1. Chapter 47 Stress, Anxiety, Coping, and Adaptation

2. 47-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Stress, Anxiety, Coping, and Adaptation  Stress is the body’s physiological reaction to any stimulus that evokes a change.  A stressor is any situation, event, or agent that threatens a person’s security.  A certain amount of stress is necessary for survival.

3. 47-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Anxiety is a vague, nonspecific, uncomfortable subjective response as the result of a perceived or actual threat to one’s biologic, psychologic, or social integrity.  Anxiety is a pervasive feeling of dread or apprehension. Stress, Anxiety, Coping, and Adaptation

4. 47-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Stress, Anxiety, Coping, and Adaptation  Coping is a complex of behavioral, cognitive, and physiologic responses that aim to prevent or minimize unpleasant or harmful experiences that challenge one’s personal resources.

5. 47-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Stress, Anxiety, Coping, and Adaptation  Adaptation is an ongoing process by which individuals adjust to stressors in order to achieve homeostasis.  Homeostasis is the equilibrium between physiological, psychological, sociocultural, intellectual, and spiritual needs.

6. 47-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Sources of Stress  Individuals experience stress primarily from their bodies, their thoughts, and the environment.  A situation or event that evokes stress in one person, may not affect another person.

7. 47-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Responses to Stress  Every individual has unique responses to stress.  A person’s response to stress is influenced by mental attitude, lifestyle, perception, and heredity.

8. 47-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Responses to Stress  Physiological Response to Stress General Adaptation Syndrome (GAS) -Alarm -Resistance -Exhaustion Local Adaptation Syndrome (LAS)

9. 47-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Responses to Stress  Psychoneurologic Regulation  Neuroendocrine Regulation  Stress Response The stress response is interwoven in its relationships among the nervous, endocrine, and immune systems.

10. 47-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Manifestations of Stress Physiological Psychological Cognitive Behavioral Spiritual Responses to Stress

11. 47-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Outcomes of Stress The process of coping ineffectively with stressors is referred to as maladaptation. Eustress is a type of stress that results in positive outcomes. Distress is experienced when stressors evoke an ineffective response. Responses to Stress

12. 47-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Outcomes of Stress  Crisis is an acute state of disorganization occurring when the individual’s usual coping mechanisms are no longer effective.  Characterized by extreme anxiety, inability to function, and disorganized behavior.

13. 47-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Can be a negative experience but also has the potential to be an opportunity for growth  The outcome is unique according to each individual’s perception and coping abilities. Crisis

14. 47-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Crisis  Characteristics common to all crises Experienced as a sudden event. Has an identifiable precipitating event. Perceived as overwhelming. Intervention is required for equilibrium to be achieved.

15. 47-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Balancing Factors Perception Coping mechanisms Situational support Outcomes of Stress

16. 47-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Outcomes of Stress  Anxiety Behavioral responses observed in the anxious person are personal and interpersonal. Usually accompanied by other closely connected emotions such as anger, guilt, hostility, or depression.

17. 47-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Outcomes of Stress  Coping Behaviors Problem-focused mechanisms Cognitively-focused mechanisms Emotion-focused use of ego-defense mechanisms

18. 47-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Outcomes of Stress  Defense Mechanisms Protective mechanisms against feelings of inadequacy and unworthiness. Some are automatic responses. Other responses are purposeful and planned.

19. 47-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Selected Defense Mechanisms  Denial  Projection  Repression  Rationalization  Regression  Suppression

20. 47-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Stress and Illness  Illness occurs when a person’s adaptive attempts are unsuccessful.  A major outcome of prolonged periods of stress is impairment of the immune system.  The body is less able to protect itself from disease.

21. 47-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Impact of Illness and Treatment  Hospitalization, surgery, and long-term care admission are major disruptions that can evoke the stress response.  An unfamiliar environment, loss of control over one’s schedule, and being dependent on others for care require adaptation in order to maintain a steady state.

22. 47-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Some cues that a person may be reacting adversely to hospitalization Increased stress response Higher levels of anxiety Increased or impaired use of coping mechanisms Inability to function Disorganized behavior Impact of Illness and Treatment

23. 47-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Stress and Change  Change is a dynamic process in which an individual’s behavior is altered in response to a stressor.  Change is both inevitable and constant.  Change can be constructive or destructive.  Change can be stressful to an individual because it activates the GAS.

24. 47-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Types of Change Developmental Reactive Covert Overt Stress and Change

25. 47-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Theories of Change Lewin’s Theory of Change Lippitt’s Theory of Change Stress and Change

26. 47-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Resistance to Change Many people resist change because of the energy required to adapt. Energy is also required to resist change or to maintain the status quo. Individuals differ in their ability to tolerate (or even thrive on) change. Stress and Change

27. 47-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Changing Paradigms One’s paradigm (pattern, mindset) greatly colors one’s perceptions and behaviors. By changing paradigms, an individual can determine what is positive in the old system and use it to create a newer, better system. Stress and Change

28. 47-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Nurse as a Change Agent Initiating change is an expectation for professional nurses. True change agents constantly seek ways to make improvements. As an advocate for change, the nurse empowers the client to initiate change in order to adapt more successfully. Stress and Change

29. 47-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assessment  Patterns of stressors  Typical responses to stressful situations  Cause-and-effect relationships between stressors and thoughts, feelings, and behaviors  Past history of successful coping mechanisms

30. 47-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnoses  Anxiety  Ineffective Coping  Ineffective Denial  Powerlessness  Impaired Adjustment  Ineffective Role Performance

31. 47-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Disturbed Thought Processes  Defensive coping  Fear  Post-Trauma Syndrome  Impaired Social Interaction  Spiritual Distress Nursing Diagnoses

32. 47-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Outcome Identification and Planning  The nurse should work with the client in coping with their crises by establishing outcomes together.  Helping clients learn to cope successfully is part of the empowerment process.

33. 47-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Meeting Basic Needs  Environmental Strategies  Verbalization  Involvement of Family and Significant Others

34. 47-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Stress Management Techniques Exercise Relaxation Techniques Progressive Muscle Relaxation Guided Imagery Cognitive Reframing or Thought Stopping Rapid Relaxation Response

35. 47-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Crisis Intervention Identification of the Problem Identification of Alternatives Selection of an Alternative Implementation Evaluation

36. 47-36 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evaluation  Evaluating the effectiveness of a client’s coping abilities is an ongoing, comprehensive process that must include client input.

37. 47-37 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Personal Stress Management Approaches for the Nurse  Nurses must cope successfully with stress in order to maintain their own wellness, and to model health-promoting behaviors to others.

38. 47-38 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.  Stress Hardiness Nurses who cultivate hardiness will likely be resilient to stress. The three components to stress hardiness are commitment, challenge, and control. Personal Stress Management Approaches for the Nurse

39. 47-39 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Personal Stress Management Approaches for the Nurse  Exercise  Relaxation techniques  Environment changes  Journaling  Writing poetry  Hobbies as health promoting strategies

40. 47-40 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Personal Stress Management Approaches for the Nurse  Humor helps nurses manage the stress created by the nature and intensity of their work.

41. 47-41 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Burnout and Nurses  Burnout occurs when the nurse is overwhelmed by stress.  As a result, the nurse experiences physical, emotional, and behavioral dysfunction, including decreased productivity.

42. 47-42 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Burnout and Nurses  Phases of Burnout Initial feeling of enthusiasm for the job Loss of enthusiasm Continuous deterioration Crisis Inability to work effectively