1. Basic Nursing: Foundations of Skills & Concepts Chapter 16
STRESS, ADAPTATION AND ANXIETY

2. Stress is... A nonspecific response to any demand made on the body.
Such demands are called stressors.

3. Stress Management
Successful stress management is necessary for wellness of both clients
and nurses.

4. 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.

5. Homeostasis
The balance or equilibrium among the physiologic, psychological, sociocultural, intellectual, and spiritual needs of the body.
Stress is an assault on the homeostasis.

6. 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)

7. 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.

8. 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”

9. 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

10. Outcomes of Stress
Eustress - a type of stress that results in a positive outcome.
Distress - when stressors evoke an ineffective response.

11. Adaptation
An ongoing process whereby individuals use various responses to stressors and change.

12. Coping Measures The ways an individual may react to stress.
One coping measure is conditioning, behavior that becomes an automatic response.

13. 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.

14. Adaptive Measures These measures for coping with stress that
require a minimum amount of energy include:
Use of support people.
Relaxation to relieve tension.
Behavioral change.
Development of more realistic goals.
Problem solving.

15. 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.

16. 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.

17. 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.

18. Symptoms of Anxiety Severe Anxiety Rapid pulse Profuse Sweating
Selected focus of attention
Increased blood pressure
Severe Anxiety
Tense muscles
Dry mouth
Rigid posture
Shallow, rapid respiration
Tremors
Shivering
Interrupted speech

19. 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.

20. 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.

21. 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.

22. Stress and The Nursing Process
Nurses can help clients understand their anxiety and learn coping mechanisms through:
Assessment.
Nursing Diagnosis.
Planning/Outcome Identification.
Nursing Interventions.

23. 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?

24. Nursing Diagnoses Nursing diagnoses that may occur in
Response to stressors include:
Post-trauma syndrome
Impaired Social Interaction
Spiritual Distress
Hopelessness
Fatigue
Fear
Impaired adjustment
Altered role performance
Altered thought processes
Defensive coping
Sleep Pattern Disturbance

25. 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.

26. Nursing Interventions
Meeting basic needs.
Minimizing environmental stimuli.
Verbalizing feelings.
Involving family and significant others.
Using Stress-Management techniques.
Crisis intervention.

27. Important Stress-Management Techniques
Exercise
Relaxation techniques (e.g. progressive muscle relaxation, guided imagery, meditation, hypnosis)
Cognitive Reframing or Thought Stopping

28. Crisis Intervention
A specific technique used to help clients regain equilibrium.

29. The Five Steps of Crisis Intervention
Identification of the Problem
Identification of the Alternatives
Selection of an Alternative
Implementation
Evaluation

30. Stress & Nurses: Burnout
Burnout is a state of physical and emotional exhaustion that occurs when caregivers deplete their adaptive energy.

31. Factors Leading to Burnout
Job-related stress.
Heavy workload.
Interpersonal conflict in the work environment.
Organizational barriers to autonomous decision making.

32. 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.

33. Achieving Stress Hardiness
Commitment: Becoming involved in what one is doing.
Challenge: Perceiving change as an opportunity for growth instead of as an obstacle or threat.
Control: Believing that one is influential in directing what happens to oneself.