Self-Concept, Stress & Adaptation

Self-Knowledge

“Who am I?”

•This dimension reflects a person’s understanding of their own identity.

•Key Points

•It includes awareness of personal characteristics such as:

•Values

•Beliefs

•Personality traits

•Physical attributes

•Roles (e.g., parent, student, nurse)

•Self‑knowledge develops through life experiences, interactions with others, and internal reflection.

•A clear sense of self‑knowledge helps individuals make decisions that align with their identity.

•Why This Matters in Nursing

•Nurses should be aware of patients’ self‑knowledge because illness, hospitalization, or loss of independence can disrupt a person’s sense of who they are.

•Understanding this dimension helps nurses support patients experiencing identity changes (e.g., after amputation, stroke, or role changes).

Self-Expectation

“Who or what do I want to be?”

•This dimension relates to the ideal self: the goals, standards, and expectations a person sets for themselves.

•Key Points

•Influenced by:

•Personal goals

•Cultural expectations

•Family expectations

•Professional or social roles

•People often compare their real self with their ideal self.

•A large gap between the real self and ideal self can cause frustration, stress, or dissatisfaction.

•Nursing Connection

•During illness or major life changes, patients may feel they can no longer meet their own expectations.

•Nurses can help by:

•Encouraging realistic goals

•Reinforcing small achievements

•Supporting positive self-expectations

Self-Evaluation

“How well do I like myself?”

•Self‑evaluation is the emotional appraisal of one’s own worth. It includes self-esteem and feelings tied to how we perceive our successes or shortcomings.

•Key Points

•Patients use internal standards to judge how they measure up.

•This dimension is strongly influenced by:

•Life experiences

•Feedback from others

•Successes and failures

•Ability to meet personal expectations

•Clinical Relevance

•A patient’s self-esteem can affect:

•Motivation

•Communication

•Participation in care

•Recovery and coping

•Nurses should look for signs of low self‑evaluation, such as negative self-talk, withdrawal, or refusal to participate in care.

Self-Esteem

•Maslow described self‑esteem as the internal sense of worth that comes from personal accomplishments and confidence. Your slide lists several qualities belonging to this subset: strength, achievement, mastery, competence, confidence, independence, and freedom.

•Strength: Feeling capable of handling challenges.

•Achievement: Recognizing one’s own successes.

•Mastery & Competence: Belief in one’s skills or abilities.

•Confidence: Trusting yourself to manage life situations.

•Independence: Ability to make decisions and act on your own.

•Freedom: Feeling able to express yourself and choose your own path.

•Clinical Relevance:

•Illness, hospitalization, or dependence on others can disrupt self‑esteem.

•Nurses should promote activities and interactions that build confidence and reinforce what the patient can do.

•Even small accomplishments (walking to the bathroom, feeding themselves, learning a new skill) can improve this type of esteem.

Respect Needs (Esteem from Others)

•The second component involves how others view and treat the person. Your slide lists: status, dominance, recognition, attention, importance, and appreciation.

•Status: Being seen as a valued individual.

•Recognition: Receiving acknowledgment for contributions or efforts.

•Attention: Feeling noticed and heard.

•Importance: Believing that one matters to others.

•Appreciation: Being thanked or acknowledged.

•Dominance: Having influence or control in certain roles or situations.

•Clinical Relevance

•Hospital settings can unintentionally damage these needs:

•Loss of routine roles (parent, worker, caregiver).

•Wearing hospital gowns and having limited privacy.

•Feeling ignored or rushed by staff.

•Nurses help maintain respect needs by:

•Calling patients by their preferred name.

•Including them in decision-making.

•Acknowledging their feelings and past roles.

Practicing respectful touch and communication.

Significance

Significance is the feeling of being loved, cared for, accepted, and valued by others. It develops through relationships with family, friends, peers, and caregivers. When people feel significant, they tend to see themselves as worthy and important. In healthcare, significance can be threatened when patients feel isolated, ignored, or treated impersonally. Nurses can reinforce significance through respectful communication, appropriate touch, eye contact, active listening, and recognizing the patient as a unique individual.

Competence

Competence refers to the belief that one can successfully perform tasks or meet expectations. It is strengthened by past successes and reduced by repeated failures or losses of ability. Hospitalization may limit independence (e.g., needing help to walk or eat), which can lower perceived competence. Nurses should acknowledge patient efforts, encourage independence where safe, and structure tasks so the patient can experience small wins.

Virtue

Virtue relates to a person’s belief that they are acting in accordance with moral or ethical standards. When someone behaves in a way that aligns with their personal values, their sense of virtue increases. Conversely, if illness or circumstances force behavior that conflicts with personal values (e.g., relying on others, mood changes, inability to fulfill roles), self‑esteem can suffer. Encourage patients to express their values, validate their feelings, and help them reframe temporary limitations as part of healing rather than moral failure.

Power

Power involves the ability to influence one’s own life and environment—having control, autonomy, or authority. Loss of power is common in healthcare settings due to strict routines, dependency, and lack of privacy. Patients may feel powerless when they cannot make decisions or when others control their care. Support patient autonomy by offering choices, explaining procedures, asking preferences, and involving them in care planning whenever possible

Pride

•Pride strengthens self‑esteem.

Based on Positive Self‑Evaluation: Pride arises when a person evaluates themselves positively. It reflects satisfaction with one’s achievements, behaviors, or personal qualities. Pride reinforces self‑esteem, making people feel capable and accomplished. Recognizing and praising small successes can build a patient’s confidence and motivation.

In the healthcare environment, patients may feel pride when they:

•Meet a recovery milestone (e.g., walking further, managing pain).

•Learn a new skill (e.g., using an assistive device or self‑administering insulin).

Participate actively in their care.

Guilt

•Guilt can motivate positive change but may become harmful if persistent.

Based on Behaviors Incongruent With the Ideal Self: Guilt occurs when behavior does not match a person’s internal standards or expectations. People feel guilt when they believe they have “failed” or acted in a way that goes against their values or goals. Nurses can help by offering reassurance, normalizing the patient’s feelings, and reinforcing that temporary limitations do not reflect personal failure.

Common patient sources of guilt include:

•Feeling like a burden on family

•Not being able to fulfill usual roles (parent, employee, caregiver)

•Missing medications or not adhering to treatment

Shame

•Shame often leads to decreased self‑worth, avoidance, and poor coping.

•For nurses, recognizing these emotions helps guide communication, build rapport, and support the psychological well‑being of patients coping with illness or stress.

Associated With Low Global Self‑Worth: Shame is deeper and more damaging than guilt. While guilt is tied to specific actions, shame involves feeling like the whole self is unworthy, inadequate, or flawed. Create a supportive, nonjudgmental environment. Protect modesty, ask for consent before care, and emphasize the patient’s strengths.

•Shame can lead to:

•Withdrawal

•Avoidance of eye contact

•Refusal to participate in care

•Strong negative self‑talk

•Patients may experience shame when:

•Their bodies or abilities change significantly (e.g., after surgery, disability).

•They need assistance with personal care (toileting, bathing).

•They feel judged or misunderstood by others.

“Infant learns physical self different from environment.”

This is the earliest step in developing self‑concept. Infants begin to understand that their body is separate from objects and people around them. This awareness is based on sensory experiences—touch, movement, vision, physical comfort. A child who receives consistent, responsive care will learn that the world is safe and predictable. Illness or long-term hospitalization during infancy can affect attachment, sensory experiences, and the development of a secure sense of self.

“If basic needs are met, child has positive feelings of self.”

.” When caregivers meet basic physical and emotional needs, children learn that they are valued and worthy. This builds trust and forms the foundation for positive self-esteem. Children who grow up in unpredictable or neglectful environments may develop insecurity, low confidence, or difficulty trusting others.

Examples of basic needs:

•Food

•Comfort

•Safety

Emotional warmth

“Child internalizes other people’s attitudes toward self.”

Children learn who they are through the reactions and feedback they receive from others. Positive feedback builds confidence and a healthy self‑image. Negative or critical feedback can lead to doubt, shame, or negative self-perception. Patients who grew up with negative or invalidating feedback may struggle to believe in their own abilities or trust the healthcare team.

This is especially strong with:

•Parents and caregivers

•Teachers

•Friends/peers

“Child or adult internalizes standards of society.”

Over time, individuals adopt cultural, social, and moral standards as part of their identity. These expectations influence how a person evaluates themselves and their behavior. This internalization continues into adulthood as people adapt to new roles, environments, or social expectations.

Examples:

•Beauty standards

•Gender roles

•Cultural expectations about success or independence

•Social norms about illness or disability

•Nursing relevance:
Societal standards may make a patient feel:

•Embarrassed about needing help

•Ashamed of illness

•Guilty about not fulfilling roles (parent, employee, caregiver)

•Understanding these pressures helps nurses respond with empathy and support.

Self-awareness (infancy)

This stage begins very early in life. Infants start to realize that they exist as separate beings from others. Healthy attachment and responsive caregiving strengthen positive self‑awareness. Hospitalized infants or infants with inconsistent caregivers may have delayed or disrupted development of self‑awareness.

Self‑awareness grows through:

•Sensory experiences (touching their own hands/feet)

•Reactions from caregivers

Feeling their needs being met

Self‑Recognition (Around 18 Months)

Children begin to recognize themselves as distinct individuals. A common milestone is passing the mirror test, when the child recognizes their reflection as “me.” This is when children start to use words like “mine,” “me,” or “I.” Self-recognition supports self‑esteem and early autonomy (e.g., wanting to do things independently).

Toddlers at this stage understand:

•Their body

•Their actions

•Their preferences

Self‑Definition (Around 3 Years)

Imagination and pretend play also contribute to shaping self‑definition. Healthcare experiences can influence how children view their abilities and identity, especially if illness limits independence.

Children begin to describe themselves using concrete terms such as:

•“I am big.”

•“I am a girl/boy.”

•“I can run fast.”

They define themselves based on:

•Physical traits

•Abilities

•Possessions

•Simple social roles

Self‑Concept (Ages 6–7 Years)

By early school age, children begin forming a more complex and stable self‑concept. Hospitalization at this age may affect self-esteem, role performance, and confidence, especially if it interrupts school or peer interactions.

They understand:

•Personal strengths and weaknesses

•Emotional characteristics (e.g., “I’m shy,” “I’m helpful”)

•Comparisons with peers

Children at this age are strongly influenced by:

•Teachers

•Peers

•Academic success or struggle

Family expectations

Developmental Considerations

Self‑concept changes throughout the lifespan. Infants, children, adolescents, adults, and older adults all have different developmental tasks that influence how they see themselves.  Example: Teens often focus on peer approval and identity formation, while older adults may evaluate life accomplishments or losses. Disruptions in development (illness, trauma, developmental delays) can negatively affect self‑concept. Be aware of the expected developmental stage when assessing self‑concept—patients may react differently based on age and developmental needs.

Culture

Culture strongly influences beliefs, values, expectations, roles, and identity. Illness or hospitalization may conflict with cultural expectations, causing stress or changes in self‑concept. Use culturally sensitive communication, ask about cultural preferences, and avoid assumptions.

It affects:

•How individuals define success

•What traits they value

•How they view independence or dependence

Internal and External Resources

People with strong internal or external resources usually cope better with stress and maintain a more positive self‑concept. Assess what supports the patient already has and what resources they may be  lacking. Internal resources: resilience, problem‑solving skills, self‑efficacy, personal strengths. External resources: social support, financial stability, access to healthcare, stable housing.

History of Success and Failure

Past experiences greatly influence self‑esteem and self‑concept. Illness often forces temporary dependence, which some patients interpret as “failure.” Encourage small, achievable goals to promote ongoing success and rebuild confidence.

Consistent success builds confidence, while repeated failures or setbacks may lead to:

•Low self‑worth

•Fear of trying new tasks

•Negative self‑talk

Crisis or Life Stressors

Major stressors (loss, trauma, relationship changes, financial struggles) can disrupt self‑concept. People may question their roles, abilities, or sense of identity during crises. Stress can amplify negative self‑evaluation. Assess for recent stressors and help patients develop coping strategies or access support systems.

Aging, Illness, Disability, or Trauma

Changes in health, mobility, appearance, cognitive ability, or independence can significantly alter self‑concept. These changes are especially impactful when sudden (stroke, injury) or progressive (dementia). Support patient dignity, reinforce strengths, and acknowledge the emotional impact of health‑related changes.

Patients may experience:

•Loss of roles (worker, caregiver, independent adult)

•Body image changes

•Feelings of burden or inadequacy

Personal Identity

•Personal identity refers to the sense of “who I am” as a unique individual.
It includes:

•Name, gender identity, cultural identity

•Core values and beliefs

•Personality traits

•Life roles (e.g., parent, worker, caregiver)

Why this matters:
Illness or major life changes can threaten identity. For example: A stroke survivor may no longer feel like the “same person.” Someone losing independence may question their role in the family.

Nurses assess for statements like:

•“I don’t know who I am anymore.”

•“I don’t feel like myself.”

Personal Strengths

This refers to the qualities, skills, and internal resources that help a patient cope and function effectively.

Examples include:

•Problem‑solving skills

•Perseverance

•Emotional resilience

•Communication skills

•Support networks

Why this matters: Patients who can identify their strengths often cope better with illness.

Nurses can ask questions such as:

•“What helped you get through difficult times in the past?”

•“What do you feel you do well?”

Body Image

Body image is the mental picture a person has of their physical self and how they believe others perceive them.

Body image may be affected by:

•Surgery (e.g., mastectomy, amputation)

•Weight changes

•Skin changes (rashes, burns, lesions)

•Mobility limitations

•Aging

Signs of altered body image:

•Avoiding mirrors

•Expressing disgust or embarrassment about appearance

•Refusal of care involving exposed body areas

Nurses should approach these patients with sensitivity and protect dignity.

Self‑Esteem

Self‑esteem reflects how much a person likes or values themselves.

It is influenced by:

•Personal achievements

•Feedback from others

•Ability to meet expectations

•Life experiences

Low self‑esteem can lead to:

•Withdrawal

•Negative self‑talk

•Lack of motivation

•Poor adherence to treatment

Nurses should listen for statements like:

•“I can’t do anything right.”

•“I’m a burden.”

Role Performance

Role performance refers to how well a person believes they fulfill the roles expected of them (worker, parent, spouse, student, caregiver).

Illness often disrupts these roles:

•A hospitalized parent may feel guilty about not caring for children.

•A patient on bed rest may struggle with not being able to work.

•A new disability may prevent someone from fulfilling previously important roles.

Why this matters:
Role changes can trigger stress, anxiety, guilt, or loss of purpose.

Nursing assessment questions include:

•“How has your illness affected your responsibilities at home or work?”

•“Do you feel you can still meet the expectations placed on you?”

Socialization and Communication

This refers to how individuals interact with others and how comfortable they are in social situations. Does the patient initiate conversations? Do they avoid eye contact or withdraw from interactions? Do they respond appropriately and confidently? Healthy communication often reflects confidence and comfort with oneself. Patients with low self‑esteem may: Isolate themselves, Speak negatively about themselves, Avoid asking questions or expressing needs. Nurses can support patients by encouraging interaction, using open‑ended questions, and creating a safe environment for communication.

Encourage Patients to Identify Their Strengths

Many patients focus on their limitations, especially during illness. Asking them to name qualities or abilities they are proud of helps shift focus toward the positive. Use open‑ended prompts such as: “What qualities have helped you get through hard times before?” or “What is something you feel you do well?”

Examples of strengths:

•Good problem‑solving

•Persistence

•Caring for others

•Past achievements

Ability to adapt

Replace Self‑Negation With Positive Thinking

Patients often use negative self‑talk like “I can’t do anything right” or “I’m a burden.” Nurses can help reframe these thoughts by gently challenging distortions and encouraging realistic, balanced thinking. If a patient says, “I’m useless now,” a nurse might respond: “You’re facing a tough situation, but you’re working hard and making progress. Let’s focus on what you can do today.” This promotes healthier internal dialogue and a more positive self‑view.

Notice and Reinforce Patient Strengths

Reinforcement strengthens self‑esteem. When nurses praise effort, courage, or improvement, patients begin to internalize these strengths. Even small successes should be acknowledged because they build momentum and confidence.

Encourage Patients to Will for Themselves

This means helping patients take ownership of their goals and make choices that support their recovery. Encouraging autonomy strengthens confidence and a sense of control. This improves both self‑esteem and overall motivation.

Nursing examples:

•Asking patients to choose the order of their morning care

•Encouraging them to set daily goals

•Supporting them in participating in decision‑making

Help Patients Cope With Necessary Dependency

Illness often forces people to rely on others, which can feel embarrassing or discouraging. Patients may feel guilt, frustration, or shame about needing help. Normalize dependency as a temporary part of recovery (“Everyone needs help sometimes, especially during healing.”) Emphasize strengths even during dependent tasks. Encourage gradual independence as safe and appropriate. Helping patients accept necessary assistance while still recognizing their value protects their self‑esteem.

Helping Patients Maintain Sense of Self

uCommunicate worth with looks, speech, and judicious touch.

uAcknowledge patient status, role, and individuality.

uSpeak to the patient respectfully. Address by preferred name

uConverse with the patient about their life experiences

uOffer simple explanations for procedures.

uMove the patient’s body respectfully, if necessary.

uRespect the patient’s privacy and sensibilities.

uAcknowledge and allow expression of negative feelings.

Help the patient recognize strengths and explore alternatives.

Chemical Agents

Chemical agents can damage cells or disrupt normal body functioning. Exposure to harmful chemicals may cause respiratory distress, organ dysfunction, or metabolic changes. Monitoring and rapid intervention are critical.
Examples include:

•Toxins

•Poisons

•Drugs (overdose or adverse reactions)

•Acid/base imbalances

Physical Agents

These are environmental or mechanical forces that physically harm the body. Physical agents often trigger a local adaptation response (e.g., inflammation, pain). Nurses must assess for injury and protect patients from further harm.

Examples include:

•Excessive heat or cold

•Radiation

•Mechanical trauma (falls, blunt force)

•Noise

Infectious Agents

Microorganisms that invade and multiply in the body are significant physiologic stressors. Infections activate inflammatory and immune responses. Early detection—fever, redness, swelling, increased WBC count—guides treatment and prevents complications.

Examples:

•Bacteria

•Viruses

•Fungi

•Parasites

Nutritional Imbalances

Both excesses and deficiencies create stress in the body. Poor nutrition affects wound healing, immunity, energy levels, and metabolic stability. Nurses must assess dietary intake, hydration status, and lab values.
Examples:

•Malnutrition

•Dehydration

•Electrolyte disturbances

Obesity

Hypoxia

Hypoxia is lack of adequate oxygen at the tissue level and is one of the most severe physiologic stressors.

•Causes include:

•Respiratory illness

•Cardiac dysfunction

•Anemia

•Airway obstruction

•Nursing relevance:

•Hypoxia immediately threatens life and requires rapid assessment:

•Respiratory rate

•Oxygen saturation

•Level of consciousness

•Cyanosis

Early intervention (oxygen therapy, airway support) is essential.

Genetic or Immune Disorders

These disorders disrupt normal body development or immune regulation. Patients may have chronic inflammation, poor healing, recurrent infections, or organ dysfunction. Nurses provide ongoing monitoring, education, and support.
Examples:

•Autoimmune diseases

•Immunodeficiency

•Genetic syndromes

•Inherited metabolic disorders

Psychosocial Stressors

uAccidents

uStressful or traumatic experiences of family members and friends

uHorrors of history

uFear of aggression or mutilation

uEvents of history that are brought into our homes through television and the internet

uRapid changes in the world

uInherent stressors, social isolation, political divides, and change in work life separation brought on by the pandemic

Local Adaptation Syndrome (LAS)

LAS involves only one specific body part—a localized response to stress. It is a short‑term, homeostatic adjustment. Two major types are included on the next slide, but Slide 15 names them:

Components of LAS

•Reflex Pain Response

•An automatic, protective response of the nervous system.

•Occurs when a body part encounters a harmful stimulus (e.g., touching a hot stove).

•Designed to protect from further injury.

•Inflammatory Response

•A local response to injury or infection.

•Signs include redness, heat, swelling, pain, and loss of function.

•Helps isolate and repair damaged tissue.

Why LAS matters for nursing:

•LAS is often the first seen sign of a physiologic problem (injury, infection).

•Recognizing LAS helps nurses intervene early and prevent systemic stress responses.

LAS

1.Localized Response of the Body to Stress: LAS occurs only in the affected area, not throughout the entire body. This makes it different from the General Adaptation Syndrome (GAS), which involves a full‑body stress response. A cut on the finger triggers redness and swelling only in that location.

2.Involves One Specific Body Part (Tissue or Organ): The stressor affects a single, defined area such as skin, muscle, a joint, or a localized infection. The response stays “local” unless the problem becomes more severe or spreads.

3.Stress Precipitating LAS May Be Traumatic or Pathologic: Traumatic stressors: burns, cuts, sprains, blunt trauma. Pathologic stressors: infections, allergens, toxins. Both types trigger the same underlying adaptive reactions.

4.Primarily a Homeostatic, Short‑Term Adaptive Response: LAS helps restore balance (homeostasis) at the site of the stress. The body attempts to isolate the problem and initiate healing. These responses happen quickly and usually resolve once the stressor is removed.

Two Types of LAS

The slide lists the two main LAS responses, which are expanded further in your slide deck:

1. Reflex Pain Response: An automatic, protective nervous‑system response. Designed to move the body away from a harmful stimulus (e.g., touching something hot).

2. Inflammatory Response: Occurs when tissue is injured or infected. Classic signs: redness, heat, swelling, pain, and loss of function.

Why LAS Matters in Nursing: LAS is often the first sign of physical stress or injury.

Nurses must recognize early LAS symptoms to:

•Prevent further tissue damage

•Assess for infection

•Intervene before the stress becomes systemic (progressing to GAS)

Examples include assessing wound inflammation, responding to pain reflexes, and monitoring localized infections.

Student-Friendly Summary

•LAS is the body’s localized, short-term response to stress.

•It affects one area → not the whole body.

•It can result from trauma or disease.

•It includes pain reflexes and inflammation.

•It aims to restore balance and begin healing.

•Understanding LAS helps nurses identify early signs of physical stress and intervene appropriately.

General Adaptation Syndrome (GAS)

GAS is the biochemical model of stress developed by Hans Selye (1976).
It involves the whole body, not just one area. The slide lists its three stages:

•Alarm Reaction

•Stage of Resistance

•Stage of Exhaustion

These stages appear on subsequent slides, but Slide 15 introduces them as the framework of GAS.

GAS 1: Alarm Reaction

uPerson perceives stressor, defense mechanisms activated

uFight-or-flight response

uHormone levels rise, body prepares to react

uShock and counter-shock phases

The Alarm Reaction is the body’s immediate response to stress.

The stressor is detected.

Defense systems activate.

Fight‑or‑flight kicks in.

Hormones surge to prepare the body for action.

It is fast, automatic, and protective—but cannot be sustained long term.

GAS 2: Stage of Resistance

uBody attempts to adapt to stressor

uVital signs, hormone levels, and energy production return to normal

uBody regains homeostasis or adaptive mechanisms fail

•The Stage of Resistance is the body’s effort to stabilize, adapt, and cope with an ongoing stressor.

•Body systems attempt to return to normal.

•Energy is being used to maintain balance.

•Adaptation may succeed or fail.

•Success leads to recovery; failure leads to exhaustion.

GAS 3: Stage of Exhaustion

This stage occurs when the body’s adaptive mechanisms can no longer cope with the ongoing stressor. This is the point where the body’s resources have been depleted and homeostasis cannot be maintained.

uResults when adaptive mechanisms are exhausted

uBody either rests and mobilizes its defenses to return to normal or dies

•The Stage of Exhaustion happens when the body has no energy or resources left to fight the stressor.

•Coping mechanisms fail.

•Homeostasis collapses.

•The patient may recover with rest and support — or deteriorate and risk death.

•Understanding this stage helps nurses identify severe stress overload and step in before physiological collapse occurs.

Psychological Homeostasis

uMind–body interaction

uAnxiety

uCoping mechanisms

uDefense mechanisms

Psychological homeostasis is the mind’s way of maintaining emotional balance during stress.
It depends on:

•The connection between mind and body

•Levels of anxiety

•Conscious coping strategies

•Unconscious defense mechanisms

Understanding this helps nurses better assess patients’ emotional needs and support them through stressful experiences.

Coping Mechanisms

uCrying, laughing, sleeping, cursing

uPhysical activity, exercise

uTaking a deep breath, mindfulness exercises

uSmoking, drinking

uLack of eye contact, withdrawal

uLimiting relationships to those with similar values and interests

Task-Oriented Reactions to Stress

Task‑oriented reactions are direct responses to stress, including:

•Attack behavior: confronting the stressor (can be assertive or aggressive)

•Withdrawal behavior: avoiding or retreating from the stressor

•Compromise behavior: negotiating and adapting to find workable solutions

Recognizing these patterns helps nurses provide tailored support and guide patients toward healthier coping strategies.

Defense Mechanisms

uCompensation

uDenial

uDisplacement

uDissociation

uIntrojection

uProjection

uRationalization

uReaction formation

uRegression

uRepression

uSublimation

Undoing

Effects of Stress

uStress and basic human needs

uStress in health and illness

uLong term stress

uFamily stress

uCrisis

Family Stressors

uChanges in family structure and roles

uAnger and feelings of helplessness and guilt

uLoss of control over normal routines

uConcern for future financial stability

Factors Affecting Stress and Adaptation

uSources of stress

uTypes of stressors experienced

uPersonal factors

Stress and adaptation are shaped by:

•Where the stress comes from

•What type of stressor is present

•Personal traits and experiences

Nurses must assess all three to develop supportive, individualized care plans that help patients cope more effectively.

Source of Stress

uDevelopmental stress: occurs when person progresses through stages of growth and development

uSituational stress: does not occur in predictable patterns

uE.g. illness or traumatic injury, marriage or divorce, loss, new job, role change

People experience stress from two main sources:

•Developmental stress: predictable changes throughout the lifespan

•Situational stress: unexpected events that disrupt normal life

Nurses must identify both types to understand how patients are responding to stress and to support healthy adaptation.

Stressful Activities in Nursing Profession

uAssuming responsibilities for which one is not prepared

uWorking with unqualified personnel

uWorking in an environment in which supervisors are not supportive

uCaring for a patient in cardiac arrest or a dying person

uExperiencing conflict with peers

uCaring for a patient who is disengaged, nonadherent

uBeing unable to take a correct, right, or ethical course of action

Activities of Daily Living (ADLs)

uExercise

uRest and sleep

uNutrition

uUse of support systems

uUse of stress management techniques

Stress Management Techniques

uRelaxation

uMindfulness

uAnticipatory guidance

uGuided imagery

uCrisis intervention

Crisis Intervention

uStabilization

uAcknowledgment

uFacilitation of understanding

uEncourage effective coping

uRecovery

uReferral

Evaluating the Care Plan

uThe patient verbalizes the causes and effects of stress and anxiety.

uThe patient identifies and uses sources of support.

uThe patient uses problem solving to find a solution to stressors.

uThe patient practices healthy lifestyle habits and anxiety-reducing techniques.

uThe patient verbalizes a decrease in anxiety and increase in comfort.