basic nursing: foundations of skills & concepts chapter 16 stress, adaptation and anxiety
Post on 19-Dec-2015
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TRANSCRIPT
Stress is...
A nonspecific response to any demand made on the body.
Such demands are called stressors.
Stress Management
Successful stress management is necessary for wellness of both clients
and nurses.
Response to Stress
The inner force an individual uses to respond or adapt to stress is known as adaptive energy.
All persons have adaptive energy; the amount varies from individual to individual.
Homeostasis
The balance or equilibrium among the physiologic, psychological, sociocultural, intellectual, and spiritual needs of the body.
Stress is an assault on the homeostasis.
General Adaptation Syndrome
The body’s response to stressors: Stage One: Crisis/alarm (paleness,
shivering, sweating of palms, etc.) Stage Two: Adaptation/Resistance
(Flight-or-Fight response) Stage Three: Exhaustion (if adaptive
energy is inadequate to deal with prolonged or overwhelming stress)
Local Adaptation Syndrome
Physiologic response to stress (e.g. trauma, illness) affecting a specific part of the body.
Classic symptoms include redness, warmth, swelling at the site.
Manifestations of Stress (i)
Physiologic: increased pulse rate; rapid shallow breathing; dizziness; headaches; dilated pupils; nausea; diarrhea or constipation; polyuria; tension.
Psychological: irritability; increased sensitivity; sadness, depression; feeling “on edge”
Manifestations of Stress (ii)
Cognitive: impaired memory; confusion; impaired judgment; delayed response time
Behavioral: pacing; sweaty palms; rapid speech; insomnia; withdrawal;exaggerated startle reflex
Spiritual: alienation; social isolation; emptiness
Outcomes of Stress
Eustress - a type of stress that results in a positive outcome.
Distress - when stressors evoke an ineffective response.
Coping Measures
The ways an individual may react to stress.
One coping measure is conditioning, behavior that becomes an automatic response.
Factors Influencing Coping
Degree of danger perceived by individual. Immediate needs of individual. Amount of support from others. Individual’s belief in his own ability to handle a stressful
situation. Individual’s previous successes and failures in coping. Number of concurrent or cumulative stresses being
handled.
Adaptive Measures
Use of support people. Relaxation to relieve tension. Behavioral change. Development of more realistic goals. Problem solving.
These measures for coping with stress that require a minimum amount of energy include:
Defense Mechanisms
Unconscious operations that protect the mind from anxiety.
They are universal and can be positive. Defense mechanisms that prevent an
individual from making progress towards resolving and accepting stress are called maladaptive measures.
Crisis
An acute state of disorganization that occurs when the individual’s usual coping mechanisms are no longer effective.
Crises are: Characterized by extreme anxiety. Inability to function. Disorganized behavior. Limited as to how long they can last.
Anxiety
A subjective response that occurs when a person experiences a real or perceived threat to well-being.
The most common emotional response to stress.
Severe Anxiety
Profuse Sweating
Rapid pulse Increased blood
pressure
Dry mouth
Shallow, rapid respiration
Interrupted speech
TremorsShivering
Selected focus of attention
Tense muscles
Rigid posture
Symptoms of Anxiety
Illness as Stressor
Illness and hospitalization are major stressors for individuals and their families.
To alleviate the stress of hospitalization, nursing interventions should reduce the client’s feelings of unfamiliarity and loss of control.
Change
A dynamic process whereby an individual’s response to a stressor leads to an alteration in behavior
Change is an inherent part of life. Change can be constructive or
destructive.
The Nurse as Change Agent
In bringing about change to effect positive adaptation, the nurse serves as change agent, a person who intentionally creates and implements change.
Stress and The Nursing Process
Assessment. Nursing Diagnosis. Planning/Outcome Identification. Nursing Interventions.
Nurses can help clients understand their anxiety and learn coping mechanisms through:
Assessment
What are the patterns of stressors? What are the typical responses to
stressful situations? What are the cause-and-effect
relationships among stressors and thoughts, feelings, and behaviors?
What is the past history of successful coping mechanisms?
Nursing Diagnoses
Impaired adjustment Altered role performance Altered thought
processes Defensive coping Sleep Pattern
Disturbance
Post-trauma syndrome Impaired Social
Interaction Spiritual Distress Hopelessness Fatigue Fear
Nursing diagnoses that may occur inResponse to stressors include:
Planning/Outcome Identification
Identify situations that increase stress and anxiety. Verbalize a plan to decrease the effect of common
stressors. Differentiate positive and negative stressors. Categorize stressors. Demonstrate stress-management exercises. Verbalize a plan for stress management, including
necessary lifestyle modifications.
Nursing Interventions
Meeting basic needs. Minimizing environmental stimuli. Verbalizing feelings. Involving family and significant others. Using Stress-Management techniques. Crisis intervention.
Important Stress-Management Techniques
Exercise Relaxation techniques (e.g. progressive
muscle relaxation, guided imagery, meditation, hypnosis)
Cognitive Reframing or Thought Stopping
The Five Steps of Crisis Intervention
Identification of the Problem Identification of the Alternatives Selection of an Alternative Implementation Evaluation
Stress & Nurses: Burnout
Burnout is a state of physical and emotional exhaustion that occurs when caregivers deplete their adaptive energy.
Factors Leading to Burnout
Job-related stress. Heavy workload. Interpersonal conflict in the work
environment. Organizational barriers to autonomous
decision making.
Combating Burnout
Expect to be successful. Remember the power of self-fulfilling
prophecies and deliberately focus on the positive.
Let go of the need to be perfect. Listen to self-talk. Encourage the use of appropriate humor
in the workplace.