This document discusses stress, adaptation, and stress management. It defines stress as an unpleasant psychological and physiological state caused by internal or external demands exceeding one's capacity. Stress can be good or bad and cause physiological and psychological responses in the body. The document outlines models of stress including the general adaptation syndrome and sources of stress. It discusses effects of stress and normal responses. The nursing process for managing stress includes assessment, nursing diagnoses, planning, implementing pharmacological and non-pharmacological interventions, and evaluation. Non-pharmacological methods include relaxation techniques, exercise, nutrition, and social support.

1. SAIMA HABEEB
Ph.D (N) SCHOLAR

2. Basic concepts of Stress and
Adaptation
STRESS : It is an
unpleasant psychological
and physiological state
caused due to some
internal and or external
demands that go beyond
our capacity.

3. Types of Stress
Good stress [Eu stress]
 Bad stress [Chronic stress]
 Survival stress
 Internal stress:

4. STRESSORS
Any factor that causes a
person experience stress is a
stressor .
[ Ivancevich & Matteson]
Types are :
Internal stressor
External stressor

5. ADAPTATION :
The change that take place
as a result of the response to a
stressor is adaptation.

6. HOMEOSTASIS:
Various physiologic
mechanisms within the body
responds to internal changes to
maintain relative constancy in the
internal environment , which is
called Homeostasis.

7. CRISIS:
When stress overwhelms , a
person’s existing coping mechanism
disequilibrium occurs and thus
causes a crisis

8. SOURCES OF STRESS:
 Environmental
 Social
 Thoughts
 Any kind of change
 Individual personalities
 Inter personal issues
 System [family, job, school, club,
organization issues]

9. MODELS OF STRESS:
Psycho somatic model
 Adaptation model
Social environmental model
Process model

10. Psychosomatic Model
 The psychosomatic model is based
on the premise that stressors
affecting the client in one
dimension can have pathological
effect in other dimensions.

11. Adaptation model
Ability of a person to cope with stress.
Practices and norms of the person’s peer
group.
 The means that the social environment
provides an individual to adapt to a
stressor.
Nature of the process that determines
where and how an individual can use
resources in the social environment to
deal with stress.

12. Social environmental model
•This model is concerned with the
effects of a person’s work role on
health.
•When assessing the wellness level
of the client, nurses should
identify the actual and potential
stressors in work environments to
help the client modify or adapt to
them.

13. PROCESS MODEL
Outcome
Cognitive Performance
Appraisal Process
Procedure
Decision
Situation Behaviour
Perceived
Decision
Decision
Response
Selection

14. NORMAL RESPONSES TO STRESS
a)Physiological response
 Local adaptation syndrome [LAS] :
It is a localized response of the
body to stress. It involves only a specific
body part [tissue or organ] instead of the
whole body. The stress precipitating the
LAS may be traumatic or pathologic. LAS
includes 2 main responses that influence
nursing care are the reflex pain response
and inflammatory response

15. General adaptation syndrome[GAS]
It is a biochemical
model of stress developed by Hans
Selye [1976]. The GAS describes the
body’s general response to stress by
the stimulation of hypothalamus.

16. Three stages in the GAS are
Alarm reaction
Resistance reaction
Exhaustion

17. Alarm reaction
stressor
Stimulates
Hypothalamus
Stimulates
Sympathetic nervous system
Stimulates
Adrenal medulla
Release
Catecholamine
Produce
Alarm reaction

18. Resistance Reaction
Stressor
Hypothalamus
CRH, GHRH, TRH
Anterior pituitary
ACTH HGH TSH
Adrenal cortex
Glucocorticoids & Liver Thyroid gland
Mineralocorticoids Glyconeogenesis CHO
&Fat breakdown breakdown

19. Psychological responses
Mind-Body interaction
Anxiety
Coping mechanisms
Defense mechanisms

20. EFFECTS OF STRESS
Individual response to stress
The stressful personality
type: Friedmann & Roseman [1974]
classified individuals into 2 groups
according to personality
characteristics.
 Type A group :
 Type B group :

21.  Post Traumatic Stress Disorder (PTSD)
It is defined as a “delayed
and/or protracted
response to a stressful
situation [either short or
long lasting] of an
exceptionally
threatening nature which
is likely to cause
pervasive distress in
almost anyone”.

22. Stress and basic human needs
Physiologic
 Safety / security
 Love or Belongingness
 Self esteem
 Self actualization

23. Stress in computer users
 The demands of
the job &
assignments
 Increasing
competition
 Long duty hours
 Computer
defects, etc

24. Stress in healthy individuals
Circulatory system: Fight
or flight responses causes
increase in heart rate,
peripheral vasoconstriction
and that causes, increased BP
& respiration . The long term
stress may damage the heart
& arteries and thus causes
hypertension, CHD, etc.

25. Stress in healthy continues.....
Immune system
 Other systems
 Gastrointestinal systems
 Respiratory system
 Skin
 Aches
 Migraine
 Substance misuse
 Mental illness
 Accidents or unsafe behavior

26. Stress in illness
• Stress associated with
hospitalization
• Family stress
• Prolonged stress
• Stress in older adults
• Stress of patient in ICU
• Stress in Maternal and child health

27. Stress in Nursing profession
 Nursing involves activities and
interpersonal relationships that are
often stressful.
This result in a complex of behaviors
called “BURNOUT”. Burnout is a state of
exhaustion that results from repeated
emotional pressure. The three Signs are:
Emotional exhaustion
Depersonalization
Decreased sense of personal
accomplishment

28. THE NURSING PROCESS FOR THE
MANAGEMENT OF STRESS
ASSESSMENT:
 Nursing History
 Physical assessment
 Assessment of the person
 Assessment of the family
 Assessment of the environment

29. Hospital anxiety and depression scale
 The hospital anxiety and depression
scale [Zigmond & Snaith 1983]is a
selfadministered questionnaire and
consist of 14 questions . 7 questions
measure traits of anxiety, and next 7
traits of depression. With a score
greater than 8 indicates a pathological
state

30. Social readjustment rating scale
This is put forward by Holmes &Rahe
[1967] It is a fixed number of life
events and assumes that these
invoke similar stress response in
everyone. It is possible to use this
instrument within a nursing
assessment.

31. Self reporting
Stress is a psychological
construct, and because only the
individual experiencing it knows
its true meaning. A self reporting
method may prove more effective.

32. Stress points / Bio dots /Stress cards
The Bio dots or Stress squares
are commercially available
liquid crystal materials that
change colors for stress related
temperature changes

33. NURSING DIAGNOSIS

34. OUTCOME IDENTIFICATION AND
PLANNING
Decrease in the level of anxiety
Develop effective coping skills
Describe a reduction in anxiety
and an increase in comfort.

35. IMPLEMENTATION
Non-Pharmacological methods

36. Teaching Healthy
Activities of Daily
Living
Exercise:
Exercise improves
one’s general sense of
wellbeing, relieves
tension, and enables
one to cope better with
day-to-day stressors.

37. •Rest and sleep: Adequate rest and
sleep can provide “insulation” against
stress
Nutrition: Nutrition
plays an active role in
maintaining the
body’s homeostatic
mechanisms and in
increasing reactions to
stress

38. Encouraging use of support
systems
 Support systems
provide emotional
support that helps a
person identify and
verbalize feelings
associated with
stress.

39. Encouraging use of Stress
management techniques
Keeping a stress- awareness diary
This diary helps to discover and
chart their own personal stressful
events and characteristics reactions

40. Relaxation techniques
Deep Breathing
• Progressive Muscle
Relaxation

41. Meditation
Meditation is a
kind of self
discipline that helps
one achieve inner
peace and harmony
by focusing
uncritically on one
thing at a time.

42. Yogasanas
This is
exercising different parts of the
body, combined with
controlled breathing. The
postures are stretch & hold,
compress & hold. It creates
flexibility, hollowness,
lightness and helps in flow of
oxygen, food, water, electric
signals and flow of energy in
the body freely.

43. Music Therapy
• Breathing Exercise
Deep breathing
Awareness of breathing
Ten-To-One Count
Alternated-Nostril Breathing

44. Anticipatory guidance
Anticipatory
guidance focuses on
psychologically preparing
a person for an
unfamiliar or painful
event

45. Guided Imagery
Guided imagery or
positive visualization
uses a person’s own
imagination and positive
thinking to create
powerful mental
pictures or images to
reduce stress or promote
healing

46. Body Scanning
Autogenic Training
Self Hypnosis
Therapeutic Touch

47. Providing Crisis Intervention
The steps are:
Identify the problem
List all possible solutions
Choose the right one
Implement the plan
Evaluate the outcome

48. Pharmacological Methods
Anxiolytics: These drugs provide
immediate relief from the unpleasant
feelings associated with stress.
Antidepressants: These drugs are
prescribed for prolonged periods of
distress. These will also helps to
improve self esteem, helps in positive
thinking, and empower them to
address the cause of their problem.

49. Complementary Remedies:
Hypericum perforatum (St John’s
wort): It is a widely prescribed
medication. It is thought to work in a
similar way as the SSRI’s work
Valerian: It is used as an Anxiolytics
agent and having sedative
properties.

50. Stress management
strategies for you

51. Take a Deep Breath
Manage Time
Connect with Others

52. Talk it Out
Take a “Minute” Vacation
Monitor Your Physical comfort

53. Get Physical
Take Care of Your Body
Laugh

54. Know your limits
Think Positively
Develop a Sense of Life
Meaning

55. • Compromise
• Have a Good Cry
• Avoid Self Medication
• Look for the “Pieces of Gold”
Around you

56. EVALUATION
Verbalize causes and effects of
stress and anxiety
Identify and use sources of
infection
Use problem solving to find
solution to stressors
Practice healthy lifestyle habits
and anxiety reducing techniques.
Verbalizes a decrease in anxiety
and an increase in comfort

57. THANK YOU….