1. Chapter 20 Stress, Anxiety, and Adaptation Fundamentals of Nursing: Standards & Practices, 2E

2.  Copyright 2002 by Delmar, a division of Thomson Learning 20-2 Stress, Anxiety, and Adaptation  Stress is the body’s physiological or psychological reaction to any stimulus that evokes a change.  A stressor is any situation, event, or agent that threatens a person’s security.  Anxiety is a subjective response that occurs when a person experiences a threat to well-being.

3.  Copyright 2002 by Delmar, a division of Thomson Learning 20-3  Adaptation is an ongoing process by which individuals adjust to stressors in order to achieve homeostasis.  Homeostasis is the equilibrium between physiological, psychological, sociocultural, intellectual, and spiritual needs.

4.  Copyright 2002 by Delmar, a division of Thomson Learning 20-4 Sources of Stress  Individuals experience stress from multiple sources; primarily their bodies, their thoughts, and the environment.  A situation or event that evokes stress in one person, may not affect another person.

5.  Copyright 2002 by Delmar, a division of Thomson Learning 20-5 Stress  Physiological responses General adaptation syndrome (GAS)  Alarm  Resistance  Exhaustion Local adaptation syndrome (LAS)

6.  Copyright 2002 by Delmar, a division of Thomson Learning 20-6  Manifestations of stress Physiological Psychological Cognitive Behavioral Spiritual

7.  Copyright 2002 by Delmar, a division of Thomson Learning 20-7  Outcomes of stress Eustress Distress

8.  Copyright 2002 by Delmar, a division of Thomson Learning 20-8 Crisis  An acute state of disorganization  Can be a negative experience but also has the potential to be an opportunity for growth  The outcome is unique according to each individual’s perception and coping abilities

9.  Copyright 2002 by Delmar, a division of Thomson Learning 20-9  Characteristics of a crisis Experienced as a sudden event An identifiable precipitating event Perceived as overwhelming Cannot be resolved with usual coping skills Intervention is required for equilibrium to be achieved

10.  Copyright 2002 by Delmar, a division of Thomson Learning 20-10  Types of crises Developmental or maturational Situational Adventitious

11.  Copyright 2002 by Delmar, a division of Thomson Learning 20-11  Balancing factors of a crisis Perception Coping mechanism Situational support

12.  Copyright 2002 by Delmar, a division of Thomson Learning 20-12 Coping Behaviors  Coping strategies can result in successful adaptation to stress.  Examples of frequently used coping behaviors include talking, crying, laughing, exercising.

13.  Copyright 2002 by Delmar, a division of Thomson Learning 20-13 Defense Mechanisms  Psychological protective mechanisms  Unconscious operations that protect the mind from anxiety  Defense mechanisms are universal  Pathological when they become a stereotyped pattern  Pathological when they limit the individual’s ability to function

14.  Copyright 2002 by Delmar, a division of Thomson Learning 20-14 Stress and Illness  When a person’s adaptive attempts are unsuccessful, illness occurs.  One of the major outcomes of prolonged periods of stress is impairment of the immune system.  As the body fights off a threat, steroid production is increased and the body is less able to protect itself from disease.

15.  Copyright 2002 by Delmar, a division of Thomson Learning 20-15 Impact of Illness and Treatment  Changes in routine evoke the stress response.  Most clients do not have enough energy to cope with numerous changes.  Hospitalization, surgery, long-term care admission, and outpatient care services can create stress in clients.

16.  Copyright 2002 by Delmar, a division of Thomson Learning 20-16  Some cues that a person may be reacting adversely to hospitalization Increased stress response Higher levels of anxiety Increased or impaired use of coping mechanisms Inability to function Disorganized behavior

17.  Copyright 2002 by Delmar, a division of Thomson Learning 20-17 Stress and Change  Change is a dynamic process in which an individual’s behavior is altered in response to a stressor.  Change is planned or unplanned, constructive or destructive.  Change is stressful to an individual because it activates the GAS.

18.  Copyright 2002 by Delmar, a division of Thomson Learning 20-18  Characteristics of change An inevitable part of life Eustressful or distressful Self-initiated or externally imposed Occurs abruptly or has a gradual onset with insidious progression Energy is required to effect change, as well as to resist change.

19.  Copyright 2002 by Delmar, a division of Thomson Learning 20-19  Types of change Developmental Reactive Covert Overt

20.  Copyright 2002 by Delmar, a division of Thomson Learning 20-20  Theories of change Lewin’s Theory of Change Lippitt’s Theory of Change

21.  Copyright 2002 by Delmar, a division of Thomson Learning 20-21  Resistance to change Many people resist change because of the energy required to adapt. Conversely, energy is also required to resist change. Individuals differ in their ability to tolerate (or even thrive on) change.

22.  Copyright 2002 by Delmar, a division of Thomson Learning 20-22  Changing paradigms A paradigm is a pattern or model that strongly influences one’s decisions and behaviors. By changing paradigms, an individual can determine what is positive in the old system and use it to create a newer, better system.

23.  Copyright 2002 by Delmar, a division of Thomson Learning 20-23  Nurse as a change agent A change agent is a person who intentionally initiates and creates change. True change agents constantly seek ways to make improvements. As an advocate for change, the nurse empowers the client to initiate change in order to adapt more successfully.

24.  Copyright 2002 by Delmar, a division of Thomson Learning 20-24 Assessment  Client assessment of stress and anxiety level includes Patterns of stressors Typical responses to stressful situations Cause-and-effect relationships between stressors and thoughts, feelings, and behaviors Past history of successful coping mechanisms

25.  Copyright 2002 by Delmar, a division of Thomson Learning 20-25 Nursing Diagnosis  There are several NANDA approved diagnoses that may apply to clients experiencing anxiety Anxiety Ineffective coping Ineffective denial Powerlessness Impaired adjustment

26.  Copyright 2002 by Delmar, a division of Thomson Learning 20-26 Altered role performance Disturbed thought processes Defensive coping Fear Post-trauma response Impaired social interaction Spiritual distress

27.  Copyright 2002 by Delmar, a division of Thomson Learning 20-27 Outcome Identification and Planning  The client Identifies situations that increase stress and anxiety Verbalizes a plan to decrease effects of common stressors Differentiates positive and negative stressors in his or her life

28.  Copyright 2002 by Delmar, a division of Thomson Learning 20-28 Classifies stressors into categories of those that can be eliminated, can be controlled, or cannot be controlled directly by self Demonstrates the accurate use of selected stress management exercises Verbalizes a plan for stress management, including necessary lifestyle modifications

29.  Copyright 2002 by Delmar, a division of Thomson Learning 20-29 Implementation  Meeting basic needs  Environmental strategies  Involvement of significant others  Stress management techniques  Crisis intervention

30.  Copyright 2002 by Delmar, a division of Thomson Learning 20-30 Evaluation  Evaluating the effectiveness of clients’ coping abilities is an ongoing, comprehensive process that must include client input.

31.  Copyright 2002 by Delmar, a division of Thomson Learning 20-31 Personal Stress Management Approaches for the Nurse  High stress levels among nurses are associated with burnout - a state of physical and emotional exhaustion.  Burnout prevention and recovery depend on stress management.  A stress management plan is a continuous process, not the occasional use of a technique or exercise.

32.  Copyright 2002 by Delmar, a division of Thomson Learning 20-32  Nurses who cultivate hardiness will likely be resilient to stress.  There are three components to stress hardiness Commitment Challenge Control

33.  Copyright 2002 by Delmar, a division of Thomson Learning 20-33  Caring for one’s self includes Taking time out for self Using effective communication skills with co-workers, family, significant others Managing conflict effectively

34.  Copyright 2002 by Delmar, a division of Thomson Learning 20-34  Strategies for coping with professional stress Use time management methods Focus on accomplishments instead of the uncompleted tasks Practice slow, focused breathing Do not assume personal responsibility for others behaviors/problems

35.  Copyright 2002 by Delmar, a division of Thomson Learning 20-35 Know one’s own limits Whenever possible, distance self from stressors that have a negative impact Identify and change the stressors that you can directly influence Vary tasks between physical and mental activities