Course: NUR 111 FALL SEMESTER
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.
Importance of assessing sources of stress.
Understanding human responses to stress
Theoretical models of stress and coping.
Subjectivity in defining stressors.
Four Categories:
Acute, time-limited stressors.
Sequential events following initial stressor.
Chronic intermittent stressors.
Chronic permanent 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).
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.
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.
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)
Individual variations:
Internal and external manifestations across physiological, psychological, cognitive domains.
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.
Common responses include:
Fear, anxiety, anger, depression, and other emotional responses.
Cognitive processes involved:
Problem-solving, cognitive structuring, self-control, suppression, fantasizing.
Unconscious psychological adaptations essential for survival:
Types include compensation, displacement, rationalization, denial, etc.
Chronic Stress:
Increases susceptibility to illnesses and affects caregiving.
Contributes to burnout and decreased quality of care.
DSM-5 Classifications:
Anxiety disorders, obsessive-compulsive disorders, trauma-related 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.
Gender significantly influences anxiety disorders; women are more affected.
Nonmodifiable risk factors include brain chemistry and history of trauma.
Recommended Strategies:
Social support, family wellness promotion, screening for disorders.
Key Areas to Assess:
History of illnesses, health complaints, stress coping patterns.
Use physical examinations, observations, and potentially lab tests for medical conditions.
Importance of ruling out other medical causes of symptoms.
Evaluation for psychiatric disorders should involve trained professionals.
Treatment Approaches:
Therapeutic communication, teaching healthy ADLs, building support systems.
Relaxation techniques including meditation and guided imagery.
Techniques include meditation, breathing exercises, regular exercise, proper nutrition, and time management.
Acknowledging personal responses to stress.
Engaging in psychotherapy and cognitive-behavioral therapy.
Pharmacologic treatments can complement therapeutic approaches.
Five Steps:
Identify the problem.
List alternatives.
Choose from alternatives.
Implement the plan.
Evaluate the outcome.
Identify and plan for situations causing stress, help clients understand their stress responses.
Encourage acceptance of unchangeable situations while promoting actionable change.
Identify factors causing stress among nursing students.
Strategies for personal self-care to maintain the ability to care for others.