Stress | JParadisi RN's Blog

The following post is the second of a series resulting from preparations for a forthcoming breast cancer conference panel discussion on survivorship.

by jparadisi 2012

When I was diagnosed with breast cancer I was a pediatric intensive care nurse working twelve-hour shifts, a long-distance runner, practiced weight-training, and a gardener. After the diagnosis, these activities came to an abrupt halt. Surgical procedures meant no running for weeks at a time. Weight training was limited by restrictions. Chemotherapy meant avoiding infectious patients, let alone managing critically ill children with my chemo-brain. Gardening was okay, but only so long as I didn’t get cuts or wounds that could become infected due to a lowered WBC.

Surrendering an active lifestyle in exchange for the other side of the bed was not an easy adjustment, and I held out for as long as possible. During treatment I didn’t have the energy to participate in these activities to the same levels as before. I continued running after my first chemotherapy infusion until one day I completed 1 1/2 miles and then completely bonked. I had to walk back home that 1 1/2 miles with bone deep fatigue. Grudgingly, I gave up running while on chemo.

For some, physical activity is a go-to method of stress relief. For many cancer patients, when this tool is needed most, it is unavailable. It requires developing new tools for managing stress.

It’s important for nurses and health care providers who are not physically active to understand that a lack of physical activity actually creates stress for patients who are. It’s one reason your adolescent and young adult patients often become sullen. Physical activity is part of their mind-body connection.

The median age of breast cancer diagnosis is 61, so It follows that many hospital-based exercise classes for breast cancer survivors are structured with the intent of increasing physical activity and function for older, sedentary survivors. While beneficial, these classes may not meet the needs of the physically active, regardless of their age. Breast cancer patients who beg to continue swimming, running, bicycling, and even skiing are not uncommon. Here’s some exercise tips for physically active breast cancer patients:

Review your level of physical activity with your medical oncologist and surgeon before resuming or starting an exercise program. Surgery remains the cornerstone treatment for breast cancer, and physical restrictions apply post-operatively to promote healing. Mastectomy, reconstruction, and lumpectomies require different periods of recuperation. Some chemotherapy regimens used to fight specific types of breast cancer have potential to affect the heart. Those with metastatic disease may have other restrictions. Forgoing your activity of choice is difficult, but it’s important to remember that taking the time to heal is an investment in overall wellness.
Consider alternative forms of exercise. Walking is commonly prescribed during treatment. Meditation labyrinths are a great way to get some exercise and practice mindfulness at the same time. Some hospitals, spiritual centers, and churches have them. Ask about stair climbing-I used a Stair Master (once cleared by my surgeon), and did not have the energy to run outdoors. Running machines are another option: If you get tired, you can stop without having to get back home.
If you are medically cleared to use a gym make sure to bring antibacterial wipes to wipe down the machines before use, if they’re not provided: If you are receiving chemotherapy, you are more prone to infections from opportunistic germs. If you take a yoga class, (another commonly recommended activity for breast cancer patients) bring your own mat, and wear plastic flip-flops to avoid fungal infections from the studio floors.
Remember, physical fitness is not what you do in the short-term, it’s an accumulation of activity throughout a lifetime. Going through breast cancer treatment tests your body; it’s working hard. Support its healing through good nutrition and adequate rest.

Painting by jparadisi

Nursing potentiates normal holiday stressors. For many nurses, the beauty of the winter holidays is diminished by feelings of stress.

Staffing woes contribute: Who knows why every year during the holidays, patient census randomly explodes abundantly or trickles down to near nothing, resulting in too much overtime or hours-deficient paychecks?

We go home to enjoy the glow of Christmas tree lights knowing our patients spend their holidays in a hospital or hospice bed, their rooms lit by overhead fluorescent lights, and this knowledge dampens a nurse’s ability to fully enjoy celebrations of bounty. We may experience feelings of guilt that our income is dependent on the misfortune of others, in this case, illness or trauma.

Mismatched schedules, especially those of night-shift nurses, complicate holiday arrangements with family. Gift giving weighs heavily on sensitive souls: Instead of buying gifts, shouldn’t the money be given to those in need? Or are our expressions of love for family and friends, the creation of memories and traditions left after our own health fails, equally important? Someday, we will become the ones missing from the family dinner table of Christmas’s future.

Here are suggestions for handling holiday stress:

Reduce expectations. Holiday preparations and gifts are expressions of love, not declarations of wealth. Stay within your physical and fiscal boundaries.
Plan quick, easy, and low-calorie meals in between holiday parties. You’ll feel better.
Enlist the help of children with holiday baking and food preparation. This is an opportunity to teach them to cook while spending time together.
Lighten your housework load by asking children to help with age-appropriate tasks like dusting, folding clothes, drying dishes, etc. Work out a payment incentive with them. Encourage them to use the money for Christmas shopping, to buy a toy for a less fortunate child, or donate to a food bank.
Plan downtime and use it for activities with personal meaning. Don’t skip yoga class or your morning run. Take a break from wrapping gifts for a cup of fragrant hot tea or cocoa with marshmallows. Spend an hour at church, take a long walk, or meditate to regain your sense of grounding.
Remember the gifts you give. Nurses give to their patients throughout the year gifts that cannot be remunerated on a paycheck. Although we do not have magic wands to cure disease, taking time to listen and help patients with their needs goes a long way. The best way to feel better is to help someone else feel better. This is the gift of nursing.

Does your nursing job ever affect your ability to enjoy the holidays? What steps do you take to reduce holiday stress?