“international health organizations and nursing organizations”

1. STREES COPING
Objectives:
At the end of this unit, learners will be able to:
1. Define coping stress tolerance pattern.
2. Differentiate the concepts of stress as a stimulus, response, and transaction.
3. Identify physiological and psychological manifestations of stress.
4. Discuss Factors affecting coping pattern during hospitalization.
5. Describe various types of coping pattern.
6. Discuss the nursing process related to coping stress pattern.
Stress
• Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes
you feel frustrated, angry, or nervous.
• Stress is your body's reaction to a challenge or demand. Stress can be positive, such as when it helps you
avoid danger or meet a deadline. But when stress lasts for a long time, it may harm your health.
Physiologic manifestations of stress
• Diarrhea or constipation
• Forgetfulness
• Frequent aches and pains
• Headaches
• Lack of energy or focus
• Sexual problems
• Stiff jaw or neck
• Tiredness
• Trouble sleeping or sleeping too much
• Upset stomach
• Use of alcohol or drugs to relax

2. • Weight loss or gain
Psychological manifestations of stress
• Depression or anxiety
• Anger, irritability, or restlessness
• Feeling overwhelmed, unmotivated, or unfocused
• Trouble sleeping or sleeping too much
• Racing thoughts or constant worry
• Problems with your memory or concentration
• Making bad decisions
Stress tolerance pattern
• Stress tolerance is the ability to be relaxed and composed when faced with difficulties
• The nurse carries out assessment to the specific stressors or problems that confront the client, client’s
perception of the stressor and his/her response to them. It includes the individual’s capacity to resist
challenge to self-integrity, modes of handling stress, family or other support systems and perceived ability
to control or manage the situation.
• The client’s strategies to deal with the stressors and relieve tension should be noted. The nurse should ask
and record whether there is a person on whom the client can rely on when problems arise.
• The nurse should also document any defensive mechanism or other coping strategies.
Concepts of stress as a
stimulus,response,and
transaction.
Stress As a Response
• Stress as a response model, initially introduced by Hans Selye (1956), describes stress as a physiological
response pattern and was captured within his general adaptation syndrome (GAS) model. This model
describes three concepts:
1. Stress is a defensive mechanism.

3. 2. Stress follows the three stages of alarm, resistance, and exhaustion.
3. If the stress is prolonged or severe, it could result in diseases of adaptation or even death.
4. Later, in The Stress Concept: Past, Present and Future (1983), Selye introduced the idea that the stress
response could result in positive or negative outcomes based on cognitive interpretations of the physical
symptoms or physiological experience.
5. In this way, stress could be experienced as eustress (positive) or dystress (negative). However, Selye
always considered stress to be a physiologically based construct or response. Gradually, other
researchers expanded the thinking on stress to include and involve psychological concepts earlier in the
stress model
• The response model of stress incorporates coping within the model itself. The idea of adaptation or
coping is inherent to the GAS model at both the alarm and resistance stages.
• When confronted with a negative stimulus, the alarm response initiates the sympathetic nervous system
to combat or avoid the stressor (i.e., increased heart rate, temperature, adrenaline, and glucose levels).
• The resistance response then initiates physiological systems with a fight or flight reaction to the stressor,
returning the system to homeostasis, reducing harm, or more generally accommodating the stressor,
which can lead to adaptive diseases such as sleep deprivation, mental illness, hypertension, or heart
disease.
Stress As a Stimulus
• The theory of stress as a stimulus was introduced in the 1960s, and viewed stress as a significant life
event or change that demands response, adjustment, or adaptation.

4. • Holmes and Rahe (1967) created the Social Readjustment Rating Scale (SRRS) consisting of 42 life events
scored according to the estimated degree of adjustment they would each demand of the person
experiencing them (e.g., marriage, divorce, relocation, change or loss of job, loss of loved one).
Stress As a Transaction
• In attempting to explain stress as more of a dynamic process, Richard Lazarus developed the transactional
theory of stress and coping (TTSC) (Lazarus, 1966; Lazarus & Folkman, 1984), which presents stress as a
product of a transaction between a person (including multiple systems: cognitive, physiological, affective,
psychological, neurological) and his or her complex environment.
Theories of stress as response, stimulus, and transaction

5. Coping
• Coping is the person’s effort to manage psychological stress. Effectiveness of coping strategies depends
on the individual’s needs. A person’s age and cultural background influence these needs. For this reason
no single coping strategy works for everyone or for every stressor.
• The same person may cope differently from one time to another. In stressful situations most people use a
combination of problem- and emotion-focused coping strategies.
• In other words, when under stress a person obtains information, takes action to change the situation, and
regulates emotions tied to the stress
• In some cases people avoid thinking about the situation or change the way they think about it without
changing the actual situation itself.
• The type of stress, people’s goals, their beliefs about themselves and the world, and personal resources
determine how people cope with stress.
• Resources include intelligence, money, social skills, supportive family and friends, physical attractiveness,
health and energy, and ways of thinking such as optimism.
Coping mechanisms
• Coping mechanisms include psychological adaptive behaviors. Such behaviors are often task oriented,
involving the use of direct problem-solving techniques to cope with threats. Ego-defense mechanisms
regulate emotional distress and thus give a person protection from anxiety and stress.
• Ego-defense mechanisms help a person cope with stress indirectly and offer psychological protection
from a stressful event. Everyone uses them unconsciously to protect against feelings of worthlessness and
anxiety
• Occasionally a defense mechanism becomes distorted and no longer helps the person adapt to a stressor.
However, people generally find them very helpful in coping and use them spontaneously.
• Frequently short-term stressors activate ego-defense mechanisms. These usually do not result in
psychiatric disorders.
• Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature
considered an asset. (Example: A person who is a poor communicator relies on organizational skills.)
• Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into
non organic symptoms(e.g., difficulty sleeping, loss of appetite).
• Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that causes
intolerable emotional pain. (Example: A person refuses to discuss or acknowledge a personal loss.)
• Displacement is transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-
producing substitute. (Example: A person transfers anger over an interpersonal conflict to a
malfunctioning computer.)

6. • Identification is patterning behavior after that of another person and assuming that person’s qualities,
characteristics, and actions.
• Dissociation is experiencing a subjective sense of numbing and a reduced awareness of one’s
surroundings.
• Regression is coping with a stressor through actions and behaviors associated with an earlier
developmental period.
Nursing implementation
Health Promotion:
• Three primary modes of intervention for stress are to decrease stress-producing situations, increase
resistance to stress, and learn skills that reduce physiological response to stress
• Educate patients and families about the importance of health promotion.
Regular Exercise:
• A regular exercise program improves muscle tone and posture, controls weight, reduces tension, and
promotes relaxation. In addition, exercise reduces the risk of cardiovascular disease and improves
cardiopulmonary functioning.
• Patients who have a history of a chronic illness, are at risk for developing an illness, or are older than 35
years of age should begin a physical exercise program only after discussing the plan with a health care
provider
EVALUATION
• Reassess the patient for the presence of new or recurring stress-related problems or symptoms
• Determine if change in care promoted the patient’s adaptation to stress
• Ask if the patient’s expectations are being met
References:
• Anshel, M.H. (1996). Coping styles among adolescent competitive athletes. The Journal of Social
Psychology, 136, 311-323.
• Anshel, M.H. & Weinberg, R.T. (1999). Re-examining coping among basketball referees following stressful
events: Implications for coping interventions. Journal of Sport Behavior, 22, 144-161.
Thank you