Basic Nursing: Foundations of Skills & Concepts Chapter 16

1. Basic Nursing: Foundations of Skills & Concepts Chapter 16 STRESS, ADAPTATION AND ANXIETY

2. Stress is... • A nonspecific response to any demand made on the body. • Such demands are called stressors.

3. Stress Management • Successful stress management is necessary for wellness of both clients and nurses.

4. 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.

5. Homeostasis • The balance or equilibrium among the physiologic, psychological, sociocultural, intellectual, and spiritual needs of the body. • Stress is an assault on the homeostasis.

6. 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)

7. 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.

8. 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”

9. 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

10. Outcomes of Stress • Eustress - a type of stress that results in a positive outcome. • Distress - when stressors evoke an ineffective response.

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

12. Coping Measures • The ways an individual may react to stress. • One coping measure is conditioning, behavior that becomes an automatic response.

13. 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.

14. 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:

15. 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.

16. 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.

17. 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.

18. Symptoms of Anxiety Rapid pulse Profuse Sweating Selected focus of attention Increased blood pressure Severe Anxiety Tense muscles Dry mouth Rigid posture Shallow, rapid respiration Tremors Shivering Interrupted speech

19. 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.

20. 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.

21. 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.

22. 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:

23. 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?

24. 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 Nursing diagnoses that may occur in Response to stressors include:

25. 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.

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

27. Important Stress-Management Techniques • Exercise • Relaxation techniques (e.g. progressive muscle relaxation, guided imagery, meditation, hypnosis) • Cognitive Reframing or Thought Stopping

28. Crisis Intervention • A specific technique used to help clients regain equilibrium.

29. The Five Steps of Crisis Intervention • Identification of the Problem • Identification of the Alternatives • Selection of an Alternative • Implementation • Evaluation

30. Stress & Nurses: Burnout • Burnout is a state of physical and emotional exhaustion that occurs when caregivers deplete their adaptive energy.

31. Factors Leading to Burnout • Job-related stress. • Heavy workload. • Interpersonal conflict in the work environment. • Organizational barriers to autonomous decision making.

32. 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.

33. 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.