try mind/body techniques. They can add a powerful extra dimension to stress control. Meditation induces deep physical relaxation and mental awareness. Sitting comfortably and upright, close your eyes and relax. Focus your mind on an object, breathing out and in to the count of four, or look at an image such as a candle flame or flower. Even repeating a word such as "peace" for 15 to 20 minutes will help.

Visualization assists in imaging a calm, beautiful scene in detail, smell the scents and hear the sounds. You can repeat affirmation phrases such as "I feel peaceful." Before any high pressure event or anticipated conflict, picture and repeat the above mentioned affirmation. Then review what will happen in your mind, watching yourself deal confidently with the situation.

Mindfulness or active meditation can be described as giving your attention to whatever you're doing. Observe shapes, colors, textures and the movement of your body. Focus on the movement you're experiencing without worrying about the past or the future. Yoga is another approach that combines stretching exercises for fitness with controlled breathing, relaxation, and meditation.

Be active. Exercise helps dispel stress hormones for the bloodstream and stimulates the release of endorphins, that give a feeling of well being. Recommendations are for 30 minutes of moderated activity most days.

Avoid stimulants. Say "no" to excessive caffeine and alcohol. Sip herbal teas and drink water, at least eight glasses a day.

Add aromatherapy oils to your bath. Choose from basil, cedarwood, geranium, juniper, lavender, rose and ylang-ylang. Use them alone or combine two or three.

[Herb Benson. Timeless Healing: The Power and Biology of Belief. (New York: Bantam Books, 1995), 243].

A critical element in managing stress in the nursing profession is accepting that some stress does and always will exist. Some of these stresses are unique to our profession. But, what is important is how you focus on balancing this stress and developing skills to deal with it in a daily basis. The new wisdom for the 90's instructs us that the following six balance steps are necessary:

1. Being self aware is the first step toward balancing yourself and your life. Self- awareness means noticing and being aware of how and when conflict pushes your buttons. It is recognizing the clues and trusting yourself to be able to solve problem .

2. Perfection is self-abuse of the highest order. Experiment with solving the conflict that you can, and ask for help from a mentor, confidant or supervisor, if needed.

3. Celebrate what you have accomplished. Small rewards for resolving conflict, controlling your anger or dealing with criticism.

4. Become convinced that there truly is a need for new skills. Skills for self-management, conflict resolution, assertiveness and negotiation. Try new options and give them a chance.

5. Understand the need to risk and change to resolve conflict. Commit to breaking the rules, creating new role models and tolerating the unknown.

6. Expect success in controlling your emotions and dealing with conflict. Our actions and beliefs are often intertwined.

While the six balance steps may be effective on a short term and necessary basis, what about some long term efforts for the rest of your life? Take a look below.

Long-Term Stress Tips

ü Take time to "smell the roses" every day. Life is not a dress rehearsal and we do not know how long we will be here. Do something for yourself, no matter how small or insignificant it seems.

ü Ventilate tension from work by talking with a sympathetic listener.

ü Build relationships with your peer group.

ü Be active in professional organizations. Through this participation, you'll learn how others are dealing and coping with stress as well as networking and strengthening your relationships. As a result, you'll feel stronger, smarter and less stressed.

ü Be realistic about the problems on your job. Not every problem is your responsibility, and you do not have to solve all the world's problems. Take responsibility for only those problems that are yours.

ü Address and correct mistakes. Then forgive yourself and others for making mistakes.

Undoubtedly, you can think of many additional ways to keep the balance. Share them with your colleagues, talk to your boss and peers, read professional journals and continue your efforts to seek information and develop solutions.

Summary

We have taken some big steps in identifying conflict and trying to deal effectively with it in our work areas. Knowledge of and dealing with conflict and disagreements means becoming aware of its value, maximizing positive outcomes and minimizing negative consequences in resolving interpersonal and organizational issues. The results are definitely more productive and successful relationships, and improved services to the patient population that we serve.

Dealing constructively with disagreement and conflict has profound impact. We open ourselves to making real contact with others. We complete unfinished business. Our vision of what's possible, not only with ourselves but others, expands. Every human being, like every snowflake, is unique. Disagreement and conflict often reflects that uniqueness. When we are able to do something constructive with our differences and conflict, we move closer to the ideal of living together in a peaceful, satisfying workplace and world.