If you are a nurse, you have undoubtedly heard of the Nursing Care Plan. For those of you who have not, it is a written document that looks at the needs of the patient, sets goals, and plans what interventions from the staff will help to achieve those goals. It is a very systematic, measurable way to get things done.

       We are going to adapt this process to write out a Stress Management Care Plan. This will be a way for you to bring together all the techniques you have learned in this text, and to put them into practice in your own lives. If you are in the health care field, you may want to assist your clients to write one of these plans for themselves. Once again, this is reinforcing your commitment to yourself and your own wellness. You are empowering yourself to improve your life. Congratulations!

        The format for the Stress Management Care Plan is fairly simple. You are going to look back to the Stress Self-Assessment Tool from the beginning of the book, look at the stressors you identified, and write a plan on how to deal with at least one of them. You can use any or all of the stress management techniques which we have studied-put together a program that you will enjoy, because if you don't enjoy it, you are less motivated to continue the plan.

        For example, let's say that one of the things that contributes to stress in my life is that I work for a very moody person. I react to this person walking into my office by breathing more rapidly than normal. This triggers a cascade of other reactions, including tight muscles, headache, etc.

        What can I do? I don't want a new job, I can't change bosses, but I can change how I react. My goal would then reflect something that I can do-something within my control.

        The key points about writing and setting goals are:

1.	Keep it simple.
2.	Make it realistic; go for the 'small wins'.
3.	Make it measurable; the accomplishment will give you encouragement and a sense of satisfaction.
4.	Keep track of your progress on the calendar, in a notebook, etc.
5.	Reward success; revise the goal if it turns out to be not attainable.

       My goal for this example is that "within 2 weeks, my breathing will not change speeds when by boss walks into my office." This is what I want to accomplish by a certain date. How do I do this? Write a plan! What are you going to do, when and how are you going to do it?

       Once again using the example, my plan might have these points:

1.	I will practice breathing slowly and deeply for 5 minutes while sitting in my car before I go into the office every morning.
2.	When my boss walks in, I will put one hand in my lap to remind me to breathe deeply.
3.	Whenever I feel my breathing getting faster, I will take in a healing breath and release the tension.

       Get the idea? Keep it simple, keep it possible.

Plain Talk About.. Handling Stress You need  stress in your life! Does that surprise you? Perhaps so, but it is quite true. Without stress, life would be dull and unexciting. Stress adds flavor, challenge, and opportunity to life. Too much stress, however, can seriously affect your physical and mental well-being. A major challenge in this stress-filled world of today is to make the stress in your life worker you instead of against you.        Stress is with us all the time. It comes from mental or emotional activity and physical activity. It is unique and personal to each of us. So personal, in fact, that what may be relaxing to one person may be stressful to another. For example, if you are an executive who likes to keep busy all the time, "taking it easy" at the beach on a beautiful day may feel extremely frustrating, nonproductive, and upsetting. You may be emotionally distressed from "doing nothing." Too much emotional stress can cause physical illness such as high blood pressure, ulcers, or even heart disease; physical stress from work or exercise is not likely to cause such ailments. The truth is that physical exercise can help you to relax and to handle your mental or emotional stress.        Hans Selye, M.D., a recognized expert in the field, has defined stress as a "non-specific response of the body to a demand." The important issue is learning how our bodies respond to these demands. When stress becomes prolonged or particularly frustrating, it can become harmful-causing distress or "bad stress." Recognizing the early signs of distress and then doing something about them can make an important difference in the quality of your life, and may actually influence your survival. Reacting to Stress To use stress in a positive way and prevent it from becoming distress, you should become aware of your own reactions to stressful events. The body responds to stress by going through three stages: (1) alarm, (2) resistance, and (3) exhaustion.            Let's take the example of a typical commuter in rush-hour traffic. If a car suddenly pulls out in front of him, his initial alarm reaction may include fear of an accident, anger at the driver who committed the action, and general frustration. His body may respond in the alarm stage by releasing hormones into the bloodstream which cause his face to flush, perspiration to form, his stomach to have that sinking feeling, and his arms and legs to tighten. The next stage is resistance, in which the body repairs damage caused by the stress. If the stress of driving continues with repeated close calls or traffic jams, however, his body will not have time to make repairs. He may become so conditioned to expect potential problems when he drives that he tightens up at the beginning of each commuting day. Eventually, he may even develop a physical problem that is related to stress, such as migraine headaches, high blood pressure, backaches or insomnia. While it is impossible to live completely free of stress and distress, it is possible to prevent some distress as well as to minimize its impact when it can't be avoided. Helping Yourself When stress does occur, it is important to recognize and deal with it. Here are some suggestions for ways to handle stress. As you begin to understand more about how stress affects you as an individual, you will come up with your own ideas of helping to ease the tensions. Ö Try physical activity. When you are nervous, angry, or upset, release the pressure through exercise or physical activity. Running, walking, playing tennis, or working in your garden are just some of the activities you might try. Physical exercise will relieve that "uptight" feeling, relax you, and turn the frowns into smiles. Remember, your body and your mind work together. Ö Share your stress. It helps to talk to someone about your concerns and worries. Perhaps a friend, family member, teacher, or counselor can help you see your problem in a different light. If you feel your problem is serious, you might seek professional help from a psychologist, psychiatrist, social worker or mental health counselor. Knowing when to ask for help may avoid more serious problems later. Ö Know your limits. If a problem is beyond your control and cannot be changed at the moment, don't fight the situation. Learn to accept what is-for now-until such time when you can change it. Ö Take care of yourself. You are special. Get enough rest and eat well. If you are irritable and tense from lack of sleep or if you are not eating correctly, you will have less ability to deal with stressful situations. If stress repeatedly keeps you from sleeping, you should ask your doctor for help. Ö Make time for fun. Schedule time for both work and recreation. Play can be just as important to your well-being as work; you need a break from your daily routine to just relax and have fun. Ö Be a participant. One way to keep from getting bored, sad, and lonely is to go where it's all happening. Sitting alone can make you feel frustrated. Instead of feeling sorry for yourself, get involved and become a participant. Offer your services in neighborhood or volunteer organizations. Help yourself by helping other people. Get involved in the world and the people around you, and you'll find they will be attracted to you. You will be on your way to making new friends and enjoying new activities. Ö Check off your tasks. Trying to take care of everything at once can seem overwhelming, and, as a result, you may not accomplish anything. Instead, make a list of what tasks you have to do, then do one at a time, checking them off as they're completed. Give priority to the most important ones and do those first. Ö Must you always be right? Do other people upset you-particularly when they don't do things your way? Try cooperation instead of confrontation; it's better than fighting and always being "right." A little give and take on both sides will reduce the strain and make you both feel more comfortable.  Ö It's OK to cry. A good cry can be a healthy way to bring relief to your anxiety, and it might even prevent a headache or other physical consequence. Take some deep breaths; they also release tension.  Ö Create a quiet scene. You can't always run away, but you can "dream the impossible dream." A quiet country scene painted mentally, or on canvas, can take you out of the turmoil of a stressful situation. Change the scene by reading a good book or playing beautiful music to create a sense of peace and tranquility.  Ö Avoid self-medication. Although you can use prescription or over-the-counter medications to relieve stress temporarily, they do not remove the conditions that caused the stress in the first place. Medications, in fact, may be habit-forming and may also reduce your efficiency, thus creating more stress than they take away. They should be taken only on the advice of your doctor. The Art of Relaxation The best strategy for avoiding stress is to learn how to relax. Unfortunately, many people try to relax at the same pace that they lead the rest of their lives. For a while, tune out your worries about time, productivity, and "doing right." You will find satisfaction in just being, without striving. Find activities that give you pleasure and that are good for your mental and physical well-being. Forget about always winning. Focus on relaxation, enjoyment, and health. If the stress in your life seems insurmountable, you may find it beneficial to see a mental health counselor. Be good to yourself.

Source: National Institute of Mental Health 
              Lous E. Kopolow, M.D.

       Set the goals, write out the plan, and do it! To make stress management an ongoing success, you need to put what you have learned into practice every day. If you do nothing else, remember the importance of correct breathing. Teach your clients how to breathe slowly and deeply to help them release and relax. Even if they are highly stressed, they still have to breathe-you can show them how to use the healing breath.

       In order to make it easier for you to write a Stress Management Care Plan for yourself; I have included a model form on the next few pages. This will give you some structure to get you comfortable with the process. Remember to reward yourself for progress along the way. What you are doing is important, and represents your ongoing commitment to becoming the best you possible.

Stress Management Care Plan
Name __________________________Date____________________________
 
1.   The three most important causes of stress in my life are:

       a. ______________________________________________
       b. ______________________________________________
       c. ______________________________________________

2.   My reactions to these situations/people include: (Think of how your body responds, how you feel emotionally, etc. Be specific.)
       _________________________________________________________________
       _________________________________________________________________
       _________________________________________________________________
       _________________________________________________________________

3.   Pick one of the stressors listed above. Can I do one or more of the following?

      a.    Change the stress-producing situation?
               ____________________________________
      b.     Change how I interpret it?
               ____________________________________
      c.     Change how I react to the stressor?
               _____________________________________

4.    Based on which choices you make, write three goals for yourself in dealing with this stressor. Think of what you  want to change, what 
       you want to accomplish. Remember to keep it simple and measurable:

        a.______________________________________ 
        b. _____________________________________
        c. _____________________________________

5.    For each goal, write out a plan. What is your intervention going to be to resolve the stressor or your reaction to it? When are you going to 
        do this? Be specific.

        a.   _______________________________________________________________
               _______________________________________________________________
               _______________________________________________________________
               _______________________________________________________________
               Target date: _____________________
         b.  _______________________________________________________________
               _______________________________________________________________
               _______________________________________________________________
               _______________________________________________________________
                Target date: _____________________

          c.   ______________________________________________________________
                 ______________________________________________________________
                 ______________________________________________________________
                 ______________________________________________________________
                 Target date: _____________________

6.    Once you have completed your plan, come back and evaluate how it worked. Were the goals realistic? Were you happy with the results? 
        Do you need to make any changes in your plan?

        Remember: You can modify any of the techniques you learned in this book. The important thing is to do what works and what you will 
        continue doing.
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________
         __________________________________________________________________

         Congratulations! You have completed the stress management care plan! Think of this like a "senior thesis" or some type of project which represents the culmination of a great deal of learning, of growing, and of commitment.

         By writing out this plan, you have synthesized the information and techniques which you have studied in this book. You have taken that material and made it your own. You have learned how to manage your own reactions to stress more effectively.

         The benefits are many, and will ultimately result in a higher level of wellness-regardless of any physical challenges with which you may be dealing. Wellness means feeling whole, feeling comfortable with who you are and your place in the universe. You can be coping with a physical disease, and still live with a high level of wellness as defined within the holistic framework.

         The text and exercises you have worked through were designed to serve as facilitators for your own growth. In the long run, you are your own most powerful healer. You are responsible for your own search for optimum wellness. My purpose has been to share some tools with you to assist you in your quest.

         If you are a health care professional, you can bring your new knowledge into your work setting. When you work with clients, you can share some of the basic information with them—teach them some of the exercises. Most people will learn very quickly, especially with the Healing Breath exercise.

         The first step in making a change is always difficult. Stress management, if it is to be really effective, requires a change in the ways you deal with things. It requires some work. It requires an ongoing commitment to yourself. You have made major progress toward achieving a positive change in your life. You have done well; keep it up!