Christmas may be a time for celebration but nurses are also likely to deal with some of the negative consequences the festivities have for patients. Nerys Hairon investigates
Hairon, N. (2008) How Christmas festivities and pressures can damage health and well-being, Nursing Times; 104: 50/51, 33-34
The Christmas holiday period is traditionally a time for celebration. However, the festive season often brings many detrimental health effects, which nurses may encounter when coming into contact with patients over the coming weeks.
While many people will be looking forward to having time off work, the impact of Christmas can be profound and not always positive. The effects range from increased stress, family conflicts and alcohol misuse to heightened loneliness, increasing mental health difficulties and domestic violence.
The global economic downturn and associated money worries are likely to make this Christmas more stressful than most.
Here, Nursing Times outlines some of the health effects of Christmas, and suggests how nurses can help patients to cope. NHS Choices at has a range of useful articles covering different aspects of how to have a healthy Christmas. Nurses can use these as a resource.
A range of factors contribute to making Christmas a busy and potentially very stressful time of year. These include pressures of shopping, time, financial concerns and social demands, as well as fatigue, general overindulgence and lack of physical exercise.
A Medical News Today (2008) article warns that Christmas pressures can lead to anxiety, sleep disturbances, headaches, loss of appetite and poor concentration - all of which are symptoms of stress. It adds that, over time, stress can contribute to heart disease, stroke and cancer. Nurses can help patients by offering them general advice on how to reduce their stress levels (Medical News Today, 2008; NHS Choices, 2008).
According to psychologists from Coventry University, most people suffer from stress during the Christmas period, but do not recognise it (Curtis, 2002). They explain that Christmas is a time of additional responsibility and a radical shift in daily patterns, and a range of factors can contribute to raising people's stress levels. Spending weeks worrying about Christmas can also lead to immune system breakdowns, leaving people susceptible to colds. Coming into contact with more people at this time also exposes them to more infections (Curtis, 2002).
Family issues can add to the stress of Christmas. Not only are there many domestic tasks but also spending concentrated periods of time with family members can increase the risk of conflict. According to NHS Choices, statistics show that January is the busiest month for divorce lawyers. The article, titled Keep Your Cool at Christmas, contains some useful tips that nurses can direct patients to (NHS Choices, 2008). This will help minimise the risk of family conflicts over the festive season.
Christmas can be a difficult time of year for people experiencing mental distress. Mind (2008) has launched its Christmas appeal to raise funds for MindinfoLine, a confidential mental health information service to people contacting it by phone, email or letter. The charity says Christmas can often leave people feeling even more alone and isolated from their family and friends. Nurses working in mental health settings should be extra vigilant for exacerbations of mental health conditions brought on by isolation or increased stress from the festive season.
While the Samaritans do not have figures on the number of calls at Christmas compared with other times of the year, the charity says call rates are higher on Christmas Eve than on Christmas Day, while they dip on New Year's Eve but are higher the day before and on New Year's Day.
Loneliness and isolation are particular issues at Christmas. NHS Choices says that, as Christmas is associated with friends and family, it can be difficult for those on their own to avoid feeling lonely at this time.
The WRVS (2004) pointed out that Christmas can be a particularly lonely time for older people living alone who may have no one to spend the festive season with. The charity, which aims to help older people get more out of life, says there are nearly 11 million people aged 65 and over in the UK and they are twice as likely to spend Christmas alone than younger people (WRVS, 2004). Difficulties such as bad weather, crowds and increased noise make it harder for older people to leave the house and deal with daily chores. WRVS say the loneliness felt on Christmas Day is often the worst.
Psychologists from Coventry University also argue that Christmas can be a sad and nostalgic time, when the loss of a family member may become especially painful (Curtis, 2002). It is often a difficult time for bereaved people, and nurses dealing with relatives who have suffered bereavement can offer help and support during this difficult time.
Community practitioners may come into contact with many older people who are facing Christmas alone. NHS Choices (2008), working with Mind, has compiled some advice that nurses can give to patients to help them cope (see box).
Advice for people spending Christmas alone
Source: NHS Choices/ Mind (2008)
Christmas is traditionally a time for overindulgence. With ever-increasing levels of obesity, patients may need extra help and support to lose weight in January, or to prevent weight gain over the holidays. Recent research published online by the Journal of Epidemiology and Community Health suggests one in three UK adults - or 13 million people - will be obese by 2012 (Zaninotto et al, 2008).
According to NHS Choices, a typical Christmas Day's food can add up to a massive 6,000 calories - three times the recommended daily amount for most women, and over 2.5 times for most men. Its article, Christmas Food Swaps, compiled with help from the British Nutrition Foundation, suggests some changes that patients can make to reduce calorie intake. Nurses may wish to direct patients experiencing weight problems to this advice.
Accidents, injuries and violence
Nurses working in A&E and minor injury units can expect busy shifts over the festive season. According to NHS Choices, more than 80,000 people a year need hospital treatment for Christmas-related injuries such as falls, cuts and burns. The combination of excitement, stress, tiredness and alcohol can create unexpected health hazards in the home at this time of year.
The British Medical Association also warned that healthcare professionals will have to deal with the consequences of excessive alcohol consumption. A BMA spokesperson says: 'The sad fact is that many doctors and nurses will be dreading working in A&E over the holiday period because they have to deal with the effects of people drinking far too much alcohol.'
Nurses should also be vigilant for signs of domestic abuse, as the police say there are about one-third more incidents of domestic assault on Christmas Day than the daily average, as pressures lead to conflict and then violence (Christian Today, 2007).
Clearly Christmas can be a difficult time for some patient groups, such as those with family difficulties or mental health problems. However, nurses can help patients to deal with problems by offering advice on reducing stress, the risk of conflict and loneliness, so helping to make the festive season more enjoyable.
Christian Today (2007) Christmas Action to Tackle Domestic Violence . December 14, 2007.
Curtis, P. (2002) Christmas Stress is Often Ignored, Say Psychologists. guardian.co.uk,
Medical News Today (2008) Stress Proofing Your Christmas , UK.
Mind (2008) Donate to Mind's Christmas Appeal.
NHS Choices (2008) Live Well. Healthy Christmas .
WRVS (2004) Loneliness at Christmas.
Zaninotto, P. et al (2008) Trends in obesity among adults in England from 1993 to 2004 by age and social class and projections of prevalence to 2012. Journal of Epidemiology and Community Health; doi:10.1136/jech.2008.077305