Stress ManagementStress Management

ObjectivesO Define stress, adaptation,

stressor, homeostasis, lack of oriented

O behaviors and defense and coping mechanisms.

O 2. List factors influencing the response to stressors.

O 3. Compare and contrast the Local Adaptation Syndrome with the General Adaptation Syndrome.

O Describe the psychological response to a stressor.

O Discuss the physical, psychological developmental results of prolonged stress.

O List behavioral, physical and emotional indicators of stress.

O Discuss the role of the nurse in the management of stress.

O Identify the role of the nurse in relieving stress.

O Describe stress management techniques that can benefit nurses themselves.

O

Stress and StressorO Stress - physiological or

psychological tension that threatens homeostasis or a person’s psychological equilibrium.

O 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

O Local Adaptation System (LAS)—involves only one specific body partO Reflex pain responseO Inflammatory response

O General Adaptation Syndrome—biochemical model of stress (Hans Selye)O Alarm reactionO Stage of resistanceO Stage of exhaustion

Psychological Homeostasis

O Love and belonging needsO Safety and security needsO 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. TrueB. False

Answer

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

A Balance is Achieved (Homeostasis)

Defense Mechanisms and Coping Mechanisms

O are unconscious psychological strategies brought into play by various entities to cope with reality and to maintain self-image.

O are commonly termed coping strategies or coping skills. Unconscious or non conscious strategies (e.g, defense mechanisms).

Defense Mechanisms

O CompensationO DenialO DisplacementO IntrojectionO ProjectionO Rationalization

Defense Mechanisms (cont.)

O Reaction formationO RegressionO RepressionO SublimationO Undoing

QuestionWhich 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. DenialB. DisplacementC. RationalizationD. Reaction formation

AnswerAnswer: 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

O Crying, laughing, sleeping, cursingO Physical activity, exerciseO Smoking, drinkingO Lack of eye contact, withdrawalO Limiting relationships to those with

similar values and interests

Factors Affecting Response to Stressor Personal

CharacteristicsNature of Stressor

1. Ability to cope with stress - support system

- perception of stressor

- previous experience

2. Practices /norms of peer group3. Social environment4. Available resources

O IntensityO ScopeO DurationO Number and

nature of stressor

An Imbalance Occurs During a Stressful Event

General Adaptation Syndrome and Local Adaptation Syndrome

O GAS – response by whole body - how the body reacts to a stressor,

real or imagined, a stimulus that causes stress.

O LAS - the localized response of a tissue, organ, or system that occurs as a reaction to stress

Alarm Reaction

O Person perceives stressor, defense mechanisms activated

O Fight-or-flight responseO Hormone levels rise, body prepares

to reactO Shock and counter-shock phases

Stage of ResistanceO Body attempts to adapt to stressorO Vital signs, hormone levels, and

energy production return to normalO Body regains homeostasis or

adaptive mechanisms fail

Stage of ExhaustionO Results when adaptive mechanisms

are exhaustedO 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

O Mind–body interactionO Coping/defense mechanismsO Anxiety (most common)

O MildO ModerateO SevereO 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. TrueB. False

Answer

Answer: B. FalseModerate 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

O Psychological adaptive behaviors (coping mechanisms) are directed at stress management

O 1. Task-oriented behaviors – use direct problem- solving techniqueO 2. Ego-defense mechanisms – indirect methods of coping

May be: Constructive – accept challenge to resolve stressDestructive – do not help with coping

Types of Task-Oriented Behavior

O Attack behavior – action to remove/overcome stressor

O Withdrawal behavior – physical or emotional removal from stressor

O Compromise behavior – change usual method of operating , substitute goals, omit satisfaction of needs

Ego-defense mechanisms

O Unconscious behaviors that offer psychological protection from stressor

Examples: compensationconversiondenialdisplacementidentificationregressionprojectionrationalization

Adaptation to Acute and Chronic Illness

O General tasks—for example, maintaining self-esteem and personal relationships

O Illness-related tasks—for example, handling pain and disability

Effects of Long-Term Stress

O Affects physical statusO Increases risk for disease or injuryO Compromises recovery and return to

normal functionO Is associated with specific diseases

Family StressorsO Changes in family structure and rolesO Anger and feelings of helplessness

and guiltO Loss of control over normal routinesO Concern for future financial stability

Factors Affecting Stress and Adaptation

O Sources of stressO Types of stressors experiencedO Personal factors

Categories of Stress

O Developmental stressO Occurs when person progresses

through stages of growth and development

O Situational stressO 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. TrueB. False

Answer

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

Types of StressorsO Physiologic

O Chemical agents, physical agents, infectious agents, nutritional imbalances, hypoxia, genetic or immune disorders

O PsychosocialO Includes real and perceived threats

Stressful Activities in Nursing Profession

O Assuming responsibilities for which one is not prepared

O Working with unqualified personnelO Working in environment in which

supervisors are not supportiveO Caring for patient in cardiac arrest or

dying personO Experiencing conflict with peers

Teaching Healthy ADLs

O ExerciseO Rest and sleepO NutritionO Use of support systemsO Use of stress management

techniquesO Time ManagementO Problem-Solving Process

Stress Management Techniques

O RelaxationO MeditationO Anticipatory guidanceO Guided imageryO BiofeedbackO 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. TrueB. False

Answer

Answer: B. FalseIn 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 InterventionO Identify the problemO List alternativesO Choose from alternativesO Implement the planO Evaluate the outcome

Evaluating the Plan of CareO Patient verbalizes causes and effects of

stress and anxiety.O Patient identifies and uses sources of

support.O Patient uses problem solving to find

solution to stressors.O Patient practices healthy lifestyle habits

and anxiety-reducing techniques.O Patient verbalizes decrease in anxiety

and increase in comfort.