Stress management


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Stress management

  1. 1. Misamis University Ozamiz City Graduate SchoolSTRESS MANAGEMENTIn partial fulfillment of the requirements in NR 214 Submitted to: Prof. Maricar M. Mutia, RN, MN-MAN Faculty, Graduate School Submitted by: Ms. Maria Lourdes R. Balucan, BSN, RN Student, Master in Nursing Major in Maternal and Child Nursing July 7, 2012
  2. 2. Stress managementStress management refers to a wide spectrum of techniques and psychotherapies aimed at controlling apersons levels of stress, especially chronic stress, usually for the purpose of improving everydayfunctioning.In this context, the term stress refers only to a stress with significant negative consequences, or distress inthe terminology advocated by Hans Selye, rather than what he calls eustress, a stress whoseconsequences are helpful or otherwise positive.Stress produces numerous symptoms which vary according to persons, situations, and severity. These caninclude physical health decline as well as depression. According to the St. Louis Psychologists andCounseling Information and Referral, the process of stress management is one of the keys to a happy andsuccessful life in modern society. Although life provides numerous demands that can prove difficult tohandle, stress management provides a number of ways to manage anxiety and maintain overall well-being.Despite stress often being thought of as a subjective experience, levels of stress are readily measureableusing various physiological tests, similar to those used in polygraphs.Many practical stress management techniques are available, some for use by health practitioners andothers for self-help, which may help an individual to reduce stress, provide positive feelings of being incontrol of ones life and promote general well-being.The effectiveness of the different stress management techniques can be difficult to assess, as few of themhave received significant attention from researchers. Consequently, the amount and quality of evidence forthe various techniques varies widely. Some are accepted as effective treatments for use in psychotherapy,whilst others with less evidence favoring them are considered alternative therapies. Many professionalorganizations exist to promote and provide training in conventional or alternative therapies.There are several models of stress management, each with distinctive explanations of mechanisms forcontrolling stress. Much more research is necessary to provide a better understanding of whichmechanisms actually operate and are effective in practice.Historical foundationsWalter Cannon and Hans Selye used animal studies to establish the earliest scientific basis for the study ofstress. They measured the physiological responses of animals to external pressures, such as heat and cold,prolonged restraint, and surgical procedures, then extrapolated from these studies to human beings.Subsequent studies of stress in humans by Richard Rahe and others established the view that stress iscaused by distinct, measureable life stressors, and further, that these life stressors can be ranked by themedian degree of stress they produce (leading to the Holmes and Rahe Stress Scale). Thus, stress wastraditionally conceptualized to be a result of external insults beyond the control of those experiencing thestress. More recently, however, it has been argued that external circumstances do not have any intrinsiccapacity to produce stress, but instead their effect is mediated by the individuals perceptions, capacities,and understanding. 2|Page
  3. 3. ModelsTransactional modelRichard Lazarus and Susan Folkman suggested in 1984 that stress can be thought of as resulting from an“imbalance between demands and resources” or as occurring when “pressure exceeds ones perceivedability to cope”. Stress management was developed and premised on the idea that stress is not a directresponse to a stressor but rather ones resources and ability to cope mediate the stress response and areamenable to change, thus allowing stress to be controllable.In order to develop an effective stress management programme it is first necessary to identify the factorsthat are central to a person controlling his/her stress, and to identify the intervention methods whicheffectively target these factors. Lazarus and Folkmans interpretation of stress focuses on the transactionbetween people and their external environment (known as the Transactional Model). The model contendsthat stress may not be a stressor if the person does not perceive the stressor as a threat but rather aspositive or even challenging. Also, if the person possesses or can use adequate coping skills, then stressmay not actually be a result or develop because of the stressor. The model proposes that people can betaught to manage their stress and cope with their stressors. They may learn to change their perspective ofthe stressor and provide them with the ability and confidence to improve their lives and handle all of types ofstressors.Health realization/innate health modelThe health realization/innate health model of stress is also founded on the idea that stress does notnecessarily follow the presence of a potential stressor. Instead of focusing on the individuals appraisal ofso-called stressors in relation to his or her own coping skills (as the transactional model does), the healthrealization model focuses on the nature of thought, stating that it is ultimately a persons thought processesthat determine the response to potentially stressful external circumstances. In this model, stress resultsfrom appraising oneself and ones circumstances through a mental filter of insecurity and negativity,whereas a feeling of well-being results from approaching the world with a "quiet mind".This model proposes that helping stressed individuals understand the nature of thought—especiallyproviding them with the ability to recognize when they are in the grip of insecure thinking, disengage from it,and access natural positive feelings—will reduce their stressTechniquesHigh demand levels load the person with extra effort and work. A new time schedule is worked up, and untilthe period of abnormally high, personal demand has passed, the normal frequency and duration of formerschedules is limited.Many techniques cope with the stresses life brings. Some of the following ways induce a lower than usualstress level, temporarily, to compensate the biological tissues involved; others face the stressor at a higherlevel of abstraction: Autogenic training 3|Page
  4. 4.  Social activity Cognitive therapy Conflict resolution Exercise Getting a hobby Meditation Mindfulness (psychology) Deep breathing Yoga Nidra Nootropics Reading novels Prayer Relaxation techniques Artistic Expression Fractional relaxation Progressive relaxation Spas Somatics training Spending time in nature Stress balls Natural medicine Clinically validated alternative treatments Time management Planning and decision making Listening to certain types of relaxing music, particularly: o New Age music o Classical music o Psychedelic music o Christian music o Liquid funk o ambient music o Sleep Music Spending quality time with petsTechniques of stress management will vary according to the philosophical paradigm.Measuring stressLevels of stress can be measured. One way is through the use of psychological testing: the Holmes andRahe Stress Scale is used to rate stressful life events, while the DASS contains a scale for stress based onself-report items. Changes in blood pressure and galvanic skin response can also be measured to teststress levels, and changes in stress levels. A digital thermometer can be used to evaluate changes in skin 4|Page
  5. 5. temperature, which can indicate activation of the fight-or-flight response drawing blood away from theextremities.EffectivenessStress management has physiological and immune benefits.Positive outcomes are observed using a combination of non-drug interventions: treatment of anger or hostility, autogenic training talking therapy (around relationship or existential issues) biofeedback cognitive therapy for anxiety or clinical depressionHEALTH PROMOTION: Stress Management  Stress is a change in the environment that is perceived as a threat, challenge, or harm to the persons dynamic equilibrium. In times of stress, the sympathetic nervous system is activated to produce immediate changes of increased heart rate, peripheral vasoconstriction, and increased BP. This response is prolonged by adrenal stimulation and secretion of epinephrine and norepinephrine, and is known as the “fight-or-flight” reaction.  A limited amount of stress can be a positive motivator to take action; however, excessive or prolonged stress can cause emotional discomfort, anxiety, possible panic, and illness.  Prolonged sympathetic-adrenal stimulation may lead to high BP, arteriosclerotic changes, and cardiovascular disease; stress has also been implicated in acute asthma attack, peptic ulcer disease, irritable bowel syndrome, migraine headaches, and other illnesses.  Stress management can help patients control illnesses, improve self-esteem, gain control, and enjoy life more fully.  Stress management involves the identification of physiologic and psychosocial stressors through assessment of the patients education, finances, job, family, habits, activities, personal and family health history, and responsibilities. Positive and negative coping methods should also be identified.  Relaxation therapy is one of the first steps in stress management; it can be used to reduce anxiety brought on by stress. Relaxation techniques include: o Relaxation breathing—the simplest technique that can be performed at any time. The patient breathes slowly and deeply until relaxation is achieved; however, it can lead to hyperventilation if done incorrectly. 5|Page
  6. 6. o Progressive muscle relaxation—relieves muscle tension related to stress. The patient alternately tenses, then relaxes muscle groups until the entire body feels relaxed. o Autogenic training—can help relieve pain and induce sleep. The patient replaces painful or unpleasant sensations with pleasant ones through self-suggestions; may require extensive coaching at first. o Imagery—uses imagination and concentration to take a “mental vacation.” The patient imagines a peaceful, pleasant scene involving multiple senses. It can last as long as the patient decides. o Distraction—uses the patients own interests and activities to divert attention from pain or anxiety and includes listening to music, watching television, reading a book, singing, knitting, doing crafts or projects, or physical activities. To assist patients with relaxation therapy, follow these steps: o Review the techniques and encourage a trial with several techniques of the patients choice. o Teach the chosen technique and coach the patient until effective use of the technique is demonstrated. o Suggest that the patient practice relaxation techniques for 20 minutes per day to feel more relaxed and to be prepared to use them confidently when stress increases. o Encourage the patient to combine techniques such as relaxation breathing before and after imagery or progressive muscle relaxation along with autogenic training to achieve better results. Additional steps in stress management include dealing with the stressors or problem areas and increasing coping behaviors. o Help the patient to recognize specific stressors and determine if they can be altered. Then develop a plan for managing that stressor, such as changing jobs, postponing taking an extra class, hiring a babysitter once per week, talking to the neighbor about a problem, or getting up 1 hour earlier to exercise. o Teach the patient to avoid negative coping behaviors, such as smoking, drinking, using drugs, overeating, cursing, and using abusive behavior toward others. Teach positive coping mechanisms, such as continued use of relaxation techniques and fostering of support systems—family, friends, church groups, social groups, or professional support groups. 6|Page
  7. 7. Patient Education GuidelinesStress ManagementStress is a common phenomenon among most individuals today and can be related to job, relationship,financial, and other pressures. Known as the “fight-or-flight” reaction, the physiologic and emotionalresponse to stress can lead to tension, anxiety, and a variety of health threats. Stress can be minimized bybetter coping with it and adapting to its causes. Follow this guide to better manage stress.RECOGNIZE STRESS  First, identify signs that you may be under stress (eg, irritability, tension, fatigue, insomnia, loss of interest in activities, feeling overwhelmed, or fighting with spouse and others).  Next, try to identify the true cause of stress. For example, you may snap at your children for playing the stereo too loudly, but what is the underlying cause of your irritability?  Examine areas of your job, family life, financial stability, and other roles and responsibilities that may be demanding or problematic.DO SOMETHING ABOUT IT  Try to manage stressful areas better—be assertive, negotiate, and say no if necessary. For example, confront the person with whom you are at odds and work out a mutual agreement, put the plan in writing, and try to stick to it.  Make more time for yourself and important relationships. Say no to responsibilities that you do not have time for and get help from a family member or friend, or hire a babysitter when necessary.RELAXWhen you enter a stressful situation or you feel tension rising, practice the following relaxation techniques;you will be able to think more clearly and function more effectively.Relaxation BreathingConcentrate on breathing slowly and deeply with eyes closed (if possible) for several minutes when youneed a quick tension reducer or before beginning one of the other methods.  Breathe in through your nose and mouth with face relaxed for a count of 1 and 2 and 3 and 4.  Hold your breath for 4 seconds, without straining.  Breathe out through your nose and pursed lips for a count of 6.  Repeat two or three times, breathe naturally for about 30 seconds, then repeat one or more sequences.  If you feel dizzy or tingling in your fingertips, you may be hyperventilating; slow down your breathing and do not breathe out so forcefully.Progressive Muscle RelaxationBecause stress may cause you to subconsciously contract your muscles, in this exercise you will alternatelytense and relax your muscle groups one by one, until your entire body is in a state of relaxation.  Assume a comfortable position, either sitting or reclining, and close your eyes. 7|Page
  8. 8.  Start with your forehead and tense the muscles so you feel tightness or strain; hold this position for 5 to 10 seconds.  Next, relax your forehead, noting the relief; concentrate on this for 10 to 15 seconds.  Progress from head to toe with each muscle group, including your jaw, shoulders, arms, hands, abdomen, buttocks, legs, and feet (you can do both sides simultaneously).  Note the feeling of total relaxation in your body once you have relieved tension from all your muscles.  Complete the exercise by opening your eyes, taking a few deep breaths, stretching, and arising slowly.ImageryImagery allows you to take a mental vacation by using your imagination and diverting your attention fromstressful thoughts.  Assume a comfortable position, breathe deeply, and close your eyes.  Count backward from 5 and begin to imagine a pleasant place such as a beach or garden.  Put yourself in that place by imagining it with all your senses (eg, hear the sound of waves washing up on the beach, feel the warm sun saturating your skin, or taste a tangy drink of lemonade).  Stay in that place for about 5 minutes, imagining different images.  Slowly let the images fade, breathe deeply, and count to 5 before opening your eyes.DistractionYou can use many methods of distraction to block your concentration from anxiety and stressful matters.Using your senses to listen to music, petting your dog, or reading can be relaxing.  Choose activities that you enjoy—reading, watching television, listening to music, taking a walk, playing an instrument, knitting, doing a craft, or drawing or painting.  Adjust the distraction method to your mood—if you are extremely tense, do not attempt a complex project or listen to loud, lively music. Rather, listen to quiet, soothing music or sketch a free-form design.  Use a variety of methods—some reserved for longer periods of time and others that can be used on the spot when needed (eg, a portable tape player with headphones and your favorite music or a book of poetry).ReferencesNettina, S.M., Lippincott Manual of Nursing Practice, 9th Ed. United States of America: Lippincott, Williams & Wilkins, 2010. 8|Page