KP

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.