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Stress[1]
Stress can provide stimulus for change and growth in moderate amounts, but too much stress can lead to poor judgment, physical illness, and an inability to cope. Hans Selye defined stress as any situation that requires an individual to respond or take action, and his General Adaptation Syndrome model describes the physiological events of the stress response as alarm, resistance, and exhaustion phases. Prolonged or severe stress can overwhelm the body's ability to maintain homeostasis and lead to further health issues if coping mechanisms are inadequate. Assessment of stress includes evaluating physiological indicators as well as psychological factors like coping behaviors and perception of stressors.
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Stress[1]
- 1. Concepts Related toStress and Adaptation
- 2. Stress Provides stimulus forchange and growth – Some positive, necessary – Too much • Poor judgment, physical illness, inability to cope • Affects all dimensions of person’s life – Changes in internal and external environments • Essential to adapt for survival – “Fight or Flight”
- 3. Define the Conceptof Stress Hans Selye -General Adaptation Syndrome – Describes physiological events during stress response • STRESSORS – internal or external stimuli that cause stress – Physiological, psychological, social, environmental, developmental, spiritual or cultural – Internal or external • STRESS – any situation where nonspecific demand requires an individual to respond or take action • Perception may initiate the stress response
- 4. Physiological Adaptation Body’s abilityto maintain homeostasis – Controlled by nervous and endocrine systems • Unconscious responses – automatic • Negative feedback system – Adjust heart and respiratory rates, blood pressure, temperature, fluid and electrolyte balances, hormone secretions, level of consciousness • Medulla oblongata • Reticular formation • Pituitary gland
- 5. Medulla Oblongata Controls vitalfunctions necessary to survival – Heart rate, blood pressure, respiration
- 6. Reticular Formation Small clusterof neurons in brain stem and spinal cord Controls vital functions, continuously monitoring physiological status of body through connections with sensory and motor tracts
- 7. Pituitary Gland Pituitary gland,attached to hypothalamus – Produces hormones necessary for adaptation to stress • Secretions of thyroid, gonadal and parathyroid hormones – Hormone levels fall, secretions increase – Hormone levels rise, secretions decrease
- 8. Limitations of Homeostatic Control Healthy-meetday to day needs – Only short term control over body’s equilibrium • Cannot adapt to long-term changes in hormones or vital functions – Illness, injury or prolonged stress decreases adaptive capacity • Results in inadequate homeostatic control or breakdown of feedback system – Leads to further illness or death – Severe stress • Hormones insufficient in quantity to provide physiological energy needed for coping – Condition deteriorates, functioning declines
- 9. Models of StressRelated to Nursing Practice Selye’s GAS model – Stress- nonspecific response of body to any demand made on it • Physiological response of the whole body – No individual responses – Useful determining physiological responses
- 10. Adaptation Model People experienceanxiety and increased stress when unprepared to cope with stressful situations 4 factors determine if situation is stressful – Person’s experience with similar stressors, support systems and overall perception of the stressor – Practices and norms of peer group • Can they talk about it? – Impact of social environment in assisting individual to adapt to stressor – Resources available
- 11. Stimulus-based Model Focuses ondisturbing or disruptive events in the environment – Change is normal – Perceptions are irrelevant – All have common threshold
- 12. Transaction-based Model Views personand environment in dynamic, reciprocal, interactive relationship – Stress originates from relationship between the person and the environment
- 13. Factors Influencing Responseto Stressors Physiological functioning Personality Behavioral characteristics Nature of stressor – Perception of intensity or magnitude – Scope – Duration – Other stressors – Predictability – Resources available – Support group
- 14. Adaptation Processes physiological orpsychosocial dimensions change in response to stress – An attempt to maintain optimal functioning – Requires active response from whole person
- 15. Dimensions of Adaptation Physical –Local adaptation and general adaptation syndrome Developmental – Success in past, more likely to succeed now Emotional – Physiological defense mechanisms, personality strengths Intellectual – Education, problem solving, communication skills, realistic perception Social – Social network Spiritual
- 16. Local Physiological Adaptation Responseof body tissue, organ or part to the stress of trauma, illness or other physiological change – Blood clotting, wound healing, accommodation to light, response to pressure • Localized • Adaptive, needs stressor to stimulate it • Short term • Restorative
- 17. Localized Adaptation Syndrome Reflexpain response – CNS responds • Protects from further tissue damage – Sensory receptor, sensory nerve to spinal cord, connector neuron in spinal cord, motor nerve from spinal cord, effector muscle • Pull hand from hot surface
- 18. Localized Adaptation Syndrome InflammatoryResponse – Stimulated by trauma or infection • Localizes infection, prevents spread, promotes healing – Local pain, swelling, heat, redness, change in functioning • First phase – changes in cells and circulatory system – Vasoconstriction, histamine release, increased blood flow, increasing WBC’s, capillary permeability increased • Second phase – release or exudate • Third phase – repair of tissue by regeneration or scar formation
- 19. 3 Phases ofGeneral Adaptation Syndrome Physiological response of whole body to stress – Involves many body systems • Primarily autonomic nervous system and endocrine system
- 20. Alarm Reaction Mobilizes defensemechanisms of body and mind to cope with stressor – Hormone levels rise to increase blood volume – Increase blood glucose levels to make energy available – Epinephrine and norepinephrine increase • “fight or flight” – Increased heart rate, blood flow to muscles, oxygen intake, greater mental alertness – Pupils dilate for greater visual field • May last a minute to many hours – Extreme or long term • May threaten life – If stressor still present after initial alarm reaction, progresses to next phase
- 21. Resistance Phase Body stabilizes –Hormone levels, heart rate, blood pressures and cardiac output return to normal – Attempting to adapt • If stress can be resolved, body repairs damage • If stressor remains present and adaptation fails, enters third phase
- 22. Exhaustion Phase When bodycan no longer resist stress and energy is depleted – Physiological response is intensified • Energy is compromised • Adaptation diminishes – Body cannot defend itself • Physiological regulation diminishes – If stress continues, death may result
- 23. Behavioral Responses toStress Psychological adaptive behaviors (Coping Mechanisms) – Constructive • Help accept challenge to resolve conflict – Destructive • Do not help cope with stressor – Affect reality orientation, problem-solving abilities, personality and in severe cases, ability to function – Task oriented • Use problem solving skills to cope with threat – Ego-defense mechanisms • Regulate emotional distress, protecting from anxiety and stress
- 24. Task-oriented Behaviors Use cognitiveabilities to reduce stress, solve problems, resolve conflicts – Enable one to cope realistically with demands of stressor • Attack behavior – act to remove or overcome a stressor or satisfy a need • Withdrawal behavior – removing the self physically or emotionally from the stressor • Compromise behavior – changing the usual method of operating, substituting goals, or omitting the satisfaction of needs to meet other needs or to avoid stress
- 25. Ego-defense Mechanisms usedas Stress Responses Unconscious behaviors that offer psychological protection from a stressful event – Help protect against feelings of worthlessness and anxiety • Can become distorted, becomes destructive – Compensation • Make up for deficiency by exaggerating strength – Conversion • Transfer conflict into nonorganic symptom – Denial • Refuse to consciously acknowledge – Displacement • Transfer emotions to less anxiety-producing substitute – Identification • Pattern behavior after another
- 26. Effects of ProlongedStress Developmentally – Unable to complete devekopmental task • Repeated stress can lead to maturational crisis Intellectually – Short term memory impaired – Ability to learn impaired Emotionally – Relate to prior experiences Family – Respect client’s ideals of family • Poor communication and maladaptive behaviors may affect outcome Lifestyle – Smoking, drinking, obesity, homosexuality • Set aside personal judgments Sociocultural – Individualized beliefs Spiritual – Individualized
- 27. Spiritual Religion and spiritualityare not the same Religion – System of organized beliefs and worship Spirituality – Unique capacity for love, joy, caring, compassion and for finding meaning in life’s difficult experiences During stress, one relies on their faith, but may abandon their practices out of disillusionment and anger
- 28. Assessment of Stress Physiological – objective – Elevated B/P – Increased neck, shoulder and back tension – Elevated pulse and respirations – Sweaty palms – Cold hands and feet – Slumped posture – Fatigue – Tension headache – Upset stomach – High pitched voice – Nausea, vomiting and diarrhea – Appetite change, weight change – Urinary frequency – Abnormal labs • Elevated adrenocorticotropic hormone, cortisol, catecholamine levels, hyperglycemis – Restless • Difficulty falling asleep or frequent awakening – Dilated pupils
- 29. Physical Disorders relatedto Stress Cardiovascular and gastrointestinal diseases Some cancers Immunological disorders Migraine headaches Infertility Burnout Exacerbates Parkinson’s and Tourette’s syndrome
- 30. Levels of Stress Mild – Few minutes to few hours • Usually don’t affect health unless several at once Moderate – Several hours to days Severe – several weeks to several years • More frequent and longer, the higher the health risk • As stress increases, stress behaviors increase, decreasing energy and adaptive responses Assess perception to decide level for patient – several weeks to several years • More frequent and longer, the higher the health risk • As stress increases, stress behaviors increase, decreasing energy and adaptive responses
- 31. Assessment of Stress(cont) Psychological – Assess for destructive behaviors Developmental – Assess where they are developmentally • Any delays, are they new? Emotional – Observe behavior Intellectual – Assess learning, cognitive appraisal, attention span Family – What do they consider effective emotional support • Do they have it? Lifestyle – Smoking, obesity, drug abuse, chronic sleep deprivation – Regular exercise, adequate rest, nutritious diet Sociocultural – Be aware of cultural differences Spiritual – Examine how beliefs and values have changed What does client expect?
- 32. Nursing Diagnoses Relatedto Stress Need defining characteristics – Identify etiology Activity intolerance Anxiety Caregiver role strain Coping, ineffective family or individual: compromised or disabling Fatigue Fear Growth and development, altered Hopelessness Injury, risk for Self-esteem disturbance
- 33. Stress Management Techniques Goals –Reduce frequency of stress-inducing situations – Decrease physiological response to stress – Improve behavioral and emotional responses to stress
- 34. Stress Management Techniques Healthpromotion – Regular exercise – Good nutrition – Adequate rest – Effective time management • More in control of life – Prioritize tasks – Interactions with positive support systems – Humor
- 35. Acute Care Crisis Intervention –Therapeutic technique to help resolve immediate stress problem • Addresses immediate, urgent need for stress reduction – Crises • When one encounters problems or stress situations they are unable to cope with in usual fashion • SITUATIONAL – External • Symptoms transient, episode brief • new baby, role change, acute illness, family change • DEVELOPMENTAL – Internal • Unable to complete developmental tasks of stage • can occur at any point •
- 36. Crisis Intervention Resolution ofconflict depends on realistic perception, use of adequate coping mechanisms – Health promotion
- 37. Restorative Care Assist inlife style changes that are healthy and stress reducing – SMOKING CESSATION – HUMOR • Use appropriately – Laughing alleviates stress, releases endorphins – SPIRITUALITY • Prayer, meditation or reading religious material – SELF ESTEEM • Stress positive characteristics – RELAXATION TECHNIQUES • Guided imagery, progressive relaxation, meditation, biofeedback – STRESS MANAGEMENT
- 38. Stress in Workplace Stressis working women’s number one problem – Stressors: workload, institutional policies, conflict with co-workers, dealing with death, conflict with physicians, inadequate preparation to deal with emotional needs of clients and families • Level of stress depends on personality, health status, previous experiences with stress, coping mechanisms – Job stress = Burnout • Depletes energy to deal with it • Sense of helplessness and negativism • No positive rewards • Anger or apathy – Identify stressors and strive to eliminate them