Cardiopulmonary rehabilitation (CR/PR) is integral to patient recoveries but can be highly stressful for individuals experiencing heart conditions and surgeries. Caring for these patients can also be stressful for their rehab teams. Within CR/PR, staff collaborate and provide patient care using a team-based interdisciplinary model. However, they often find themselves under pressure due to juggling multiple demands (e.g., workload of multiple patients, conflict with patients, colleagues, and management) in the ever-evolving landscape of health care (e.g., changes to documentation, billing, insurance, and practice guidelines). This is why self-care and evidence-based practice skills in communication and stress management are important not only for patients but for staff.
Sharon Y. Lee, PhD, assistant professor in the Department of Psychiatry and Human Behavior at Warren Alpert Medical School of Brown University, offers tips for improving job satisfaction among CR/PR professionals through strong team cohesion, self-care, effective interpersonal communication, and a positive professional identity. According to research, when health care professionals improve their own well-being, they find greater purpose and meaning from their work. “This plays a direct role in reducing staff turnover,” says Dr. Lee.
Strategies for Successful Stress Management
To help CR/PR staff manage stress, each member of the team should take the time to identify their own negative thinking patterns. For example, when managers note an error in documentation, does the CR/PR staff member magnify the significance of the error? Or when the manager praises the way that they managed a challenging patient interaction, do they disqualify the recognition? Identifying these thinking patterns early can provide staff members with a place to start to modify their own perspectives on each type of situation they face while providing care.
According to Dr. Lee, another stress management strategy for health care professionals who are prone to worrying is to proactively schedule “worry time.” She explains, “All of us worry. Instead of trying to suppress your doubts, it can be more helpful to acknowledge that you have anxieties and give these worries a metaphorical container so that they don't spill out into other activities and parts of your day.”
To better monitor stress levels, staff should identify their own early warning signs and symptoms. These red flags can appear in many parts of the body, including the heart, stomach, muscles, and skin. Dr. Lee adds that they are also highly individualized, manifesting as teeth grinding, racing thoughts, tension headaches, and gastrointestinal discomfort. “Conducting a ‘body scan’ where a person brings attention to different parts of the body from head-to-toe and notices sensations can be helpful for developing greater awareness of stress-related signs and symptoms,” she notes. Knowing these ahead of time can help staff engage in self-care activities sooner to better manage their stress.
How We Communicate Can Set Clear Boundaries
In the workplace, tension and stress can be amplified by indirect communication, such as passive-aggressive behaviors or ignoring unconstructive behaviors. This increase in tension or stress also can reduce team performance and erode morale. “On the flip side, direct communication increases clarity and decreases uncertainty, which reduces the likelihood of misunderstanding and mistakes,” says Dr. Lee.
There are specific practices CR/PR staff members can adopt and use in their workplaces today. First and foremost is to adopt and leverage interpersonal effectiveness skills, which should come as second nature in CR/PR because they encompass how personnel communicate with colleagues, their bosses, and patients. Dr. Lee adds, “These skills also should include being able to assert yourself and say ‘no.’”
For managers, effective communication can include validating challenges, actively praising staff, and framing questions to invite feedback. For staff members, it can include sharing internal thought processes with colleagues, providing greater clarity on their perspectives, acknowledging existing dynamics openly, or enlisting help with saying no.
Building a Culture Focused on Well-Being
Every staff member may be in charge of their own well-being and stress management, but managers and leaders need to acknowledge that health care systems — hospitals, workflow, and teams — can help to alleviate or amplify stress. “Leaders have an active role in regularly ‘taking the temperature’ of their team and individual staff members,” explains Dr. Lee. “Every person on a team contributes to the culture of a workplace environment. Expressing care and concern for employees at the individual level can make a difference.”
According to Dr. Lee, “Leaders and managers should not assume they know what challenges each staff member faces. They should ask, and ask repeatedly.” Additionally, leaders should encourage staff members to privately complete self-care assessments to determine which areas of their life may require greater self-care. These evaluations examine the emotional, spiritual, physical, psychological, relationship, and workplace areas of each member’s life.
Individual health care professionals are in charge of their own stress management; but without guidance and self-care tools, staff may be unaware of how stress levels and tension are impacting their work with patients and their relationships with colleagues and family members. CR/PR teams need to develop essential skills, recognize external stressors in the work environment, and seek help when needed. “Health care professionals see and know the importance of prevention on a daily basis. The next step is to turn that preventive lens on ourselves and our own well-being,” Dr. Lee emphasizes.
Check out the recording of Sharon Y. Lee’s webinar, “Take One for the Team: Well-Being Practices to Bring Back to Your Cardiopulmonary Rehab," at the Learning Center.