1. NRS_320/105_Collings Stress and Coping Chapter 31

2. NRS_320/105_Collings What is Stress? An individual experience A disruptive force [physical/mental] A perception of a stimulus as: Positive [challenge] or negative [threat] Within or beyond coping ability Isolated or added to existing stress ‘Normal’ [pregnancy] or unexpected [illness/injury]

3. NRS_320/105_Collings Stress Levels Stress Daily life, added responsibility, injury/illness within our ability to adapt & cope Crisis Stress that overwhelms our ability to cope Trauma Stress response persisting beyond the end of the stressor

4. NRS_320/105_Collings Physiologic Response Alarm reaction Fight-or-flight response General adaptation syndrome [GAS] ↑ ADH, Cortisol, Aldosterone → protein & fat catabolism, electrolyte and fluid balance changes ↑ Epinephrine, Norepinephrine → ↑HR, B/P, BG, O2 intake, alertness

5. NRS_320/105_Collings Physiologic Response Continuing stress → Resistance Physiologic stabilization, repair Coping mechanisms are working Social/family support May change perception of event and/or ability to handle stress

6. NRS_320/105_Collings Physiologic Response If stress continues → Exhaustion Body cannot resist continued injury Depletion of energy Adaptation decreases Coping mechanisms are not working Causes harm R/T Immune response, hormone effects, new [unhealthy] coping mechanisms Can lead to death

7. NRS_320/105_Collings Stress Algorithm Stressor Appraisal: stakes, scope, other stressors This is ExcitingScary Coping reinforced → growth Alarm [GAS] Coping mechanisms Resistance Stress continues? NO YES Try new coping mechanisms, Deplete endorphins, energy, physiologic adaptation DEATH Successful? YES NO Physical, emotional Harm

8. NRS_320/105_Collings Coping Based on: Previous experience Culture Resources available Problem-focused Emotion –focused Ultimately helpful or harmful

9. NRS_320/105_Collings Crisis Requires new coping skills Developmental Crisis Maturational – pregnancy, birth, death Situational External: illness, injury Severity based on stakes & effect Chronic stress may become crisis as resources are exhausted

10. NRS_320/105_Collings Nursing Implications Focus : Prevent or reduce stressors Add resources for coping Prevent/reduce added stress Relieve pain, anxiety Engage healthy coping Rest, exercise, alternative therapies Identify & Involve others as resources Family, community, spiritual, healthcare

11. NRS_320/105_Collings Factors affecting Stress Number & severity of stressors Physical + Situational Financial, role concerns Available resources Perceived/actual Additive stress – many changes Previous experience & success Age – R/T coping mech., #of stressors & support available

12. NRS_320/105_Collings Assessment Establish relationship – 1 st Do not assess stress while causing it Subjective: Verbal – anxiety, overwhelmed, upset Objective – VS, nonverbal indicators Eye contact, hygiene, wt gain/loss

13. NRS_320/105_Collings Assessment Number and severity of stressors Within past year, month, present Perceived meaning, stakes Coping mechanisms and effectiveness Available resources Are they being used? Awareness of what is available

14. NRS_320/105_Collings Nursing Diagnosis Ineffective Coping R/T life stress AEB excessive ETOH intake Anxiety… Role Strain R/T caregiver role… Altered sleep patterns Nutrition: less than body requirements R/T lack of appetite 2* to stress/anxiety about diagnosis AEB wt loss of 12 lbs in 30 days

15. NRS_320/105_Collings Goals Should be based on Patient needs/priorities Nursing judgment What does the patient need to better cope? Information, access to resources, respite, coping strategies Can we reduce the # or severity of stressors? Improve coping strategies?

16. NRS_320/105_Collings Goals - examples Pt will utilize daily walk of 30 minutes to relieve stress [healthy coping strategies] Pt will ask for help from family for caregiver responsibilities: brother to provide dinner 3X/week, sister to do laundry 1/week [resources] Pt will report pain at < 3/10 within 30 minutes and throughout shift [reduce stressors]

17. NRS_320/105_Collings Interventions Identify stressors Identify coping mechanisms Reinforce/ teach healthy coping Decrease use of unhealthy coping Identify/access resources Complementary therapies: imagery, relaxation

18. NRS_320/105_Collings Evaluation Acute Stress may be self-limiting If coping strategies not harmful Stressor goes away Chronic Stress can be adapted to Reassess for stressors, coping Sleep, appetite, hope, social interactions Perception of stressor Effectiveness of coping strategies Were client’s needs met? AEB? Plan now?

19. NRS_320/105_Collings RN Stress & Burnout Burnout: Emotional exhaustion, depersonalization of others, perceptions of ↓ personal accomplishment R/T intense involvement with people in a care-giving environment Burned-out RN’s are not effective ID roles and control areas ID coping behaviors & effectiveness Resources? Time off, hobbies, rituals

20. Table work Assess your own or a partner’s stress levels using one of the tools provided Number & severity Additive over past year Coping mechanisms Effective? Healthy? Resources – available and utilized NRS_320/105_Collings

21. Tools http://www.mayoclinic.com/health/stress- assessment/SR00029http://www.mayoclinic.com/health/stress- assessment/SR00029 http://health.redorbit.com/HealthToolsDetails.aspx?whic h=stress&quiz=yhttp://health.redorbit.com/HealthToolsDetails.aspx?whic h=stress&quiz=y http://www.stress-management.net/stress-test.htm http://www.arc.sbc.edu/stressquiz.html NRS_320/105_Collings

22. Stress plan You may write your self-care plan on stress and coping, sleep… or another issue that we cover [nutrition, self-care / hygiene…. NRS_320/105_Collings

23. Questions ? NRS_320/105_Collings