Stress and coping.pdf

Stress and Coping
Copyright © 2019 by Ghaniullah 1
Acknowledgment:
Dr. Saqib Rabbani
Sir. Tanzeel ul Rehman
Facilitator
Ghaniullah
BsN,RN

Copyright Disclaimer
Copyright © 2019 by Ghaniullah
All rights reserved. This Presentation or any portion thereof
may not be reproduced or used in any manner whatsoever
without the proper acknowledgment of the owner.
Ghaniullah
Jr. Nursing Instructor
BSN,RN
Ghaniullah0018@gmail.com

Learning Objectives
At the end of this session the learner will be able to:-
 Define stress.
 Demonstrate understanding of different forms of stress.
 Describe nature of stressor.
 Identify causes of stress.
 Identify major sources of psychological stress.
 Discuss effects of stress on human body.
 Identify factors influencing stress intolerance.
 Develop understanding about achieving self-control through
self modification.
 Understand how defense mechanisms reacts.

Introduction
 Stress is any change in the environment that requires your
body to react and adjust in response. The body reacts to
these changes with physical, mental and emotional
responses.
 Stress is excessive burning of energy resources.(Selye
1956,1974).
 Stress is the wear and tear that life causes on the
body.(Sheila L Videback, 11th edition 2011)
 Stress is a physical and psychological strain.(Atkinson)
 80% of all modern diseases have their origins in stress.

Examples of Stress
One person can thrive in a situation that creates great distress
for another. For example, many people view public speaking as
scary, but for teachers and actors, it is an everyday, enjoyable
experience. Marriage, children, airplanes, snakes, a new job, a
new school, and leaving home are examples of stress-causing
events.

Pathophysiology of stress
The body responds to
these stressors by
activating the
hypothalamic–pituitary–
adrenal axis. The resultant
increase in catecholamine,
glucocorticoid, and
mineralocorticoid levels
leads to a cascade of
physiological responses
known as the stress
response.

Sources of Stress
There are many sources of stress, these are broadly
classified as:
 Internal stressors: they originate within a person e.g.:
cancer, feeling of depression.
 External stressors: it originates outside the individual e.g.:
moving to another city, death in a family.
 Developmental stressors: it occurs at predictable times
throughout an individual‘s life. e.g.: child- beginning of
school.
 Situational stressors: they are unpredictable and occur at
any time during life. It may be positive or negative. e.g.:
death of family member, marriage/ divorce.

Sources of Clinical Stress
For Patient
 Uncertainty
 Fear
 Pain
 Cost
 Lack of knowledge
 Risk for harm
 Unknown resources
For Nurses
 Poor patient outcomes
 Risk of making an error
 Unfamiliar situations
 Excessive workload
 Inadequate resources

STRESSOR
 Events that produce physical and psychological
demands on a person
 Situations, activities, and relationships that cause
‘trauma’ to one’s physical, emotional,or psychological self.

Nature/Types of Stressors
 Threat
 Frustration
 Pressure
 Conflict

Threat
 a statement of an intention to inflict pain, injury, damage,
or other hostile action on someone in retribution for
something done or not done.
 a person or thing likely to cause damage or danger.

Frustration
Frustration is the emotional state that a person experiences
when needs, wants and desires are not readily available or are
not attainable. This emotion is easily seen in young children. for
instance, when they see a toy they can't have and then cry and
fuss.
 External blockage:
A nurse want to give time for
higher studies, but job timing
doesn’t allow him/her.
 Internal blockage:
The sensitivity of nurse stop
her working with patient.

Pressure
Pressure is another force which serves as stress, when it is
unwanted and arbitrary.
e.g. student is already working very hard with his best efforts
but if parents is unnecessarily put pressure to work hard.
External :
 Parents
 Teachers
 Government
 society
Internal :
Competition
Hard work
Etc.

Conflict
Whenever two or more goals comes into competition with
each other in such a way that achievements of one goal is
blocked by other goal
OR
be incompatible or at variance; clash.
3 types:
 Approach-Approach Conflicts
 Avoidance-Avoidance Conflicts
 Approach-Avoidance Conflicts

Types of Conflicts
1. Approach-Approach Conflicts
Having to choose between two desirable or positive
alternatives (e.g., choosing between a new BMW or Mercedes)
2. Avoidance-Avoidance Conflicts
Being forced to choose between two negative or undesirable
alternatives (e.g., choosing between going to the doctor or
contracting cancer)
NOT choosing may be impossible or undesirable
3. Approach-Avoidance Conflicts
Being attracted (drawn to) and repelled by the same goal or
activity; attraction keeps person in the situation, but negative
aspects can cause distress

Response to stress
Stress tolerance is the ability to be relaxed and composed
when faced with difficulties. Having positive stress tolerance is
being able to stay calm without getting carried away by strong
emotions of helplessness and hopelessness.
Stress intolerance is the failure to be relaxed and composed
when faced with difficulties. Having inability to stay calm
accompanied by strong emotions of helplessness and
hopelessness.

factors influencing stress
intolerance.
Below are five major factors that influence your stress
tolerance level.
 One's knowledge and preparedness. ...
 Optimistic approach. ...
 Hardiness and stress fight. ...
 Sensation Seeking behavior and stressful situations. ...
 The possible availability of Social support.

EFFECTS OF STRESS
PHYSICAL MANIFESTATION OF STRESS
 Increased heart rate.
 Dilation of pupils
 Dry mouth
 Pilo-erection.
 Sweating and sweaty palms.
 Headache.
 Stiff neck and/or tight shoulders.
 Rapid breathing.
 Upset stomach, nausea, or diarrhea.

EFFECTS OF STRESS
EMOTIONAL MANIFESTATION OF STRESS:
 Irritability
 Intolerance
 Short Temper
 Exhaustion
 Lack of concentration
 Frustration over minor challenges
 Anger, Apprehension, anxiety,fear
 Sadness, grief

EFFECTS OF STRESS
BEHAVIOURAL MANIFESTATION OF STRESS:
 Social withdrawal.
 Poor sleeping
 Poor eating habits
 Smoking
 Drug abuse
 Relationships problems
 Talking too fast
 Over reacting
 Defensive
 Burnout
 Grinding teeth
 Hostile

EFFECTS OF STRESS
EFFECTS ON PERFORMANCE:
 Decrease effectiveness
 Poor judgments
 Poor decisions
 Short attention span
 Poor concentration
 Low self confidence
 Increase absenteeism
 Impaired task performance

LONG TERM EFFECTS
Long terms effects of stress are harmful, a persons
 Become depressed
 Feel helpless/hopeless
 Explosive/impulsive
 Personality changes
 Mental illness
 Physical problems

LONG TERM EFFECTS CONT…
Physical Conditions Related to Stress:-
 Heart diseases
 Gastrointestinal problems
 Skin problems
 Diabetes
 Immune system diseases/Infections
 Chronic pain
 Infertility

FORMS OF STRESS
Eustress (Good stress)
 Moderate levels of stress may actually improve
performance and efficiency
Example
Getting nervous in anticipation of an important contest which
motivates you to practice more.
Distress
Too much stress may cause an unproductive anxiety level
Example
Forgetting an assignment because of feeling overwhelmed
 Too little stress may result in boredom
 No stress no progress

Generalized Adaptation Syndrome
Hans Selye (1956, 1974), an
endocrinologist, identified the physiologic
aspects of stress, which he labeled the
general adaptation syndrome. He used
laboratory animals to assess biologic
system changes; the stages of the body’s
physical responses to pain, heat, toxins,
and restraint; and, later, the mind’s
emotional responses to real or perceived
stressors. He determined three stages of
reaction to stress:

PHYSIOLOGICAL RESPONSE OF
BODY TO STRESS
STAGE I-ALARM REACTION
Fight and flight response which alert the body against
stressor.
ANS react and release large amount of
adrenaline and cortisone.
Lasting 1 minute to 24 hours.

STAGEII:STAGEOFADAPTATION/RESISTACE
If stressor is continue body attempts to cope
with stressor and to limit the stressor to the
smallest area of body. Fight, flight or freeze
happens.
BODY TO STRESS

STAGE III-STAGE OF EXHAUSTION:
If stress persist for a long time body’s
resistance may be reduced or collapse
quickly.
BODY TO STRESS

 Always take time for yourself at least 30 min/ day.
 Be aware of your own stress meter; know when to step back
and cool down.
 Concentrate on controlling your own situation, without
controlling everybody else.
 Daily exercise will burn off the stress chemicals.
 Eat lots of fresh fruit, veggies, bread and water; give
your body the best for it to perform at its best.
 Forgive others, do not hold grudges and be tolerant; not
everyone is capable as you.
 Gain perspective on things, how important is the issue?
ABC of Stress Management

 Hugs, kisses and laughter; have fun and don‘t be afraid
to share your feelings with others.
 Identify stressors and plan to deal with them better next
time.
 Judge your own performance realistically; don‘t set
goals out of your own reach.
 Keep a positive attitude, your outlook will influence
outcomes and the way others treat you.
 Limit alcohol, drugs and other stimulants, they affect
your perception and behavior.
 Manage money well, seek advice and save at least
10% of what you earn.

 No is a word you need to learn to use without
feeling guilty.
 Outdoor activities by yourself, or with friends and families,
can be a great way to relax.
 Play your favorite music rather than watching TV.
 Quit smoking; it is stressing your body daily, not to mention
killing you too.
 Relationships; nurture and enjoy them, learn to listen more
and talk less.
 Sleep well, with firm mattress and supportive pillow; don‘t
over heat yourself and allow plenty of ventilation.

 Treat yourself once a week with a massage, dinner out and
the movies.
 Understand things from the other person point of
view.
 Verify information from the source before exploding.
 Worry less, it really doesn‘t get things completed better or
quicker.
 Yearly goal setting; plan what you want to achieve based on
your priorities in your career, relationships etc.
 X-ray your feelings.
 Zest for life; each day is a gift, smile and be thankful that
you‘re the part of the bigger picture.

Defense Mechanisms
 In Freudian psychoanalytic theory, defense mechanisms are
unconscious psychological strategies brought into play by
various entities to cope with reality and to maintain self-
image.
 White and Gilliland (1975) stated that the term mechanisms
of defense refers to the various automatic, involuntary, and
unconsciously instituted psychological activities by which the
human being attempts to exclude unacceptable urges or
impulses from awareness.
 According to American Psychiatric Association (1994),
“defense mechanisms are patterns of feelings,
thoughts, or behaviors that are relatively involuntary.
They arise in response to perceptions of psychic danger
or conflict, to unexpected change in the internal or
external environment, or in response to cognitive
dissonance.”

Important properties
 Defenses are a major means of managing impulse and
affect
 Defenses are unconscious.
 Defenses are discrete from one another.
 Although often the hallmarks of major psychiatric
syndromes, defenses are dynamic and reversible.
 Defenses can be adaptive as well as pathological.

Purpose of defense mechanism
 First, defenses allow individuals a period of respite to master
changes in self-image that cannot be immediately
integrated, as might result from puberty, an amputation, or
a promotion (i.e., changes in reality).
 Second, defenses can deflect or deny sudden increases in
biological drives. Awareness of instinctual wishes is
usually diminished; alternatively, antithetical wishes may
be passionately adhered to.
 Third, defenses enable individuals to mitigate
unresolved conflicts with important people, living or
dead.
 Finally, ego mechanisms of defense can keep anxiety,
shame, and guilt within bearable limits during sudden
conflicts with conscience and culture.

Defense
Mechanism
Narcissitic Immature Mature
Denial
Projection
Distortion
Acting Out
Passive Aggressive
Regression
Blocking
Hypochondriasis
Schizoid Fantasy
Introjection
Somatization
Controlling
Dissociation
Displacement
Externalization
Reaction Formation
Inhibition
Repression
Intellectualization
Isolation
Sexualization
Rationalization
Altruism
Humor
Anticipation
Sublimation
Asceticism
Suppression
Neurotic

Narcissistic defenses
 Narcissistic defenses are the most primitive and appear in
 children and persons who are psychotically disturbed.
 Permit one to effectively rearrange external experiences
to eliminate need to cope with reality.
 Pathological users of these appears irrational or insane to
 others.
 Psychotic defenses common in overt psychosis.
 Found in dreams and throughout childhood.

Denial
 Denial is an outright refusal to
admit or recognize that
something has occurred or is
currently occurring
Projection
 A defense mechanism in which
people attribute their own
inadequacies or faults to
someone else.

Distortion
 Grossly reshaping external reality to suit inner needs.
 Including unrealistic megalomania beliefs, hallucinations,
wish- fulfilling delusions, especially grandiose(Large)

Immature defenses
Immature defenses are seen in adolescents and some
nonpsychotic patients.
 Acting Out
 Passive Aggressive
 Regression
 Blocking
 Hypochondriasis
 Schizoid Fantasy
 Introjection
 Somatization

Acting Out
 Acting Out is performing an extreme behavior in order
to express thoughts or feelings the person feels
incapable of otherwise expressing.
 When a person acts out, it can act as a pressure release,
and often helps the individual feel calmer and peaceful
once again.
 For instance, a child’s temper tantrum is a form of acting
out when he or she doesn’t get his or her way with a
parent.
 Self-injury may also be a form of acting-out, expressing
physical pain what one cannot stand to feel emotionally.
Immature defenses

Passive aggressive
 Expressing aggression toward others
indirectly through passivity,
masochism, and turning against the
self.
 Passive aggressive behavior might
not always show that the person is
angry . They might appear in
agreement, polite, friendly, down-
to-earth, kind and well-meaning.
However, underneath there may
be manipulation going on - hence
the term "Passive-Aggressive".
Immature defenses

Regression
It is a reversion to immature patterns of the behaviour
Blocking
Temporarily or transiently inhibiting thinking.
Blocking closely resembles repression but differs in that tension
arises when the impulse, affect, or thought is inhibited.
Immature defenses
During exam After exam

Hypochondriasis
refers to excessive worry about having a serious
illness.
Schizoid fantasy
Tendency to retreat into fantasy in order to resolve
inner and outer conflicts.
Introjection
Unconscious internalization of the qualities of an
object or person.
Somatization
Feelings are manifest as physical symptoms rather
than psychological distress.
Immature defenses

Neurotic defenses are encountered in obsessive compulsive
and hysterical patients as well as in adults under stress.
 Controlling
 Dissociation
 Displacement
 Externalization
 Reaction Formation
 Inhibition
 Repression
 Intellectualization
 Isolation
 Sexualization
 Rationalization
Neurotic defenses

Controlling
Attempting to manage or regulate events or
objects in the environment to minimize anxiety and
to resolve inner conflicts.
Dissociation
Temporarily but drastically modifying a person's
character or one's sense of personal identity to
avoid emotional distress.
In extreme cases, dissociation can lead to a
person believing that they have multiple selves.
Displacement
The expression of an unwanted feeling or thought,
directed towards a weaker person instead of a
more powerful one
Neurotic defenses

Externalization
Tending to perceive in the external world and
in external objects elements of one's own
personality
Reaction Formation
Reduces anxiety by taking up the opposite
feeling, impulse or behavior
Inhibition
Includes decrease or loss of motivation to
engage in some goal directed activity to
prevent anxiety arising out of conflicts with
unacceptable impulses i.e. writing blogs
Neurotic defenses

Repression
Primary defense mechanism in which
unacceptable or unpleasant ID impulses are
pushed back into the unconscious
Intellectualization
works to reduce anxiety by thinking about
events in a cold, clinical way
Isolation
Separation of feelings from ideas and events
i.e. Describing a murder with graphic details
with no emotional response.
Neurotic defenses

Sexualization
Sexualization is a way of transforming an experience of pain
or terror into pleasurable excitation.
Rationalization
A defense mechanism whereby people justify a negative
situation in a way that protects their self esteem
Neurotic defenses

The Mature defenses are defined by a healthy and conscious
relationship with reality.
 Altruism
 Humor
 Anticipation
 Sublimation
 Asceticism
 Suppression
Mature defenses

Altruism
Using constructive and instinctually gratifying
service to others to undergo a vicarious
experience(living life through someone else's
eyes).
Humor
The individual deals with emotional conflict or
external stressors by emphasizing the amusing
or ironic aspects of the conflict or stressor.
Anticipation
Realistically anticipating or planning for future
inner discomfort
Stage fright is a type of anticipation, stemming
from the actor or actress hoping that they
perform well.
Mature defenses

Sublimation
A defense mechanism considered healthy by
Freud, in which a person diverts unwanted
impulses into socially acceptable thoughts,
feelings or behavior.
Asceticism
Asceticism is a lifestyle characterized by
abstinence from worldly pleasures, often
pursuing spiritual goals.
Suppression
Consciously or semiconsciously postponing
attention to a conscious impulse or conflict.
Mature defenses

References
 Morton, P.G., & Fontaine, D. K. (2013). Essentials of critical
care nursing: Wolters Kluwer Health/Lippincott Williams &
Wilkins.
 Rana, M. H., Ali, S., & Mustafa, M. (2012). A Handbook of
Behavioural Sciences for Medical & Dental Students.
University of Health Sciences.
 Sole, M.L., Klein, D.G., Moseley, M.J., Brenner, Z.R. and
Powers, J., 2009. Introduction to critical care nursing. 5th
Edition St. Louis, Mo.: Saunders,
 Semple, D. & Smyth, R. 2013. Oxford handbook of
psychiatry, Oxford University Press.
 Videbeck, S. 2013. Psychiatric-mental health nursing,
Lippincott Williams & Wilkins.

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