NUR 111 Stress and Coping 2016

Stress and Coping Overview

• Course: NUR 111 FALL SEMESTER

Homeostasis and Stress

• Homeostasis: State of dynamic balance in the body.

• Stress: The body's reaction to a stimulus that:

  • Demands change.

  • Disrupts homeostasis.

• Categories of Stressors:

  • Physical, mental, emotional.

• Stress Response / Coping:

  • Involves adaptation to stressors.

Understanding Stressors

• Importance of assessing sources of stress.

• Understanding human responses to stress

  • Theoretical models of stress and coping.

• Subjectivity in defining stressors.

Types of Stressors

• Four Categories:

  • Acute, time-limited stressors.

  • Sequential events following initial stressor.

  • Chronic intermittent stressors.

  • Chronic permanent stressors.

Additional Stressors

• Developmental Stressors:

  • Challenges encountered throughout the life span.

• Internal Stressors:

  • Physical, spiritual, cognitive, emotional, psychological.

  • Daily hassles and stressors from experiences.

• External Environmental Stressors:

  • Triggers outside the individual.

  • Eustress (positive) vs. distress (negative).

The Coping Process

• Cognitive Appraisal:

  • Primary appraisal: First instinctive evaluation.

  • Secondary appraisal: Predicting impact, intensity, duration.

• Reappraisal and Adaptation:

  • Successful coping leads to adaptation.

  • Unsuccessful coping results in new responses to the stressor.

• Effective Coping:

  • Coping as a process, not a trait.

  • Types of coping:

    • Problem-focused coping.

    • Emotion-focused coping.

    • Avoidance coping.

    • Approach coping.

    • Meaning-focused coping.

  • Each type operates on cognitive, behavioral, affective levels.

Theoretical Models of Stress and Coping

• Stimulus-based models:

  • Define stress by the stressor event.

  • Physiological and psychological reactions occur.

  • Holmes and Rahe's SRRS scale assesses stress.

• Response-based models:

  • Stress seen as a response to a stressor.

  • Chain of physiological events includes:

    • General Adaptation Syndrome (GAS)

    • Local Adaptation Syndrome (LAS)

    • Three-stage response: Alarm, Resistance, Exhaustion.

Transactional Model of Stress

• Considers individual differences in perceptions and responses.

• Incorporates cognitive appraisals and coping mechanisms.

• Involves relationships between nurse, client, and environment.

• Aims to reduce client's stress and enhance coping resources. (Hildegard Peplau)

Manifestations of Stress

• Individual variations:

  • Internal and external manifestations across physiological, psychological, cognitive domains.

Physiological Indicators of Stress

• Signs:

  • Dilated pupils, increased heart rate, sweating, pallor of skin.

  • Retention of sodium, increased respiration, decreased urine output.

  • Dry mouth, muscle tension, elevated blood sugar & alertness.

Psychological Indicators of Stress

• Common responses include:

  • Fear, anxiety, anger, depression, and other emotional responses.

Cognitive Indicators of Stress

• Cognitive processes involved:

  • Problem-solving, cognitive structuring, self-control, suppression, fantasizing.

Ego Defense Mechanisms

• Unconscious psychological adaptations essential for survival:

  • Types include compensation, displacement, rationalization, denial, etc.

Integrating Stress and Coping Concepts

• Chronic Stress:

  • Increases susceptibility to illnesses and affects caregiving.

  • Contributes to burnout and decreased quality of care.

Alterations in Coping Responses

• DSM-5 Classifications:

  • Anxiety disorders, obsessive-compulsive disorders, trauma-related disorders.

Prevalence of Anxiety Disorders

• Generalized Anxiety Disorder (GAD) affects 6.8 million adults in the U.S.; more prevalent in women.

• Other disorders include OCD, phobias, and PTSD.

Genetic Considerations

• Gender significantly influences anxiety disorders; women are more affected.

• Nonmodifiable risk factors include brain chemistry and history of trauma.

Prevention of Stress-Related Disorders

• Recommended Strategies:

  • Social support, family wellness promotion, screening for disorders.

Nursing Assessment of Stress

• Key Areas to Assess:

  • History of illnesses, health complaints, stress coping patterns.

  • Use physical examinations, observations, and potentially lab tests for medical conditions.

Diagnostic Tests

• Importance of ruling out other medical causes of symptoms.

• Evaluation for psychiatric disorders should involve trained professionals.

Interventions and Therapies

• Treatment Approaches:

  • Therapeutic communication, teaching healthy ADLs, building support systems.

  • Relaxation techniques including meditation and guided imagery.

Stress Reduction Methods

• Techniques include meditation, breathing exercises, regular exercise, proper nutrition, and time management.

Collaborative Approaches to Stress Management

• Acknowledging personal responses to stress.

• Engaging in psychotherapy and cognitive-behavioral therapy.

• Pharmacologic treatments can complement therapeutic approaches.

Crisis Intervention Steps

• Five Steps:

  1. Identify the problem.

  2. List alternatives.

  3. Choose from alternatives.

  4. Implement the plan.

  5. Evaluate the outcome.

Helping Clients Adapt to Stress

• Identify and plan for situations causing stress, help clients understand their stress responses.

• Encourage acceptance of unchangeable situations while promoting actionable change.

Adapting to Stress in Nursing Profession

• Identify factors causing stress among nursing students.

• Strategies for personal self-care to maintain the ability to care for others.