Chapter 3 The Stuart Stress Adaptation Model of Psychiatric Nursing Care

Conformity/Deviance Separate continuum from health/illness Unusual lifestyles not regarded as sick Combines into four patterns: 2

Criteria of Mental Health Positive attitudes toward self Growth, self-actualization, and resilience Integration Autonomy Reality perception Environmental mastery 5

Mental Illness Defined Behavioral or psychological pattern demonstrated by an individual that causes significant distress, impaired functioning, and decreased quality of life Underlying psychobiological dysfunction Is not the result of social deviance or conflicts with society 6

Magnitude of Mental Illness By 2020 mental disorders projected to increase Worldwide, major depression predicted to become second-leading disease burden Mental illness impact previously underestimated Highlights public significance and need for mainstreaming mental health issues 7

Biopsychosocial Components Views human behavior holistically Includes both individual and environment For example: Man with myocardial infarction may also become severely depressed because he fears ability to work and satisfy wife sexually Woman seeking treatment for major depression also may develop gastric ulcers exacerbated by depression 8

Stuart Stress Adaptation Model 9

Predisposing Factors: Biological Genetic background Nutritional status Biological sensitivities General health Exposure to toxins 11

Predisposing Factors: Psychological Intelligence Verbal skills Morale Personality Past experiences Self-concept Motivation Psychological defenses Locus of control (sense of control over fate) 12

Predisposing Factors: Sociocultural Age Gender Education Income Occupation Social position Cultural background Religious upbringing and beliefs Political affiliation Socialization experiences Level of social integration or relatedness 13

Precipitating Stressors Stimuli that are challenging, threatening, or demanding to individual Require increased energy Produce tension and stress May originate in person’s internal or external environment Timing, duration, number, frequency of stressors significant 14

Life Strain and Hassles Chronic conditions related to family tension, job dissatisfaction, loneliness Strife associated with marital relations Parental challenges associated with teenage and young adult children Strain related to household economics Overload or dissatisfaction in work role Small, daily hassles or strains may affect moods and health more than major misfortunes do 16

Appraisal of Stressors Determines meaning of stressful situation’s impact for individual Evaluation of event’s significance to person’s well-being Cognitive Affective Physiological Behavioral Social responses 17

Cognitive Response Appraisal Damage and potential damage evaluated Situation’s power to produce harm Resources available to neutralize or tolerate harm Perception of stressful life events in people with hardiness or resilience Commitment Challenge Control 18

Affective Response Appraisal Affective response is arousal of a feeling Usually nonspecific or generalized anxiety reaction, expressed as emotions May include joy, sadness, fear, anger, acceptance, distrust, anticipation, or surprise Emotion over long period is a mood Prolonged mood may be considered an attitude 19

Physiological Response Appraisal Brain responses reflect interaction of several neuroendocrine hormones and transmitters May include growth hormone, prolactin, adrenocorticotropic hormone (ACTH), luteinizing and follicle-stimulating hormones, thyroid-stimulating hormones, vasopressin, oxytocin, insulin, epinephrine, norepinephrine Fight-or-flight physiological response to stress affects immune system, decreasing ability to fight disease 20

Behavioral Response Appraisal Emotional and physiological responses, with cognitive analysis of stressful situation Phase 1: behavior to change stressful environment or allow escape from it Phase 2: behavior to change external circumstances and aftermath Phase 3: intrapsychic behavior that defends against unpleasant emotional arousal Phase 4: intrapsychic behavior that comes to terms with event by internal readjustment 21

Social Response Appraisal Search for meaning Seeking information about problem Social attribution Identifying contributing factors Social comparison Comparing skills and capacities with others with similar problems Evaluating need for support from social network or support system 22

Appraisal of Stressors Is Key Must understand nature and intensity of stress response Nurses must not presume to know how certain stressors will affect patient Individual appraisal of stressful event is key to understanding coping efforts Essential part of psychiatric nurse’s assessment 23

Coping Resources Options or strategies for determining what can be done? What is at stake? Economic assets, abilities, skills Defensive techniques, social supports, motivation Health and energy, spiritual supports, positive beliefs Problem-solving and social skills Material resources, physical well-being Relationships with individual, family, group, society 24

Coping Mechanisms Efforts directed at stress management Problem focused (coping with threat itself) Negotiation, confrontation, seeking advice Cognitively focused (control meaning) Positive comparison, selective ignorance, substitution of rewards, devaluation of desired objects Emotion focused (ego defense mechanisms) Denial, suppression, projection 25

Coping Mechanisms Constructive Destructive Anxiety treated as warning signal Individual accepts it as challenge to resolve problem Uses past experiences to meet future threats Destructive Anxiety warded off Conflict not resolved Uses evasion instead of resolution 27

Pattern of Response Based on specific predisposing factors Nature of stressor Perception of situation Analysis of coping resources, mechanisms 28

Evaluation of Coping Responses Evaluated on continuum of adaptation or maladaptation Responses that support integrated functioning are adaptive Lead to growth, learning, goal achievement Responses that block integrated functioning are maladaptive Prevent growth, decrease autonomy, interfere with mastery of environment 29

Nursing Diagnosis Based on patient’s response to actual or potential stress, including: Clinical judgment about individual, family, or community response to stress Statement of problem from nursing perspective Adaptive and maladaptive responses Contributing stressors Use NANDA-I–approved diagnoses 30

health or illness state Medical Diagnoses Health problems or disease states of patient in medical model of psychiatry Mental disorders or mental illnesses Important to distinguish between nursing and medical models of care Psychiatric nurses can promote patients’ adaptive responses regardless of health or illness state 31

Nursing and Medical Diagnoses 32

Neurosis/Neuroses Distressing symptom or group of symptoms Unacceptable and alien to individual Reality testing grossly intact Behavior does not violate major social norms (but functioning may be impaired) Enduring or recurrent without treatment No organic cause or factor 33

Psychosis/Psychoses Regressive behavior Personality disintegration Significant reduction in level of awareness Great difficulty in functioning adequately Gross impairment in reality testing Presence of delusions or hallucinations without insight into their pathological nature Psychotic problems most severe level of mental illness 35

Treatment Stages Each stage has its own treatment goals, assessments, interventions 40

Treatment Stages 41

Treatment Stages 42

Treatment Stages 43