Stress, Coping, Crisis, and Self-Concept in Nursing Care (Vocabulary Flashcards)
Personal context and coping foundations
Speaker shares happy place as a coping anchor during nursing school stress: mentions being one of eight siblings, married with two kids, and family/or home as the happy place.
Acknowledges that happy places vary by person (beach, music, etc.).
Encourage students to think of a happy place when stressed as a quick resilience tool.
Practical study tip: review objectives and attempt to answer them to prepare for tests.
Objective 1: Distinguish between stress, stressor, and appraisal
Stress: imbalance of homeostasis; threat can be real or perceived; can be physical, chemical, or emotional; produces tension in body or mind.
Stressor: the underlying cause that provokes stress; can be physical, psychological, or social stimuli that threaten homeostasis.
Appraisal: how a person interprets the impact of a stressor; determines whether a stress response is triggered.
Important nuance: stress only emerges when a person perceives a threat; responses vary between individuals (everybody responds differently).
Relationship among concepts: stress is the effect; stressor is the cause; appraisal is the interpretation that may lead to the stress response.
Reminders:
If a question about stress is asked, focus on the interplay between stressor, appraisal, and the resultant stress response.
Not all stressors provoke a stress response; individual differences matter.
General Adaptation Syndrome (GAS): three stages and body systems involved
GAS overview: a three-stage, body-wide response to stress that can be triggered by physical or psychological demands; involves autonomic nervous system and endocrine responses.
Reference framework: central autonomic changes and endocrine cascades; related to homeostasis restoration (allostasis).
Stage 1: Alarm (fight-or-flight)
CNS aroused; defenses mobilized.
Physiological changes: increases in hormone levels, blood volume, blood glucose, epinephrine, blood pressure, heart rate, cardiac output, oxygen intake, mental alertness; pupils dilate to broaden visual field.
Stage 2: Resistance
Body attempts to stabilize and return toward balance; allostasis defined as regulation of systems to maintain balance.
Hormone levels tend to drop from alarm levels; heart rate and blood pressure begin normalizing; cardiac output returns to baseline.
Body repairs damage; energy and resources are consumed to regain allostasis.
If stressor continues, allostatic load accumulates, leading toward exhaustion.
Stage 3: Exhaustion
Prolonged stress depletes compensatory mechanisms; adaptation fails; energy reserves exhausted.
Physiological response intensifies as the body struggles to cope.
Chronic activation leads to allostatic load; long-term risks include chronic hypertension, depression, sleep deprivation, chronic fatigue syndrome, autoimmune disorders.
Immunological impact: stress can impair immune function, increasing infection risk and contributing to chronic conditions such as hypertension, diabetes, cancer.
Practical takeaway: understand three stages and the shift from mobilization (alarm) to stabilization (resistance) to depletion (exhaustion); chronic stress has lasting health consequences.
Note on resources: GAS description aligns with common nursing texts and related OSmosis content; page refs like Fig. 37-1 (OS) are provided as optional references.
Primary and secondary appraisal; coping concepts
Reactions to stress vary by individual; intensity/duration of threat influence response; anticipatory context and prior stressors can compound effects.
Primary appraisal: evaluate event in terms of personal meaning; if perceived as threat, stress occurs.
Secondary appraisal: contemplate coping strategies and available resources; if demand exceeds coping ability, stress results.
Appraisal framework allows view of stress as challenge or threat or potential for growth.
Coping: cognitive-behavioral efforts to manage the stressor; effectiveness depends on individual needs (age, culture, type of stress, goals, beliefs, resources).
No one-size-fits-all coping strategy; people may use different strategies for different stressors and across life stages.
Examples of coping strategies discussed: sleep, exercise; emphasises personalization and safety of methods.
Ego defense mechanisms (defense against anxiety) discussed with examples:
Compensation: compensating a deficiency in one area by emphasizing another asset (e.g., strong organizer compensating for poor speaking).
Denial: avoiding acknowledgment of painful information.
Displacement: redirecting emotions from the stressor to a different, safer target (e.g., venting at a device).
Conversion: transforming anxiety into a physical symptom (sleep/appetite changes).
Identification: patterning behavior after someone perceived as confident.
Dissociation: numbness or reduced awareness of surroundings (daydreaming, time loss).
Regression: reverting to earlier development patterns under stress (bedwetting, regressive sleep changes).
Clinical note: defense mechanisms can become maladaptive if they do not help adaptation; may require adjustment of coping strategies.
Post-traumatic stress disorder (PTSD) and stress types
Stress types:
Chronic stress: occurs in a relatively stable condition with ongoing stressors (e.g., balancing family responsibilities and a full-time job).
Acute stress: time-limited events that threaten a person for a relatively brief period.
Daily hassles: routine life stressors (commuting, household maintenance, dealing with difficult people, money management).
PTSD: occurs after exposure to trauma; common in military veterans, first responders, survivors of accidents or disasters; characterized by intense fear and helplessness.
Symptoms: nightmares, emotional detachment, flashbacks, depression.
Secondary traumatic stress: trauma from witnessing others' suffering (compassion fatigue); intrusive symptoms (nightmares, avoidance, sleep difficulties, relational issues).
Nursing relevance: healthcare workers may experience secondary traumatic stress depending on work setting; awareness and support are important.
Factors influencing stress and coping; crisis theory
Situational factors: work-related stressors (burnout, supervision changes, transfers, promotions, chronic illness in family, financial worries); caregiver burden is common in nursing and hospice work.
Maturational factors: life-stage differences (children, adolescents, adults, older adults); changes in appearance, family roles, independence, and losses influence stress and coping.
Sociocultural factors: environmental and social stressors; poverty, disability, isolation (e.g., isolation during COVID-19 in long-term care); cultural views on aging, disability, and transition can shape stress perceptions and coping strategies.
Crisis concepts: a turning point where prior coping strategies fail and change is needed; three types of crisis:
Developmental crisis: transitions in life stages (marriage, childbirth).
Situational crisis: external events (job loss, car crash, serious illness).
Adventitious crisis: disasters (natural or man-made) or violent crime.
Crisis intervention: goals include patient safety and anxiety reduction; problem-solving focus; explore emotions and develop new coping strategies; the crisis may lead to growth or regression depending on management and support.
Role of nurses: acknowledge patient perceptions; provide crisis support and guidance; coordinate with multidisciplinary teams.
Coping strategies and health promotion for stress management
Health promotion basics in stress management:
Regular exercise: improves muscle tone, reduces tension, supports cardiovascular/pulmonary function.
Regular rest/sleep: essential for reducing fatigue and improving problem-solving; establish consistent bedtime routines.
Support systems: emotional and informational support from community, churches, cancer societies, etc.
Time management: prioritize tasks, distinguish urgent vs routine tasks; delegation when appropriate.
Guided imagery and visualization; progressive muscle relaxation; mindfulness-based stress reduction.
Journaling: emotional expression and self-reflection.
Assertiveness training: effective communication of needs and requests; resolve conflicts.
Journal writing and mindfulness practice are highlighted as practical, accessible tools.
Social isolation prevention and leisure skill development (especially in older adults).
Animal-assisted interventions (therapy dogs) and other leisure/social activities to promote engagement.
Acute vs ongoing strategies: coping takes time; ongoing evaluation and adaptation are needed; access to professional counseling when stress escalates.
Real-world nursing context: burnout is common; collaboration with counseling services is beneficial; sharing experiences with colleagues helps coping.
The nursing process application to stress and coping
Core assessment: establish trusting relationships; be open and honest; gather information about the patient’s home situation, problem-solving abilities, precipitating events; tailor coping strategies to the individual; allow patients to express priorities; use open-ended questions; maintain a non-threatening environment; cultural competence is essential.
Objective findings: observe appearance, gait, hygiene, eye contact, behavior while sitting, speech; safety concerns require immediate attention.
Safety considerations: any expressed suicidal ideation or plan must be taken seriously; hospitalized patients with potential suicide risk require one-to-one observation and psychiatric referral when indicated.
Nursing diagnoses related to stress and coping: anxiety; coping deficits; risk for post-trauma response; despair; ineffective coping; other related concerns.
Planning: goals should be achievable and tailored; examples include effective coping for stress, caregiver coping, positive caregiver emotional health.
Outcomes: measurable indicators such as engagement in support groups, caregiver rest routines, attendance at groups, patient-reported coping improvements.
Interventions: prioritize safety first; explore patient values and priorities; utilize available resources; collaborate with multidisciplinary team (psychiatry, psychology, social work, specialty nurses).
Expected outcomes: realistic, measurable, patient-centered expectations (e.g., attendance at support groups; caregiver rest schedules; discussion of coping strategies with social worker within 24 hours if needed).
Implementation: three core methods of intervention in stress management:
Decrease stress-producing situations where possible.
Increase resistance to stress via skills training and health promotion.
Teach techniques to optimize physiological responses to stress (e.g., relaxation, mindfulness, imagery).
Emphasis on health promotion: exercise, rest, social support, time management, guided imagery, relaxation, mindfulness, journaling, assertiveness, and other self-care strategies.
Evaluation: ongoing reassessment from the patient’s perspective; adjust goals based on feedback; verify if expectations were met; determine if support systems are in place for home continuation.
Complementary, alternative, and integrated therapies in nursing
Definitions and distinctions:
Complementary therapies: used in addition to conventional treatment.
Alternative therapies: used as primary treatment (may replace conventional care).
Integrated/Integrative therapies: complementary therapies used within conventional care by licensed health care providers; emphasizes therapeutic relationships and whole-person care.
Rationale for use:
Patient demand for less invasive/toxic options; desire for active patient involvement; belief that combining approaches yields better outcomes.
Common therapies and nurse-facing considerations:
Relaxation, meditation, imagery (breathing-based techniques, visualization).
Biofeedback: mind-body technique teaching self-regulation of physiological responses; requires referral; uses instruments to measure physiological signals and provide feedback.
Acupuncture: needle-based energy flow along channels (acupoints); evidence supports modulation of pain pathways; safety considerations include sterile needles and contraindications (immunocompromised patients, pregnancy, seizures, etc.).
Therapeutic touch: energy-field-based approach with five phases (centering, assessing, unruffling, treating, evaluating); used for pain, dementia, and anxiety; contraindicated in certain conditions (abuse history, pregnancy, neonates, dying patients).
Traditional Chinese medicine, Pilates, chiropractic therapies: require specialized training and professional oversight.
Herbal therapies: wide variety of herbs used worldwide; safety concerns due to contamination and lack of FDA regulation; advise patient to use reputable manufacturers and look for USP verification; table references exist in course materials (e.g., safe vs unsafe herbs listed on pages 7:19 and 7:20 in the text, Box 32-2 and 32-3).
Patient safety and professional judgment: evaluate appropriateness, monitor responses, and be mindful of potential interactions with conventional medications.
Relaxation, imagery, and meditation in clinical practice
Relaxation therapies:
Purpose: reduce generalized cognitive, physiological, and behavioral arousal; lower brain activity and peripheral signs of stress.
Forms: progressive (head-to-toe muscle tocusing and relaxing) and passive (mental stillness without targeted muscle tension).
Benefits: lower blood pressure and heart rate; decreased muscle tension; improved well-being; reduced distress, pain, and anxiety; improved mood; reduced depression; less breathlessness in chronic conditions.
Limitations: initial increase in muscle tension awareness; potential symptom amplification in some cases; progressive relaxation requires energy, not suitable for all patients, especially those with high energy depletion.
Imagery and meditation:
Meditation: limiting stimuli by focusing attention on a single stable or repetitive stimulus; requires quiet space, comfortable position, receptive attitude, and focused attention; aims for mindful nonjudgmental awareness; long-term practice required; benefits include reduced anxiety and improved mood, lower relapse risk in addiction, and better overall well-being.
Contraindications/considerations: some may experience increased blood pressure or adverse effects with certain medications; fear of losing control may complicate practice.
Guided imagery: nurse-guided verbal instructions to shift attention away from upsetting thoughts; uses visualization (e.g., beach scene) with sensory cues (sounds, smells, breathing rhythm).
Creative visualization: patient-directed imagery focusing on positive external images; goals include setting attainable images and repeating positive statements; monitor for anxiety or discomfort; broadly applicable to pediatric and adult populations for pain relief, sleep improvement, and management of chronic conditions (asthma, cancer, migraines, etc.).
Practical considerations: image should be individualized to the patient; observe for anxiety or worsening symptoms; incorporate into care plans where appropriate.
Biofeedback and acupuncture crosswalk (brief): see above for definitions and clinical considerations.
Applications across populations: imagery/meditation useful for pain management, sleep quality, nightmares, and chronic conditions; requires ongoing practice, patient suitability, and monitoring for adverse responses.
Self-concept and its clinical significance in nursing
Self-concept definition: how an individual thinks about themselves; subjective and formed through unconscious/subconscious processes; influences management of situations and relationships.
Self-concept development across lifespan: begins in early childhood; adolescence amplification of self-concept due to peer comparison; adulthood focus on achievement and self-esteem; older adults face functional decline and autonomy loss.
Self-esteem vs self-concept:
Self-concept: overall perception of oneself (thoughts, beliefs).
Self-esteem: emotional appraisal of self-worth; higher self-esteem linked to resilience and better stress coping.
Factors influencing self-concept:
Identity stressors: job loss, marital status changes, abuse/neglect, dependency, repeated failures, societal attitudes, conflict with others.
Body image stressors: effects of illness or procedures (stroke, colostomy, anorexia, incontinence, obesity, amputation, scarring, mastectomy).
Role performance stressors: ability to fulfill major roles (caregiving, parenting, career); role conflict, ambiguity, and strain can erode self-esteem.
Age-related considerations: adolescence often shows high depression rates; adults face work-family balance; older adults face independence loss.
Role of culture: cultural views shape self-concept; language, time orientation, and access to care influence experience and expression; involve patients in decision-making and respect cultural differences.
Self-concept components and psychosocial/cognitive development stages
Components of low self-esteem: identity, body image, role performance, and self-esteem interplay.
Identity: conscious sense of individuality; vulnerable during adolescence due to physical/psychological changes and social pressures; social media can influence identity formation.
Body image: attitudes toward body appearance and function; aging, illness-related changes alter body image; cultural and societal standards influence body image and risk for depression/eating disorders.
Role performance: perceived ability to fulfill significant social roles; resilience depends on success in meeting role expectations; difficulty can lead to low self-esteem and anxiety.
Role of social and cultural context: family, peers, media influence; celebrities with body-image challenges can offer role models but also contribute to pressure; focus on health and wellness, not thinness or masculine ideals.
How nurses’ own self-concept and actions affect patient self-concept
Nurses model acceptance and form therapeutic relationships; patient perception of care influences their self-concept and coping.
Nurses should be aware of their own beliefs, biases, and emotions to avoid imposing judgments on patients.
Strategies for promoting positive self-concept:
Establish a therapeutic relationship with open dialogue and active listening.
Use open-ended questions; avoid judging or expressing surprise; acknowledge patient feelings.
Be mindful of nonverbal cues (facial expressions, body language) that could signal judgment or discomfort.
Provide nonjudgmental, matter-of-fact, and supportive communication.
Encourage patient expression of concerns and preferences; tailor care to individual needs.
Clinical implications: recognition that altered self-concept requires sensitive, individualized care; healthcare providers should support patients’ sense of worth and autonomy.
Evidence-based practices for identity confusion, disturbed body image, and role conflict
Core approach: establish a therapeutic nurse-patient relationship; listen, observe behaviors, set collaborative goals; select interventions that promote healthy self-concept.
Assessment clues: negative self-evaluation; dependence on others; reluctance to express views; passive attitude; signs of anxiety or fear; poor eye contact; somatic signs (slumped posture, tearfulness).
Communication tips: avoid why questions; avoid questions that yield only yes/no answers; practice active listening; use therapeutic communication.
Nursing diagnoses commonly used: disturbed body image, caregiver role strain, disturbed personal identity, ineffective role performance, readiness for enhanced self-concept, various levels of self-esteem issues.
Planning and outcomes: realistic, measurable goals; identify patient strengths and limitations; leverage strengths to overcome limitations; patient education to reduce helplessness and improve self-concept.
Interdisciplinary collaboration: involve families, friends, or significant others as appropriate and culturally aligned; plan with the patient’s desires and cultural norms in mind.
Implementation examples: promote self-care, elicit patient strengths, reinforce successful coping, support home-based maintenance, and adjust plans as patient needs evolve.
Evaluation: frequent reassessment from the patient’s perspective; confirm whether expectations are met; determine need for additional supports; acknowledge that coping and adjustment take time.
Desired outcomes: improved self-acceptance, acceptance of appearance or functional change, and active patient engagement in activities that support a positive self-concept.
Cultural considerations and self-concept
Cultural self-concept is dynamic and shaped by group identification and social interactions beyond the group; integration with external influences.
Nursing implications: maintain an open, nonrestrictive attitude; encourage cultural practices; ask what is important to the patient to feel better; offer treatment choices compatible with cultural values.
Shared decision-making is essential; be mindful of cultural norms when involving family or community in care decisions.
Clinical judgment measurement model and nursing process to promote self-concept
Assessment indicators for negative self-concept include: excessive dependence, reluctance to express opinions, passive attitude, nervousness, avoidance of eye contact, poor posture, and frequent crying.
Communication approach: therapeutic, open dialogue; avoid blaming language; practice active listening; validate patient experiences without expressing personal judgments.
Nursing diagnoses relevant to self-concept: Disturbed body image; caregiver role strain; disturbed personal identity; ineffective role performance; readiness for enhanced self-concept; chronic or situational low self-esteem.
Planning and goals: realistic and measurable; emphasize patient strengths and coping resources; plan to restore or enhance self-concept through education, supportive counseling, and collaborative care.
Implementation planning: target level of care (acute, restorative, continuing) and encourage self-promotion and autonomy; elicit perceived strengths; reinforce coping responses; provide patient education.
Evaluation strategies: ongoing, patient-centered assessment of whether expectations are met; explore patient’s perceptions of progress; assess home support and ability to continue coping strategies after discharge.
Outcome indicators: patient verbalizes self-acceptance; adapts to appearance or functional changes; seeks and utilizes supportive resources; demonstrates increased confidence in managing daily tasks.
Summary and practical takeaways
Stress concepts are interconnected: stressor causes stress via appraisal; response varies by person.
GAS describes a predictable three-stage physiological response with implications for health, including the concept of allostatic load and long-term risks if stress is chronic.
Appraisal (primary and secondary) and coping strategies are central to managing stress; diverse coping mechanisms and defense mechanisms exist, some adaptive and some maladaptive.
PTSD and secondary traumatic stress highlight the impact of trauma exposure and exposure to others’ suffering on nurses and patients alike.
Crisis theory emphasizes turning points requiring new coping strategies; crisis interventions focus on safety and anxiety reduction and can lead to growth with proper support.
The nursing process is a structured framework for assessing, planning, implementing, and evaluating coping strategies; safety planning (including suicide risk) is critical.
Complementary, alternative, and integrative therapies offer additional options but require careful assessment of safety, evidence, and patient preferences; nurses should be trained or have access to appropriate referrals.
Relaxation, imagery, and meditation are evidence-informed techniques to reduce physiological arousal and improve well-being; ongoing practice is essential for benefits.
Self-concept is a core psychosocial construct that shapes patient health behaviors and responses to illness; nurses influence self-concept through therapeutic relationships, culturally sensitive care, and patient-centered communication.
Cultural considerations are integral to care planning; involve patients in decisions and respect diverse values and practices.
Clinical judgment and nursing process steps (assessment, diagnosis, planning, implementation, evaluation) should be applied with a focus on promoting positive self-concept and adaptive coping, while ensuring safety and collaboration.
Practical nursing implications include recognizing burnout and compassion fatigue in oneself and colleagues, promoting wellness strategies, and utilizing available supports to sustain compassionate patient care.
If you’d like, I can convert these notes into a condensed study sheet with a quick-reference checklist for exams or tailor a version focused on a specific nursing course (e.g., psychiatric-mental health rotation or medical-surgical stress management modules).