Chapter10/Exam2

Adverse Childhood Experiences (ACEs)

• Definition and Impact: Adverse Childhood Experiences (ACEs) are events that occur in childhood which sensitize individuals to stress in later life.

• Types of ACEs:

  • Any form of psychological, physical, or sexual abuse.

  • Witnessing violence against a parent, with a particular emphasis on violence against the mother.

  • Living with household members who:

    • Experience substance use disorders.

    • Are mentally ill.

    • Have ever been incarcerated.

Early Stress-Response Theories

• Fight-or-Flight Response:

  • This is a physiological state in which the body prepares for a situation that the individual perceives as a threat to survival.

  • Physiological Changes: The response is characterized by:

    • Increased blood pressure.

    • Increased heart rate.

    • Increased respirations.

    • Increased cardiac output.

  • Gender Differences: New research indicates that men and women exhibit different neural responses to stress.

• General Adaptation Syndrome (GAS):

  • Alarm (Acute Stress) Stage: This initial stage activates the sympathetic nervous system and the Hypothalamic-Pituitary-Adrenal (HPA) axis to keep the individual on alert.

  • Resistance (Adaptation) Stage: During this stage, there is sustained and optimal resistance to the stressor. Processes such as recovery, repair, and renewal may occur during this time.

  • Exhaustion Stage: This stage occurs when resources are depleted. At this point, the stress may become chronic.

Classifications and Critiques of Stress

• Bad Stress Versus Good Stress:

  • Distress: This is negative, draining energy. It results in feelings of anxiety, depression, confusion, helplessness, hopelessness, and fatigue.

  • Eustress: Defined as normal, physiological, positive energy. It motivates individuals and results in positive feelings and purposeful movement.

• Critique of the General Adaptation Syndrome (GAS) Theory:

  • The theory is criticized because different types of stressors bring about different patterns of response.

  • The degree of stress is considered an important factor that GAS does not fully differentiate.

  • GAS is noted to reflect male-oriented responses to stress.

  • Gender-Specific Response: Research suggests females tend to respond to stress by "tending and befriending."

Physiological and Immune Mediators of Stress

• Immune System Stress Responses:

  • There is a significant interaction between the nervous system and the immune system during the alarm phase of General Adaptation Syndrome.

  • Stress negatively affects the body’s ability to produce protective factors.

  • Defined links exist among stress (viewed through a biopsychosocial lens), the immune system, and the development of disease.

• Mediators of the Stress Response:

  • Stressors: Can be Physiological (environmental or physical) or Psychological (stressful events).

  • Perception: How the individual interprets the stressor.

  • Individual Temperament: Personal disposition and personality traits.

  • Social Support: Including formal support groups.

  • Culture: Cultural background and expectations.

  • Spirituality and Religion: Belief systems that provide framework and comfort.

Nursing Management and Measurement of Stress

• Measuring Stress Level:

  • Social Readjustment Rating Scale (Holmes and Rahe): This scale measures the level of positive and negative stressful life events over a $1$-year period.

  • Recent Life Changes Questionnaire: Assessment tool for identifying current stressors.

  • Perceived Stress Scale-10 Item (PSS-10): This scale assesses feelings and thoughts during the last month.

• The Perceived Stress Scale-10 Item (PSS-10) Content:

  1. In the last month, how often have you been upset because of something that happened unexpectedly?

  2. In the last month, how often have you felt that you were unable to control the important things in your life?

  3. In the last month, how often have you felt nervous and “stressed”?

  4. In the last month, how often have you felt confident about your ability to handle your personal problems?

  5. In the last month, how often have you felt that things were going your way?

  6. In the last month, how often have you found that you could not cope with all the things that you had to do?

  7. In the last month, how often have you been able to control irritations in your life?

  8. In the last month, how often have you felt that you were on top of things?

  9. In the last month, how often have you been angered because of things that were outside of your control?

  10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?

• PSS-10 Scoring Methodology:

  • Items $4$, $5$, $7$, and $8$ are positively stated items.

  • Scores are obtained by reversing the scores on these positive items: ($0=4$, $1=3$, $2=2$, $3=1$, $4=0$).

  • The final score is the sum of all $10$ items.

• General Nursing Assessment of Stress:

  • Assessing coping styles.

  • Identifying health-sustaining habits.

  • Evaluating life satisfaction.

  • Identifying social supports.

  • Identifying effective and healthy responses to stress.

Stress Management through Relaxation Techniques

• Techniques for Stress Reduction:

  • Biofeedback: Using electronic monitoring to train for voluntary control over autonomic functions.

  • Deep Breathing Exercises: Regulating breath to calm the nervous system.

  • Guided Imagery: Focusing on positive mental images.

  • Progressive Relaxation: Tensing and then releasing specific muscle groups.

  • Meditation: Practicing focused attention or awareness.

  • Mindfulness: Maintaining a moment-by-moment awareness of thoughts, feelings, and surroundings.

  • Physical Exercise: Using body movement to reduce stress hormones.

  • Cognitive Reframing: Changing the way one perceives and thinks about a stressor.

  • Journaling: Writing down thoughts and feelings for clarity and release.

  • Humor: Using laughter and lightheartedness as a coping mechanism.

Questions & Discussion

• Question: Which reaction to stress is healthy?

  • A. Distress

  • B. Eustress

  • C. Stressor

  • D. None of the above

  • Answer: B. Eustress

• Question: In General Adaptation Syndrome (GAS), which stage occurs first?

  • Options: Alarm, Resistance, Exhaustion

  • Answer: Alarm