Stress and adaptation

Stress and adaptation

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  STRESS AND ADAPTATION Presentedby, Ms Flavia. Dass M.Sc Nsg 1st year KIMS, Hubli Presented to, Mr S.M. Badiger Professor KIMS, Hubli ADVANCE NURSING PRACTICE Presentation on
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  INTRODUCTION Stress is apart of life. Everyone feels stress at one time or another. The experience of stress & the way one response to it are unique to each individual. The process of responding to stress is constant & dynamic & essential to the person’s physical, emotional & social well being.
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  TERMINOLOGIES • STRESS It isa condition in which the human responds to changing in its normal balanced state. Stress results from a change in the environment, that is presided as a challenge a threat or a danger and can have both negative & positive effects. - Pender & Parsons 2006
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  • STRESSORS stressors arethemselves neither positive or negative but they can have positive or negative effects as the persons responds to the changes.
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  • ADAPTATION when personis in a threatening situation immediate response occur, those response are often involuntary called coping response. The change that takes place as a result of the response to a stressor is adaptation
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  CONCEPT OF STRESS& STRESSORS Stress is any situation in which a non – specific demands requires an individual to response or take action Selye 1976 It involves physiological & psychological responses.
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  Stress can leadto negative or counter productive feelings or threaten emotional well being. It can threaten the way a person normally perceives reality, solve problems, thinks in general; & a person’s relationship & sense of belonging. in addition, stress can threaten a person’s general outlook on life, attitude towards loved one & health status.
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  TYPES OF STRESS STRESS EUSTRESSDISTRESS
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  • EUSTRESS The optimalamount of stress, which helps to promote health & growth e.g. Praise from a superior for hard working • DISTRESS Stress due to an excess of adaptive demands placed upon us. The demands are so great that they lead to bodily & mental damage e.g. unexpected death of a loved one
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  TYPES OF DISTRESS •ACUTE STRESS It’s our body’s immediate reaction to a new challenge event or demand & it triggers your fight or flight response e.g. Pressures of a near miss automobile accident or arguments with family..
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  • EPISODIC ACUTESTRESS when acute stress happens frequently, it’s called episodic acute stress • CHRONIC STRESS If acute stress isn’t resolved & begins to increase lasts for long period of time, it becomes chronic stress. This stress is constant & doesn’t go away.
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  TYPES OF STRESSORS STRESSORS PSYCHOLOGICAL STRESSORS PHYSIOLOGICAL STRESSORS
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  • PSYCHOLOGICAL STRESSORS a)Accidents can cause stress for the victim, the person who caused the accident & the families of both b) Stressful experiences of family members & friends c) Fear of aggression or mutilation from others such as murder, rape, terrorist & attacks d) Events that we see on TV such as war, earthquake, violence e) Developmental & life events f) Rapid changes in our world, including economic & political structures & technology
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  • PHYSIOLOGICAL STRESSORS a)Chemical agents b) Physical agents Illness, injuries, hormonal fluctuation, inadequate sleep or nutrition c) Infection agents d) Nutrition imbalance e) Genetic or immune disorders
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  SCOURCES OF STRESS Theyare many sources of stress, these are broadly classified as  Internal stressors: They originate with in a person like- Inability to accept uncertainty negative self talk unrealistic expectations perfectionism lack of assertiveness
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   EXTERNAL STRESSORS Itoriginates outside the individual like- →Major life changes →work →Relationship difficulties →financial problems →being too busy →children & family
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  PHYSIOLOGY OF ADAPTATION Physiologicaladaptation to stress is the body’s ability to maintain a state of relative balance. This ability is a dynamic form of equilibrium in the body’s internal environment The internal environment constantly changes, & the body’s adaptive mechanism continually function to adjust to these changes & thus to maintain equilibrium or homeostasis
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  The body makesadjustments in heart rate, respiratory rate, blood pressure, temperature, fluid & electrolyte balance, hormone secretion & level of consciousness all directed at maintaining adaptation.
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  MECHANISM OF PHYSIOLOGYOF ADAPTATION Physiological mechanisms of adaptation functions through negative feedback, a process by which the controlling mechanism senses an abnormal state, such as lowered body & makes adaptive response, such as initiating shivering to generate body heat
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  MECHANISMS USED INADAPTING STRESSORS • MEDULLA OBLONGATA The medulla oblongata control vital functions necessary to survival. These include heart rate, blood pressure & respiratory. Impulses traveling to & from the medulla oblongata can increase or decrease these vital functions.
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  • RETICULAR FORMATION Thereticular formation is a small cluster of neurons in the brainstem & spinal cord. It also controls vital functions & continuously monitors the physiological status of the body through connections with sensory & motor tract
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  • PITUITARY GLAND Thepituitary gland produces hormones necessary for adaptation to stress. In addition, the pituitary gland regulates the secretion of thyroid gonadal & parathyroid hormones. Hormones secretion like other homeostatic mechanisms is normally regulated, by a feedback mechanism that continuously monitors hormone level in blood. When hormone level drops, the pituitary gland receives a message to increase hormone secretion. When hormone level rise, the pituitary gland decreases hormone production
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  MODELS OF STRESS •RESPONSE BASED MODELS OF STRESS Selye stress response is characterized by a chain or pattern of a physiologic events called General adaptation syndrome
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  GENERAL ADAPTATION SYNDROME(Dr. Hans Selye) • A homeostatic mechanism is aimed at counter acting the everyday stress of living. If they are successful, the internal environment maintains normal physiological limits of temperature, chemistry & pressure • If stress is extreme or long lasting, the normal mechanism may not be sufficient. In this case the stress triggers a wide-ranging set of bodily changes called GAS
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  A. Alarm reactionor fight or flight response It is the body’s initial reaction to a stressor. It is a set of reactions include
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  Stressor hypothalamus Sympathetic nervous system Adrenal medulla Catecholamine (epinephrine, nor epinephrine produces) Alarm reaction Fight or Flight response
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  A stress responseis characterized by alarm reaction include o Increased heart rate o Increased blood supply to organs active in stress response o Increased production of RBC leading to increase in ability of blood to clot o Increased rate of breathing o The liver converts glycogen to glucose & release into the bloodstream which provides energy to fight o Decrease production of saliva & digestive enzymes
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  B . ResistanceReaction It is the 2nd stage in stress response Stressor Hypothalamus CRH, GHRH, TRH Anterior pituitary Fight or Flight response
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  C . Exhaustionstage In this, the cells start to die & the organs weakens. Long term resistance reaction put a heavy demand on the body
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  GENERAL ADAPTATION SYNDROME
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  • STIMULUS BASEDMODEL The stimulus – based model focuses on the following assumptions 1. Life change events are normal & they require the same type & duration of adjustment 2. People are passive recipients of stress & their perception of the events are irrelevant 3. All the people have a common threshold of stimulus & illness results at any point after the threshold
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  As the stimulusbased model does not allow for individual differences in perception & response to stressors. Nurses may experience difficulty when attempting to use this model in stress management because of the lack of flexibility for individual adaptation
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  • Transaction BasedModel The transaction based model views the person & environment in a dynamic, reciprocal interactive relationship This model was developed by Lazarus & Folkman, views the stressor as an individual perceptual response rooted in psychological & cognitive processes
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  Stress originates fromthe relationship between the person & the environment This model focuses on stress related processes such as cognitive appraisal & coping
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  • Adaptation Model Factorsdetermine whether a situation is stressful (Mechanic, 1962) • The ability to cope with stress • The practice & norms of the person’s peer group • Resources that can be used to deal with the stressor
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  The adaptation modelis based on the understanding that people experience anxiety & increased stress when they are unprepared to cope with stressful situation Using this model & appropriate interventions, nurses can help the client & families to promote health in all human dimensions
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  FACTORS INFLUCING RESPONSETO STRESSORS The response to any stressor depends on physiological accounting, personality & behavioral characteristics , as well as the nature of the stressor The nature of the stressor involves the following factors • Intensity . Duration • Scope . Number & nature of stressors
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  ADAPTATION TO STRESSORS Adaptationis the process by which the physiological of psychosocial dimensions change in response to stress An adaptative response occurs when a stimulus from the internal or external environment causes a departure from the balances state of organism Adaptation is an attempt to maintain the optimal functioning
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  Adaptation involves • Reflexes •Automatic body mechanisms for protection • Coping mechanisms • Leading to adjustment or mastery of a situation A stressor that stimulates adaptation may be • Short term such as fever • Long term such as paralysis of limb
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  DIMENSIONS OF ADAPTATION Physical dimension  Adaptative resources : Local adaptation syndrome e.g. Fever  Unsuccessful outcome can result in death  Successful outcome results in resolution
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   Developmental dimension Adaptive resource : successful coping in the past developmental task/ stages or successful adaptation to past stressors e.g. Retirement  Unsuccessful outcome can result in depression  Successful outcome results in alteration of role functions to other meaningful activities
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  Emotional dimension  Adaptiveresponse are : psychological defense mechanisms, individual personality changes e.g. Rape  Unsuccessful outcome can result in irrational fear of me  Successful outcome can result in integration of traumatic memory
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  Intellectual dimension  Adaptiveresponses are: Formal education, ability to solve problem, communication skills , positive coping strategies e.g. diagnosis of cancer  Unsuccessful outcome can result iin denial of cancer & fore goes for treatment  Successful outcome can result in using of an active problem solving approach to make decisions about care
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  Social dimension  Adaptiveresponse are : social network provides support, others may direct person to needed resources e.g. Alcoholism in a family member  Unsuccessful outcome can result in withdrawal from family & other social contacts  Successful outcome can result in active participation of all the family members in alcoholic anonymous support group
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  Spiritual development Adaptive responseare : Prayer group, support from priests, rabbi & minister e.g. Family member feels that he has abandoned by god Unsuccessful outcome can result in withdrawal from church activities not mingling with church people Successful outcome can result in seeking friends from the church, becoming volunteers for in church activities
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  RESPONSE TO STRESS Characteristicsof the Stress Response • Stress response is natural, protective & adaptive • There are normal response to stressors; stressors encountered in everyday circumstances increase catecholamine excretion, which causes an increase in heart rate & blood pressure • Physical & emotional stressors trigger similar responses. Magnitude & patterns may differ
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  • There arelimits in ability to compensate • Magnitude & duration of stressors may be so great that homeostatic mechanism for adjustment fail. Leading to death • Repeated exposure to stimuli results in adaptive changes; that is, tissue level of the enzyme trysine hydrolase increase which increase capacity for the body to produce nor epinephrine & epinephrine • There are individual differences in response to same stressors
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  PHYSIOLOGICAL RESPONSE • Theclassic research by Selye (1946,1976) has identified 2 physiological responses to stress: • The local adaptation syndrome (LAS) • The General adaptation syndrome (GAS)
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  • THE LOCALADAPTATION SYNDROME The LAS is are response of a body tissue, organ or part to the stress of trauma, illness or other physiological change The body produces many localized responses to stress which include blood clotting ,wound healing ,accommodation of the eye to light & response to pressure
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  All the formsof LAS share the following characteristics • The response is localized; it does not involve entire body system • The response is adaptive , meaning that a stressor is necessary to stimulate it • The response is short term. It does not persist in definitely • The response is restorative, meaning that the LAS assist in restoring homeostasis to the body region or part Two localized responses, the reflex pain response & the inflammatory response
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  • THE GENERALADAPTATION SYNDROME (GAS) The GAS is a defense response of the whole body to stress. It involve several body system primarily the autonomic nervous system & endocrine system. The GAS consists of the Alarm reaction, The resistance stage & exhaustion stage
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  PSYCHOLOGICAL RESPONSE • Exposureto a stressor results in psychological & physiological adaptive response • As people are exposed to stressors, their ability to meet their basic needs is threatened • This threat, whether actual or perceived; produce frustration anxiety & tension psychological adaptive behaviors assist the person’s ability to cope with stressors • Psychological adaptive behaviors can be constructive or destructive
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  • Constructive behaviorshelp accept the challenge to resolve conflict, even anxiety can be constructive • Destructive behaviors affect reality ,orientation problem, solving abilities, personality & in severe circumstances, the ability to function. Anxiety can also referred to be destructive • Psychological adaptive behaviors are also referred to as coping mechanism
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  TASK ORIENTATION BEHAVIORs •The task oriented behaviors involves using cognitive abilities to reduce stress, solve problems, resolve conflicts & gratify needs • Task oriented behavior enables a person to cope realistically with demands of a stressor • The 3 general types of task – oriented behavior are Attack behavior, Withdrawal behavior & Compromise
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  EGO DEFENSE MECHANISMS •Ego defense mechanism, first described by Sigmud Freud,are unconscious behaviors that offer psychological protection from stressful events • They are used by everyone & help protect against feelings of worthlessness & anxiety • Occasionally a defense mechanism can become distorted & is no longer to assist the person in adapting to a stressor
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  PLANNING In most situations,stress management plans are long term & are conducted in the clients home or on an outpatient basis. The general goals for clients who require stress management include the following: 1. Reduction in frequency of stress – inducing situation 2. Decreased physiological response to stress 3. Improved behavioral & emotional response to stress
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  COPING WITH STRESS Biofeedback Using thought process to control a physiological response • A person is taught a series of exercise designed to help them learn how to gain control over the physiological response that is being monitored • Bio feedback can be beneficial in helping people mange stress related problems such as high BP, chronic pain & migraines
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  Meditation or relaxation Adeeply relaxed state; reduces psychological & physiological tension  When in a relaxed or meditative state, people typically report. o Feeling calm o A low level or absence of anxiety o Response associated with low level of overall physiological arousal such as lower heart rate, slower breathing rate & loss of muscle tension
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  Physical exercise Engaging inphysical activity • A physical exercise is physical activity that is usually planned & performed to improve or maintain one’s physical condition • Aerobic exercise is the best for physical & mental health, although anaerobic exercise is better than no exercise at all
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  Social support Is helperassistance from other people when needed • Appraisal support – Person is helped to realistically appraise the stressor • Tangible support – Person is given tangible support e.g. food , financial support etc • Informed support- Person is given information • Emotional support – Person is given warmth, care & nurturing
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  NURSING DIAGNOSIS FORSTRESS  Anxiety related to : • Change in health status • Maturational or situational crisis  Altered growth & development related to: • Separation from significant others • Situational crisis (unplanned pregnancy)  Caregiver role strain related to: • Adjustment to medical diagnosis • Adjustment to decrease level of physical function
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  Fatigue related to: •Overwhelming psychological demands • Excessive role demands Hopelessness related to: • Long term stress • Lost belief in values Ineffective family coping: compromised or disabling or ineffective individual coping related to: • Inadequate coping methods • Prolonged stress
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  Risk for injuryrelated to : • Impaired problem- solving abilities Sleep pattern disturbance related to: • Maturation or situational
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  IMPLEMENTATION • The nurseis responsible for implementing thoughtful interventions that are caused out in several nursing domains
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  HEALTH PROMOTION • Beforespecific stress management techniques are taught to the client, the nurse must establish a helping role • Presenting or just being there for the client fosters sense of support that facilities personal growth • When helping the client reduces stress the nurse reduces stressful situations, decreases the physiological response to stress & improve the behavioral & emotional responses to stress • Creating a trusting caring environment serves as a foundation for any change
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  REDUCING STRESSFUL SITUATION Thereare several methods that assist in stress reduction Structure Illness, crises or change in living arrangements disturb a client’s routine, thereby disturbing the pattern of living & resulting in greater energy expenditure A plan that assist a client to renew a familiar life structure or develop a new routine consistent with a changed life situation can reduce stress
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  Time management Persons whouse time efficiently generally experience less stress because they feel more in control of their lives. A nurse acting in the teaching – coaching domain may assist client to prioritize tasks if they are feeling over whelmed or immobilizes Environmental modification Although all stress cannot be avoided, those life changes that are under the client’s control can be deliberately postponed so more energy is available for coping with unavoidable stressors
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  STRESS MANAGEMENT • Regularexercise Almost any form of exercise or movement can increase your fitness level while decrease your stress. The most important thing is to pick an activity you enjoy. Exercising regularly can have a positive effect on your mood by relieving the tension, anxiety, anger & mild depression that often go hand in hand with stress.
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  • Humor Adopting ahumorous view towards life situations can take the edge off everyday stressor. Being able to laugh stress away is the smartest way to ward off its effects • Provides good cardiac condition • Reduce stress hormones ( epinephrine, cortisol, dopamine & growth hormone) • Boast immune function • Produces a general sense of well being
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  • Nutrition &Diet Good nutrition is an important stress management tool. When our bodies are poorly fed, stress takes an even greater toll on our health Eating fruits & vegetables, complex carbohydrates ( whole grain bread, brown rice), nuts ( almonds , walnuts), dairy ( yogurt & cheese)
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  • Relaxation techniques Toeffectively combat stress, you need to activate your body’s natural relaxation response. You can do this by practicing  Deep breathing exercise Mindfulness meditation – meditation helps you to switch your focus on the present rather than dwelling on the past or worrying about the future
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   Yoga –yoga reduces stress & anxiety. Yoga helps in increasing flexibility, stamina & strength. It should be done morning to start the day with more energy & feeling refreshed  Aromatherapy – it is a holistic healing treatment that uses aromatic essential oils medicinally to improve the health of the body, mind & spirit. It enhances both physical & emotional health  Spirituality – spirituality & religious people find various ways to express these qualities by praying, attending religious services, interacting with people who share the same beliefs, visiting nature
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  • Have agood cry A good cry during period of stress can be healthy way to bring relief to your anxiety • Connect with others A good way to combat sadness, boredom & loneliness is to set out activities involving others
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  • Crisis intervention Isa short term management technique designed to reduce potential permanent damage to an individual affected by a crisis • Enhancement of self esteem Is a type of motivation hat works to make people feel good about themselves. It involves a preference for positive over negative views.
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  PROMOTING STRESS MANAGEMENT FORNURSES • Most nurses experience stress in their work environment • Job stress frequently results in a condition called burnout, characterized by decreased concern for the people with whom one is working • During burnout the client experiences physical & emotional exhaustion
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  • Nurse shouldidentify specific stressors at work & strive to eliminate them • It is also helpful to gain social support from other nurses in order to maintain a caring attitude to wards clients