Sustaining mental health amidst high-pressure job scenarios: a narrative review

INTRODUCTION

In today's professional world, individuals often navigate high-pressure job scenarios that demand exceptional performance and unwavering dedication. The constant push for success and the growing pressures at work are causing a big worry for mental health. As people try to meet deadlines and do their best at work, it's taking a toll on their well-being.

From recognizing the signs of stress to implementing proactive measures for self-care, we embark on a journey to promote resilience and a healthy equilibrium between professional aspirations and mental well-being.

In a world where career ambitions often coexist with stress, mastering art of balancing the two is crucial for sustained success and overall life satisfaction. Maintaining mental health and well-being is essential to living a healthy life even in high-pressure professional contexts. Stress can be defined as the response to events that threaten or challenge a person. The term stress refers to negative emotional experiences with associated behavioral, biochemical, and physiological changes that are related to the perceived acute or the chronic challenges.¹

Workplace stress is a psychological burden related to one’s job. Workplace stress stems from pressures that do not always align with the person’s skills, knowledge, or expectations.

World health organization categorizes stress-related hazards at work into two divisions (Table 1).

*World health organization categorizes stress-related hazards at work into divisions.

While stress is inherent in various occupations, its significance becomes notably heightened in professions related to human health. Nursing, for instance, is a demanding field that necessitates high-level skills, continuous vigilance, robust teamwork, and the delivery of round-the-clock care. Nursing exposes practitioners to many physical and psychological stressors, contributing significantly to job-related stress for these professionals.²

In the Indian context, nursing emerges as a pivotal profession, constituting the backbone of the healthcare system. A report of the Indian Nursing Council counts approximately 27 lakh registered nurses in the country. Despite the indispensable nature of their role, nurses in India frequently face difficulties such as excessive workloads, insufficient staffing, and limited resources.³ A 2018 study conducted by the Indian journal of medical ethics revealed that nurses in India grapple with elevated levels of stress and burnout.⁴

JOB-RELATED STRESSORS IN NURSING

Several significant stressors have been identified within the nursing community, including high work pressure and demand in the workplace, night shift, excess responsibilities, exposure to threats and violence from patient families, adapting to new therapies, managing elevated expectations, working on holidays, and dealing with life-threatening emergencies. Some other common factors are insufficient equipment and facilities, occasional conflicts with team members, inadequate teamwork, lack of managerial support, and a dearth of rewards and incentives.⁵

Workplace stress has the potential to adversely impact both the physical and mental well-being of individuals, leading to a decline in job productivity through heightened stress levels. According to the world health organization, stress is identified as a primary cause in 80% of all occupational injuries, while the American Institute of Stress attributes 40% of the financial burden in the workplace to stress.

Nursing is recognized as a profession with inherent stressors. The demanding nature of the nursing profession involves high expectations job requirements, excessive responsibility, and limited authority. Studies conducted in Iran indicate that 7.4% of nurses are absent every week due to mental fatigue or physical disabilities resulting from work-related factors a rate 80% higher than that observed in other professional groups.²

The ramifications of job stress on nurses extend beyond their well-being and can impact the quality of patient care. Given the close involvement of nurses in patient interactions, factors such as workplace location, diversity of hospitalized cases, staffing shortages, extended working hours, and the attitude of hospital administration contribute significantly to the stress experienced by nurses. Job-related stress has been linked to a decline in compassion for patients and an increase in practice errors, making it adversely associated with the quality of care provided.

While individuals can generally handle short-term stress, prolonged exposure to chronic stress leads to lasting physiological changes. The challenges related to job stress, coping mechanisms, and burnout among nurses are universally concerning for healthcare managers and administrators. Employing effective stress management skills has the potential to positively alter the impact of these stresses. Burnout represents an exhaustive state that manifests not only physically but also emotionally, mentally, and socially. It emerges from job-related stressors that prove challenging to manage without sufficient support. This condition not only diminishes motivation but also compromises the quality of care that the nurses provide. The prevalence of burnout in nursing is a considerable concern, with the 2022 national nursing workforce survey revealing that nearly 26% of surveyed registered nurses reported experiencing burnout daily, while almost 20% reported such feelings multiple times per week.⁶

EXPLORING COMPASSION FATIGUE IN NURSING

Compassion fatigue (CF) describes a phenomenon of stress that results from consistent exposure to traumatized individuals rather than exposure to trauma itself. Compassion fatigue is defined as “a convergence of secondary traumatic stress and cumulative burnout, a state of physical and mental exhaustion caused by a depleted ability to cope with the day-to-day environment.” Compassion fatigue, when experienced by nurses, can lead to a decline in productivity. Compassion fatigue, manifests as anger, exhaustion, irritability, and negative coping behaviors.⁷ It reduces the ability to exhibit sympathy and empathy, deterioration of care-related decision-making skills, and diminishes job satisfaction. According to the 2022 estimate in the International Journal of Environmental Research and Public Health, nearly 58% of nurses experience moderate to severe compassion fatigue. Nurses specializing in areas like oncology, psychiatry, pediatrics, emergency care, and intensive care are particularly susceptible.⁸

STRATEGIES TO ALLEVIATE JOB-RELATED STRESS

Prioritizing personal well-being: preparing the base

Establishing the foundation recognizes the significance of mental health as a fundamental aspect of overall well-being, directly impacting job performance. The mental state significantly influences productivity, decision-making, and interpersonal relationships. Nurses should cultivate a robust support system by seeking emotional support from friends, family, and colleagues. Finding professional help from therapists or counselors is also essential to address mental health concerns, and build resilience.

Author’s view: “Spending time with family and friends significantly decreased the impact of stress. A short trip to religious, pilgrim, personal space and ‘me’ time are important to regain energy and potential positive motivation.”

Sleep hygiene: regular schedule of sleep

"Nurses might have to work overnight for long hours without a break. This can cause sleep problems, with 57% of night-shift nurses reporting such issues. Shift work and other non-conventional patterns of work can deteriorate the natural circadian rhythm of the human body. Inadequate sleep affects nurse’s psychological health too.⁹ The challenges inherent in the nursing profession encompass substantial responsibility and heightened risks, involving constant exposure to disease, trauma, and even mortality. The persistent demands of the job can induce chronic job stress, leading to fatigue, anxiety, depression, and other psychological issues that significantly influence the quality of sleep.

Author’s view: “Adopting a regular sleep schedule promotes adequate and quality rest to enhance mental health and cognitive function by maintaining a consistent sleep cycle. Sleep must be prioritized, with an aim of 6-8 hours of sleep per 24 hours. Incorporating calming bedtime routines, reducing screen time before sleep, and creating a comfortable sleep environment such as reading a book, taking a warm bath, or practicing relaxation exercises can contribute to improved sleep quality. Avoid stimulating activities, like working or engaging in intense discussions, and caffeine/nicotine/alcohol intake just before bedtime. Keep the sleeping environment dark and quiet.”

Maintaining boundaries: learning to say "no"

Setting boundaries involves the ability to say no, and it's a concept frequently emphasized by therapists for valid reasons. It's crucial to understand that setting boundaries is not an attempt to control someone else's behavior; rather, it is about clarifying for yourself what actions you are willing or unwilling to take and knowing when to step back. Resist the urge to justify, rationalize, or apologize. While a brief explanation can be provided, avoid trying to convince others that your reasons are "good enough”.¹⁰

It's important to acknowledge that boundaries will be tested. Be prepared to uphold and reiterate them as many times as necessary to maintain their effectiveness. Employ strategies for separating work and personal life, such as time management and clear communication. One of the first steps in achieving work-life balance in a high-pressure job is to prioritize tasks and set clear boundaries. Identify critical tasks that require immediate attention and those that can be deferred. Let others know about your boundaries with colleagues and superiors. It is equally important to establish realistic expectations regarding your availability outside regular working hours. Acquiring the skill to gracefully decline commitments when needed is vital to prevent over-committing and becoming excessively stretched. This also safeguards against personal or family matters interfering with work responsibilities.

Authors' view: “Constantly attending to personal calls or regularly checking digital devices during work hours can contribute to a sense of being overwhelmed and feeling spread thin.

There was a period in my life when I consistently felt overwhelmed, attempting to manage an excessive number of responsibilities simultaneously. I found myself frequently agreeing to requests from others and taking on more than I could handle. Gradually, I realized that I needed to establish boundaries. Although it proved challenging, it became a crucial step for my mental well-being.”

Maintaining a healthy lifestyle amidst a stressful job

Physical activity is not only about staying physically healthy but is also crucial for your mental well-being. When you engage in exercise, your body releases chemicals called endorphins, which can make you feel happy and euphoric. Moreover, some studies suggest that regular exercise can be as effective as medication in reducing symptoms of depression and anxiety.¹¹ So, start moving! It's good for your body, mind, and overall inner peace. Stress often leads to suboptimal dietary choices, with the convenience of fast food becoming a tempting solution. Stress hormones can intensify cravings for fatty, salty, or sugary foods.

In addition, regular exercise stands out as a pleasurable and effective means to counteract stress. Exercise triggers the release of endorphins, the "feel-good" hormones that can alleviate anxiety and depression.

Author view: “Like many others, I've fallen prey to the tendency to consume additional calories in the form of sweets and fast food during demanding situations such as high-pressure deadlines, exams, long night shifts, or stressful events. Consequently, I experienced lethargy and encountered issues with weight gain.

Begin by consuming a nourishing meal before commencing your shift, and opt for bringing wholesome snacks to work instead of relying on fast food or vending machines. Prioritize water intake over soda or juice throughout the day.”

UNDERSTANDING CONTROL IN THE WORKPLACE

A crucial step in alleviating stress for nurses is discerning what can be controlled and what cannot. Some of job requirement like shift duties, long working hours, and difficult working situations cannot be controlled. For instance, nurses may not have control over their working hours but can take mental health breaks during extended shifts and prioritize self-care afterward. While individuals cannot dictate how others perceive them, focusing on one's actions and professionalism proves essential.¹²

Authors' view: “Giving appreciations to employs. While coworkers may not be chosen, effective communication within the team remains a choice.”

EMBRACING MINDFULNESS PRACTICES

Nurturing inner peace is not always a walk in the park. It's a continuous journey and a commitment that demands practice. Prioritizing self-care is pivotal in this endeavor, involving the conscious allocation of time for personal well-being amid life's hustle and bustle. Embracing specific self-care practices becomes instrumental in preserving this invaluable inner tranquility, a realization held by those well-versed in its importance.

Mindfulness means being aware of all that is happening inside and around oneself. Deep breathing, yoga, walks in nature, mindful eating while savoring all tastes, textures, and flavors of the food, and increasing awareness of one's own body by bringing attention to each body part are some examples of mindfulness activities.¹³

These activities promote focusing on the present moment, aiding in letting go of concerns about the future or regrets from the past. Regular physical activity, linked to improved sleep quality, is encouraged, but intense workouts close to bedtime should be avoided.

MEDITATION

We can’t talk about inner peace without mentioning meditation. It’s like trying to bake a cake without flour. Throughout millennia, meditation has served as a timeless tool for individuals seeking harmony within themselves. The beauty lies in its flexibility, with no rigid rules on how to engage. Supported by solid scientific findings, meditation has been proven to alleviate stress, enhance concentration, and foster increased happiness.

Author's view: "Try taking just 5 minutes of meditation in the morning or before going to bed. Your mind will appreciate it. Remember, doing it regularly is important, so turn it into a habit, and you'll see your inner peace get better. Mindful Distraction proves beneficial by engaging in hobbies and interests that divert attention from work-related stressors.”

RELIEVING STRESS THROUGH CREATIVITY

Creative pursuits, such as writing, drawing, or crafting, offer a unique avenue for expressing emotions and channeling stress into a tangible, positive outlet. The act of creation can be therapeutic, promoting a sense of accomplishment and fulfillment.

Regular exercise has demonstrated the ability to boost cognitive function, encompassing enhancements in memory and executive functions.

Authors' view: “Enjoy hobbies and interests outside of work to have fun and express your creativity. Doing these things not only helps you relax but also makes you feel fulfilled.”

DISCONNECTING FROM DIGITAL DEVICES

Here's a personal experience I went through a few years ago. I often felt tired, anxious, and couldn't focus. My mind was always busy with various thoughts. Then, I figured out the reason for my constant use of digital devices. So, I decided to do a digital detox. I started setting aside a few hours each day to completely disconnect from all digital devices. No phone, no laptop, nothing Just me and my surroundings.¹⁴

Author view: “It was hard at first, but slowly I noticed a difference. My mind felt clearer, I was more present, and my stress levels went down. Since then, regular digital detoxes have become part of my self-care routine. It's not always easy in our connected world, but it's worth it. Give it a try you might find that quiet space you've been longing for.”

WORK-LIFE INTEGRATION

Nurturing relationships helps individuals maintain a sense of balance between personal and professional life. Spending quality time with loved ones outside of work provides a much-needed break and reinforces the importance of a well-rounded life beyond professional achievements.

Work-life integration is an approach to achieving a peaceful and balanced coexistence between one's professional and personal life. Unlike the traditional concept work-life integration recognizes that the boundaries between work and life are increasingly porous. Our life consists of various aspects, including work, family, health, and personal pursuits. Integrating these aspects seamlessly allows individuals to address their diverse needs without feeling torn between conflicting demands.

Authors' view: “Continuously stressed individuals may experience temporary or chronic back, headache, and elevated heart rate, which, over time, elevates the risk of heart attack, stroke, and hypertension. Additional physical effects of stress include a weakened immune system, insomnia, and daytime fatigue.”

EMOTIONAL WELL-BEING: EMOTIONAL SUPPORT AND UNDERSTANDING

High-pressure jobs can sometimes lead to isolation as individuals become engrossed in their work. Nurturing relationships acts as a buffer against this isolation, promoting social connections that are vital for mental well-being. Pursuing activities that bring joy and satisfaction triggers the release of endorphins, the body's natural mood elevators. Whether it's playing a sport, reading, or cooking, these activities contribute to a positive emotional state, counteracting the negative effects of stress.¹⁵

Knowing that there are individuals who understand and empathize with the pressures of your job provides emotional support that can help alleviate stress and anxiety.

Authors' view: “Colleagues facing similar high-pressure situations can offer a unique form of understanding. Sharing experiences, both positive and challenging, creates a sense of camaraderie and solidarity, reinforcing the notion that you are not alone in navigating the demands of your job.

Relationships provide a safe space to express concerns and vent frustrations. Talking about challenges and stressors with trusted individuals helps in processing emotions, preventing bottling up, and reducing the negative impact of stress.”

ENHANCED EMOTIONAL RESILIENCE

Nurturing relationships contributes to the development of effective coping mechanisms. The emotional support and understanding offered by trusted individuals enhance an individual's ability to bounce back from setbacks and navigate stressors more effectively. Relationships distribute the burden of challenges. Emotional resilience can be built by developing healthy physical habits like healthy eating, adequate sleep, and exercise, and taking out time for oneself each day. Practicing gratitude, and building strong social connections can enhance emotional resilience. Sharing responsibilities and relying on others for support can prevent an individual from feeling overwhelmed by the weight of their high-pressure job, fostering a sense of collective strength and resilience.

Authors' view: “Strong relationships contribute to a positive work environment. Colleagues who are supportive and collaborative create a culture that values mental well-being, making the workplace a more conducive space for navigating high-pressure situations. Nurturing relationships within a team fosters cohesion. A cohesive team is better equipped to handle challenges collectively, leveraging each member's strengths and mitigating the negative impact of high-pressure scenarios.”

PHYSICAL AND MENTAL RESTORATION

Taking purposeful breaks

Disconnecting allows the mind to wander and engage in reflective thinking. These moments of mental freedom are conducive to creativity and problem-solving. It involves taking purposeful breaks during the workday. Whether it's a short walk, a few minutes of deep breathing, or a brief chat with a colleague, these breaks provide moments of respite that contribute to mental rejuvenation and sustained focus when returning to work tasks.¹⁶

Authors' view: “Some of the most innovative ideas emerge when the mind is not constrained by the immediate pressures of work. Stepping back from work through disconnecting provides an opportunity to gain perspective. In particular, nurses have the opportunity to take time for themselves after particularly lengthy shifts or challenging work weeks.”

Improved professional standing

Break down complex tasks into smaller, more manageable steps. This promotes consistent progress and helps reduce the feeling of being overwhelmed. High-pressure roles often come with tight deadlines and substantial workloads. This method allows individuals to focus on one step at a time, easing the sense of overwhelm and ensuring that each aspect of the task receives the required attention.

Authors' view: “When tasks are broken down into smaller steps, it provides clarity on what needs to be accomplished. This clarity helps individuals stay focused on the immediate task at hand, minimizing distractions and increasing productivity. In high-pressure situations, maintaining focus is essential for meeting deadlines and delivering quality work.”

SEEKING SUPPORT AND COPING WITH STRESS BY REACHING OUT TO COLLEAGUES

Seeking support and reaching out to colleagues are important strategies for coping with stress and maintaining good mental health in high-pressure jobs. Establishing open communication channels with colleagues creates a supportive work environment. Encouraging honest discussions about workload, challenges, and stressors helps build a sense of camaraderie and allows individuals to express their feelings without fear of judgment.

Authors' view: “We can support our team members or coworkers by recognizing signs of distress, anxiety, and depression. We can express our concern and empathy, by asking them about their well-being and coping mechanisms. Can share our own experiences to foster openness. Provide information on available resources, such as employee counseling services, wellness initiatives, or peer support groups available. Stay engaged by following up with colleagues, by sending them messages, calls, or meeting for coffee to inquire about their well-being and whether they've explored the suggested resources. We can offer ongoing feedback, encouragement, and recognition for their efforts. Sometimes we can invite colleagues to join us in uplifting activities like exercise, meditation, hobbies, or socializing. Avoid judgment, blame, or pressure, and instead create an environment that promotes understanding and support.”

ROLE OF THE MANAGEMENT IN PRESERVING THE MENTAL HEALTH OF EMPLOYEES

At the preventive level, WHO recommends that employers plan and implement organizational interventions such as flexible work arrangements, stringent frameworks against workplace harassment, bullying, and violence, etc. For mental health protection and promotion, WHO suggests that managers must be empowered with training to recognize and respond to the mental health needs of employees, building IPR with their employees through open communication and active listening. Workers must be trained to increase awareness and reduce stigma related to mental health. Individuals must be trained to build emotional resilience and adopt healthier coping strategies to fight psychological distress. If the employee has a psychological condition, the organization must support them to participate and thrive at work by making reasonable accommodations for them (e.g. flexible working hours, extra time to complete work, regular support meetings with managers), and helping them to return to work after the absence meaningfully.

CONCLUSION

Workplace stressors can contribute to mental health issues. Nurses can confront these stressors by advocating for improved working conditions and seeking additional support from management. Open communication between nurses and management can foster a more positive work environment.

Given these challenges, nurses in India must prioritize their mental health. Through practices such as self-care, seeking support, mindfulness, preventing compassion fatigue, engaging in continuing education, practicing emotional intelligence, finding meaning in their work, fostering positive relationships, taking breaks, and addressing workplace stressors, nurses can safeguard their mental health and continue delivering high-quality patient care. Additionally, government and healthcare organizations must acknowledge the pivotal role of nurses and provide the necessary support and resources to enable them to perform effectively while maintaining their mental health and well-being.

Cultivating relationships builds a network of trust that extends beyond the workplace. Knowing that you have a support system in place fosters a sense of security and resilience, providing a foundation to withstand the challenges that high-pressure jobs may present.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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