2. Stress
Provides stimulus for change and growth
– Some positive, necessary
– Too much
• Poor judgment, physical illness, inability to cope
• Affects all dimensions of person’s life
– Changes in internal and external environments
• Essential to adapt for survival
– “Fight or Flight”
3. Define the Concept of Stress
Hans Selye -General Adaptation Syndrome
– Describes physiological events during stress response
• STRESSORS – internal or external stimuli that cause stress
– Physiological, psychological, social, environmental, developmental,
spiritual or cultural
– Internal or external
• STRESS – any situation where nonspecific demand requires
an individual to respond or take action
• Perception may initiate the stress response
4. Physiological Adaptation
Body’s ability to maintain homeostasis
– Controlled by nervous and endocrine systems
• Unconscious responses – automatic
• Negative feedback system
– Adjust heart and respiratory rates, blood pressure, temperature,
fluid and electrolyte balances, hormone secretions, level of
consciousness
• Medulla oblongata
• Reticular formation
• Pituitary gland
6. Reticular Formation
Small cluster of neurons in brain stem and
spinal cord
Controls vital functions, continuously
monitoring physiological status of body
through connections with sensory and
motor tracts
7. Pituitary Gland
Pituitary gland, attached to hypothalamus
– Produces hormones necessary for adaptation
to stress
• Secretions of thyroid, gonadal and parathyroid
hormones
– Hormone levels fall, secretions increase
– Hormone levels rise, secretions decrease
8. Limitations of Homeostatic
Control
Healthy-meet day to day needs
– Only short term control over body’s equilibrium
• Cannot adapt to long-term changes in hormones or vital
functions
– Illness, injury or prolonged stress decreases adaptive
capacity
• Results in inadequate homeostatic control or breakdown of
feedback system
– Leads to further illness or death
– Severe stress
• Hormones insufficient in quantity to provide physiological
energy needed for coping
– Condition deteriorates, functioning declines
9. Models of Stress Related to
Nursing Practice
Selye’s GAS model
– Stress- nonspecific response of body to any
demand made on it
• Physiological response of the whole body
– No individual responses
– Useful determining physiological responses
10. Adaptation Model
People experience anxiety and increased stress
when unprepared to cope with stressful
situations
4 factors determine if situation is stressful
– Person’s experience with similar stressors, support
systems and overall perception of the stressor
– Practices and norms of peer group
• Can they talk about it?
– Impact of social environment in assisting
individual to adapt to stressor
– Resources available
11. Stimulus-based Model
Focuses on disturbing or disruptive events
in the environment
– Change is normal
– Perceptions are irrelevant
– All have common threshold
12. Transaction-based Model
Views person and environment in
dynamic, reciprocal, interactive
relationship
– Stress originates from relationship between the
person and the environment
13. Factors Influencing Response to
Stressors
Physiological functioning
Personality
Behavioral characteristics
Nature of stressor
– Perception of intensity or magnitude
– Scope
– Duration
– Other stressors
– Predictability
– Resources available
– Support group
14. Adaptation
Processes physiological or psychosocial
dimensions change in response to stress
– An attempt to maintain optimal functioning
– Requires active response from whole person
15. Dimensions of Adaptation
Physical
– Local adaptation and general adaptation syndrome
Developmental
– Success in past, more likely to succeed now
Emotional
– Physiological defense mechanisms, personality strengths
Intellectual
– Education, problem solving, communication skills, realistic
perception
Social
– Social network
Spiritual
16. Local Physiological Adaptation
Response of body tissue, organ or part to
the stress of trauma, illness or other
physiological change
– Blood clotting, wound healing,
accommodation to light, response to pressure
• Localized
• Adaptive, needs stressor to stimulate it
• Short term
• Restorative
17. Localized Adaptation Syndrome
Reflex pain response
– CNS responds
• Protects from further tissue damage
– Sensory receptor, sensory nerve to spinal cord,
connector neuron in spinal cord, motor nerve from spinal
cord, effector muscle
• Pull hand from hot surface
18. Localized Adaptation Syndrome
Inflammatory Response
– Stimulated by trauma or infection
• Localizes infection, prevents spread, promotes healing
– Local pain, swelling, heat, redness, change in functioning
• First phase – changes in cells and circulatory system
– Vasoconstriction, histamine release, increased blood flow,
increasing WBC’s, capillary permeability increased
• Second phase – release or exudate
• Third phase – repair of tissue by regeneration or scar
formation
19. 3 Phases of General Adaptation
Syndrome
Physiological response of whole body to
stress
– Involves many body systems
• Primarily autonomic nervous system and endocrine
system
20. Alarm Reaction
Mobilizes defense mechanisms of body and mind to
cope with stressor
– Hormone levels rise to increase blood volume
– Increase blood glucose levels to make energy available
– Epinephrine and norepinephrine increase
• “fight or flight”
– Increased heart rate, blood flow to muscles, oxygen intake, greater
mental alertness
– Pupils dilate for greater visual field
• May last a minute to many hours
– Extreme or long term
• May threaten life
– If stressor still present after initial alarm reaction, progresses to next
phase
21. Resistance Phase
Body stabilizes
– Hormone levels, heart rate, blood pressures and
cardiac output return to normal
– Attempting to adapt
• If stress can be resolved, body repairs damage
• If stressor remains present and adaptation fails, enters
third phase
22. Exhaustion Phase
When body can no longer resist stress and
energy is depleted
– Physiological response is intensified
• Energy is compromised
• Adaptation diminishes
– Body cannot defend itself
• Physiological regulation diminishes
– If stress continues, death may result
23. Behavioral Responses to Stress
Psychological adaptive behaviors
(Coping Mechanisms)
– Constructive
• Help accept challenge to resolve conflict
– Destructive
• Do not help cope with stressor
– Affect reality orientation, problem-solving abilities, personality and
in severe cases, ability to function
– Task oriented
• Use problem solving skills to cope with threat
– Ego-defense mechanisms
• Regulate emotional distress, protecting from anxiety and stress
24. Task-oriented Behaviors
Use cognitive abilities to reduce stress, solve
problems, resolve conflicts
– Enable one to cope realistically with demands of
stressor
• Attack behavior – act to remove or overcome a stressor
or satisfy a need
• Withdrawal behavior – removing the self physically or
emotionally from the stressor
• Compromise behavior – changing the usual method of
operating, substituting goals, or omitting the satisfaction
of needs to meet other needs or to avoid stress
25. Ego-defense Mechanisms used as
Stress Responses
Unconscious behaviors that offer psychological
protection from a stressful event
– Help protect against feelings of worthlessness and anxiety
• Can become distorted, becomes destructive
– Compensation
• Make up for deficiency by exaggerating strength
– Conversion
• Transfer conflict into nonorganic symptom
– Denial
• Refuse to consciously acknowledge
– Displacement
• Transfer emotions to less anxiety-producing substitute
– Identification
• Pattern behavior after another
26. Effects of Prolonged Stress
Developmentally
– Unable to complete devekopmental task
• Repeated stress can lead to maturational crisis
Intellectually
– Short term memory impaired
– Ability to learn impaired
Emotionally
– Relate to prior experiences
Family
– Respect client’s ideals of family
• Poor communication and maladaptive behaviors may affect outcome
Lifestyle
– Smoking, drinking, obesity, homosexuality
• Set aside personal judgments
Sociocultural
– Individualized beliefs
Spiritual
– Individualized
27. Spiritual
Religion and spirituality are not the same
Religion
– System of organized beliefs and worship
Spirituality
– Unique capacity for love, joy, caring, compassion and
for finding meaning in life’s difficult experiences
During stress, one relies on their faith, but may
abandon their practices out of disillusionment
and anger
28. Assessment of Stress
Physiological – objective
– Elevated B/P
– Increased neck, shoulder and back tension
– Elevated pulse and respirations
– Sweaty palms
– Cold hands and feet
– Slumped posture
– Fatigue
– Tension headache
– Upset stomach
– High pitched voice
– Nausea, vomiting and diarrhea
– Appetite change, weight change
– Urinary frequency
– Abnormal labs
• Elevated adrenocorticotropic hormone, cortisol, catecholamine levels,
hyperglycemis
– Restless
• Difficulty falling asleep or frequent awakening
– Dilated pupils
29. Physical Disorders related to
Stress
Cardiovascular and gastrointestinal diseases
Some cancers
Immunological disorders
Migraine headaches
Infertility
Burnout
Exacerbates Parkinson’s and Tourette’s
syndrome
30. Levels of Stress
Mild
– Few minutes to few hours
• Usually don’t affect health unless several at once
Moderate
– Several hours to days
Severe
– several weeks to several years
• More frequent and longer, the higher the health risk
• As stress increases, stress behaviors increase, decreasing energy and
adaptive responses
Assess perception to decide level for patient
– several weeks to several years
• More frequent and longer, the higher the health risk
• As stress increases, stress behaviors increase, decreasing energy and
adaptive responses
31. Assessment of Stress (cont)
Psychological
– Assess for destructive behaviors
Developmental
– Assess where they are developmentally
• Any delays, are they new?
Emotional
– Observe behavior
Intellectual
– Assess learning, cognitive appraisal, attention span
Family
– What do they consider effective emotional support
• Do they have it?
Lifestyle
– Smoking, obesity, drug abuse, chronic sleep deprivation
– Regular exercise, adequate rest, nutritious diet
Sociocultural
– Be aware of cultural differences
Spiritual
– Examine how beliefs and values have changed
What does client expect?
32. Nursing Diagnoses Related to
Stress
Need defining characteristics
– Identify etiology
Activity intolerance
Anxiety
Caregiver role strain
Coping, ineffective family or individual: compromised or
disabling
Fatigue
Fear
Growth and development, altered
Hopelessness
Injury, risk for
Self-esteem disturbance
33. Stress Management Techniques
Goals
– Reduce frequency of stress-inducing situations
– Decrease physiological response to stress
– Improve behavioral and emotional responses
to stress
34. Stress Management Techniques
Health promotion
– Regular exercise
– Good nutrition
– Adequate rest
– Effective time management
• More in control of life
– Prioritize tasks
– Interactions with positive support systems
– Humor
35. Acute Care
Crisis Intervention
– Therapeutic technique to help resolve immediate stress
problem
• Addresses immediate, urgent need for stress reduction
– Crises
• When one encounters problems or stress situations they are unable
to cope with in usual fashion
• SITUATIONAL
– External
• Symptoms transient, episode brief
• new baby, role change, acute illness, family change
• DEVELOPMENTAL
– Internal
• Unable to complete developmental tasks of stage
• can occur at any point
•
37. Restorative Care
Assist in life style changes that are healthy and stress
reducing
– SMOKING CESSATION
– HUMOR
• Use appropriately
– Laughing alleviates stress, releases endorphins
– SPIRITUALITY
• Prayer, meditation or reading religious material
– SELF ESTEEM
• Stress positive characteristics
– RELAXATION TECHNIQUES
• Guided imagery, progressive relaxation, meditation, biofeedback
– STRESS MANAGEMENT
38. Stress in Workplace
Stress is working women’s number one problem
– Stressors: workload, institutional policies, conflict
with co-workers, dealing with death, conflict with
physicians, inadequate preparation to deal with
emotional needs of clients and families
• Level of stress depends on personality, health status,
previous experiences with stress, coping mechanisms
– Job stress = Burnout
• Depletes energy to deal with it
• Sense of helplessness and negativism
• No positive rewards
• Anger or apathy
– Identify stressors and strive to eliminate them
