1. Chapter 3 The Stuart Stress Adaptation Model of Psychiatric Nursing Care

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

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

6. 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

7. 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

8. 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

9. Stuart Stress Adaptation Model9

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

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

13. 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

14. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

27. 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

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

29. 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

30. 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

31. 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

32. Nursing and Medical Diagnoses32

33. 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

35. 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

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

41. Treatment Stages 41

42. Treatment Stages 42

43. Treatment Stages 43