UNIT VIII.pdf

UNIT VIII.pdf

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  UNIT VIII Human Reponsesto Illness Misbah khan Lecturer (DION&M ,DUHS) BSN Year 1, Semester II OBJECTIVES • At the end of this unit, learners will be able to: 1. Define coping stress tolerance pattern. 2. Differentiate the concepts of stress as a stimulus, response, and transaction. 3. Identify physiological and psychological manifestations of stress. 4. Discuss Factors affecting coping pattern during hospitalization. 5. Describe various types of coping pattern. 6. Discuss the nursing process related to coping stress pattern. Stress • Stress is a condition in which an individual experiences changes in the normal balanced state. • Parents refer to the stress of raising children, working people talk of the stress of their jobs, and students at all levels talk of the stress of school. • STRESSOR: A stressor is any event or stimulus that causes an individual to experience stress. • When a person faces stressors, responses are referred to as coping strategies, coping responses, or coping mechanisms STRESS AND COPING PATTERN • Coping-stress-tolerance patterns indicate how someone will allow their personal life to be influenced by occurring events and what they will take away from the experience • This pattern describe the client’s general coping pattern and the effectiveness of pattern in term of stress tolerance.
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  MODELS OF STRESS •Nurses can use these models to assist clients in strengthening healthy coping responses and in adjusting unhealthy, unproductive responses. • Three main models of stress are 1) Stimulus based 2) Response based 3) Transaction based Stimulus-Based Models • In stimulus-based stress models, stress is defined as a stimulus, a life event, or a set of circumstances that arouses physiological and/or psychological reactions that may increase the individual’s vulnerability to illness. • EXAMPLE :a person’s relatively recent experiences, such as divorce, pregnancy, and retirement. Response-Based Models • Stress may also be considered as a response. • This definition was developed and described by Selye: “the nonspecific response of the body to any kind of demand made upon it” • Example: Parts of the body affected by stress are the gastrointestinal tract. With prolonged stress, deep ulcers appear in the lining of the stomach. General Adaptation Syndrome (GAS) • Selye’s stress response is characterized by a chain or pattern of physiological events called the general adaptation syndrome (GAS) or stress syndrome. • To differentiate the cause of stress from the response to stress Stages of General Adaptation Syndrome • Hans Selye (1907–1982): Founder of the stress theory • Selye (1976) proposed that both the GAS have three stages: i. Alarm reaction ii. Resistance
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  iii. Exhaustion i. AlarmReaction: • The initial reaction of the body is the alarm reaction, which alerts the body’s defenses. ii. Resistance • The stage of resistance, is when the body’s adaptation takes place. In other words, the body attempts to cope with the stressor. iii. Exhaustion • The adaptation that the body made during the second stage cannot be maintained. • This means that the ways used to cope with the stressor have been exhausted. • If adaptation has not overcome the stressor, the stress effects may spread to the entire body. Transaction-Based Models • Although Lazarus (2006) recognizes that certain environmental demands and pressures produce stress in substantial numbers of people • He emphasizes that people and groups differs in their sensitivity and vulnerability to certain types of events, as well as in their interpretations and reactions.
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  • In termsof illness, one person may respond with denial, another with anxiety, and still another with depression. Manifestations of Stress Physiologic  Sweating  Increase heart rate  Increase respiratory  Mouth may be dry  Muscles tension increase  Digestive disorders  Headache Psychological  Anxiety  Fear  Anger  Depression Physiological Manifestations of Stress. • Responses to stress vary depending on the individual’s perception of events. • The physiological signs and symptoms of stress result from activation of the sympathetic and neuroendocrine systems of the body. • Clinical Manifestations lists physiological indicators of stress.
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  Psychological Manifestations OfStress • Psychological manifestations of stress include anxiety, fear, anger, depression, and unconscious ego defense mechanisms. • Some coping patterns are helpful; others are a hindrance, depending on the situation and the length of time they are used or experienced Anxiety • A common reaction to stress is anxiety • A state of mental uneasiness, apprehension, dread, or foreboding or a feeling of helplessness related to an impending or anticipated unidentified threat to self or significant relationships. Fear: • Fear is an emotion or feeling of apprehension aroused by impending or seeming danger, pain, or another perceived threat. • The fear may be in response to something that has already occurred, in response to an immediate or current threat, or in response to something the person believes will happen. • The nursing student may be fearful in anticipation of the first experience in a client care setting. ANGER • Anger is an emotional state consisting of a subjective feeling of animosity or strong displeasure DEPRESSION
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  • Depression isa common reaction to events that seem overwhelming or negative. • Depression, an extreme feeling of sadness, despair, dejection, lack of worth, or emptiness. EGO DEFENSE MECHANISMS • Ego defense mechanisms are unconscious psychological adaptive mechanisms • Mental mechanisms that develop as the personality attempts to defend itself, establish compromises among conflicting impulses, and calm inner tensions. COPING • Coping may be described as dealing with change successfully or unsuccessfully. • A coping strategy (coping mechanism) is a natural or learned way of responding to a changing environment or specific problem or situation. • According to Folkman and Lazarus (1991), coping is “The cognitive and behavioral effort to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person” Types of Coping Strategies • Different types of coping strategies have been described: ➢ Problem focused ➢ Emotion focused. ➢ Long term coping strategies ➢ Short term coping strategies ➢ Adaptive coping ➢ Maladaptive coping Types Of Coping Pattern Problem-focused coping • Refers to effort that improve situation by making change or taking some change Emotion-focused coping  It includes thoughts and action that relieve emotional distress  It does not improve situation but the person often feel better
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  Types Of CopingPattern Adaptive coping  Help person to deal effectively with stressful events  Effective coping Maladaptive coping  These strategies can cause un-necessary distress for person  Ineffective coping Ways To Cope Anxiety And Stress  Exercise  Good sleep & nutrition  Time management  Relaxation techniques: ❖ Breathing exercises ❖ Progressive relaxation ❖ Massage ❖ Guided imagery ❖ Yoga ❖ Meditation ❖ Music therapy ❖ Humor and laughter Factor Affecting Coping Pattern  The number, duration and intensity of stressor  Past experiences of individual  Support system available to individual  Personal qualities of a person
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  Nursing process relatedto stress and coping Assessment:  Nursing history (client-perceived stressor, manifestation of stress, past and present coping strategies)  Physical examination of stress indicators (nail biting, nervousness, weight changes) or stress related health problems (hypertension, dyspnea) Interviewing question to patient i. How long you have been dealing with these stressor? ii. How do you usually handle stressful situation? If the patient does not adequately describe, ask the following: • Cry • Get angry • Talk to someone (who?) • Withdraw from situation • Control other and situation • Go for walk of perform physical activity • Try to arrive at solution • Pray • Laugh, joke or use some other expression of humor • Use relaxation technique such as yoga, guided imagery iii. How well your usual coping strategy work? Nursing Diagnosis  Anxiety: uneasy feeling of discomfort companied by an autonomic response, the source of anxiety often unknown  Caregiver role strain: difficulty in performing the care giver role  Compromised family coping: supportive primary person (family member) provide insufficient or ineffective support or assistance or encouragement that may needed by client to manage adaptive task for health challenge
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   Decisional conflict:uncertainty about course of action to be taken when choice among competing actions involves risk, loss or challenge to personal life values  Fear: response perceived threat that is consciously recognized as danger  Impaired adjustment: inability to modify lifestyle/behavior in a manner consistent with a change in health status  Ineffective coping: inability to form valid appraisal of a stressor, inadequate choices of practiced responses and inability to use resources Implementations • Encouraging Health Promotion Strategies – Exercise – Nutrition – Sleep – Time management • Minimizing Anxiety • Mediating Anger • Using Relaxation Techniques • Crisis Intervention Implementations • Plan a daily relaxation program with meaningful quiet time to reduce tension (e.g., exercise, read, listen to music, soak in a tub, or meditate). • Study assertiveness techniques to overcome feelings of powerlessness in relationships with others. • Learn to say no. • Learn to accept failures—your own and others—and make it a constructive learning experience. • Accept what cannot be changed. There are certain limitations in every situation. Get involved in constructive change efforts if organizational policies and procedures cause stress. • Develop collegial support groups to deal with feelings and anxieties generated in the work setting.
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  • Participate inprofessional organizations to address workplace issues. • Seek counseling if indicated to help clarify and cope with concerns. References • Berman, A., Frandsen, G., Snyder, S., Kozier, B., & Erb, G. L. (2016). Kozier and Erb's fundamentals of nursing, volumes 1-3 (10th ed.). • Delaune, S. C. (2010). Fundamentals of nursing (4th ed.). Delmar Pub.