The document provides a comprehensive overview of stress, emphasizing its definitions, types, biological and psychological responses, and factors influencing stress experiences. It outlines the negative and positive aspects of stress, differentiating between distress, eustress, and neutral stress, while addressing various stressors and their impacts. Additionally, it covers coping mechanisms, psychological responses such as anxiety and grief, and stress management techniques in the context of mental health nursing.

1.  Presented By: Preeti
 M.Sc (N) 1st year
 Specialty : Psychiatric
or Mental Health
Nursing

2.  Introduction
 Definition
 Types, factors
 Stressor and its types
 Psychological adaptation to stress
 Stress as a biological response
 Stress as an environmental event
 Stress as a transaction between the individual
and the environment
 Stress management

3.  Stress is an universal experience. Stress is part
of being alive. Right from the time of birth till
the last breathe drawn, an individual is
invariably exposed to various stressful
situations.
Stress may be physical, mental or emotional.
Stress has become a serious concern in present
age. Its effects on the health is resulting into
various physiological and psychological
disorders in body. It leads to various health
problems like blood pressure, heart attack,
diabetes, migraine.

4. According to Selye “Stress as excessive burning of energy
resources”.
According to Woodworth “A state of strain, whether
physical and psychological”.
Stress is a non-specific response of the body to any positive
and negative demand placed on it and the potential of
illness.
 BASIC CONCEPT OF STRESS
 Stress is a non-specific response to an internal or
external environment.
 Stress reactions are purposeful and intially protective.

5.  Stress, on positive side helps to maintain equilibrium,
to increase motivation, learning, creativity,
development and motivation.
 On negative side stress is noxious, unpleasant and
damaging.
 Complete freedom from stress is death.
 TYPES OF STRESS
1. Distress : It is arise due to an excess of adaptive
demands. The demands are so great that they lead to
bodily and mentally damage. E.g : death of loved one.
2. Eustress : It is an optimal amount of stress which
helps to promote health and growth. E.g : praise from
a teacher for a well written assignment.
3. Neutral stress : Here, the subject neither feels good
nor bad to the stress. Equilibrium and homeostasis is
maintained.

6.  Biological factors : It includes genetic
background, nutritional status, biological
sensitivities.
 Psychological factors : It includes intelligence
verbal skills, personality, past experience etc.
 Socio cultural factors : It includes age, gender,
education, income, occupation, social position
etc.
 Precipitating factors : It includes fear, anxiety,
pain, traumatic experience etc.

7.  A biological, psychological, social or chemical
factor that causes physical emotional tension. A
stressor is a stimuli that proceeding a change.
 Types of stressor :
Acute stressor
• Short period
Chronic stressor
• Long period

8.  Acute stressor : Changes of any kind that
required some adjustment in behavior or
lifestyle could cause stress.
 Chronic stressor : It is of 5 types;
1. Persistent life difficulties
2. Role strain
3. Social group
4. Community-wide strains
5. Daily haste
 Positive situations : Include marriage,
pregnancy, child birth, etc.
 Negative situations : Includes frustration,
conflicts, and pressure.

9.  Any blockage in the achievement of goal is
called frustration. E.g : A student wanted to be
doctor and makes all efforts to clear the PMT but
unable.
 Frustration is of two types: External and Internal
 External frustration : E.g, A student wanted to
go for higher studies but poor financial position
does not permit him.
 Internal frustration : E.g, A student wanted to
achieve higher grades but lower intelligence
level serve as internal blockage.

10.  It is most serious type of stress. It is a condition
when two or more than two goals come into
competition with each other in such a way that
achievement of one goal is blocked by other.
 Types of conflict :
Approach-
approach
• In this two
attractive goals
are present.
Avoidance-
avoidance
• In this two
aversive goals
are present.
Approach-
avoidance
• In this one
attractive and
one aversive
goals are
present.

11.  Pressure is an excessive stressful demands from an
individual. E.g : A student is already working very
hard with his best efforts but if parents
unnecessarily put pressure to work hard, then it is
called a serious stress.
 External pressure : E.g, parents and teachers
continuously demand from children to get high
grades even when they are getting good marks
according to his/her ability.
 Internal pressure : E.g, a student want to join an
IAS services and feel internal pressure to work
hard to be successful in competitive exam.

12.  Environmental stressor
 Physiological stressor
 Social stressor
 Change of any kind can induce stress
 Individual personality that can induce stress
 Interpersonal issues they can induce stress
 System (family, job, school, organization issues
that can induce stress)

13.  Individual response to stressful situation was
influenced by his or her personal perception or event.
Anxiety and grief have been described as two major
primary psychological response patterns to stress.
Anxiety Grief

14. POSITIVE STRESS
RESPONSE
NEGATIVE STRESS
RESPONSE
1. Problem solving
2. Using social support
3. Reframing : Redifining
the situation (to see
positive as well as
negative sides of
problem), how to solve.
1. Avoidance
2. Self-blame
3. Wishful thinking : It
involves thinking that
will resolve by
themselves e.g,
“everything will be
fine”.

15.  Anxiety drives from the Greek root “to press right”.
Anxious is related to Latin word angor, which means “to
distress”. Anxiety involves one’s body, perception of self,
and relationships with others.
Characteristics of anxiety :
 It is an emotional and subjective experience of an individual.
 It is provoked by the unknown and precedes all new
experiences such as entering school, starting a new job or
giving child birth.
 Anxiety is communicated interpersonally
 Culture is related to anxiety

16. Mid
anxiety
Moderate
anxiety
Severe
anxiety
Panic
anxiety

17.  Defense mechanism is firstly used by Sigmund
freud. It is a technique to reduce the anxiety.
Adjustment is the process by which an
individual maintains a balance between his
needs and circumstances.

18. SUCCESSFUL UNSUCCESSFUL
 Repression
 Rationalization
 Intellectualization
 Compensation
 Substitution
 Sublimation
 Suppression
 Reaction formation
 Displacement
 Denial
 Isolation
 Projection
 Regression
 Conversion
 Fixation
 Fantasy

19.  Repression : (Motivated forgetting) expelling an
idea from conscious awareness. E.g : a mother
shows seems unaware of the date or events
surrounding her child’s death.
 Rationalization : Making excuses for behaviour in
which we failed. E.g : when a fox faces failure to
reach the grapes then she said, the grapes are sour.
 Intellectualization/isolation of affect : Seperation
of feelings from ideas and events. E.g : a child who
has beaten, discusses the beatings without any
display of emotion.
 Compensation : Develop positive traits and
distract attention attention from the weaknesses.
 Substitution : Replacing unachievable goal with
achievable goal.

20.  Sublimation : Transfer unacceptable feelings or
impulse into socially accepted behaviour. E.g :
sublimating aggressive impulses toward a career
as a boxer.
 Suppression : Pushing into the unconscious. E.g :
trying to forget something that causes your
anxiety.
 Reaction formation : Taking the opposite belief
because the true belief causes anxiety. E.g : women
who actually dislike her mother in law, hide her
feelings by being always nice to her.
 Displacement : transfer an idea from more
threatning object to less threatning object. E.g :
yelling out your partner after argument with your
boss.

21.  Denial : Any individual refuses to face the reality. E.g :
parents of the ill child will deny the serious kind of
illness.
 Projection : Placing blame for own difficulties upon
others. E.g : a student placing blame on her teacher
because of fail in exam.
 Regression : (flight to childhood) a nurse makes an
error in giving medication and starts crying.
 Somatization or Conversion : Converting psychic
derivatives into somatic manifestation. E.g : getting a
headache while giving an exam.
 Fixation : It refers to the point in which an individual’s
development at which certain aspects of the emotional
development do not advance. E.g: thumb sucking
continuously till adult age.
 Fantasy : (day-dreaming) It is an imaging and wishful
thinking. E.g : a boy is punished by the teacher he
creates fantasy of shooting the teacher.

22.  Grief is defined as the emotional process of coping
with a loss. These responses include helplessness,
loneliness, hopelessness, sadness, guilt and anger.
 Theories of grief
 Engel’s theory(1964) : It has three phases;
1. Shock and disbelief – individual denies the reality
and physical reactions appears.
2. Develop awareness – feeling of desperation and it
includes anger, depression, frustration etc.
3. Reorganization and restitution – begins to
reorganize life and new self awareness also
developed.

23.  Kubler – Ross (1969) stages of dying
I has five stages of grief :
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
 Martocchio’s phases (1985)
Martocchio describes 5 phases of grief. Intense reaction usually
subside within 6-12 months. Active mourning may continue for
3-5 years.
1. Shock and disbelief
2. Yearning and protest
3. Anguish, disorganization & despair
4. Identification in breavement
5. Reorganization and restitution

24.  Provide an open accepting environment.
 Encourage ventilation of feelings and listen
actively
 Provide various diversional activities
 Provide teaching about common symptoms of
grief
 Reinforce goal-directed activities

25. 1. Alarm reaction : In the face of excessive stress, all
biological defense mechanisms are alarmed by the
activation of ANS. This first stage is called alarm
reaction.
2. Stage of resistance : All biological resources are
activated and physiological changes will takes place
like rise BP, sugar level, hormone level, heart rate.
3. Stage of exhaustion : If stress continuous, then
resources starts to deplete and the person losses its
ability to resist stress. This may lead to weakness and
death.

26.  This concept defines, stress the “thing” or
“event” that triggers the adoptive physiological
and psychological responses in an individual.
 The changes can be either negative and
positive.

27.  Precipitating event : A stimulus arising from
the internal or external environment and
perceived by the individual in a specific
manner.
 Individual’s perception :
 Primary appraisal – a judgment about the
situation :
1. Irrelevant
2. Benign positive
3. Stress appraisal

28.  Secondary appraisal :
An assessment of skills, resources, and
knowledge that the person possesses to deal
with the situation.
 Predisposing factors
1. Genetic influences
2. Past experiences
3. Existing conditions

29. 1. Awareness
2. Relaxation
3. Meditation
4. Interpersonal communication with a caring
others
5. Problem solving
6. Pets
7. Music
8. Manage time
9. Monitor your physical comfort

30. 10. Take care of your body
11. Laugh
12. Know your limits
13. Think positively
14. Compromise
15. Have a good cry
16. Avoid self medication

31.  Autogenic training
 Cognitive therapy conflict resolution
 Physical exercise
 Hobbies
 Meditation
 Deep breathing exercise
 Creativity
 A stress ball
 The term spa

32. 1. Assessment
2. Nursing diagnosis
3. Goals and interventions
4. Evaluation

33.  Introduction
 Definition
 Types
 Factors
 Psychological
adaptation to stress
 Stress as a biological
response
 Stress as an
environmental event
 Stress as transaction
between the
individual and the
environment
 Stress management,
techniques of stress
management, nursing
management

34.  Define stress?
 Enlist the types of stress?
 Write the factors of stress?
 Define stressor? Explain the types of stress?
 Explain about the stress adaptation model?
 What is defense mechanism? Enlist the types of
defense mechanism?
 Define projection? Give its example
 Explain the techniques of stress management?

35.  Bhaskara Raj Elakkuvana D. a textbook of
Mental Health (Psychiatric) Nursing. edition 1st
Bangalore: EMMESS publisher : Pp (82-94).
 Sreevani R. a textbook of A Guide To Mental
Health & Psychiatric Nursing. Edition 4th New
Delhi: Jaypee publishers : Pp (328-331).
 Mann Gulshan, Kumar Harish Sharma. a
textbook of Psychology for nurses. edition 5th
Jalandhar: Lotus publishers : Pp (179-194)

36. ANY QUERY