The document outlines strategies for coping with and managing stress. It defines stress and identifies sources of stress such as developmental stress from life stages and situational stress from life events. The document discusses the body's response to stress, including anxiety and defense mechanisms. It also addresses crisis, providing crisis intervention, and factors that affect stress and adaptation such as personal characteristics and lifestyle habits. Nursing interventions are suggested to help patients manage stress through healthy behaviors, social support, and relaxation techniques.

1. Bekalu Assefa(BSc N)
Coping and stress management
10/26/2023
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2. Session objectives
At the end of this session the students will be able to:
Define stress
Identify normal coping and adaptation process
Identify altered coping and adaptation process
Apply nursing process for coping and stress
management
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3. Stress
The response of the body or the system to any demand made
on it.
Is a feeling of emotional or physical tension.
Stress results from a change in the environment that is
perceived as a challenge, a threat, or a danger.
Stressors
A stressor is anything that is perceived as challenging,
threatening, or demanding
Can be internal (e.g., an illness, a hormonal change, or fear)
or external (e.g., loud noise or cold temperature) 10/26/2023
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4. Stress
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 Stress tolerance pattern refers to:
 Patterns of cognitive and behavioral efforts to
manage demands.
 The ability to be relaxed and composed when
faced with difficulties.
 For instance:-previously experienced and
includes the stress response history of the
individual, family or community.

5. Adaptation
The ability to adapt changing stress in the
environments.
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6. Anxiety
 The most common human response to stress is anxiety
Anxiety is a vague, uneasy feeling of discomfort or
dread from an often unknown source
Anxiety is often present before new experiences, such
as starting college or beginning a new job
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7. The four levels of anxiety
A) Mild anxiety: is present in day-to-day living.
 It increases alertness and perceptual fields, facilitates problem
solving.
 It is often manifested by restlessness and increased questioning
B) Moderate anxiety: narrows a person’s perceptual fields so that
the focus is on immediate concerns.
 More frequent or persistent symptoms than mild anxiety.
 Un able to control worrying or being un able to relax several days,
stomach pain, sweating/dry mouth, rapid speech/high pitched
voice but still it is manageable.
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8. Levels of anxiety cont…
C) Severe anxiety: creates a very narrow focus on specific
details, causing all behavior to be geared toward.
 Symptoms sever anxiety are frequent and persistent includes
increase heart rate, chest pain, vomiting, diarrhea, social
withdrawal and results to work loss.
 Eventually impaired decision making.
D) Panic: causes the person to lose control and experience
dread/fear and terror.
 Symptoms include rapid onset of extreme fear, palpitation,
rapid breathing. 10/26/2023
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9. Coping
Coping has been defined as “efforts to master condition
of harm, threat, or challenge when a routine or automatic
response is not readily available.”
Thus, the coping pattern is the system’s pattern of
responding to non routine threats.
To understand coping and promote well-being., one must
first understand the concept of stress, because coping is
the system’s attempt to adapt to stress.
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10. Coping Mechanisms
Are behaviors used to decrease stress and anxiety
Typical coping behaviors include the following:
Crying, Laughing, sleeping, cursing/ evil prayer
 physical activity, exercise
smoking, drinking
lack of eye contact, withdrawal
limiting relationships to those with similar values and
interest 10/26/2023
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11. Defense Mechanisms
unconscious reactions to stressors
These mechanisms protect one’s self-esteem and are
useful in mild to moderate anxiety
Commonly occurring defense mechanisms
Compensation: A person attempts to overcome a
perceived weakness by emphasizing a more desirable
trait. Egg A student who has difficulty with
academics may excel in sports.
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12. Denial: A person refuses to acknowledge the presence
of a condition that is disturbing. Eg Despite finding a
lump in her breast, a woman does not seek medical
treatment
Displacement: A person transfers (displaces) an
emotional reaction from one person to another
person/object. Eg. An employee who is angry with a
co-worker kicks a chair.
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13. Common defense mechanisms cont…
Introjection: A person incorporates qualities or values
of another person into his own ego structure. Eg. An
older sibling tells his preschool sister not to talk to
strangers, expressing his parents’ values to his younger
sister.
Projection: A person’s thoughts or impulses are
attributed to someone else. Eg A person who denies any
sexual feelings for a coworker accuses him of sexual
harassment. 10/26/2023
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14. Common defense mechanisms cont…
Rationalization: A person tries to give a logical or
socially acceptable explanation for questionable behavior
(“behavior justification”). Eg . A patient who forgot to
keep a healthcare appointment says, “If patients didn’t
have to wait 3 months to get an appointment, they
wouldn’t forget them.”
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15. Common defense mechanisms cont…
Undoing: An act or communication used to negate a
previous act or communication. Eg. A husband who
was physically abusive to his wife may bring her an
expensive present the next day.
Regression: A person returns to an earlier method of
behaving. Eg Children often regress to soiling diapers
or demanding a bottle when they are ill.
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16. Effect of stress
The effects of stress on a sick or injured person are, in
contrast, usually negative.
Stress can cause illness, and illness causes stress.
A person who reacts to stress by overeating, smoking,
using alcohol or illegal drugs, or becoming hyperactive
puts additional strain on the body
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17. The anxiety initially activates the person’s usual
methods of coping
If these are not effective, the person experiences more
anxiety because the coping mechanisms are not working
As the crisis continues, the person tries new methods of
coping or redefines the threat
This may lead to resolution of the crisis or, if not
effective, may result in severe or panic levels of anxiety
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18. Crisis
A crisis is the build up of stressor to beyond a point where
the person can handle the situations. or is the sequence of
unwanted events which leads to disturbance.
During crisis the person will un able to function and will
needs assistance to get back to functional level.
Crises may be maturational, situational, or adventitious.
Maturational crisis: occur during developmental events
that require role change, such as when a teenager moves
I into adulthood. 10/26/2023
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19. Crisis cont…
Situational crisis: occur when a life event disrupts a
person’s psychological equilibrium, such as loss of a
job or death of a loved family member.
Adventitious crisis: are accidental and unexpected
events, resulting in multiple losses and major
environmental changes, such as fires, earthquakes,
and floods, that involve not only individuals, but also
entire communities
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20. Crisis cont…
The crisis is more likely to be successfully resolved
if the person realistically views the event, if effective
coping mechanisms are present, and if situational
support systems are available.
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21. Providing Crisis Intervention
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A crisis is a situation that cannot be resolved by usual
coping mechanisms.
Crisis intervention is a five-step problem-solving
technique designed to promote a more adaptive
outcome
The steps are as follows:
1. Identify the problem

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2. List alternatives: All possible solutions to the problem
need to be listed.
3. Choose from among alternatives: Each option needs
to be carefully considered, using a “what would
happen if” approach.
4. Implement the plan: The alternative chosen is put into
action.
5. Evaluate the outcome: The effectiveness of the plan
needs to be carefully considered.

23. Factors affecting stress and adaptation
1. Sources of Stress
 They can be categorized into two broad areas—
developmental stress and situational stress
a) Developmental Stress: occurs as a person progresses
through the normal stages of growth and development
from birth to old age
 Within each stage, certain tasks must be achieved to
resolve the crisis and reduce the stress
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24. Examples associated with developmental stress:-
The infant learning to trust others
 The toddler learning to control elimination
The adolescent striving for independence
b) Situational Stress: occur at any time, although the
person’s ability to adapt may be strongly influenced by
his or her developmental level
Examples : Illness or traumatic injury, Marriage or
divorce , loss
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25. 2. Types of Stressors
1. Physiologic Stressors : include chemical agents
(drugs, poisons), physical agents (heat, cold, trauma),
infectious agents (viruses, bacteria), nutritional
imbalances, hypoxia, and genetic or immune
disorders
2. Psychosocial Stressors: Accidents, Horrors of
history, Rapid changes in our world, wars,
earthquakes, and violence in schools
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26. 3. Personal Factors
A person’s adaptation to stress, whether positive or
negative, is influenced by a number of personal
factors.
Stress management techniques;-
 Teaching Healthy Activities of Daily Living
 Encouraging Use of Support Systems
 Encouraging Use of Stress Management Techniques
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27. 1. Teaching Healthy Activities of Daily Living
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Exercise, rest and sleep, and good nutrition are
important components of stress reduction
2.Encouraging Use of Support Systems
Support systems provide emotional support that helps a
person identify and verbalize feelings associated with
stress
3. Encouraging Use of Stress Management Techniques

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Relaxation: deep breathing and progressive muscle
relaxation
Meditation: emptying of the mind of thoughts, or the
concentration of the mind on one thing.
Anticipatory guidance: Focuses on psychologically
preparing a person for an unfamiliar or painful event
Guided imagery: A person creates a mental image,
concentrates on the image, and becomes less
responsive to stimuli (including pain)

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Thank you!!!