1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 23 Stress, Anxiety, Adaptation, and Change

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress, Anxiety, and Adaptation Stress –Body’s physiological reaction to any stimulus that evokes change Anxiety –Subjective response –Occurs during threat to well-being –Pervasive feeling of dread (continued)

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress, Anxiety, and Adaptation Adaptation –Process to adjust to stressors Sources of Stress –Physiological –Psychological –Cognitive –Environmental –Sociocultural

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Responses to Stress Physiological Responses to Stress –General adaptation syndrome (GAS) Alarm Resistance Exhaustion –Local adaptation syndrome (LAS) (continued)

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Responses to Stress Manifestations of Stress –Physiological –Psychological –Cognitive –Behavioral –Spiritual (continued)

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Responses to Stress Outcomes of Stress –Opportunity for personal growth Eustress –Risk of disorganization Distress

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Crisis Acute state of disorganization Can be negative experience Has potential to be opportunity for growth Outcome unique according to individual’s perception and coping abilities (continued)

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Crisis Characteristics: –Sudden event –Identifiable precipitating event –Perceived as overwhelming –Unresolved with usual coping skills –Intervention required (continued)

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Crisis Balancing factors: –Perception –Coping mechanism –Situational support (continued)

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Crisis Types: –Developmental or maturational –Situational –Adventitious

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Anxiety Coping behaviors: –Can result in successful adaptation to stress –Frequently used coping behaviors: Talking Crying Laughing Exercising (continued)

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Anxiety Defense mechanisms: –Unconscious operations –Protect mind from anxiety

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress and Illness Interwoven concepts –If stressed and adaptive attempts unsuccessful, illness occurs –If ill, fewer adaptive resources available to cope with stressors

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Impact of Illness and Treatment Hospitalization –Increased stress response –Higher levels of anxiety –Increased or impaired use of coping mechanisms –Inability to function –Disorganized behavior (continued)

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Impact of Illness and Treatment Depersonalization –Treating individual as object –Dehumanizing –Avoid by reducing client’s feelings of unfamiliarity and loss of control

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress and Change Types of change: –Developmental –Reactive –Covert –Overt (continued)

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress and Change Theories of change: –Lewin –Lippitt Resistance to change –Conformity –Dissimilar beliefs –Habits (continued)

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress and Change Resistance to change –Satisfied with status quo –Secondary gains –Threats to basic needs –Fear –Unrealistic goals (continued)

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress and Change Changing paradigms –Paradigm Pattern, model, or mind-set that influences decisions and behaviors (continued)

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress and Change Changing paradigms –Overcoming barriers to change Flexibility Adaptability Resilience (continued)

21. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress and Change Nurse as change agent –Intentionally initiates and creates change –Constantly seeks ways to make improvements –Empowers client to initiate change to adapt more successfully

22. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress, Anxiety, Adaptation, Change and the Nursing Process 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 (continued)

23. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress, Anxiety, Adaptation, Change and the Nursing Process Diagnosis –Anxiety –Ineffective coping –Ineffective denial –Powerlessness –Impaired adjustment –Ineffective role performance (continued)

24. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress, Anxiety, Adaptation, Change and the Nursing Process Diagnosis –Disturbed thought processes –Ineffective coping –Fear –Post-trauma syndrome –Impaired social interaction –Spiritual distress (continued)

25. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress, Anxiety, Adaptation, Change and the Nursing Process Outcome identification and planning –Client involvement –Self-responsibility issues (continued)

26. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress, Anxiety, Adaptation, Change and the Nursing Process Implementation –Meeting of basic needs –Environmental strategies –Verbalization –Involvement of family and significant others (continued)

27. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress, Anxiety, Adaptation, Change and the Nursing Process Implementation –Stress management techniques: Exercise Relaxation techniques –Progressive muscle relaxation –Guided imagery –Cognitive reframing and thought stopping –Crisis intervention (continued)

28. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stress, Anxiety, Adaptation, Change and the Nursing Process Evaluation –Ongoing, comprehensive process –Requires verbal input from client and significant others –Observation of client behavior

29. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Personal Stress Management Approaches for the Nurse Nursing burnout –Physical and emotional exhaustion –Prevention and recovery depend on stress management Stress management plan –Continuous process Rather than occasional use of technique (continued)

30. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Personal Stress Management Approaches for the Nurse Stress hardiness –Commitment –Challenge –Control (continued)

31. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Personal Stress Management Approaches for the Nurse Caring for self –Taking time out for self –Using effective communication skills with co- workers, family, and significant others –Managing conflict effectively

32. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Strategies for Coping with Professional Stress Time management Focus on accomplishments Slow, focused breathing Avoidance of assuming personal responsibility for others’ problems Knowledge of own limits (continued)

33. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Strategies for Coping with Professional Stress Distancing of self from stressors that have negative impact –If possible Identification and changing of stressors that can be influenced directly Variation of tasks between physical and mental activities