2. Human Response to Threat, Stress, and Anxiety NUR 210 Nursing Concepts, Processes, and Skills

3. Stress Principles Primary response to a stressor is behavioral The impact is cumulative Circumstances alter the impact or harm done by a stressor

4. Continued…. People are remarkably adaptable. Various psychological or social factors can ease or exaggerate the effects of a stressor There are definite low points when stressors are poorly tolerated.

5. Continued… Conditioning is an important protection. Responses to stress throughout life are both local and general.

6. General Adaptation Syndrome “GAS” Hans Selye (1947) Stressors: Internal and External stimuli that cause stress –Internal: originate inside a person –External: originate outside a person

7. STRESS A nonspecific response both physiological and psychological to any disruption of one’s homeostasis or equilibrium. –Distress:damaging to health –Eustress: protects health –Posttraumatic Stress Disorder

8. MAJOR MECHANISMS OF ADAPTATION Medulla Oblongata Reticular Formation Pituitary Gland

9. MODELS OF STRESS Selye Lazarus Holmes and Rahe

10. Selye: Adaptation Model: GAS A defense response of the whole body to stress –Alarm Reaction –Resistance Stage –Exhaustion Stage

11. GAS Immediate response to stress –ANS –Endocrine system Prolonged state of stress can cause disease

12. Holmes and Rahe: Stimulus-based Model Holmes and Rahe (1976) Focuses on disturbing/disruptive events within an environment No flexibility, does not allow for individual differences in perception and response

13. Lazarus and Folkman: Transaction-based Model Lazarus and Folkman (1984) Persons and environment dynamic/interactive relationship Individual perceptional response rooted in psychological and cognitive process –beliefs –perception of control –uncertainty

14. RESPONSE TO STRESS Physiological functioning Personality Behavioral characteristics Nature of the stressor Influenced by: –intensity, scope, duration –# and nature of other stressors –predictability

15. Types of Stressors Situational: job changes, chronic illness Maturational: stressors vary with life stage Sociocultural: environmental and social

16. ASSESSMENT Physiological indicators Psychological indicators Developmental indicators Emotional Behavioral indicators

17. ASSESSMENT Intellectual indicators Family indicators Lifestyle indicators Sociocultural indicators Spiritual indicators

18. NURSING DIAGNOSIS “ineffective coping” Requires the presence of appropriate defining characteristics Identify the probable etiology for the problem

19. PLANNING Outcome: effective coping Select nursing interventions to promote adaptation to stress Consult Involve client, family and peers Identify community resources

20. IMPLEMENTATION Health Promotion –time management, exercise, diet, rest, support system Acute Care –crisis intervention Restorative Care –humor, enhancing self-esteem, relaxation techniques, spirituality, stress management workshops, guided imagery,

21. EVALUATION Reassess presence of new or recurring stress related problems/symptoms Determine if change in care promoted the client’s adaptation to stress Ask of the client’s expectations are being met