Seminar on stress and its management premnath r

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Seminar on stress and its management premnath r

  1. 1. SEMINAR ON STRESS AND ITS MANAGEMENT Presented by, Premnath R I year MSc Nursing Govt. CON Kottayam
  2. 2. History • ‘Stringere’ means ‘to draw tight’ • Walter Cannon refer it as external factors that disrupted homeostasis. • The term stress coined by Hans Selye.
  3. 3. Stress - Definition • The non-specific response of the body to any demand placed upon it. (Hans Selye) Stress should be restricted to conditions where an environmental demand exceeds the natural regulatory capacity of an organism. (Bruce McEwen and Jaap Koolhas)
  4. 4. Relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being. (Lazarus and Folkman , 1984)
  5. 5. EUSTRESS Eustress or positive stress occurs when your level of stress is high enough to motivate you to move into action to get things accomplished.
  6. 6. DISTRESS Distress or negative stress occurs when your level of stress is either too high or too low and your body and/or mind begin to respond negatively to the stressors.
  7. 7. CONCEPTS OF STRESS • Stress as a biological response. • Stress as an environmental event. • Stress as a transaction between the individual and the environment.
  8. 8. Stress as a biological response • In 1956, Selye described the syndrome of symptoms as the “fight or flight syndrome”. He described the reaction in 3 different stages. 1. Alarm reaction stage- during this stage, the physiological response of the “fight or flight” syndrome are initiated.
  9. 9. 2. Stage of resistance- the individual uses the physiological response of the first stage as a defence in the attempt to adapt to the stressor. 3. Stage of exhaustion- this stage occurs when there is a prolonged exposure to the stressor to which the body has adjusted. The adaptive energy is depleted and the individual can no longer draw from the resources for adaptation. Diseases of adaptation (eg., headache, mental disorders, coronary artery diseases, ulcers) may occur.
  10. 10. General Adaptation Syndrome
  11. 11. Alarm reaction stage
  12. 12. Stress responses in alarm reaction • Heart rate and strength of cardiac muscle contraction increases • Blood vessels supplying to the skin and viscera constrict; at the same time blood vessels supplying to skeletal muscles and brain dilate; thus decreasing blood supply to organs which do not assume an immediate active role. • RBC production is increased leading to an increase in the ability of the blood to clot. This helps to control bleeding.
  13. 13. • Liver converts glycogen into glucose and releases it into he blood stream; this provides energy needed to fight the stressor. • The rate of breathing increases and respiratory passages widen to accommodate more air. • Production of saliva and digestive enzymes reduces.
  14. 14. The General Adaptation Syndrome: Alarm Phase Figure 3.2
  15. 15. STRESS - BODY RESPONSE
  16. 16. Resistance Reaction • It is initiated by regulating hormones secreted by hypothalamus. • It is a long-term reaction. • Regulating hormones are • Corticotropin Releasing Hormone (CRH) • Growth Hormone Releasing Hormone (GHRH) • Thyrotrophic Releasing Hormone(TRH)
  17. 17. • CRH stimulates the anterior pituitary to increase its secretion of adrenocorticotrophic hormone(ACTH). The action of these hormones helps to control bleeding, maintain blood pressure etc. • GHRH stimulates anterior pituitary to secrete human growth hormone(HGH). • TRH causes the anterior pituitary to secrete thyroid stimulating hormone (TSH). The combined action of HGH and TSH help to supply additional energy to the body.
  18. 18. Exhaustion stage • At this stage, cells start to die, and the organs weaken. • A long – term resistance reaction put heavy demand on the body, particularly on the heart, blood vessels, and adrenal cortex, which may suddenly fail under strain.
  19. 19. • Immune system is exhausted and function is impaired resulting in decompensation. • The result can manifest itself in obvious illnesses such as ulcers, depression, diabetes, trouble with the digestive system or even cardiovascular problems, along with other mental illnesses.
  20. 20. Stress as an environmental event • Stress as the “thing” or “event” that triggers the adaptive physiological and psychological response in the individual. • The event is one that create change in the life pattern of the individual, requires significant adjustment in the life style, and taxes available personal resource. • The change can be either positive, such as accomplishing an outstanding personal achievement, or negative, such as being fired from a job.
  21. 21. • Holmes and Rahe(1967) devised the social readjustment rating scale. Numerical values were assigned to various events, or changes, that are common in people’s lives. • Holmes and Rahe concluded that the higher the score on the social readjustment rating scale, the greater the susceptibility of the individual to physical or psychological illness.
  22. 22. Stress as a transaction between the individual and the environment • Personal characteristics as well as the nature of the environmental event are considered. (Lazarus& Folkman,1984)
  23. 23. Precipitating event  A precipitating event is a stimulus arising from the internal or external environment and is perceived by the individual in a specific manner.  Determination that a particular person/environment relationship is stressful depends upon the cognitive appraisal of the situation by the individual.
  24. 24. • Cogni t i ve apprai sal i s t he i ndi vi dual ’s eval uat i on of t he per sonal si gni f i cance of t he event or occur r ence. The event pr eci pi t at es a r esponse on t he par t of i ndi vi dual , and t he r esponse i s i mpact ed by t he i ndi vi dual ’s per cept i on of t he event .
  25. 25. Predisposing factors Types of precipitating factors include genetic influences, past experiences and existing conditions. • Genetic influences are those circumstances of an individual’s life that are acquired by heredity. Examples include family history of physical and psychological conditions and the individual’s temperament.
  26. 26. • Past experiences are occurances that result in learned patterns that can influence an individual’s adaptation response. • They include previous exposure to the stressor, learned coping responses, and degree of adaptation to previous experiences.
  27. 27. • Existing conditions incorporate vulnerabilities that influence the adequacy of the individual’s physical , psychological and social resources for dealing with adaptive demands. • Examples include current health status, motivation, developmental maturity, severity and duration of the stressor, financial and educational resources, age, existing coping strategies, and a support system of caring others.
  28. 28. STRESS ADAPTATION MODELS 1. Stuarts Stress Adaptation Model 2. Transactional model of stress and coping 3. Psychosomatic model
  29. 29. Stuarts Stress Adaptation Model
  30. 30. TRANSACTIONAL MODEL OF STRESS AND COPING PRECIPITATING EVENT PREDISPOSING EVENT COGNITIVE APPRAISAL IRRELEVANT BENIGN POSITIVE STRESS APPRAISAL NO RESPONSE PLEASURABLE RESPONSE
  31. 31. STRESS APPRAISAL HARM THREAT CHALLENGE SECONDARY RESPONSE AVAILABILITY OF COPING STRATEGIES PERCEIVED EFFECTIVENESS OF COPING STRATEGIES, PERCEIVED AVAILABILITY TO USE COPING STRATEGIES EFFECTIVELY QUALITY OF RESPONSE ADAPTIVE MALADAPTIVE
  32. 32. PSYCHOSOMATIC MODEL • Psychic phase: It is marked by mild, but persistent psychological and behavioral symptoms of stress like irritability, disturbed sleep, anorexia etc. • Psychosomatic phase: If stress condition continues, these symptoms become more pronounced along with beginning of generalized physiological symptoms like occasional hypertension, tremors etc.
  33. 33. • Somatic phase: It is marked by increased function of organ. At this stage, one begins to identify beginning of a disease stage. • Organic phase: It is marked by full involvement of a so called disease state with physiological changes like ulcerated stomach or chronic hypertension. PSYCHOSOMATIC MODEL
  34. 34. CAUSES OF STRESS • 1.Catastrophs • 2.Major life changes • 3.Daily hassles
  35. 35. Catastrophe A catastrophe is a sudden, often life- threatening calamity or disaster that pushes people to the outer limits of their coping capability. Catastrophes include natural disasters—such as earthquakes, tornadoes, fires, floods, and hurricanes—as well as wars, torture, automobile accidents, violent physical attacks, and sexual assaults. Catastrophes often continue to affect their victims’ mental health long after the event has ended.
  36. 36. Major life changes The most stressful events involve major life changes, such as death of a spouse or family member, divorce, imprisonment, losing one’s job, and major personal disability or illness.
  37. 37. Daily hassles • living in a noisy neighborhood • commuting to work in heavy traffic • disliking one’s fellow workers • worrying about owing money • waiting in a long line • misplacing • losing things. When taken individually, these hassles may feel like only minor irritants, but cumulatively, over time, they can cause significant stress.
  38. 38. Symptoms of stress • Feelings • Behavior • Physiology
  39. 39. Feelings • The individual becomes anxious and is scared. • The person feels that he has got something to loose or something wrong will take place. • The person becomes irritable and moody. • Individual develops a negative frame of mind and suffers from low self-esteem. • The person loose faith in his capabilities and is afraid of the failures. • Not able to concentrate and is involved in his own plans and thoughts.
  40. 40. PHYSIOLOGICAL AND BEHAVIORAL CHANGES • Speech problems. • Impulsive Behavior • Crying for no apparent reason. • Laughing in a high pitch and nervous tone of voice. • Grinding of teeth • Increasing smoking and use of drugs and alcohol. • Being accident-prone • Perspiration /sweaty hands • Increased heart beat • Trembling • Nervous ticks
  41. 41. PHYSIOLOGICAL AND BEHAVIORAL CHANGES • Dryness of throat and mouth. • Tiring easily • Urinating frequently • Sleeping problems • Diarrhea / indigestion / vomiting/ nausea • Butterflies in stomach • Headaches • Premenstrual tension • Pain in the neck and or lower back • Susceptibility to illness • Loss of appetite or over eating
  42. 42. EFFECTS OF STRESS • Stress response • Disease • Decreased immune response • Mental illness
  43. 43. STRESS MANAGEMENT • Become aware of stressors and emotional and physical reactions. • Relaxation • Meditation • Interpersonal relation with caring other • Problem solving • Pets
  44. 44. STRESS MANAGEMENT • Music • Recognize what we can change • Reduce the intensity of emotional reactions to stress • Learn to moderate physical reactions to stress • Build physical reserves. • Maintain emotional reserves
  45. 45. STRESS MANAGEMENT TECHNIQUES 1. Stress Diary - Finding Optimum Stress Levels 2. Psyching Up' - Raising Stress Levels to Improve Performance 3. Anticipating Stress - Managing Stress by Preparing For It 4. Get a hobby or two, relax and have fun: Talk with friends or someone you can trust about worries/problems.
  46. 46. STRESS MANAGEMENT TECHNIQUES 5.Other Techniques: • Meditation can also be a good effort to bring down the stress levels. • Taking exercise • Effective time Management • Good Food and nutrition.
  47. 47. THE NURSING PROCESS FOR THE MANAGEMENT OF STRESS ASSESSMENT:  Nursing History  Physical assessment  Assessment of the person  Assessment of the family  Assessment of the environment
  48. 48. NURSING DIAGNOSIS
  49. 49. OUTCOME IDENTIFICATION AND PLANNING • Decrease in the level of anxiety • Develop effective coping skills • Describe a reduction in anxiety and an increase in comfort.
  50. 50. IMPLEMENTATION • Non-Pharmacological methods
  51. 51. A TO Z OF STRESS MANAGEMENT • Always take time for yourself, at least 30 minutes per day. • Be aware of your own stress meter: Know when to step back and cool down. • Concentrate on controlling your own situation, without controlling everybody else. • Daily exercise will burn off the stress chemicals.
  52. 52. A TO Z OF STRESS MANAGEMENT • Eat lots of fresh fruit, veggies, bread and water; give your body the best for it to perform at its best. • Forgive others, don't hold grudges and be tolerant -- not everyone is as capable as you. • Gain perspective on things, how important is the issue? • Hugs, kisses and laughter: Have fun and don't be afraid to share your feelings with others.
  53. 53. A TO Z OF STRESS MANAGEMENT • Identify stressors and plan to deal with them better next time. • Judge your own performance realistically; don't set goals out of your own reach. • Keep a positive attitude, your outlook will influence outcomes and the way others treat you. • Limit alcohol, drugs and other stimulants, they affect your perception and behavior.
  54. 54. A TO Z OF STRESS MANAGEMENT • Manage money well, seek advice and save at least 10 per cent of what you earn. • No is a word you need to learn to use without feeling guilty. • Outdoor activities by you, or with friends and family, can be a great way to relax. • Play your favorite music rather than watching television.
  55. 55. A TO Z OF STRESS MANAGEMENT • Quit smoking. • Relationships. • Sleep well. • Treat yourself once a week with a massage, dinner out, the movies. • Understand things from the other person's point of view. • Verify information from the source before exploding.
  56. 56. A TO Z OF STRESS MANAGEMENT • Worry less. • Xpress. • Yearly goal setting. • Zest for life.
  57. 57. Stress Management Strategies Remove the Stressor Withdraw from the Stressor Change Stress Perceptions Receive Social Support Control Stress Consequences Stress Management Strategies
  58. 58. Inverted-U Hypothesis: Stress and Performance:
  59. 59. Who Wants to Get Rid of All the Stress in Your Life? Only One Group of People Have No Stress
  60. 60. The Key Word Is…. Balance
  61. 61. DISCUSSION QUESTION
  62. 62. Self management of stress
  63. 63. Stress management strategies for you
  64. 64. • Take a Deep Breath • Manage Time • Connect with Others
  65. 65. • Talk it Out • Take a “Minute” Vacation • Monitor Your Physical comfort
  66. 66. • Get Physical • Take Care of Your Body • Laugh
  67. 67. • Know your limits • Think Positively • Develop a Sense of Life Meaning
  68. 68. •Compromise •Have a Good Cry •Avoid Self Medication •Look for the “Pieces of Gold” Around you

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