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  1. 1. STRESS
  2. 2. Personal definition <ul><li> What is Stress? </li></ul>
  3. 3. Stress and Adaptation <ul><li>STRESS </li></ul><ul><ul><li>A condition in which the person responds to changes in the normal balanced state </li></ul></ul><ul><ul><li>Selye: non specific response of the body to any kind of demand made upon it </li></ul></ul><ul><ul><li>Any event – environmental / internal demands or both tax or exceed the adaptive resources of an individual, social system or tissue systems </li></ul></ul>
  4. 4. Stress and Adaptation <ul><li>STRESSOR </li></ul><ul><ul><li>Any event or stimulus that causes an individual to experience stress </li></ul></ul><ul><li>They may neither positive or negative , but they have positive or negative effects </li></ul><ul><ul><ul><li>Internal Stressor (illness, hormonal change, fear) </li></ul></ul></ul><ul><ul><ul><li>External Stressor (loud noise, cold temperature) </li></ul></ul></ul><ul><ul><ul><li>Developmental Stressor </li></ul></ul></ul><ul><ul><ul><li>Situational Stressor </li></ul></ul></ul>
  5. 5. Stress and Adaptation <ul><li>COPING- a problem solving process that the person uses to manage the stresses or events with which he/she is presented. </li></ul>
  6. 6. Stress and Adaptation <ul><li>ADAPTATION- the process by which human system modifies itself to conform to the environment. It is a change that results from response to stress. </li></ul>
  7. 7. Stress and Adaptation <ul><li>SOURCES OF STRESS </li></ul><ul><li>Internal </li></ul><ul><li>External </li></ul><ul><li>Developmental </li></ul><ul><li>Situational </li></ul>
  8. 8. Stress Characteristics <ul><li>It is a universal phenomenon. </li></ul><ul><li>It is an individual experience. </li></ul><ul><li>It provides stimulus for growth and change. </li></ul><ul><li>It affects all dimension of life. </li></ul><ul><li>It is not a nervous energy. </li></ul>
  9. 9. Effects of Stress on the Body <ul><li>Physical - affects physiologic homeostasis </li></ul><ul><li>Emotional - affects feeling towards self </li></ul><ul><li>Intellectual - influences perception and problem solving abilities </li></ul><ul><li>Social – can alter relationships with others </li></ul><ul><li>Spiritual - affects one’s beliefs and values </li></ul>
  10. 10. Effects of Stress on the Body <ul><li>Metabolic Disorders </li></ul><ul><ul><li>Hyper/hypothyroidism </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><li>Cancer </li></ul><ul><li>Accident proneness </li></ul><ul><li>Skin disorders </li></ul><ul><ul><li>Eczema </li></ul></ul><ul><ul><li>Pruritus </li></ul></ul><ul><ul><li>Urticaria </li></ul></ul><ul><ul><li>Psoriasis </li></ul></ul><ul><li>Respiratory disorders </li></ul><ul><ul><li>Asthma </li></ul></ul><ul><ul><li>Hay fever </li></ul></ul><ul><ul><li>Tuberculosis </li></ul></ul><ul><li>CVD </li></ul><ul><ul><li>Coronary artery disease </li></ul></ul><ul><ul><li>Essential hypertension </li></ul></ul><ul><ul><li>CHF </li></ul></ul><ul><li>GIT disorders </li></ul><ul><ul><li>Constipation </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><ul><li>Duodenal ulcer </li></ul></ul><ul><ul><li>Anorexia nervosa </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Ulcerative colitis </li></ul></ul><ul><li>Menstrual irregularities </li></ul><ul><li>Musculoskeletal disorders </li></ul><ul><ul><li>RA </li></ul></ul><ul><ul><li>LBP </li></ul></ul><ul><ul><li>Migraine Headache </li></ul></ul><ul><ul><li>Muscle tension </li></ul></ul>
  11. 11. GENERAL THEORETICAL FRAMEWORKS FOR UNDERSTANDING STRESS <ul><li>Stress can be defined differently by the three models </li></ul><ul><li>STIMULUS </li></ul><ul><li>RESPONSE </li></ul><ul><li>TRANSACTION </li></ul>
  12. 12. Stress and Adaptation <ul><li> Models of Stress </li></ul><ul><li>STIMULUS based models </li></ul><ul><li>RESPONSE based models </li></ul><ul><li>TRANSACTION based models </li></ul>
  13. 13. Stress as a Stimulus <ul><li>Holmes and Rahe 1967: They studied the relationship between specific life changes such as divorce or death, and the subsequent onset of illness. </li></ul><ul><li>Focus: disturbing events within the environment </li></ul>
  14. 14. Stress as a Transaction <ul><li>The transactional stress theory includes cognitive, affective, and adaptive responses from person and environment interaction. The person responds to perceived environmental changes by coping mechanisms. </li></ul><ul><li>Transactional theory of stress emphasizes that people & groups differ in their sensitivity & vulnerability to certain types of events, as well as in their interpretations & reactions </li></ul>
  15. 15. Stress As a Response <ul><li>Disruptions caused by harmful stimulus or stressors </li></ul><ul><li>Specifies particular response or pattern of responses that may indicate a stressor </li></ul><ul><li>Selye (1976): developed models of stress, that defines stress as a non-specific response of the body to any demand made on it </li></ul>
  16. 16. Stress As a Response <ul><li>Focus: reactions of the BODY </li></ul><ul><li>Selye used the term “stressor’ as the stimulus or agents that evokes a stress response in the person . </li></ul><ul><li>A stressor may be anything that places a demand on the person for change or adaptation. </li></ul>
  17. 17. Stress As a Response <ul><li>Hans Selye (1976) “ non-specific response of the body to any kind of demand made upon it </li></ul><ul><li>He called it “non-specific” because the body goes through a number of biochemical changes and re-adjustments without regard to the nature of the stress producing agents. </li></ul><ul><li>Any type of stressor may produce the same responses in the human body </li></ul>
  18. 18. Stress As a Response <ul><li>Advantage : response to stress is purely physiologic; determines physiological response to stress </li></ul><ul><li>Disadvantage: does not consider individual differences in response pattern </li></ul>
  19. 19. Stress as a response <ul><li>SELYE proposed two Stress adaptation responses </li></ul><ul><li>General Adaptation Syndrome </li></ul><ul><li>Local Adaptation Syndrome </li></ul>
  20. 20. General Adaptation Syndrome <ul><li>Physiologic responses of the whole body to stressors </li></ul><ul><li>Involves the Autonomic Nervous System, and Endocrine System </li></ul><ul><li>Occurs with the release of adaptive hormones and subsequent changes in the WHOLE body </li></ul>
  21. 21. General Adaptation Syndrome Stressor Alarm reaction Shock phase Epinephrine Cortisone Stages of resistance Stages of exhaustion Three stages adaptation to stress for both GAS/LAS: Counter-shock Phase Rest Death Normal state
  22. 22. General Adaptation Syndrome <ul><li>I. ALARM REACTION </li></ul><ul><li>Initial reaction of the body; “ fight OR flight” responses </li></ul><ul><li>Mobilizing of the defense mechanisms of the body and mind to cope with stressors. </li></ul><ul><li>SHOCK PHASE- the autonomic nervous system reacts; release of Epinephrine and Cortisol </li></ul><ul><li>COUNTERSHOCK PHASE- reversal of the changes produced in the shock phase </li></ul>
  23. 23. General Adaptation Syndrome <ul><li>II. STAGE OF RESISTANCE: </li></ul><ul><li>The BODY stabilizes, hormonal levels return to normal, heart rate, blood pressure and cardiac output return to normal </li></ul><ul><li>2 things may occur: </li></ul><ul><li>Either the person successfully adapts to the stressors and returns to normal, thus resolving and repairing body damage; or </li></ul><ul><li>The stressor remains present, and adaptation fails (ex. Long-term terminal illness, mental illness, and continuous blood loss) </li></ul>
  24. 24. General Adaptation Syndrome <ul><li>III. STAGE OF EXHAUSTION: </li></ul><ul><li>Occurs when the body can no longer resist stress and body energy is depleted. </li></ul><ul><li>The body’s energy level is compromised and adaptation diminishes. </li></ul><ul><li>Body may not be able to defend self that may end to death. </li></ul>
  25. 25. Stress and Adaptation <ul><li>A-R-E </li></ul><ul><li>ALARM: sympathetic system is mobilized! </li></ul><ul><li>RESISTANCE: adaptation takes place </li></ul><ul><li>EXHAUSTION : adaptation cannot be maintained </li></ul>
  26. 26. GAS <ul><li>Hypothalamus </li></ul><ul><li>Anterior Pituitary Gland </li></ul><ul><li>Adrenal Gland </li></ul><ul><li>Adrenal Cortex Adrenal medulla </li></ul>
  27. 29. Adrenal gland
  28. 30. Adrenal Gland
  29. 31. Adrenal Gland
  30. 32. Hormonal Changes <ul><li>Adrenal Cortex </li></ul><ul><li>MINERALOCORTICOIDS </li></ul><ul><ul><li>Aldosterone </li></ul></ul><ul><ul><li>Na+ retention </li></ul></ul><ul><ul><li>WATER retention </li></ul></ul><ul><ul><li>Protein anabolism </li></ul></ul><ul><li>GLUCOCORTICOIDS </li></ul><ul><ul><li>Cortisol </li></ul></ul><ul><ul><li>(Anti-inflammatory) </li></ul></ul><ul><ul><li>Protein catabolism </li></ul></ul><ul><ul><li>Gluconeogenesis </li></ul></ul><ul><li>Adrenal Medulla </li></ul><ul><li>NOREPINEPHRINE </li></ul><ul><ul><li>Peripheral vasoconstriction </li></ul></ul><ul><ul><li>Decreased blood to kidney </li></ul></ul><ul><ul><li>Increased renin (angiotensin) </li></ul></ul><ul><li>EPINEPHRINE </li></ul><ul><ul><li>Tachycardia </li></ul></ul><ul><ul><li>Increased myocardial activity </li></ul></ul><ul><ul><li>Increased Bronchial dilatation </li></ul></ul><ul><ul><li>Increased Blood clotting </li></ul></ul><ul><ul><li>Increased Metabolism </li></ul></ul><ul><ul><li>Increased Fat Metabolism </li></ul></ul>
  31. 33. Local Adaptation Syndrome <ul><li>Localized responses to stress </li></ul><ul><li>Ex. Wound healing, blood clotting, vision, response to pressure </li></ul><ul><li>Adaptive: a stressor is necessary to stimulate it </li></ul><ul><li>Short- term </li></ul><ul><li>Restorative: assist in homeostasis </li></ul>
  32. 34. Local Adaptation Syndrome <ul><li>Reflex Pain response: </li></ul><ul><li>Localized response of the CNS to pain </li></ul><ul><li>Adaptive response and protects tissue from further damage </li></ul><ul><li>Involves a sensory receptor, a sensory serve to the spinal cord, a connector neuron, motor nerve, effector’s muscles. Example: unconscious removal of hand from a hot surface, sneezing, etc. </li></ul><ul><li>Inflammatory Response: </li></ul><ul><li>Stimulated by trauma or infection, thus preventing it to spread; also promotes healing </li></ul><ul><li>Pain, heat, redness, swelling </li></ul>
  33. 35. FACTORS INFLUENCING RESPONSE TO STRESS <ul><li>Age, Sex </li></ul><ul><li>Nature of Stressors </li></ul><ul><li>Physiological functioning </li></ul><ul><li>Personality </li></ul><ul><li>Behavioral Characteristics </li></ul><ul><li>Level of personal control </li></ul><ul><ul><li>Availability of support system </li></ul></ul><ul><ul><li>Feelings of competence </li></ul></ul><ul><ul><li>Cognitive appraisal, Economic Status </li></ul></ul>
  34. 36. The MANIFESTATIONS OF STRESS <ul><li>INDICATORS OF STRESS </li></ul><ul><li>Physiologic </li></ul><ul><li>Psychological </li></ul><ul><li>Cognitive </li></ul><ul><li>Verbal-Motor </li></ul>
  35. 37. Physiological Indicators <ul><li>Dilated pupils </li></ul><ul><li>Diaphoresis </li></ul><ul><li>Tachycardia, tachypnea, HYPERTENSION, increased blood flow to the muscles </li></ul><ul><li>Increased blood clotting </li></ul><ul><li>Bronchodilation </li></ul><ul><li>Skin pallor </li></ul><ul><li>Water retention, Sodium retention </li></ul><ul><li>Oliguria </li></ul><ul><li>Dry mouth, decrease peristalsis </li></ul><ul><li>Hyperglycemia </li></ul>
  36. 38. Remember these Physiologic Manifestations of Stress <ul><li>Pupils dilate to increase visual perception when serious threats to the body arise </li></ul><ul><li>Sweat production (diaphoresis) increases to control elevated body heat due to increased metabolism </li></ul>
  37. 39. Remember these Physiologic Manifestations of Stress <ul><li>Heart rate or pulse rate increases to transport nutrients & byproducts of metabolism more effectively </li></ul><ul><li>Skin becomes pale (Pallor) because of constriction of peripheral blood vessels to shunt blood to the vital organs. </li></ul>
  38. 40. Remember these Physiologic Manifestations of Stress <ul><li>BP increases due to vasoconstriction of vessels in blood reservoir (skin, kidneys, lungs), due to secretion of renin, Angiotensin I and II </li></ul><ul><li>Increased rate/depth of respiration with dilation of bronchioles, promoting hyperventilation and increased oxygen uptake </li></ul>
  39. 41. Remember these Physiologic Manifestations of Stress <ul><li>Mouth may become dry, urine output may decrease. The peristalsis of the intestines decreases leading to constipation </li></ul><ul><li>For serious threats, there is improved mental alertness </li></ul>
  40. 42. Remember these Physiologic Manifestations of Stress <ul><li>Increased muscle tension to prepare for rapid motor activity/defense </li></ul><ul><li>Increased blood sugar (glucocorticoids & gluconeogenesis) to supply energy source to the body. </li></ul>
  41. 43. Psychological indicators <ul><li>This includes anxiety, fear, anger, depression and unconscious ego defense mechanisms </li></ul>
  42. 44. Anxiety <ul><li>A state of mental uneasiness, apprehension, or helplessness, related to anticipated unidentified stress </li></ul><ul><li>Occurs in the Conscious, subconscious, or unconscious levels </li></ul>
  43. 45. Levels of Anxiety <ul><li>4 Levels of Anxiety: </li></ul><ul><li>Mild </li></ul><ul><li>Moderate </li></ul><ul><li>Severe </li></ul><ul><li>Panic </li></ul>
  44. 46. Levels of Anxiety <ul><li>Mild- increased alertness, motivation and attentiveness </li></ul><ul><li>Moderate- perception narrowed, selective inattention and physical discomfort </li></ul>
  45. 47. Levels of Anxiety <ul><li>Severe- behaviors become automatic, details are not seen, senses are drastically reduced, very narrow focus on specific details, impaired learning ability. </li></ul><ul><li>Panic- overwhelmed, unable to function or to communicate, with possible bodily harm to self and others, loss of strong displeasure </li></ul>
  46. 48. Anxiety
  47. 49. ANXIETY Palpitation, choking, chest pain Tachycardia, Hyperventilation Slight Increase NONE VS changes Trembling unpredictable response Difficult to understand Easily distracted Voice tremors Focus on particular object Increased questioning Communication Distorted perception Inability to focus Narrowed focus Increased arousal Perception and attention PANIC SEVERE MODERATE MILD CATEGORY
  48. 50. Fear <ul><li>It is a mild to severe feeling of apprehension about some perceived threat. </li></ul><ul><li>The Object of fear may or may not be based on reality. </li></ul>
  49. 51. Anxiety versus fear Result of discrete physical or psychological entity, definite and concrete events Result of psychological or emotional conflict Definite Vague Related to the present Related to the future Source is identifiable Source may not be identifiable Emotion of apprehension State of mental uneasiness FEAR ANXIETY
  50. 52. Anger <ul><li>Subjective feeling of strong displeasure </li></ul><ul><li>It is an emotional state consisting of subjective feeling of animosity or strong displeasure </li></ul>
  51. 53. Depression <ul><li>Emotional Symptoms: </li></ul><ul><ul><ul><li>Tiredness </li></ul></ul></ul><ul><ul><ul><li>emptiness </li></ul></ul></ul><ul><ul><ul><li>numbness </li></ul></ul></ul><ul><li>Physical signs </li></ul><ul><ul><ul><li>loss of appetite </li></ul></ul></ul><ul><ul><ul><li>weight loss </li></ul></ul></ul><ul><ul><ul><li>constipation </li></ul></ul></ul><ul><ul><ul><li>headache </li></ul></ul></ul><ul><ul><ul><li>dizziness </li></ul></ul></ul><ul><li>Behavioral signs: </li></ul><ul><ul><li>irritability </li></ul></ul><ul><ul><li>inability to concentrate </li></ul></ul><ul><ul><li>difficulty making decision </li></ul></ul><ul><ul><li>loss of sexual desire </li></ul></ul><ul><ul><li>crying </li></ul></ul><ul><ul><li>sleep disturbance </li></ul></ul><ul><ul><li>social withdrawal </li></ul></ul>
  52. 54. Unconscious Ego defense mechanism <ul><li>These are PSYCHOLOGIC adaptive mechanisms </li></ul><ul><li>Mental mechanisms that develop as the personality attempts to DEFEND itself, establishes compromises among conflicting impulses and allays inner tensions </li></ul>
  53. 55. Unconscious Ego defense mechanism <ul><li>The unconscious mind working to protect the person from anxiety </li></ul><ul><li>Releases tension </li></ul>
  54. 56. COGNITIVE MANIFESTATIONS <ul><li>Thinking responses that include problem solving, prayer, structuring, self control, suppression and fantasy </li></ul><ul><li>Thinking responses of the individual toward stress </li></ul>
  55. 57. COGNITIVE MANIFESTATIONS <ul><li>PROBLEM SOLVING: Use of specific steps to arrive at a solution </li></ul><ul><li>STRUCTURING: manipulation of a situation so that threatening events do not occur </li></ul>
  56. 58. COGNITIVE MANIFESTATIONS <ul><li>SELF CONTROL / DISCIPLINE: assuming a sense of being in control or in charge of whatever situation </li></ul><ul><li>SUPPRESSION: willfully putting a thought / feeling out of one’s mind </li></ul>
  57. 59. COGNITIVE MANIFESTATIONS <ul><li>FANTASY / DAYDREAMING: “ make believe” or imagination of unfulfilled wishes as fulfilled </li></ul><ul><li>PRAYER: identification, description of the problem, suggestion of solution, then reaching out for help or support to the supreme being </li></ul>
  58. 60. VERBAL / MOTOR MANIFESTATIONS <ul><li>First hand responses to stress </li></ul>
  59. 61. VERBAL / MOTOR MANIFESTATIONS <ul><li>CRYING: feelings of pain, joy, sadness are released </li></ul><ul><li>VERBAL ABUSE: release mechanism toward non living objects, and stress producing events </li></ul><ul><li>LAUGHING: anxiety reducing response that leads to constructive problem solving </li></ul>
  60. 62. VERBAL / MOTOR MANIFESTATIONS <ul><li>SCREAMING: response to fear or intense frustration and anger </li></ul><ul><li>HITTING AND KICKING: spontaneous response to physical threats or frustrations </li></ul><ul><li>HOLDING AND TOUCHING: responses to joyful, painful or sad events </li></ul>
  61. 63. Coping
  62. 64. COPING <ul><li>A problem solving process or strategy that the person uses to manage the out-of-ordinary events or situations with which he/she is presented. </li></ul><ul><li>Successfully dealing with problems </li></ul>
  63. 65. Coping related terms <ul><li>Adaptive coping- helps person deal effectively with stress </li></ul><ul><li>Maladaptive coping- results in unnecessary distress for the person and stressful events </li></ul>
  64. 66. MODES OF ADAPTATION <ul><li>1. Physiologic mode (biologic adaptation) </li></ul><ul><ul><li>Occurs in response to increased or altered demands placed on the body & results in compensatory physical changes. </li></ul></ul><ul><li>2. Psychological Mode </li></ul><ul><ul><li>Involves a change in attitude & behavior toward emotionally stressful situations. (Ex. Stopping smoking) </li></ul></ul><ul><li>3. Socio-cultural Mode </li></ul><ul><ul><li>Changing persons behavior in accordance with the norms, conversions, & beliefs of various groups (leaving in new country) </li></ul></ul>
  65. 67. CHARACTERISTICS OF ADAPTIVE RESPONSES <ul><li>All attempts to maintain homeostasis </li></ul><ul><li>Whole body or total organism response </li></ul><ul><li>Have limits (Physiologic, Psychologic/Social) </li></ul><ul><li>Requires time </li></ul><ul><li>Varies from person to person </li></ul><ul><li>Maybe inadequate or excessive (infection/allergy </li></ul>
  66. 68. MANIFESTATIONS OF ALTERED COPING <ul><li>Addictive behaviors </li></ul><ul><li>Physical illness </li></ul><ul><li>Anxiety and depression </li></ul><ul><li>Violent behaviors </li></ul>
  67. 69. Applying the Nursing Process <ul><li>A </li></ul><ul><li>D </li></ul><ul><li>P </li></ul><ul><li>I </li></ul><ul><li>E </li></ul>
  68. 70. Assessment <ul><li>1. Utilize the Nursing History </li></ul><ul><ul><li>Subjective data- such as the functional pattern, risk pattern and dysfunctional pattern. </li></ul></ul><ul><li>2. Physical Examination – centered on the changes in the ANS and NES. Objective data- Physical assessment, Diagnostic tests and procedures </li></ul><ul><li>3. Laboratory Examination </li></ul>
  69. 71. Diagnoses <ul><li>Utilize those accepted by NANDA </li></ul><ul><li>Anxiety 7. Fear </li></ul><ul><li>Caregiver role strain 8. Impaired adjustment </li></ul><ul><li>Compromised family coping 9. Ineffective coping </li></ul><ul><li>Decisional conflict 10. Ineffective Denial </li></ul><ul><li>Defensive coping 11. Post-trauma Syn </li></ul><ul><li>Disabled Family coping 12. Relocation Stress Syn </li></ul>
  70. 72. Planning <ul><li>There are four important guidelines to be followed in choosing nursing goals. The nurse must choose goals geared : </li></ul><ul><ul><li>To eliminate as many stressors as possible </li></ul></ul><ul><ul><li>To teach about the effects of stress to the body </li></ul></ul><ul><ul><li>To teach how to cope with stress </li></ul></ul><ul><ul><li>To teach on how to adjust to stress </li></ul></ul>
  71. 73. Planning <ul><li>Examples of Patient outcome criteria are: </li></ul><ul><li>After 3 hours/ 4days: </li></ul><ul><li>1. The patient will identify sources of stress in his/her life </li></ul><ul><li>2. The patient will identify usual personal coping strategies for stressful situations </li></ul><ul><li>3. The patient will define the effect of stress and coping strategies on activities of daily living </li></ul>
  72. 74. Implementation <ul><li>There are essentially three ways to manage Stress: </li></ul><ul><li>Eliminate the causes/sources of stress </li></ul><ul><li>Produce a relaxation response in the body </li></ul><ul><li>Suggest a change in lifestyle, if possible </li></ul>
  73. 75. Implementation <ul><li>Stress reduction techniques: </li></ul><ul><li>Proper nutrition </li></ul><ul><li>Regular exercise, physical activity & recreation </li></ul><ul><li>Meditation, Breathing exercises, creative imagery, YOGA </li></ul><ul><li>Communication, time management, expression of feeling, talking it out, organizing time </li></ul><ul><li>Biofeedback </li></ul><ul><li>Therapeutic touch </li></ul><ul><li>Relaxation response , Problem Solving Techniques </li></ul>
  74. 76. Implementation <ul><li>Minimize anxiety </li></ul><ul><li>Support the client and the family </li></ul><ul><li>Orient the client to the hospital </li></ul><ul><li>Give the client in a hospital some way of maintaining identity. </li></ul><ul><li>Provide information when the client has insufficient information. </li></ul>
  75. 77. Implementation <ul><li>Massage </li></ul><ul><li>These include effleurage (stroking), friction, pressure, petrissage (kneading or large, quick pinches of the skin, subcutaneous tissue and muscle), vibration and percussion. </li></ul><ul><li>Purposes </li></ul><ul><ul><li>- enhances or induces relaxation before sleep </li></ul></ul><ul><ul><li>-stimulates skin circulation </li></ul></ul><ul><li>Duration: 5-20 minutes </li></ul>
  76. 78. Implementation <ul><li>Progressive Relaxation </li></ul><ul><li>Jacobson (1930), the originator of the Progressive relaxation technique </li></ul>
  77. 79. Implementation <ul><li>Guided Imagery </li></ul><ul><li>Imagery is &quot;the formation of a mental representation of an object that is usually only perceived through the senses&quot; (Sodergren 1985) . Example: </li></ul><ul><li>Visual -A valley scene with its many greens </li></ul><ul><li>Auditory -Ocean waves breaking rhythmically </li></ul><ul><li>Olfactory -Freshly baked bread </li></ul><ul><li>Gustatory -A Juicy hamburger </li></ul><ul><li>Tactile-proprioceptive -Stroking a soft, furry cat </li></ul>
  78. 80. Implementation <ul><li>Biofeedback is a technique that brings under conscious control bodily processes normally thought to be beyond voluntary command. muscle tension, heartbeat, blood flow, peristalsis, & skin temperature – can be voluntarily controlled </li></ul><ul><ul><li>feedback provided through: </li></ul></ul><ul><ul><li>a. temperature meters (that indicate temp. changes) </li></ul></ul><ul><ul><li>b. EMG (electromyogram) that shows electric potential created by contraction the muscles </li></ul></ul>
  79. 81. Implementation <ul><li>Therapeutic Touch </li></ul><ul><li>“ a healing meditation, because the primary act of the nurse (healer) is to &quot;center&quot; the self and to maintain that center (mental concentration and focusing) throughout the process. </li></ul>
  80. 82. Implementation <ul><li>CRISIS INTERVENTION </li></ul><ul><ul><li>A technique of helping the person go through the crisis </li></ul></ul><ul><ul><li>To mobilize his resources </li></ul></ul><ul><ul><li>To help him deal with the here and now </li></ul></ul><ul><ul><li>A five step problem solving technique designed to promote a more adaptive outcome including improved abilities to cope with future crises </li></ul></ul>
  81. 83. Evaluation <ul><li>The evaluation of the plan of care is based on the mutually established expected outcomes. </li></ul><ul><li>It is important to observe BOTH verbal and non-verbal cues when evaluating the usefulness of the plan. </li></ul>
  82. 84. Stress Management for Nurses <ul><li>Plan daily relaxation program </li></ul><ul><li>Establish a regular pattern of exercise </li></ul><ul><li>Study assertive techniques. Learn to say “no” </li></ul><ul><li>Learn to accept failures </li></ul><ul><li>Accept what cannot be changed </li></ul><ul><li>Develop collegial support </li></ul><ul><li>Participate in professional organization </li></ul><ul><li>Seek counseling </li></ul>