This document defines stress and discusses its causes, effects, and coping mechanisms. It states that stress is the body's nonspecific response to demands for change and can be caused by life events, physical/psychological/social factors, and environmental/internal stressors. Both short-term and long-term effects of stress are outlined, affecting physical and mental health. Adaptation and coping strategies like problem-focused coping, social support, and relaxation techniques are recommended to manage stress. Nurses are encouraged to help patients identify stressors and adopt healthy coping behaviors.

1. Prepared By:
Mrs. AKila. A, M.Sc(N), M.Sc(PSY),
Associate Professor

2. INTRODUCTION
Stress is a universal phenomenon. All
people experience it. Stress affects the
whole person in all the human dimensions,
the perception of stress and the responses
to it are highly individualised, not only from
person to person, but also from one time
to another in the same person.

3. DEFINITION
Stress is the nonspecific response of the
body to any demand for change – Selye.
Stress as that which occurs when “ an
individual perceives that the demands of
an external situation are beyond his or her
perceived ability to cope with them”
- Lazarus and Folkman

4. TYPES OF STRESS
According to “selye” there are two types
1.Distress or damaging stress.
Example: Death of a loved one, Chronic
illness
2.Eustress or stress that protects health.
Eustress is motivating energy, such as
happiness, hopefulness and purposeful
movement.
Example: Learning a new hobby

5. According to Lazarus, (1999) there are several
types of stress –
• Work stress,
• Family stress,
• Chronic stress,
• Acute stress,
• Daily hassles,
• Trauma
• Crisis.

6. 1.Work and family stress interact, family
being the background for work stress, and
work the background for family stress.
2.Chronic stress occurs in stable
conditions and from stressful roles.
Chronic stress is living with a ling – term
illness.
3.Acute stress is provoked by time – limited
events that are threatening for a relatively
brief period

7. STRESSORS
Stressors are situations, circumstances or
any stimulus that is perceived to be a
threat.
CLASSIFICATION OF STRESSORS:
1. Life events or daily hassels:
• Death of a loved one
• Divorce, injury, being fired at work
• Trouble with in laws

8. 2.External or Internal:
External Stressors are adverse physical
conditions.
Example: Hot or Cold temperatures
Stressful Psychological
environments
Poor housing, Traffic Jams.
Internal Stressors can be Physical conditions
Example: Illness,
Unrealistic Expectations
Tendency to worry

9. 3.Physical, Psychological or Social
Stressors:
Physical:
- Sleep deprivation, Lack of relaxation
- alcohol abuse, Poor diet, Hyperglycemia
Psychological:
- unhappy childhood, Unemployment
- excessive anger, low self esteem
Social:
- Poverty, Racial Prejudice, Victim of crime
- Harassement and bureaucracy

10. Other classifications
1.ENVIRONMENTAL STRESSORS:
• Nature and manmade Catastrophies:
-Earth quakes, floods, Fire breaking
incidence and accidents.
- Death of the near and dear
- Robbery and cheating
- Terrorist attacks
- Communal Violence

11. 2 . INTERNAL OR
PSYCHOPHYSIOLOGICAL STRESSORS:
Some persons are characterized to posses
a particular type of behaviour more prone to
stress than others.
• Depending on the stress bearing or
tolerance capacity
• Poor health, defective sensory organ,
illness and fatal diseases.
• Sleeping disorders, Drug addiction
• Unhappiness and frustration

12. STRESSORS ACROSS LIFESPAN
DEVELOPMENT
CHILDHOOD:
-Conflicts between Parents, abuse, neglect
- Unreasonable family expectations,
- Changes in family’s financial situation
- Low academic Performance
- Chronic illness
- Sudden hospitalisation

13. ADOLESCENCE:
- Coping with academic pressures
- Lack of acceptance by peers
- Increased arguments with friends
- Accepting their own physical changes
- Relationship with opposite sex
- Leaving home for higher studies

14. ADULTHOOD:
- Starting a career, Marriage
- Running a household independently
- Adjusting with in- laws, Parents
- Relocating, meeting deadlines in jobs,
Loan payments.

15. MIDDLE AGE:
- Coping with health problems
- Dealing with teenage children
- Marriage and career of children
- Taking care of aged parents
- Job burnout
- Mid-career changes

16. OLD AGE:
- Failing health and stamina
- Relocating with children
- Living alone
- Living with reduced income
- Adjusting to retirement
- Loneliness

17. STRESS CYCLE
Generation
of stress
Stress
overloading
&
Persistence
Physiologic
al &
Psychologic
al damage
to the stress
Distress
(uncomfort,
Unhappiness &
unproductivity
Sources of
stress
(internal &
External)

18. STRESS CYCLE
STRESSORS
STRESS
REACTIONS
WEAR &
TEAR OF
BODY
REDUCED
OPTIMAL
HEALTH
INCREASED
SENSITIVITY

19. 1.Stressors which can be a problem at home, the work
place, with friends or anything that causes stress.
2. Stress Reactions:
If an individual perceives that he will not be able to
cope with the stressor, it results in negative reactions
like anxiety, worry, low energy and lack of interest.
3.Wear and Tear of the body:
• The nervous system responds by releasing stress
hormones which prepares an individual to meet
emergency situation. It weakens the immune system.
• Pain, aches, fatigue a well a memory and
concentration problems are commonly seen at this
stage.

20. 4.Reduced optimal health:
Continuing Stress will leads to Reduced
optimal health
- Common Symptoms (physical):
• High BP,
• Digestive Problems
• Skin problems, Asthma, depression
• Cancer

21. 5. Increased Sensitivity:
• The stressed individual feels exhausted
physically and emotionally and this will
increase his sensitivity to stress, when
minor matters can become overwhelming.
• Thus the vicious cycle of stress begins
operating.

22. EFFECTS OF STRESS
EFFECT OF STRESS ON HEALTH:
• 70% of today’s illnesses are stress related.
• It can affect by direct or indirectly
Persistent stressors
Release of stress hormones
Circulatory Immune suppression Digestive
system system
illness

23. IMMEDIATE EFFECTS OF
STRESS
(i) Behavioural changes:
- Nervousness, Panic reactions,
Exhaustion, Paralysed thinking
- Alcohol consumption
- Restlessness, Sleep disorders
(ii) Physiological changes:
- Increased in muscular tension
- Abnormal changes in heart beat and BP
- Problem related to digestion

24. (iii) Emotional Changes:
- Victim of the outburst of anger, fear,
jealousy and hatredness.
- High state of anxiety, restlessness and
depression.
- Problems related to lack of interest in
love making and social intimacy.
(iv) Cognitive Changes:
- Increased distractibility
- Decreased concentration

25. LONG TERM EFFECTS OF STRESS
(i) Behavioural Changes:
- Serious behavioural disorders
- Forgetfulness , obesity
- Excessive alcohol consumption and Drug
addiction.
(ii) Physiological Changes:
- A known victim of high BP, heart diseases,
skin diseases, Ulcer, even cancer

26. (iii) Emotional changes:
- Serious emotional disorders like chronic
anxiety, depression, fear and phobia
- Changes in Personality and mental illness.
(iv) Cognitive changes:
- Serious cognitive disorder
Example:
- Memory Problems, obsessive thoughts
and sleep disorder

27. ADAPTATION-Hans Selye’s
theory
• In the 1930s, 1940s,and 1950s Hans Selye
enlarged on cannon’s fight – or – flight
hypothesis to describe the general adaptation
syndrome ( GAS),
• A three – stage reaction to stress.
• The GAS describes how the body responds
to stressors through the –
- Alarm reaction
- Resistance stage
- Exhaustion stage.

28. • Alarm reaction:
- During the alarm reaction rising hormone
levels result in increased blood glucose
levels, epinephrine and nor epinephrine
amounts, heart rate, blood flow to muscles,
oxygen intake, and mental alertness.
-In addition, the pupils of the eyes dilate to
produce a greater visual field. This change in
body systems prepares an individual for fight
or flight and may last from 1 minute to many
hours. If the stressor poses an extreme threat
to life or remains for a long time, the person
progress to the second stage, resistance.

29. Resistance stage:
-During the resistance stage the body
stabilizes and responds in an opposite
manner to the alarm reaction.
-Hormone levels, heart rate, blood
pressure and cardiac output return to
normal and the body repairs any damage
that may have occurred.
- If the stressor remains, and there is no
adaptation the person enters the third
stage, exhaustion

30. Exhaustion stage:
-This occurs when the body no longer the
effects of the stressor and when the energy
necessary to maintain adaptation is depleted.
-The physiological response is intensified,
but the person’s energy level is
compromised, and adaptation to the stressor
diminishes.
-The body is unable to defend itself against
the impact of the event, physiological
regulation diminishes, and if the stress
continues, death may result.

31. COPING
Stress requires not only bodily adaptation,
but also adaptation at the mental level.
-Coping is expending conscious effort to
master, reduce or tolerate stress.
-Coping defined as “ ongoing cognitive and
behavioural efforts to manage specific internal
or external demands that are appraised as
taxing or exceeding the resources of the
person.

32. TYPES OF COPING
• ACCORDING TO GENERAL STRATEGIES:
1.Direct Action response
Example: Manipulating, escaping from stressor
2.Information Seeking(trying to understand better)
3. Inhibition of action (doing nothing)
4. Intra psychic or Palliative Coping(individual
reappraises the situation- by defense mechanism or
changes in environment)
5.Turning to help from others and emotional support

33. 2.SPECIFIC STRATEGIES:
1. Appraisal focused Strategies:
It occurs when the person modifies the
way he / she thinks.
Example: Using positive appraisal or
reframing a situation to see it in a positive
light.
2. Problem focused Coping:
It is aimed at changing or eliminating the
source of stress.
Example: seeking information or social
support, Learning new skills to manage
the problem.

34. 3.Emotion focused strategies:
These are directed at managing or
reducing emotional distress.
Example:
- Releasing pent up emotions
- Watching TV
- Exercises

35. OTHER METHODS OF COPING
1. Task oriented coping or directed coping:
It focuses on the immediate problem
and aims to change an uncomfortable
situation.
(i) Attack (confrontation)- removing
obstacles
(ii) Withdrawl – Escaping from stress
(iii) Compromise – Accepting the
substitute goal.

36. TECHNIQUES OF COPING
1. Information providing techniques
2. Relaxation training
3. Cognitive restructuring techniques
4. Systematic desensitization
5. Biofeed back mechanism
6.Modelling techniques
7. Humour
8.Exercise
9. Diet

37. 10. Time management
11. Practising positive thinking
12. Giving up unrealistic expectations

38. IMPLICATIONS FOR NURSES
• Nurse should understand and identify the
stressors of the patient.
• Nurses should manage work related stress
- Dealing with death and dying
- Heavy work load, Night shift
- Low supportive relationships in
workship.
- Uncertainty about patients treatment.

39. • Nurses are able to recognise the signs
and symptoms of stress and identify the
coping mechanisms.
• Nurse can encourage the patient to use
the adaptive coping strategies and
adaptive healthy lifestyle choices.