Stress and anxiety are basic to life, no matter how wealthy,
powerful; good working and happy- mild stress can be
stimulating, motivating and sometimes even desirable.
The word stress derived from English word. Originally it was
used in physics and it is meant an external pressure , tension ,
load of an object. It was conceived as pressure from
environment , then as strain within the person.
The term stress was introduced in medicine in 1949by
Canadian Endocrinologist Hans Selye he described stress as the
body’s adjustment to new circumstances , and the bodys
stereotypical and non specific response to environmental
Stress is a state manifested by a specific syndrome
which consist of all the non specificaly induced changes
within a biological system .
by Hans seyle
Stress is mind and body’s response or reaction to a real
or imagined threat, event or change.
A physical or psychological stimulus that can produce
mental tension or physiological reactions that may lead
LEVELS OF STRESS
Two types of stress- Eustress or positive stress
- Distress or negative stress
Eustress or positive stress occurs when the
level of stress is high enough to motivate to move
into action to get things accomplished.
Distress or negative stress occurs when level of
stress is either too high or too low and body and/or
mind begin to respond negatively to the stressors.
When we experience a stressful event or
perceive something to be stressful psychological
changes occur in the body. This experience or
perception disrupts body’s normal balance and
immediately body begins to respond to the
stressor(s) as effectively as possible
During this stage body tries to cope or adapt to the
stressors by beginning a process of repairing any damage
the stressor has caused..
• During this stage the stressor is not
being managed effectively and the body
and mind are not able to repair the
At work place
At Organizational Level
At Personal Level
Inter personal factors
Workplace stressors of staff
Inadequate staff cover
Relationship with other clinical staff
Leadership and management style
lack of adequate supervisory support
Coping with emotional needs of patients and their families
poor patient diagnosis
Death and dying
Lack of reward
At Organisational Level
Technical – emergence of new technologies
Strategic – globalization, privatization, take-overs,
At Personal Level
Entries & exits to the family
Change in job
Unexciting but tight routine
Struggle of day to day life
Economic, physical & emotional
support from friends, family &
Inter personal factors
• Interpersonal relationship within the nursing
profession and between other professions
• Shorter stay for patients
• Supervision of assistive personnel
• Interdisciplinary conflict
• Purchasing a new home
COMMON SYMPTOMS OF STRESS
Change in appetite
The physiological signs and symptoms of stress result from
activation of sympathetic and neuro- endocrine systems of
Pupils dilate to increase visual perception
Sweat production increases
Heart rate and cardiac output increases
Skin is pallid due to peripheral blood vessel constriction
Mouth may be dry
Urine output decreases
Blood sugar increases
The manifestations: of stress includes- anxiety, fear, anger, depression
and unconscious ego defense mechanism.
Anxiety: state of mental uneasiness, apprehension, dread or
feeling of helpness. It can be experienced at conscious,
subconscious or unconscious level.
Fear: it is an emotion/ feeling of apprehension aroused by
impending or seeming danger, pain or threat.
Depression: it is an extreme feeling of sadness, despair,
lack of worth or emptiness.
Unconscious ego defense mechanism: it is a Psychologic
adaptive mechanism developing as the personality attempts
to defend itself and alay inner tensions
problem solving: the person assesses the situation or problem analyzes,
chose alternatives, carries out selected alternatives and evaluates.
Structuring: arrangement/ manipulation of a situation so that
threatening events does not occur.
Self control: assuming a manner and facial expression that conveys a
sense of being in control or in change.
Suppression: willfully putting a thought or feeling out of mind.
Day dreaming: unfulfilled wishes and desires are imagined as fulfilled or a
threatening experience is re worked or re played so that it ends differently
• Sullivan Elanor J , Decker Philip J . Effective
leadership and management in nursing.
Addison Wesley; 1997
• Barret jean. Ward management and teaching .
New Delhi , Konark publishers; 1994
• Ann R L . Basic concepts of psychiatric mental
health nursing. 7th edition. Philadelphia .
• C. Adey: “Stress: Who cares?”, in Nursing
Times, Vol. 28, 1987, pp. 52-53.
• J.T. Bailey, S.M. Steffen and J.W. Grout: “The
stress audit: Identifying the stressors of ICU
• nursing”, in Journal of Nursing Education, Vol.
19, 1980, pp. 15-25