SEMINAR ON STRESS AND ITS MANAGEMENT

Presented by, Premnath R I year MSc Nursing Govt. CON Kottayam

History

• ‘Stringere’ means ‘to draw tight’

• Walter Cannon refer it as external

factors that disrupted homeostasis.

• The term stress coined by Hans

Selye.

Stress - Definition

• The non-specific response of the body to any demand placed upon it.

(Hans Selye) Stress should be restricted to conditions where

an environmental demand exceeds the natural regulatory capacity of an organism.

(Bruce McEwen and Jaap Koolhas)

Relationship between the person and the

environment that is appraised by the

person as taxing or exceeding his or her

resources and endangering his or her

well-being.

(Lazarus and Folkman , 1984)

EUSTRESS

Eustress or positive stress occurs

when your level of stress is high

enough to motivate you to move into

action to get things accomplished.

DISTRESS

Distress or negative stress occurs

when your level of stress is either too

high or too low and your body and/or

mind begin to respond negatively to

the stressors.

CONCEPTS OF STRESS

• Stress as a biological

response.

• Stress as an environmental

event.

• Stress as a transaction

between the individual and

the environment.

Stress as a biological response

• In 1956, Selye described the syndrome of

symptoms as the “fight or flight syndrome”.

He described the reaction in 3 different stages.

1. Alarm reaction stage- during this stage, the

physiological response of the “fight or flight”

syndrome are initiated.

2. Stage of resistance- the individual uses the physiological response of the first stage as a defence in the attempt to adapt to the stressor.

3. Stage of exhaustion- this stage occurs when there is a prolonged exposure to the stressor to which the body has adjusted. The adaptive energy is depleted and the individual can no longer draw from the resources for adaptation. Diseases of adaptation (eg., headache, mental disorders, coronary artery diseases, ulcers) may occur.

General Adaptation Syndrome

Alarm reaction stage

Stress responses in alarm reaction

• Heart rate and strength of cardiac muscle contraction increases

• Blood vessels supplying to the skin and viscera constrict; at the same time blood vessels supplying to skeletal muscles and brain dilate; thus decreasing blood supply to organs which do not assume an immediate active role.

• RBC production is increased leading to an increase in the ability of the blood to clot. This helps to control bleeding.

• Liver converts glycogen into glucose and

releases it into he blood stream; this

provides energy needed to fight the stressor.

• The rate of breathing increases and

respiratory passages widen to accommodate

more air.

• Production of saliva and digestive enzymes

reduces.

The General Adaptation Syndrome: Alarm Phase

Figure 3.2

STRESS - BODY RESPONSE

Resistance Reaction

• It is initiated by regulating

hormones secreted by

hypothalamus.

• It is a long-term reaction.

• Regulating hormones are

• Corticotropin Releasing Hormone (CRH)

• Growth Hormone Releasing Hormone

(GHRH)

• Thyrotrophic Releasing Hormone(TRH)

• CRH stimulates the anterior pituitary to increase its secretion of adrenocorticotrophic hormone(ACTH). The action of these hormones helps to control bleeding, maintain blood pressure etc.

• GHRH stimulates anterior pituitary to secrete human growth hormone(HGH).

• TRH causes the anterior pituitary to secrete thyroid stimulating hormone (TSH). The combined action of HGH and TSH help to supply additional energy to the body. 

Exhaustion stage

• At this stage, cells start to die, and the organs weaken.

• A long – term resistance reaction put heavy demand on the body, particularly on the heart, blood vessels, and adrenal cortex, which may suddenly fail under strain.

• Immune system is exhausted and

function is impaired resulting in

decompensation.

• The result can manifest itself in obvious

illnesses such as ulcers, depression,

diabetes, trouble with the

digestive system or even cardiovascular

problems, along with other mental

illnesses.

Stress as an environmental event

• Stress as the “thing” or “event” that triggers the adaptive physiological and psychological response in the individual.

• The event is one that create change in the life pattern of the individual, requires significant adjustment in the life style, and taxes available personal resource.

• The change can be either positive, such as accomplishing an outstanding personal achievement, or negative, such as being fired from a job.

• Holmes and Rahe(1967) devised the

social readjustment rating scale.

Numerical values were assigned to

various events, or changes, that are

common in people’s lives.

• Holmes and Rahe concluded that the

higher the score on the social

readjustment rating scale, the

greater the susceptibility of the

individual to physical or

psychological illness.

Stress as a transaction between the individual and the environment

• Personal characteristics as well as

the nature of the environmental

event are considered.

(Lazarus&

Folkman,1984)

Precipitating event

A precipitating event is a stimulus arising from

the internal or external environment and is

perceived by the individual in a specific manner.

Determination that a particular

person/environment relationship is stressful

depends upon the cognitive appraisal of the

situation by the individual.

• Cognitive appraisal is the

individual’s evaluation of the personal

significance of the event or occurrence.

The event precipitates a response on the

part of individual, and the response is

impacted by the individual’s perception of

the event.

Predisposing factors

Types of precipitating factors

include genetic influences, past

experiences and existing conditions.

• Genetic influences are those circumstances

of an individual’s life that are acquired by

heredity. Examples include family history of

physical and psychological conditions and

the individual’s temperament.

• Past experiences are occurances that result

in learned patterns that can influence an

individual’s adaptation response.

• They include previous exposure to the

stressor, learned coping responses, and

degree of adaptation to previous experiences.

• Existing conditions incorporate vulnerabilities

that influence the adequacy of the individual’s

physical , psychological and social resources

for dealing with adaptive demands.

• Examples include current health status,

motivation, developmental maturity, severity

and duration of the stressor, financial and

educational resources, age, existing coping

strategies, and a support system of caring

others.

STRESS ADAPTATION MODELS

1. Stuarts Stress Adaptation Model

2. Transactional model of stress and

coping

3. Psychosomatic model

Stuarts Stress Adaptation Model

TRANSACTIONAL MODEL OF STRESS AND COPING

PRECIPITATING EVENTPREDISPOSING EVENT

COGNITIVE APPRAISAL

IRRELEVANT BENIGN POSITIVE STRESS APPRAISAL

NO RESPONSE PLEASURABLE RESPONSE

STRESS APPRAISAL

HARM THREAT CHALLENGE

SECONDARY RESPONSE

AVAILABILITY OF COPING STRATEGIES

PERCEIVED EFFECTIVENESS OF COPING STRATEGIES, PERCEIVED AVAILABILITY TO USE COPING STRATEGIES

EFFECTIVELY

QUALITY OF RESPONSE

ADAPTIVE MALADAPTIVE

PSYCHOSOMATIC MODEL

• Psychic phase: It is marked by mild, but

persistent psychological and behavioral

symptoms of stress like irritability, disturbed

sleep, anorexia etc.

• Psychosomatic phase: If stress condition

continues, these symptoms become more

pronounced along with beginning of

generalized physiological symptoms like

occasional hypertension, tremors etc.

• Somatic phase: It is marked by increased

function of organ. At this stage, one begins

to identify beginning of a disease stage.

• Organic phase: It is marked by full

involvement of a so called disease state

with physiological changes like ulcerated

stomach or chronic hypertension.

PSYCHOSOMATIC MODEL

CAUSES OF STRESS

• 1.Catastrophs

• 2.Major life changes

• 3.Daily hassles

CatastropheA catastrophe is a sudden, often

life-threatening calamity or disaster that pushes people to the outer limits of their coping capability.

Catastrophes include natural disasters—such as earthquakes, tornadoes, fires, floods, and hurricanes—as well as wars, torture, automobile accidents, violent physical attacks, and sexual assaults.

Catastrophes often continue to affect their victims’ mental health long after the event has ended.

Major life changes

The most stressful events

involve major life changes, such as

death of a spouse or family member,

divorce, imprisonment, losing one’s

job, and major personal disability or

illness.

Daily hassles• living in a noisy neighborhood• commuting to work in heavy traffic• disliking one’s fellow workers• worrying about owing money• waiting in a long line• misplacing • losing things.

When taken individually, these hassles may feel like only minor irritants, but cumulatively, over time, they can cause significant stress.

Symptoms of stress

• Feelings

• Behavior

• Physiology

Feelings

• The individual becomes anxious and is scared.

• The person feels that he has got something to loose or something wrong will take place.

• The person becomes irritable and moody.

• Individual develops a negative frame of mind and suffers from low self-esteem.

• The person loose faith in his capabilities and is afraid of the failures.

• Not able to concentrate and is involved in his own plans and thoughts.

PHYSIOLOGICAL AND BEHAVIORAL CHANGES

• Speech problems. • Impulsive Behavior • Crying for no apparent reason. • Laughing in a high pitch and nervous tone of

voice. • Grinding of teeth • Increasing smoking and use of drugs and

alcohol. • Being accident-prone • Perspiration /sweaty hands • Increased heart beat • Trembling • Nervous ticks

PHYSIOLOGICAL AND BEHAVIORAL CHANGES

• Dryness of throat and mouth. • Tiring easily • Urinating frequently • Sleeping problems • Diarrhea / indigestion / vomiting/ nausea • Butterflies in stomach • Headaches • Premenstrual tension • Pain in the neck and or lower back • Susceptibility to illness • Loss of appetite or over eating

EFFECTS OF STRESS

• Stress response

• Disease

• Decreased immune response

• Mental illness

STRESS MANAGEMENT

• Become aware of stressors and emotional

and physical reactions.

• Relaxation

• Meditation

• Interpersonal relation with caring other

• Problem solving

• Pets

STRESS MANAGEMENT

• Music

• Recognize what we can change

• Reduce the intensity of emotional reactions to

stress

• Learn to moderate physical reactions to stress

• Build physical reserves.

• Maintain emotional reserves

STRESS MANAGEMENT TECHNIQUES

1. Stress Diary - Finding Optimum Stress Levels

2. Psyching Up' - Raising Stress Levels to

Improve Performance

3. Anticipating Stress - Managing Stress by

Preparing For It

4. Get a hobby or two, relax and have fun: Talk

with friends or someone you can trust about

worries/problems.

STRESS MANAGEMENT TECHNIQUES

5.Other Techniques:

•   Meditation can also be a good effort to bring down the stress levels.

• Taking exercise • Effective time Management • Good Food and nutrition.

THE NURSING PROCESS FOR THE MANAGEMENT OF

STRESSASSESSMENT: Nursing History

Physical assessment

Assessment of the person

Assessment of the family

Assessment of the environment

NURSING

DIAGNOSIS

OUTCOME IDENTIFICATION AND PLANNING

• Decrease in the level of

anxiety

• Develop effective coping

skills

• Describe a reduction in

anxiety and an increase in

comfort.

IMPLEMENTATION• Non-Pharmacological methods

A TO Z OF STRESS MANAGEMENT

• Always take time for yourself, at least 30

minutes per day.

• Be aware of your own stress meter: Know

when to step back and cool down.

• Concentrate on controlling your own

situation, without controlling everybody else.

• Daily exercise will burn off the stress

chemicals.

A TO Z OF STRESS MANAGEMENT

• Eat lots of fresh fruit, veggies, bread and water; give your body the best for it to perform at its best.

• Forgive others, don't hold grudges and be tolerant -- not everyone is as capable as you.

• Gain perspective on things, how important is the issue?

• Hugs, kisses and laughter: Have fun and don't be afraid to share your feelings with others.

A TO Z OF STRESS MANAGEMENT

• Identify stressors and plan to deal with them better next time.

• Judge your own performance realistically; don't set goals out of your own reach.

• Keep a positive attitude, your outlook will influence outcomes and the way others treat you.

• Limit alcohol, drugs and other stimulants, they affect your perception and behavior.

A TO Z OF STRESS MANAGEMENT

• Manage money well, seek advice and save

at least 10 per cent of what you earn.

• No is a word you need to learn to use

without feeling guilty.

• Outdoor activities by you, or with friends

and family, can be a great way to relax.

• Play your favorite music rather than

watching television.

A TO Z OF STRESS MANAGEMENT

• Quit smoking.• Relationships.• Sleep well.• Treat yourself once a week with a

massage, dinner out, the movies.• Understand things from the other

person's point of view.• Verify information from the source

before exploding.

A TO Z OF STRESS MANAGEMENT

• Worry less.

• Xpress.

• Yearly goal setting.

• Zest for life.

Stress Management Strategies

Remove the Stressor

Withdraw from the Stressor

Change Stress Perceptions

Receive Social Support

Control Stress Consequences

Stress Management Strategies

Inverted-U Hypothesis:

Stress and Performance:

Who Wants to Get Rid of All the Stress in Your

Life?Only One Group of

People Have No Stress

The Key Word Is….Balance

DISCUSSION QUESTION

Self management of stress

Stress management strategies for you

• Take a Deep Breath

• Manage Time

• Connect with Others

• Talk it Out

• Take a “Minute” Vacation

• Monitor Your Physical comfort

• Get Physical

• Take Care of Your Body

• Laugh

• Know your limits

• Think Positively

• Develop a Sense of Life Meaning

•Compromise

•Have a Good Cry

•Avoid Self Medication

• Look for the “Pieces of Gold” Around you