Basic Nursing: Foundations of

Skills & Concepts Chapter 16

STRESS, ADAPTATION AND ANXIETY

Stress is...

A nonspecific response to any demand made on the body.

Such demands are called stressors.

Stress Management

Successful stress management is necessary for wellness of both clients

and nurses.

Response to Stress

The inner force an individual uses to respond or adapt to stress is known as adaptive energy.

All persons have adaptive energy; the amount varies from individual to individual.

Homeostasis

The balance or equilibrium among the physiologic, psychological, sociocultural, intellectual, and spiritual needs of the body.

Stress is an assault on the homeostasis.

General Adaptation Syndrome

The body’s response to stressors: Stage One: Crisis/alarm (paleness,

shivering, sweating of palms, etc.) Stage Two: Adaptation/Resistance

(Flight-or-Fight response) Stage Three: Exhaustion (if adaptive

energy is inadequate to deal with prolonged or overwhelming stress)

Local Adaptation Syndrome

Physiologic response to stress (e.g. trauma, illness) affecting a specific part of the body.

Classic symptoms include redness, warmth, swelling at the site.

Manifestations of Stress (i)

Physiologic: increased pulse rate; rapid shallow breathing; dizziness; headaches; dilated pupils; nausea; diarrhea or constipation; polyuria; tension.

Psychological: irritability; increased sensitivity; sadness, depression; feeling “on edge”

Manifestations of Stress (ii)

Cognitive: impaired memory; confusion; impaired judgment; delayed response time

Behavioral: pacing; sweaty palms; rapid speech; insomnia; withdrawal;exaggerated startle reflex

Spiritual: alienation; social isolation; emptiness

Outcomes of Stress

Eustress - a type of stress that results in a positive outcome.

Distress - when stressors evoke an ineffective response.

Adaptation

An ongoing process whereby individuals use various responses to stressors and change.

Coping Measures

The ways an individual may react to stress.

One coping measure is conditioning, behavior that becomes an automatic response.

Factors Influencing Coping

Degree of danger perceived by individual. Immediate needs of individual. Amount of support from others. Individual’s belief in his own ability to handle a stressful

situation. Individual’s previous successes and failures in coping. Number of concurrent or cumulative stresses being

handled.

Adaptive Measures

Use of support people. Relaxation to relieve tension. Behavioral change. Development of more realistic goals. Problem solving.

These measures for coping with stress that require a minimum amount of energy include:

Defense Mechanisms

Unconscious operations that protect the mind from anxiety.

They are universal and can be positive. Defense mechanisms that prevent an

individual from making progress towards resolving and accepting stress are called maladaptive measures.

Crisis

An acute state of disorganization that occurs when the individual’s usual coping mechanisms are no longer effective.

Crises are: Characterized by extreme anxiety. Inability to function. Disorganized behavior. Limited as to how long they can last.

Anxiety

A subjective response that occurs when a person experiences a real or perceived threat to well-being.

The most common emotional response to stress.

Severe Anxiety

Profuse Sweating

Rapid pulse Increased blood

pressure

Dry mouth

Shallow, rapid respiration

Interrupted speech

TremorsShivering

Selected focus of attention

Tense muscles

Rigid posture

Symptoms of Anxiety

Illness as Stressor

Illness and hospitalization are major stressors for individuals and their families.

To alleviate the stress of hospitalization, nursing interventions should reduce the client’s feelings of unfamiliarity and loss of control.

Change

A dynamic process whereby an individual’s response to a stressor leads to an alteration in behavior

Change is an inherent part of life. Change can be constructive or

destructive.

The Nurse as Change Agent

In bringing about change to effect positive adaptation, the nurse serves as change agent, a person who intentionally creates and implements change.

Stress and The Nursing Process

Assessment. Nursing Diagnosis. Planning/Outcome Identification. Nursing Interventions.

Nurses can help clients understand their anxiety and learn coping mechanisms through:

Assessment

What are the patterns of stressors? What are the typical responses to

stressful situations? What are the cause-and-effect

relationships among stressors and thoughts, feelings, and behaviors?

What is the past history of successful coping mechanisms?

Nursing Diagnoses

Impaired adjustment Altered role performance Altered thought

processes Defensive coping Sleep Pattern

Disturbance

Post-trauma syndrome Impaired Social

Interaction Spiritual Distress Hopelessness Fatigue Fear

Nursing diagnoses that may occur inResponse to stressors include:

Planning/Outcome Identification

Identify situations that increase stress and anxiety. Verbalize a plan to decrease the effect of common

stressors. Differentiate positive and negative stressors. Categorize stressors. Demonstrate stress-management exercises. Verbalize a plan for stress management, including

necessary lifestyle modifications.

Nursing Interventions

Meeting basic needs. Minimizing environmental stimuli. Verbalizing feelings. Involving family and significant others. Using Stress-Management techniques. Crisis intervention.

Important Stress-Management Techniques

Exercise Relaxation techniques (e.g. progressive

muscle relaxation, guided imagery, meditation, hypnosis)

Cognitive Reframing or Thought Stopping

Crisis Intervention

A specific technique used to help clients regain equilibrium.

The Five Steps of Crisis Intervention

Identification of the Problem Identification of the Alternatives Selection of an Alternative Implementation Evaluation

Stress & Nurses: Burnout

Burnout is a state of physical and emotional exhaustion that occurs when caregivers deplete their adaptive energy.

Factors Leading to Burnout

Job-related stress. Heavy workload. Interpersonal conflict in the work

environment. Organizational barriers to autonomous

decision making.

Combating Burnout

Expect to be successful. Remember the power of self-fulfilling

prophecies and deliberately focus on the positive.

Let go of the need to be perfect. Listen to self-talk. Encourage the use of appropriate humor

in the workplace.

Achieving Stress Hardiness

Commitment: Becoming involved in what one is doing.

Challenge: Perceiving change as an opportunity for growth instead of as an obstacle or threat.

Control: Believing that one is influential in directing what happens to oneself.