Foundation week 2 stress and coping

stress

an actual or alleged hazard to balance of homestaiss

stressors

physical psychological or social stimuli that can produce stress and endanger homeostasis

appraisal

how a person interprets the impact of the stressor

how they view or deal with the impact of stress

scientific knowledge base nervous system

fight of flight result as arousal of sympathetic nervous system

neurophysiological response to stress

medulla oblongota : controls hr respiration blood pressure

reticular formation: monitor physiolgical status of the body sensory motor tracts

pituitary gland: produces cortisol works with parathyroid hormone

GAS general adaptation syndrome

extension of fight or flight

an immediate physiological response of the whole body to stress involves several body systems especially in autonomic nervous and endocrine systems and includes immunological changes

GAS three stage reaction to stress

alarm reaction: CNS arousal body defense system monetized

resistance stage: fuel fight or flight and this where the body stabilized does the opposite of the alarm system repairs itself

return to normal

if chronic allostasis occurs and is known as allostatic load which leads to chronic illness

exhaustion stage: continues stress cause breakdown compensatory mechanisms and homestais which result in disease

Alarm stage

CNS arousal body defense system monetized

e central nervous system is aroused, and body defenses are mobilized; this is the fight-or-flight response. During this stage rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine, heart rate, blood flow to muscles, oxygen intake, and mental alertness. In addition, the pupils of the eyes dilate to produce a greater visual field. If the stressor poses an extreme threat to life or remains for a long time, the person progresses to the second stage, resistance.

resistance stage:

fuel fight or flight and this where the body stabilized does the opposite of the alarm system repairs itself

return to normal

if chronic allostasis occurs and is known as allostatic load which leads to chronic illness

also contributes to the fight-or-flight response, and the body stabilizes and responds, attempting to compensate for the changes induced by the alarm stage (Huether et al., 2020). Hormone levels, heart rate, blood pressure, and cardiac output should return to normal, and the body tries to repair any damage that occurred. However, these compensation attempts consume energy and other bodily resources.

recovery dependent on this stage base don adpatation to stress and much more

exhaustion stage:

continues stress cause breakdown compensatory mechanisms and homestais which result in disease

This occurs when the body is no longer able to resist the effects of the stressor and has depleted the energy necessary to maintain adaptation. The physiological response has intensified, but the person’s ability to adapt to the stressor diminishes (Huether et al., 2020). Even in the face of chronic demands, an ongoing state of chronic activation can occur. This chronic arousal with the presence of powerful hormones causes excessive wear and tear on bodily organs and is called allostatic load. A persistent allostatic load can cause long-term physiological problems such as chronic hypertension, depression, sleep deprivation, chronic fatigue syndrome, and autoimmune

u cant adapt to stress is this phase

primal appraisal

• evaluating an event for its personal meaning

Appraisal of an event or circumstance is an ongoing perceptual process. Stress results when a person identifies an event or circumstance as a harm, loss, threat, or challenge

secondary appraisal

• focuses on possible coping strategies

Stress occurs if the demands placed on the person by the event exceed the ability to cope. Balancing factors contribute to restoring equilibrium. According to crisis theory, because feedback cues lead to reappraisals of the original perception, coping behaviors constantly change as individuals perceive new information. When coping behaviors are ineffective and repeated over and over, a state of stress can result. Stress emerges either when a person views an event as posing a significant risk of harm or when the person is unable to cope with the event’s demands.

coping

• the persons effort to manage psychological stress

The effectiveness of coping strategies is influenced by a variety of factors, such as a person’s age, cultural 808background, individual circumstances, and past use of coping strategies. Thus no single coping strategy works for everyone or for every stressor.

sense of personal control, support system competence can affect how u cope

ego defense mechanisms

regulate emotional distress and give a person protection from anxiety and stress

compensation , denial identofication ,regression and conversion ,displacemnt,dissociation

compensation

Making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset

(e.g., a person who is a poor communicator relies on organizational skills)

Conversion:

Unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms

(e.g., difficulty in sleeping, loss of appetite)

denail

Avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain

(e.g., a person refuses to discuss or acknowledge a personal loss)

Displacement:

Transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-producing substitute

(e.g., a person transfers anger over an interpersonal conflict to a malfunctioning computer)

Identification:

Patterning behavior after that of another person and assuming that person’s qualities, characteristics, and actions

Dissociation:

Experiencing a subjective sense of numbing and a reduced awareness of one’s surroundings

Regression:

Coping with a stressor through actions and behaviors associated with an earlier developmental period

types of stress

chronic

occurs in stable conditions and results from stressful roles

examples realtionships, fmaily , work

acute stress

time limited events that threaten a person for relatively brief period provoke acute stress

relatively brief time limited stress

posttraumatic stress disorder

begins when a person experiences witnesses or is confronted with a traumatic event

may include flashbacks=recurrent and intrusive recollections of the event

look into triggers as a nurse

we need to be able to recognizes respond to caregiver stress

types of crises developmental

occur as a person moves through the stages of life

situational stress

external sources such as job change motor vheicle crash death sever illness provoke situational crises

adventitious stress

a major or manmade disaster or crime of violence can create an adventitious crises

a person may advance or regress as the result of a crises depending on how he or she manages the crises

true

example of developmental stress

Starting school or entering adolescence

• Leaving home for college

• Getting married

• Becoming a parent

• Career progression or retirement

• Adjusting to aging changes

example of situational stress

Losing a job or being fired

• Sudden illness or injury (e.g., new cancer diagnosis, car accident)

• Divorce or relationship breakup

• Financial crisis

• Being a victim of a crime

• Unexpected death of a loved one

example of adventitious stress

• natural disasters (earthquake, wildfire, hurricane)

• Acts of violence (shootings, assault, domestic violence)

• Community disasters (terrorist attacks, mass casualty events)

• Large-scale accidents (train crash, building collapse)

Neuman systems model

approach to help understand the responses of p.t families and communities to stress

p.t fam or community are constantly changing in response to stress

talks about primary secondary teritiary interventions

Roys adaptation model

describes how individuals can effectively respond to stressors in the environment

RN can assist with modyfiyng or regulating peripheral stimuli

Pender’s health promotion model

focus on promoting health managing stress and increasing levels of wellbeing

why we need nursing theories and role of stress?

nurses develop interventions to prevent or reduce stress on p.t or to help them cope

stress on the rise and takes toll

APA

American psychological association

about 70 to 90 physician office are stress related

many adults suffer adverse health effects from stress

stress is linked to leading cause of death

Heart diseas

cancer

lung disease

accidents

cirrhosis of the liver

suicide

common stressors in older adults

-health related stressors examples being

pain mobility decline

chronic illness

-loss related stressor

example loss of a spouse

-role and social stressors

being dependent and losing independence or social isolation

-environmental stressors

relocating home to living faculty or navigating healthcare

Why Older Adults Are More Vulnerable to Stress

• decreased physiological reserves

Aging reduces the body’s ability to respond to stress (e.g., slower healing, weaker immune response).

• Multiple concurrent stressors

Older adults often face several losses at once.

• Changes in coping mechanisms

Long‑standing coping strategies may no longer work or may be harder to use.

• Cognitive changes

Memory or processing changes can make stress feel more overwhelming.

• Social support may shrink

Friends and family may move away or pass away.

effects of stress

weight gain/loss

headaches

elevated blood pressure

sleep disturbances

loss of concentration

decreased productivity

decreased creativity

impaired learning

decreased work performance and productivity

chronic stress can cause diabetes mental illness etc.

signs and symptoms of burnout

belly fat

depression

insomnia

nervousness

headaches

lack of interest etc.

factors influencing stress and coping

situational factors

for nurses and HCP ?

p.t?

maturational factors

what stage inof life p.t in

what stage are u in?

how will this affect coping stress

sociocultural factors

poverty

homelessness

cultural inconsistencies

can cause add to stress

compassion fatigue

state of burnout and secondary traumatic stress

can cause physical mental and emotional health issue

early recognition and supportive work environment can mitigate(tea for the soul program where u care for one another)

new grads more at risk

second victim syndrome

when medical error occurs that inflicts significant harm on p/t and the p.t family

u feel guilty and this can affect ur work

secondary traumatic stress

the stress that HCP experience witnessing other suffering

critical thinking

determine p.t persecution of the situation and ability to cope with the stress

personal experiences with stress and coping increase ur ability to empathize with p.t temporarily immobilized by stress

practice standards for psychiatric mental stress coping mechanisms and support systems

nursing porcess assesment

see through p.t eyes gather info including p.t perception

synthesize the information

apply critical thinking

environmental factors

subjective findings: p.t states i’m overwhelmed

objective findings: they are groomed

ask if the homicidal or suicidal

diagnosis

to diagnose for stress

look for ineffective coping

multiple diagnosis

anxiety

caregiver role

fear insomnia etc

planning

goals and outcome setting priorities for care

desirable outcomes: effective coping, family coping, caregiver emotional health, pschysoal adjustment

setting priorities

teamwork collaboration

implementation (doing part)

health promotion such as regular exercise, support systems etc

acute care crisis intervention

restorative and continuing care: long term impact of crisis

we look at what can we do

ADPIE

knowledge Base-assement

• Types of stress

• Basic stress response

• Factors influencing stress

• Physiological, emotional, behavioral risks

• Basic coping mechanisms

• Cultural influences

• Communication principles

• Effects of illness/disability on stressors, appraisal, response, lifestyle

2. Attitudes-implemntation

• Confidence that stress can be managed

• Fair, unbiased assessment

• Convey confidentiality of patient information

3. Standards-planning

• ANA Standards and Scope of Nursing Practice

• Clinical Practice Guidelines (e.g., ANA Psychiatric Mental Health Nursing Standards)

• Intellectual standards (e.g., significance to patient)

• Agency policies and procedures

• Professional standards of care and ethics

4. Experience-planning

• Caring for patients with stress from illness, lifestyle, family, or work

• Personal experience with stress

5. Environment -diagnosis

• Time pressure vs. time for support

• Communication with colleagues

• Interruptions during care

• Culturally effective communication