Chapter 23

1. Chapter 23 Stress, Anxiety, Adaptation, and Change

2. Stress, Anxiety, and Adaptation • Stress • Body’s physiological reaction to any stimulus that evokes change • Anxiety • Subjective response • Occurs during threat to well-being • Pervasive feeling of dread (continued)

3. Stress, Anxiety, and Adaptation • Adaptation • Process to adjust to stressors • Sources of Stress • Physiological • Psychological • Cognitive • Environmental • Sociocultural

4. Responses to Stress • Physiological Responses to Stress • General adaptation syndrome (GAS) • Alarm • Resistance • Exhaustion • Local adaptation syndrome (LAS) (continued)

5. Responses to Stress • Manifestations of Stress • Physiological • Psychological • Cognitive • Behavioral • Spiritual (continued)

6. Responses to Stress • Outcomes of Stress • Opportunity for personal growth • Eustress • Risk of disorganization • Distress

7. Crisis • Acute state of disorganization • Can be negative experience • Has potential to be opportunity for growth • Outcome unique according to individual’s perception and coping abilities (continued)

8. Crisis • Characteristics: • Sudden event • Identifiable precipitating event • Perceived as overwhelming • Unresolved with usual coping skills • Intervention required (continued)

9. Crisis • Balancing factors: • Perception • Coping mechanism • Situational support (continued)

10. Crisis • Types: • Developmental or maturational • Situational • Adventitious

11. Anxiety • Coping behaviors: • Can result in successful adaptation to stress • Frequently used coping behaviors: • Talking • Crying • Laughing • Exercising (continued)

12. Anxiety • Defense mechanisms: • Unconscious operations • Protect mind from anxiety

13. Stress and Illness • Interwoven concepts • If stressed and adaptive attempts unsuccessful, illness occurs • If ill, fewer adaptive resources available to cope with stressors

14. Impact of Illness and Treatment • Hospitalization • Increased stress response • Higher levels of anxiety • Increased or impaired use of coping mechanisms • Inability to function • Disorganized behavior (continued)

15. Impact of Illness and Treatment • Depersonalization • Treating individual as object • Dehumanizing • Avoid by reducing client’s feelings of unfamiliarity and loss of control

16. Stress and Change • Types of change: • Developmental • Reactive • Covert • Overt (continued)

17. Stress and Change • Theories of change: • Lewin • Lippitt • Resistance to change • Conformity • Dissimilar beliefs • Habits (continued)

18. Stress and Change • Resistance to change • Satisfied with status quo • Secondary gains • Threats to basic needs • Fear • Unrealistic goals (continued)

19. Stress and Change • Changing paradigms • Paradigm • Pattern, model, or mind-set that influences decisions and behaviors (continued)

20. Stress and Change • Changing paradigms • Overcoming barriers to change • Flexibility • Adaptability • Resilience (continued)

21. Stress and Change • Nurse as change agent • Intentionally initiates and creates change • Constantly seeks ways to make improvements • Empowers client to initiate change to adapt more successfully

22. Stress, Anxiety, Adaptation, Change and the Nursing Process • Assessment • Patterns of stressors • Typical responses to stressful situations • Cause-and-effect relationships between stressors and thoughts, feelings, and behaviors • Past history of successful coping mechanisms (continued)

23. Stress, Anxiety, Adaptation, Change and the Nursing Process • Diagnosis • Anxiety • Ineffective coping • Ineffective denial • Powerlessness • Impaired adjustment • Ineffective role performance (continued)

24. Stress, Anxiety, Adaptation, Change and the Nursing Process • Diagnosis • Disturbed thought processes • Ineffective coping • Fear • Post-trauma syndrome • Impaired social interaction • Spiritual distress (continued)

25. Stress, Anxiety, Adaptation, Change and the Nursing Process • Outcome identification and planning • Client involvement • Self-responsibility issues (continued)

26. Stress, Anxiety, Adaptation, Change and the Nursing Process • Implementation • Meeting of basic needs • Environmental strategies • Verbalization • Involvement of family and significant others (continued)

27. Stress, Anxiety, Adaptation, Change and the Nursing Process • Implementation • Stress management techniques: • Exercise • Relaxation techniques • Progressive muscle relaxation • Guided imagery • Cognitive reframing and thought stopping • Crisis intervention (continued)

28. Stress, Anxiety, Adaptation, Change and the Nursing Process • Evaluation • Ongoing, comprehensive process • Requires verbal input from client and significant others • Observation of client behavior

29. Personal Stress Management Approaches for the Nurse • Nursing burnout • Physical and emotional exhaustion • Prevention and recovery depend on stress management • Stress management plan • Continuous process • Rather than occasional use of technique (continued)

30. Personal Stress Management Approaches for the Nurse • Stress hardiness • Commitment • Challenge • Control (continued)

31. Personal Stress Management Approaches for the Nurse • Caring for self • Taking time out for self • Using effective communication skills with co-workers, family, and significant others • Managing conflict effectively

32. Strategies for Coping with Professional Stress • Time management • Focus on accomplishments • Slow, focused breathing • Avoidance of assuming personal responsibility for others’ problems • Knowledge of own limits (continued)

33. Strategies for Coping with Professional Stress • Distancing of self from stressors that have negative impact • If possible • Identification and changing of stressors that can be influenced directly • Variation of tasks between physical and mental activities