Elder Companion: Lesson 6—Stress Management

Introduction

The Elder Companion training program is designed to train persons interested in becoming employed by local service providers as sitter/companions for the elderly. The objective of the program is to help participants develop the necessary skills to provide high-quality care including assistance with daily living activities (DLAs), home management services and companionship for the elderly adult.

This training course is preparatory to studying to become a certified nursing assistant (CNA).

For an overview of the training course, see FCS5246/FY586.

In the Elder Companion training program, the following topics are addressed:

• Lesson 1 Roles and Responsibilities
• Lesson 2 Aging
• Lesson 3 Communication
• Lesson 4 Nutrition
• Lesson 5 Home Maintenance and Safety
• Lesson 6 Stress Management
• Lesson 7 Time Management
• Lesson 8 Leisure Activities
• Lesson 9 Getting a Job

In addition to the nine topics that are taught as Lessons 1 through 9 in a classroom setting, training program participants will be required to make a field observation at an elder care facility. An Agent's guide and observation form are provided in Attachment 1. (See training course overview FCS5246.)

Agent's Teaching Guide: Stress Management

Part 1: Stress ... What Is Yours?

Part 2: Warning Signs of Stress

Part 3: Job Stress for the Elder Companion

Part 4: Managing Stress

Time: 2 Hours

Equipment/Supplies:

PC/laptop (or alternative method to display slides)/screen, PowerPoint slides created from Handouts B, H, and K

Instructor: County faculty, Psychologist, Mental Health Professional

Handouts:

Part 1

• Handout A: Know Your Stressors
• Handout B: Ideas to Remember
• Handout C: Stress Myths and Facts
• Handout D: Stressor Diary

Part 2

• Handout E: Check for Body Warning Signs
• Handout F: Check for Behavior Warning Signs

Part 3

• Handout G: Stressful Job Situations
• Handout H: Stress Prevention for an Elder Companion

Part 4

• Handout I: Dealing With Stress
• Handout J: Relaxation Recipes
• Handout K: Six Steps to Managing Stress

Objectives (Expected Outcomes):

After this section, participants will be able to:

• Identify factors that create negative stress.
• Explain how negative stress affects behavior.
• Describe methods of managing stress.

Part 1: Stress ...What Is Yours? Lesson Plan

Introduction

We all have various stresses in our lives. In fact, life would be quite dull without stress. Where does stress in our lives come from? It comes from within us: the mental (thinking), emotional (feelings), or physical responses to various situations. Those outside events or situations causing us stress are called stressors.

Do we all respond to stressors in the same way? No, stress is very personal and unique to each individual. For example, what might be relaxing for you may be very stressful for me. You have your own combination of stressors that affect you most.

Take a moment to think about what kind of day you have had so far. How many stressors—mild or major—have you encountered today?

DO:

• Complete Handout A, Know Your Stressors.
• Have the participants write as many stressors in their life that they can on the worksheet.
• Ask them to mark the ones that cause them the most stress.

REFLECT:

• Ask the participants to share and compare their lists. This may be done in small groups first, then with the large group.
• What similarities exist? What differences exist? Discuss why one situation/event may be stressful for one person and not another.
• Show transparency created from Handout B, Ideas to Remember and distribute the handout. Are there different levels of stressors represented in our lists? Did you identify:
• Mild frustrations, some of which you experience every day;
• More serious stresses that interfere with getting the most out of life; or...
• Serious stressors from major life changes?

DO:

• Have participants check their STRESS I.Q. by agreeing or disagreeing to the Stress Myths and Facts (Handout C).

REFLECT:

• Have participants share their responses and discuss the correct answers.

APPLY:

• Thinking about stress as a problem that everyone faces, what questions do you have? Make a list of those that occur to you that you hope will be answered in the sessions ahead.
• Encourage participants to start a Stressor Diary (Handout D). Instructions suggest that they record stressful events or things that happen as well as negative thoughts and their feelings throughout their day that make them uncomfortable.

Handout A: Know Your Stressors

Identifying Your Everyday Stressors

In the space below, take three minutes to write down quickly as many stressors in your life as you can recall. If you find it helpful, you can list your stressors as they occur in different part of your life. (Feel free to add your own other categories, too.)

• Work
• Family
• Home
• Friends
• Other

Now read through your list and mark those stressors that cause you the most stress.

Handout B: Ideas to Remember

• STRESSORS are situations in your life that cause you to feel stress.
• Some stressors are mild frustrations.
• Others can be life changing events.
• RECOGNIZING stressors is the first step in conditioning stress in your life.

Handout C: Stress Myths and Facts

Do you agree (A) or disagree (D) with the following myths or facts about handling stress in your life:

____ Stress is not a part of my life.

____ Stress affects humans of all ages, including elderly people.

____ Stress is no big deal.

____ The “wear and tear” of stress on your body leads to illness and can reduce your life expectancy.

____ Stress is just a freak condition that occurs when things are really going badly in your life.

____ You experience stress every day in your life. Fighting stress is part of maintaining your whole health.

____ Stress just happens. You can't help the bad things that happens in your life—good and bad.

____ Actually, you set up a great deal of what happens in your life—good and bad. By making good choices you can avoid much stress.

____ Stress is just too powerful when it happens—it's stronger than you can handle.

____ Coping with stress takes practice—but you can learn to handle any stress you experience, no matter how powerful.

____ I'm too busy to worry about stress—I don't have time to practice stress techniques.

____ Effective use of stress-beating techniques will end up saving you time.

____ I've tried techniques before but they didn't work.

____ Your attitude makes a huge difference in how well the techniques work for you.

Handout D: Stressor Diary

(see Table 1)

Directions

• For one day, observe yourself and write down any stressor that you experience as it happens.
• Be aware of the things you complain about, too. Your negative thoughts are also stressors.
• Watch for feelings you are uncomfortable with and bury quickly.
• At the end of the day, review your diary. Answer these questions: Does anything surprise you? Do you see any patterns? What have you learned about yourself?

Part 2: Warning Signs of Stress: Lesson Plan

Introduction

One of the many ways we can know that we are experiencing too much stress is by paying attention to our bodies. What are some body signals for stress? (List on whiteboard/flip chart.)

Have you ever experienced poor health conditions because you let everyday stresses keep you from taking care of your own body needs? (Have participants share experiences.)

Besides physical ones, what are some other reactions to stress that experience? (List on whiteboard/flip chart). These reactions represent behavioral responses. They are often a result of our thoughts (mental perspective of the situation) or our emotions (feelings that result from the situation).

DO:

Take a STRESS CHECK-UP!

Using the Body and Behavior Warning Signs Check Sheets (Handouts E and F), have participants check for any major changes in behavior or physical discomforts that may be attributed to stresses in their lives.

Compare these lists with ones they may have generated in Lesson 1.

REFLECT:

Let the participants share some of their responses, if they are comfortable doing so.

Ask them to report how often they deal with these warning signals. Do they feel they know how or can handle situations and reduce the stress they experience?

Why is it important to be concerned with physical/body stress signals?

Your good health is your most important stress-fighting tool. You are much more able to cope with a stressful situation if your body and mind are well.

APPLY:

Encourage them to think about watching for signs of stress in their everyday lives and to develop ways to deal with them. Tell them that there will be some helpful suggestions covered later in the lesson.

Handout E: Check for Body Warning Signs

What you do

When you feel under a lot of stress and pressure, which of the following responses do you notice?

Place a check before those items that apply and occur frequently or regularly.

Place an X before those that occur only occasionally.

____ Feeling exhausted/fatigued

____ Headaches

____ Dizziness

____ Face feels hot, flushed

____ Hands and/or feet feel cold or sweaty

____ Skin blemishes

____ Dry mouth/throat

____ Grind teeth/jaw pain

____ Neck/shoulders tighten up/ache

____ Heart beats faster

____ Heartburn/indigestion

____ Chest pain

____ Back tightens up/aches

____ Stomach upset/nausea

____ Cramps

____ Increased urination

____ Diarrhea

____ Legs get shaky or tighten up

Now what signs are you going to watch for?

______________________________________________________

______________________________________________________

______________________________________________________

What will you do when you notice stressful signs?

______________________________________________________

______________________________________________________

______________________________________________________

Handout F: Check for Behavior Signs

What you do

When you feel under a lot of stress and pressure, which of the following responses do you notice?

Place a check before those items that apply and occur frequently or regularly.

Place an X before those that occur only occasionally.

____ Crying

____ Depression

____ Restlessness, fidgeting or frantic increase in normal activity level

____ Lack of interest in things that normally interest you

____ Feeling exhausted/fatigued

____ Withdrawal from friends and normal social activities

____ Aggression: shorter temper/anger aroused more easily/lowered tolerance of frustration

____ Boredom

____ Lack of concentration

____ Desire to sleep or go to bed to escape

____ Inability to sleep

____ Nightmares

____ Change in appetite: eating more or less than what's normal for you

____ Moodiness, oversensitivity

____ Difficulty making decisions

____ Nail biting

____ Increased smoking

____ Drug/alcohol misuses

____ Dry mouth/throat

____ Grinding teeth

____ Tapping fingers/feet

Now what signs are you going to watch for?

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

What will you do when you notice stressful signs?

_________________________________________________

_________________________________________________

_________________________________________________

_________________________________________________

Part 3: Job Stress for the Elder Companion Lesson Plan

Introduction

Job stress for the elder companion occurs on a regular basis. Stress occurs in several areas that we will explore by looking at some possible situations you might encounter. Job stress can be grouped under the following categories:

• Job Changes Often
• Work Agreements
• Instructions
• Family Space
• Personal Stressors
• Need to Talk/Share

DO:

Stressful Job Situations!

• Distribute Handout G, Stressful Job Situations. Divide the participants into three groups. Give each group one of the three Stressful Job Situations, and ask them to identify the category of stress and offer ideas to reduce the stress. Allow 5–10 minutes. Let each group report.
• Use a whiteboard or flip chart to record the stress and the possible approaches.
• Show slide created from Handout H, Stress Prevention for an Elder Companion, and distribute the handout. Incorporate the group's suggestions.

REFLECT:

• What are the main stressors for an elder companion?
• What are some approaches to relieve the stress?

APPLY:

• How will you deal with these stresses?

Handout G: Stressful Job Situations

A companion may face the following situations on the job. These situations can be stress producing. In small groups review each situation and make suggestions about how to handle.

Situation 1.

Mrs. Jones has been hired by Mrs. North to care for her elderly sister-in-law who is recovering from a stroke. The elderly client is staying in her own home with a daughter who works during the day. She needs daily help with personal care, meals and exercise.

Mrs. Jones was hired to work six hours a day. She comes in at 10 each morning and gets her instructions from Mrs. North. Mrs. North stays with her sister-in-law each morning from 8 to 10 because the daughter's work starts at 8 am. When Mrs. Jones arrives for work the first day, she is instructed by Mrs. North in the daily routine of lunch and exercise. Mrs. Jones carries out the indicated routine for several days. One evening the daughter comes in from work and tells Mrs. Jones that she is upset that the house has not been cleaned.

What do you think Mrs. Jones should do?

Situation 2.

Mrs. Taylor has been sitting from 8 am to noon with Miss Anderson in the hospital. Miss Anderson is an elderly woman who has just had hip surgery and seems to be doing well. Mrs. Taylor was hired to keep Miss Anderson company until she can go home. Mrs. Taylor has had a few hints from the nurse's aides that she should be doing more than just chatting with Miss Anderson. She has been asked at least once by an aide why she has not given Miss Anderson her bed bath.

What do you think Mrs. Taylor should do?

Situation 3.

Mr. Black has been sitting with Mr. Vansky, a cancer patient, for about six months. Although Mr. Vansky is dying, he never talks about death. Lately, he talks all the time about when he is “up and around” again. There is no close family for Mr. Black to discuss his concerns with.

What do you think Mr. Black should do?

Handout H: Stress Prevention for an Elder Companion

Suggestions are provided here to prevent/reduce stress before it starts:

1. Job changes may be often. Can you deal with frequent changes and different clients?
2. Work agreements should be settled before taking a job.

• Have other companions had problems with this particular family or situations?
• Is a “trial period” with the family possible before taking on a long-term job?
• Will you be given a gas allowance or use of the family car?
• What is the expected length of the job?
• Who in the family is the “main” authority or contact person for instructions and reporting observations?

3. Instructions are important.

• One person should be identified as your source of instructions.
• Learn to accept instructions.
• Never try to impose your ways on a client or family.
• Be sure you know exactly what is expected of you; then carry out these instructions accurately.
• Write down instructions (or better yet, have the family member in charge do it).
• Don't resent those who tell you what to do—and in some cases how to do it.
• The well-being of the client is the most important consideration.

4. Recognize family space.

• Some places in the house are private and you should stay out.
• Respect “private space” when family members are talking over “private” matters.

5. Consider personal stressors.

• Can your own health tolerate the work needed in a given situation?
• Can you live with an irregular income if companion jobs aren't available?
• Can you deal with emotional involvement? No longer being needed or the death of a client could upset you. Know that this can happen and be ready to deal with such changes.

6. Need to talk.

• Establish a network with other companions to discuss concerns.
• Helpful in dealing with stress.
• Client's/family's confidentiality must be maintained.

Part 4: Managing Stress: Lesson Plan

Introduction

We have learned that stress is an everyday part of life. The challenge is to learn how to handle the situation in a positive and helpful way.

DO:

Dealing With Stress

• Give each participant a copy of Handout I, Dealing With Stress. Read the directions and emphasize this is for them alone to see. Allow 5–10 minutes for them to record how they deal with stress.
• Distribute Handout J, Relaxation Recipes! Deep breathing, relaxation techniques: taking a walk, reading, etc. It is important to plan time to take relaxation breaks in your daily schedule.
• Show transparency created from Handout K, Six Steps to Managing Stress, and distribute the handout. Ask each participant to look at their Dealing With Stress check sheet and identify the behaviors they already practice.

REFLECT:

• What are some positive ways of managing stress?
• What are some negative ways of managing stress?
• What are some methods that can relieve physical stress?

APPLY:

• Have group practice Relaxation Recipes!
• What is one new stress managing behavior that I will attempt to develop?

Handout I: Dealing with Stress

Following is a list of some of the ways people attempt to deal with stress. Some show positive, productive attempts at stress reduction while others are negative, non-productive and actually harmful.

Try to be honest as you rate your own reactions to stress. Circle the entry for ways you usually deal with stress. Since this exercise is meant to be seen only by you, you'll only be judging yourself.

When I find myself in a stressful situation or feeling stressed, I may:

• go for a walk, run or find some other active way to work off steam.
• talk my problem or feelings over with a friend, spouse or significant other.
• just deny the problem and go on.
• watch TV or go to the movies, anything to escape.
• write down my feelings and thoughts in an attempt to better understand the situation.
• get drunk and forget about it.
• eat.
• take a nice warm bath or do something else nice for myself.
• get angry and blow off steam.
• take a deep breath and let myself relax.
• figure out where I might get some help and talk with that person.
• accept that some things are just going to be painful and that I have to live with that.
• look for someone to blame.

Handout J: Relaxation Recipes!

Below are two ways in which you can cope with stress and reduce tension in your life. Choose the one that works for you.

Abdominal Breathing

Take five or ten minutes once or twice a day to practice the abdominal breathing method below until it becomes routine. It can be used to reverse the stress response whenever it is triggered.

For practice purposes, place your hands on your abdomen, right below the navel. The fingertips of each hand should touch one another.

Breathe through your nose. Many people breathe through their mouths, an almost sure sign of stress overload, and not nearly as healthy.

Inhale very slowly. As you do, push the abdomen out as though it were a balloon expanding. Your fingers should separate. As the abdomen expands, your diaphragm will move downward, allowing fresh air to enter the bottom part of the lungs. Keeping your back straight will aid the process of maximizing inhalation. As you continue inhaling, expand your chest. More air should now enter, filling the middle part of the lungs. Slightly contracting the abdomen, raise your shoulders and collarbones. This should fill the upper part of the lungs. At this point, the entire respiratory mechanism has been employed and no portion of the lungs is left unfilled.

Hold your breath for about five seconds.

Exhalation is as important as inhalation. Proper exhalation not only expels all used air, it opens space for fresh, new air to enter. After holding your breath, begin slowly to exhale through the nose. As you do so, draw in the abdomen. This will lift the diaphragm. The expanded rib cage will return to its normal position, and the lungs will empty. Remember, exhale slowly and let all the air empty out. If comfortable, hold it a second or two before beginning the inhalation again.

When you resume, remember to inhale slowly and completely. Repeating the word “calm” or “relax” as you exhale is also helpful.

Autogenic Relaxation

This activity shows you the effect relaxation has on the body. Word formulas are cue signals sent by the mind to the body, telling that part of the body to relax. Assume a comfortable position. You may lie down; close your eyes; loosen any tight clothing; and be quiet.

Assume a passive attitude. Focus on yourself and on achieving a state of relaxation in specific areas of your body. Tune out all thoughts of other events or happenings.

Repeat the word formulas as follows. Keep the words in sequence and repeat each formula silently.

Allow all your body parts to become heavy, warm and relaxed.

Focus on your state of deep relaxation. Remember, repeating the procedure increases your ability to relax.

Handout K: Six Steps to Managing Stress

1. Eat right! Good nutrition can go a long way in giving your body the proper balance to handle stress. Foods high in sugar, fat, salt, and caffeine put chemical stress on an already stressed body. Stop smoking, as the chemicals in a cigarette rev up the body in much the same way as stress. Eliminate these extra stressors altogether.
2. Get enough sleep. Dr. George Sheehan says we are a generation of “sleep cheats.”

   Because our lives are so busy with job, family, care giving, and voluntary commitments, we tend to cram in more hours of activities to get these jobs done. Being a “sleep cheat” ultimately will backfire. Try to get between 7 to 8 hours of sleep each night. Avoid sleeping pills since these pills negatively alter normal sleep patterns.

3. Actively work off stress and tension. We hear about this every day, yet fewer than 20% of Americans exercise regularly. Too many “couch potatoes” means too little stress eliminated. Just think of the 1988 Olympics. Florence Joyner, the 100 meter gold medalist, was an example of beauty, grace, and physical fitness. Exercise needn't be painful or boring. Too often in the past, physical exercise coaches told their students, “No pain, no gain.” This philosophy has been rapidly replaced with the notion that exercise can be a wonderful reward in itself—one that is fun to do.
4. Relax. Bubble baths are wonderful! Long, hot showers work for some. Simply closing your eyes and deep breathing can trigger your body into releasing tension.
5. Make a list. This may sound silly, but it's one of the simplest means to organize what needs to be accomplished. List the things that need to be done first, second, third, and so on. By ranking what needs to be done, the tasks that cannot be put off are taken care of first. Too often, we try to do everything at once with the result that nothing gets done the right way. We may feel guilt over a poorly done job; or guilt about eliminating tasks we think we need to do that might not have to be done at all or could be delegated to someone else. A humorous way to look at the list is to label it a “Worry List”—let the list “worry” for you!
6. Learn acceptance. So often, we worry about things that we cannot control. Face that fact! If you cannot control a situation or occurrence, then learn to accept that as a reality. Conserve your energies for the things that you can control. Your focus and your capacity to accomplish those factors within your control will become clearer and easy to do if all of your energies are directed toward that accomplishment instead of being channeled off into a direction over which you have zero control.

Acknowledgment

Original article written by Elizabeth B. Bolton, professor emeritus, UF/IFAS Department of Family, Youth and Community Sciences, Gainesville, FL 32611.