1. Stress Management

2. 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.

3. 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.

4. 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

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

6. 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

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

8. A Balance is Achieved (Homeostasis)

9. 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).

10. Defense Mechanisms Compensation Denial Displacement Introjection
Projection
Rationalization

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

12. 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

13. 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.

14. 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

15. 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

16. An Imbalance Occurs During a Stressful Event

17. 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

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

19. 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

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

21. The General Adaptation Syndrome

22. Diagram of the GAS Model

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

24. 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

25. 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.

26. 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

27. 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

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

29. 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

30. 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

31. 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

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

33. 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

34. 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

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

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

37. 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

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

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

40. 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

41. 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.

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

43. 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.