Stressed? Just Breathe

This is a review of the autonomic nervous system and an explanation of how nurses can use deep breathing to help reduce their stress response. Nurses Stress 101 Article

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Stressed? Just Breathe

Several years ago, I was working as a bedside nurse in a Neonatal Intensive Care Unit. I had just had an uncomfortable and confrontational conversation with my patient's mother. She was rightfully upset about aspects of her baby's care that were outside of my realm of influence.  Yet I was the only person available at the time to hear her frustrations. I remember walking back to the nurse's station feeling so overwhelmed. My body language must have indicated I was stressed because one of my coworkers said to me, "Just breathe.” So, I did. I took several slow deep breaths. It was like magic. I was amazed at how quickly my body responded. The feeling of overwhelm quickly melted away. So, what exactly happened here? Why did taking a few breaths improve my stress level so quickly and dramatically? The answer lies in the physiology of the stress response and how it can be diminished by deep breathing.

You may remember learning in nursing school that the autonomic nervous system is divided into the sympathetic and parasympathetic nervous systems. When we perceive a threat, the stress response causes the sympathetic nervous system to send signals to the adrenal glands telling them to begin releasing the hormones adrenaline and cortisol. The adrenaline results in a more rapid respiratory rate, higher blood pressure, and heart rate, as our body prepares to either fight the threat or escape from danger, also known as the "fight or flight" response. After the initial adrenaline surge, cortisol kicks in to ensure we stay on high alert, until the threat of danger has passed.

The stress response was essential to our ancestor's survival when they had to escape predators or other threats to physical safety. In our modern world, our bodies respond to non-life-threatening stimuli in a similar way. When our bodies don't perceive the threat of danger to be gone, we stay in a state of a long-term activated stress response. The physical manifestations can include headaches, sweaty palms, jaw clenching, and lightheadedness, while psychological symptoms may include feelings of being overwhelmed, tearfulness, frustration, and even anger and difficulty making decisions. If we continually live in a long-term state of an activated stress response, and elevated cortisol levels, we also increase our risk of developing chronic physical diseases such as cardiovascular disease and cancer and psychological diseases such as anxiety and depression.

When we perceive that the cause of the stress response, the threat, is over, the parasympathetic system is stimulated. This happens in large part due to the vagus nerve. Over three-quarters of the parasympathetic system consists of the vagus nerve, and its nerve fibers are mostly sensory. Once the vagus nerve receives information that the coast is clear, the "rest and digest" response can begin. This causes a decrease in heart rate and blood pressure, and the body can calm down and can focus on other tasks, such as digestion.

In times of overwhelming stress, one way we can call upon the parasympathetic system for relief is by taking deep, controlled, belly or diaphragmatic, breaths. This sends signals via the vagus nerve to your brain that you are safe and no longer are in need of the "fight or flight" response. There are lots of different breathing exercises you can practice to help calm your sympathetic nervous system. They can be used anytime, in any situation, on or off the clock. Experiment with a few to determine which you prefer.

As nurses, we encounter stressful situations daily in all work environments, such as patient status decline, family complaints, fatigue from long hours, conflicts with coworkers, etc.

Chances are you, too, have felt the overwhelm of our work environment and the subsequent physical and psychological effects of stress.

So, the next time you find yourself feeling this way while taking care of others, remember to take some time to take care of yourself and just breathe. 


Anatomy, Autonomic Nervous System: National Center for Biotechnology Information: StatPearls Publishing LLC: National Library of Medicine

Deep Breathing and Relaxation: The University of Toledo, Counseling Center

Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review: JBI Evidence Synthesis. LWW

Relaxation therapies: UCLA Health

Stress Effects: The American Institute of Stress

Understanding the stress response: Harvard Health Publishing

Claire B. Crompton RNC-NIC has worked in adult oncology, low-risk neonatal and maternal care, neonatal intensive care, and clinical education. She has a passion for empowering others through sharing knowledge.

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Specializes in Critical Care.

I was never able to "just breathe" during the stress, although I have read a lot about the importance of nasal breathing vs mouth breathing.  That if you are a mouth breather you are in a constant state of low-level stress just from that and aren't taking as deep of breaths as you would if you breathed thru your nose.  I have always been a mouth breather second to asthma and allergies, and while I can occasionally breathe thru my nose, I don't feel like I get enough air and the thought of just breathing thru my nose would make me panic stricken.  There are several YouTube videos about this and how to switch to nasal breathing, exercises to do, but depending on the cause you may need a surgical procedure to switch to mouth breathing.   It is a very fascinating subject, and they say even the shape of your face changes depending on if you are a nose or mouth breather!  Also they say the external nasal strips do help to open the nasal airway which surprised me I thought they were just a gimmick.

Now what I have used in the past was hypnosis and found it to be very effective.  First with a therapist and then I created a self-hypnosis tape tailored to a work situation that was very upsetting to me.  While I never liked pulling sheaths, I was able to do it without fear after using the hypnosis tape.  The fear had set in because of a few bad experiences when we first started taking cath patients.  Hypnosis is very powerful and there are scripts available that you can tailor to you own situation.  Hypnosis should be respected and used with care.

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