1. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 0

2. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 1 Chapter 4 The Stuart Stress Adaptation Model of Psychiatric Nursing Care

3. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 2 The Stuart Stress Adaptation Model Views nature as ordered on a social hierarchy Assumes a holistic biopsychosocial approach to psychiatric nursing practice Regards adaptation/maladaptation as distinct from health/illness Incorporates elements of primary, secondary, and tertiary levels of prevention Identifies four stages of psychiatric treatment and related nursing activities Can be used across psychiatric settings throughout the continuum of care Is based on standards of psychiatric nursing care and professional performance

4. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 3 The Criteria of Mental Health Possesses a positive attitude toward self, including acceptance of self and self-awareness Seeks growth, development, and self-actualization Integrates or balances inner and outer conflicts and regulates moods Strives for autonomy or self-determination, a balance between dependence and independence, and acceptance of the consequences of one’s actions Tests assumptions about the world by empirical thought Demonstrates environmental mastery and feels success in an approved role in society

5. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 4 Figure 4-2 Patterns of behavior.

6. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 5 Figure 4-4 Biopsychosocial components of the Stuart Stress Adaptation Model of psychiatric nursing care.

7. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 6 Figure 4-5 Comparison of nursing and medical models of care.

8. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 7 DSM-IV-TR Axes I and II constitute the entire classification of mental disorders plus conditions that are not attributable to a mental disorder that are a focus of attention or treatment. Axis III allows the clinician to identify any physical disorder potentially relevant to the understanding or treatment of the individual. Axis IV is for reporting psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders. Axis V is for reporting the clinician’s judgment of the individual’s overall level of functioning. This information is useful in planning treatment, measuring its impact, and predicting outcomes.

9. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 8 Treatment Stages and Activities CRISIS STAGE Nursing goal: Stabilization of the patient Nursing assessment: Focuses on the risk factors that threaten the patient’s health and well-being Nursing intervention: Directed toward managing the environment to provide safety Nursing expected outcome of care: No harm to the patient or others

10. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 9 Treatment Stages and Activities (cont.) ACUTE STAGE Nursing goal: Remission of the patient’s illness Nursing assessment: Focuses on the patient’s symptoms and maladaptive coping responses Nursing intervention: Directed toward treatment planning with the patient and the modeling and teaching of adaptive responses Nursing expected outcome of care: Symptom relief

11. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 10 Treatment Stages and Activities (cont.) MAINTENANCE STAGE Nursing goal: Complete recovery of the patient Nursing assessment: Focuses on the patient’s functional status Nursing intervention: Directed toward reinforcement of the patient’s adaptive coping responses and patient advocacy Nursing expected outcome of care: Improved patient functioning

12. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 11 Treatment Stages and Activities (cont.) HEALTH PROMOTION STAGE Nursing goal: Achievement of the patient’s optimal level of wellness Nursing assessment: Focuses on the patient’s quality of life and well-being Nursing intervention: Directed toward inspiring and validating the patient Nursing expected outcome of care: Optimal quality of life for the patient

13. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 12 Summary of the Stuart Stress Adaptation Model Predisposing factors—Risk factors that influence both the type and amount of resources the person can elicit to cope with stress (such as genetic background, intelligence, self-concept, age, ethnicity, education, gender, belief systems) Precipitating stressors—Stimuli that the person perceives as challenging, threatening, or demanding and that require excess energy for coping (such as life events, injury, hassles, and strains) Appraisal of stressor—An evaluation of the significance of a stressor for a person’s well-being, considering the stressor’s meaning, intensity, and importance (such as hardiness, perceived seriousness, anxiety, and attribution)

14. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 13 Summary of the Stuart Stress Adaptation Model (cont.) Coping resources—An evaluation of a person’s coping options and strategies (such as finances, social support, and ego integrity) Coping mechanisms—Any effort directed at stress management (such as problem solving, compliance, and defense mechanisms) Continuum of coping responses—A range of adaptive or maladaptive human responses (such as social changes, physical symptoms, and emotional well-being) Treatment stage activities—The range of nursing functions related to the treatment goal, nursing assessment, nursing intervention, and expected outcome (such as environment management, patient teaching, role modeling, and advocacy)