Stress Management

Objectives Define stress, adaptation, stressor, homeostasis, lack of oriented behaviors and defense and coping mechanisms. 2. List factors influencing the response to stressors. 3. Compare and contrast the Local Adaptation Syndrome with the General Adaptation Syndrome. Describe the psychological response to a stressor. Discuss the physical, psychological developmental results of prolonged stress. List behavioral, physical and emotional indicators of stress. Discuss the role of the nurse in the management of stress. Identify the role of the nurse in relieving stress. Describe stress management techniques that can benefit nurses themselves.

Stress and Stressor Stress - physiological or psychological tension that threatens homeostasis or a person’s psychological equilibrium. Stressor – any event, situation, or other stimulus encountered in a person’s external or internal environment that necessitates change or adaptation by the person.

Physiologic Homeostasis Local Adaptation System (LAS)—involves only one specific body part Reflex pain response Inflammatory response General Adaptation Syndrome—biochemical model of stress (Hans Selye) Alarm reaction Stage of resistance Stage of exhaustion

Psychological Homeostasis Love and belonging needs Safety and security needs Self-esteem needs

Question Tell whether the following statement is true or false. The inflammatory response is a response of the central nervous system to pain. A. True B. False

Answer Answer: B. False The reflex pain response is a response of the central nervous system to pain.

A Balance is Achieved (Homeostasis)

Defense Mechanisms and Coping Mechanisms are unconscious psychological strategies brought into play by various entities to cope with reality and to maintain self-image. are commonly termed coping strategies or coping skills. Unconscious or non conscious strategies (e.g, defense mechanisms).

Defense Mechanisms Compensation Denial Displacement Introjection Projection Rationalization

Defense Mechanisms (cont.) Reaction formation Regression Repression Sublimation Undoing

Question Which defense mechanism listed below is portrayed in the following scenario? After throwing his lunch tray on the floor, a patient complains to the nurse manager about the quality of the food he is being fed during his hospital stay. A. Denial B. Displacement C. Rationalization D. Reaction formation

Answer Answer: C. Rationalization Rationale: In rationalization, a person tries to give a logical or socially acceptable explanation for questionable behavior. A person in denial refuses to acknowledge the presence of a condition that is disturbing. Displacement refers to a person transferring an emotional reaction from one person to another. Reaction formation occurs when a person develops conscious attitudes or behaviors opposite to what he desires to do.

Coping Mechanisms Crying, laughing, sleeping, cursing Physical activity, exercise Smoking, drinking Lack of eye contact, withdrawal Limiting relationships to those with similar values and interests

Factors Affecting Response to Stressor Personal Characteristics Nature of Stressor 1. Ability to cope with stress - support system - perception of stressor - previous experience 2. Practices /norms of peer group 3. Social environment 4. Available resources Intensity Scope Duration Number and nature of stressor

An Imbalance Occurs During a Stressful Event

General Adaptation Syndrome and Local Adaptation Syndrome GAS – response by whole body - how the body reacts to a stressor, real or imagined, a stimulus that causes stress. LAS - the localized response of a tissue, organ, or system that occurs as a reaction to stress

Alarm Reaction Person perceives stressor, defense mechanisms activated Fight-or-flight response Hormone levels rise, body prepares to react Shock and counter-shock phases

Stage of Resistance Body attempts to adapt to stressor Vital signs, hormone levels, and energy production return to normal Body regains homeostasis or adaptive mechanisms fail

Stage of Exhaustion Results when adaptive mechanisms are exhausted Body either rests and mobilizes its defenses to return to normal or dies

The General Adaptation Syndrome

Diagram of the GAS Model

Emotional Responses to Stress Mind–body interaction Coping/defense mechanisms Anxiety (most common) Mild Moderate Severe Panic

Question Tell whether the following statement is true or false. Mild anxiety narrows a person’s perceptual fields so that the focus is on immediate concerns, with inattention to other communications and details. A. True B. False

Answer Answer: B. False Moderate anxiety narrows a person’s perceptual fields so that the focus is on immediate concerns, with inattention to other communications and details.

Psychological Response to Stress Psychological adaptive behaviors (coping mechanisms) are directed at stress management 1. Task-oriented behaviors – use direct problem- solving technique 2. Ego-defense mechanisms – indirect methods of coping May be: Constructive – accept challenge to resolve stress Destructive – do not help with coping

Types of Task-Oriented Behavior Attack behavior – action to remove/overcome stressor Withdrawal behavior – physical or emotional removal from stressor Compromise behavior – change usual method of operating , substitute goals, omit satisfaction of needs

Ego-defense mechanisms Unconscious behaviors that offer psychological protection from stressor Examples: compensation conversion denial displacement identification regression projection rationalization

Adaptation to Acute and Chronic Illness General tasks—for example, maintaining self-esteem and personal relationships Illness-related tasks—for example, handling pain and disability

Effects of Long-Term Stress Affects physical status Increases risk for disease or injury Compromises recovery and return to normal function Is associated with specific diseases

Family Stressors Changes in family structure and roles Anger and feelings of helplessness and guilt Loss of control over normal routines Concern for future financial stability

Factors Affecting Stress and Adaptation Sources of stress Types of stressors experienced Personal factors

Categories of Stress Developmental stress Situational stress Occurs when person progresses through stages of growth and development Situational stress Does not occur in predictable patterns

Question Tell whether the following statement is true or false. An example of situational stress is the stress related to a marriage or divorce. A. True B. False

Answer Answer: A. True An example of situational stress is the stress related to a marriage or divorce.

Types of Stressors Physiologic Psychosocial Chemical agents, physical agents, infectious agents, nutritional imbalances, hypoxia, genetic or immune disorders Psychosocial Includes real and perceived threats

Stressful Activities in Nursing Profession Assuming responsibilities for which one is not prepared Working with unqualified personnel Working in environment in which supervisors are not supportive Caring for patient in cardiac arrest or dying person Experiencing conflict with peers

Teaching Healthy ADLs Exercise Rest and sleep Nutrition Use of support systems Use of stress management techniques Time Management Problem-Solving Process

Stress Management Techniques Relaxation Meditation Anticipatory guidance Guided imagery Biofeedback Crisis intervention

Question Tell whether the following statement is true or false. In the stress management technique known as anticipatory guidance, a person creates a mental image, concentrates on the image, and becomes less responsive to stimuli. A. True B. False

Answer Answer: B. False In the stress management technique known as guided imagery, a person creates a mental image, concentrates on the image, and becomes less responsive to stimuli.

Crisis Intervention Identify the problem List alternatives Choose from alternatives Implement the plan Evaluate the outcome

Evaluating the Plan of Care Patient verbalizes causes and effects of stress and anxiety. Patient identifies and uses sources of support. Patient uses problem solving to find solution to stressors. Patient practices healthy lifestyle habits and anxiety-reducing techniques. Patient verbalizes decrease in anxiety and increase in comfort.