Stress, anxiety, & Coping Therapeutic communication, and ISBAR

What is stress?

An actual or perceived threat to homeostasis caused by external circumstances.

What are common external stressors?

Finances, job deadlines, exams, and other situational pressures.

Does stress go away once the situation is resolved?

A: Yes — stress typically resolves when the external stressor is removed.

Can stress be positive or negative?

A: Yes — it can motivate (positive) or impair functioning (negative).

What is anxiety?

Persistent, excessive worry that continues even without a stressor.

What type of triggers are associated with anxiety?

Internal triggers (e.g., “I’m not good enough,” “I’m going to fail”).

Can anxiety interfere with daily functioning?

Yes — anxiety can significantly impact how a person lives

What is the General Adaptation Syndrome (GAS)?

The body’s stepwise, predictable response to stress.

What happens in Stage 1 of GAS ?

(Alarm Reaction) The sympathetic nervous system activates the fight‑or‑flight response.

What happens in Stage 2 of GAS?

(Resistance) The body adaptation to stress with sustained release of cortisol and epinephrine.

What happens in Stage 3 of GAS?

(Exhaustion)The body’s resources are depleted, and it can no longer cope with prolonged stress

What are acute emotional symptoms of stress during the Alarm stage?

• Lack of concentration,

• memory lapses,

• difficulty making decisions,

• confusion,

• disorientation,

• panic attacks,

• irritability,

• tearfulness,

• rage.

What are acute physical symptoms of stress during the Alarm stage?

• Increased heart rate/palpitations,

• increased respirations,

• vasodilation to arms/legs,

• increased serum glucose,

• increased blood coagulation,

• increased muscular strength,

• decreased gastric movement,

• antidiuresis,

• increased perspiration.

Why does the body increase glucose, clotting, and muscular strength during acute stress?

To prepare for the fight‑or‑flight response

What happens to gastric movement during acute stress?

It decreases.

What happens to urine production during acute stress?

It decreases (antidiuresis).

What are chronic symptoms of long‑term stress?

• Sleep changes,

• fatigue,

• digestion changes,

• loss of sexual drive,

• headaches

• , aches/pains,

• infections,

• indigestion,

• rashes/hives

• , autoimmune diseases,

• hypertension,

• depression,

• anxiety/hypochondria.

Why do chronic stress symptoms differ from acute stress symptoms?

Chronic stress depletes the body’s resources and disrupts long‑term physiological balance.

What are common maladaptive responses to stress?

• Nail biting,

• restlessness,

• fidgeting

• , alcohol/drug

• abuse,

• poor hygiene,

• social withdrawal.

What mental health disorders can develop from chronic stress?

Eating disorders, obsessive‑compulsive disorder, hypochondria, anxiety disorders.

What is the difference between acute and chronic stress responses?

Acute stress triggers immediate emotional and physical reactions; chronic stress leads to long‑term physiological and psychological deterioration.

What are adaptive (healthy) coping responses to anxiety?

• Crying,

• talking,

• therapy,

• sleep

• , exercise

• , deep breathing,

• relaxation

• , problem solving,

• music,

• prayer,

• social connection.

why must nurses teach coping skills to patients?

to help patients manage anxiety in healthy, effective ways.

How is anxiety defined?

persistent worry that continues after the stressor has passed

What are symptoms of mild anxiety?

Irritability, restlessness, insomnia.

What is the nurse’s response to mild anxiety?

Encourage coping skills and make minimal adjustments to the plan of care, addressing the patient’s most immediate concerns first

What are symptoms of moderate anxiety?

Increased physiological activity, increased psychomotor activity, headaches, stomach aches, palpitations, narrowed but present focus

What is the nurse’s response to moderate anxiety?

Address the anxiety first, ask further questions about causes, and continue with the plan of care

What are symptoms of severe anxiety?

• Hyperactivity

• , panic

• , possible paralysis or freezing,

• possible loss of consciousness

• , complete lack of focus

• , major disruption of functioning (work, school, home)

What is the nurse’s response to severe anxiety?

• Provide a safe environment, acknowledge anxious thoughts (“I can see that you are upset. I am here to listen.”),

• focus on reducing physical symptoms,

• administer medication as needed

• postpone teaching until anxiety decreases.

At which anxiety level should teaching be postponed?

Severe anxiety.

At which anxiety level does the patient still have a narrowed but present focus?

Moderate anxiety.

At which anxiety level may the patient freeze or lose consciousness?

: Severe anxiety.

What is compensation as a defense mechanism?

Making up for a deficiency in one area by emphasizing a strength in another

Example of compensation?

A poor communicator relies heavily on organizational skills

What is conversion?

Transforming emotional conflict into non‑organic physical symptoms

Examples of conversion symptoms?

Difficulty sleeping, loss of appetite

What is denial?

Refusing to acknowledge painful or distressing realities

Example of denial?

A person refuses to discuss or acknowledge a personal loss

What is displacement?

Transferring emotions from a stressful situation to a safer substitute

Example of displacement?

Example of displacement?
A: Taking anger from an interpersonal conflict out on a malfunctioning computer

What is dissociation?

A sense of numbing and reduced awareness of surroundings.

What is regression?

Reverting to behaviors from an earlier developmental stage when stressed.

What is repression?

Unconsciously pushing distressing thoughts into the subconscious; short‑term relief but harmful long‑term.

What is Rule #1 when responding to a stressed or anxious patient?

Keep yourself safe.

What are key safety actions when a patient is anxious or escalating?

Stay between the patient and the exit; keep the door open.

What communication approach should the nurse use with anxious patients?

therapeutic communication that conveys caring and separates the patient from their anxious thoughts.

Example of separating the patient from their anxious thoughts?

“That’s your worried thoughts talking. Let’s separate from that thought. What do you know is true about your diagnosis?”

What coping skills can the nurse encourage?

• Music,

• positive self‑talk,

• deep breathing,

• walking, humor (e.g., funny TikToks).

What environmental modifications can help reduce anxiety?

Quiet environment, dim lights, reducing stimuli.

What supportive resources may help anxious patients?

Spiritual support (chaplain), social support, therapy, medications

What is secondary traumatic stress?

Trauma experienced from witnessing others’ suffering

Who is most at risk for secondary traumatic stress?

Healthcare workers and first responders.

What are symptoms of secondary traumatic stress

Intrusive thoughts, nightmares, anxiety, avoidance, difficulty sleeping, trouble relating to others.

What negative coping behaviors may occur with secondary traumatic stress?

• Lateral violence,

• emotional neglect of loved ones,

• addiction (alcohol, drugs, gambling, overspending).

What is the most important step in treating secondary traumatic stress?

Recognition.

How can peers help someone experiencing secondary traumatic stress?

Talk to them when you notice symptoms; share your own experiences to help them feel seen.

What self‑care strategies help prevent or reduce secondary traumatic stress?

• limiting overtime,

• \attending debriefings

• , transferring to lower‑trauma units,

• regular exercise,

• maintaining sleep‑wake cycles.

Where does therapeutic communication develop?

In a healthcare setting.

What is the focus of therapeutic communication?

The patient and their health‑related goals.

What type of boundaries exist in therapeutic communication?

Distinct, professional boundaries with a clear start and end.

Are therapeutic communication interactions confidential?

yes

What are topics in therapeutic communication oriented toward?

Patient goals and objectives in care

Where does social communication develop?

In many settings (work, school, friendships, family, etc.).

What is the focus of social communication?

Both parties equally (in healthy relationships).

How clear are boundaries in social communication?

: Much less clear than in therapeutic communication

Is social communication ongoing and mutual?

Yes — both parties share intimately and continuously.

What is the purpose of therapeutic communication?

To promote personal growth and help patients reach health‑related outcomes.

What does therapeutic communication encourage patients to do?

Think, talk about their health situation, and express their feelings.

What are the three phases of therapeutic communication?

Orientation, Working, Termination.

What begins the orientation phase?

Eye contact, warmth, rapport building, and setting boundaries.

What does the nurse do during the orientation phase?

Introduces self and explains the purpose of the relationship.

Example of an orientation‑phase introduction?

“Hello, my name is Morgan and I am your nurse for the next 12 hours.”

When should boundaries be verbally stated?

When working with difficult patients and always with children

What happens during the working phase?

Setting SMART goals, patient self‑expression, and taking action toward goals.

What happens during the termination phase?

Evaluation of goals and clear closure of the therapeutic relationship.

Example of a termination‑phase statement?

“Mr. Smith, I have enjoyed taking care of you today. I am leaving for the evening. Monroe will be your night nurse.”

Active listening ? (surety)

being attentive to what a patient is saying both verbally and and nonverbally.

S = sit an angle facing the patient

U = uncross legs and arms

R = relax

E = eye contact

T = touch

Y = your intuition

sharing observations ?

gently telling the patient what you notice about their behavior, appearance or mood to help them feel seen and supported.

• “you seem a little quite today”

• “i noticed you haven’t eaten you breakfast”

What is the #1 strategy for developing rapport with a patient?

Ask about something they’re interested in based on cues around them.

Examples of environmental cues you can use to build rapport?

TV shows/sports, tattoos, band shirts/music, shoes, books, hobbies.

What should you do if you see no cues to start rapport?

Ask open questions like “Tell me about yourself” or “What are your hobbies?”

What can interfere with accurate perception and communication?

Perceptual biases and stereotypes

What must nurses do to provide good therapeutic communication?

Evaluate and actively correct their own biases

How can nurses work on reducing bias?

listen to different viewpoints, reflect on upbringing, and learn about diverse cultures, religions, genders, and socioeconomic backgrounds.

What does “pacing” refer to?

How fast or slow you speak and allowing pauses for responses.

What is “intonation”?

The pitch or tone of your voice (high, low).

What is the typical personal‑space distance for patient interactions?

18–40 inches, adjusted as needed during the exam.

What is “sharing empathy”?

Accurately perceiving a patient’s feelings and communicating understanding

When is humor appropriate in therapeutic communication?

Only with patients you know well; avoid dark humor unless assessing for unprocessed grief.

When can confrontation be used?

Only with well‑established trust to point out inconsistencies in statements or behaviors.

: What is the purpose of sharing feelings with a patient?

To encourage self‑expression and help them acknowledge emotions.

Why is silence therapeutic?

It gives patients space to process and continue the conversation on their own

When should the nurse provide information?

When the patient asks or appears to need clarification to reduce anxiety

What is clarifying?

Ensuring the nurse correctly interprets the patient’s verbal or nonverbal message.

What is focusing used for?

Redirecting to key issues when the patient is overwhelmed or overly talkative.

What is paraphrasing?

Restating the patient’s message briefly in your own words to show understanding

What are the major non‑therapeutic communication techniques?

Sharing opinions, generalizations, false reassurance, sympathy, and medical jargon

What major factors influence communication?

Bodily needs, emotional status, developmental age, trauma history, attitudes/beliefs, neurocognitive disorders, and environment.

How can the EHR negatively affect therapeutic communication?

Nurse facing away, focusing on checklists, splitting attention between computer/patient, missing nonverbal cues, prioritizing efficiency over connection