CHRISTIAN COLLEGE OF NURSING, NEYYOOR

SEMINAR
ON
STRESS AND ADAPTATION

PRESENTED BY GUIDED BY

J. AsirDhayani, Mrs. Femila,

MSc Nursing I st Year, Lecturer,

Medical Surgical Nursing, Mental Health Nursing,(Dept)

Christian College of Nursing, Christian College of Nursing,

Neyyoor. Neyyoor.

PRESENTED ON

-07-2012

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 STRESS AND ADAPTATION

INTRODUCTION.

“Without stress, there would be no life”

Stress is a feeling of physically emotional tension.

Everyone experiences stress as a part of daily life, but each perceive and respond to
stress in their own unique way. Stress is the debilitating effects caused by constant
pressure both at work and home. Adaptation is the process that requires a change in
behavior. So that the person is better suited to the environment. The nurses need to
understand the stress to help the clients cope effectively and adapt to the stressors
of illness and care giving stress can lead to a state of unhealthy.

TERMINOLOGY.

 Reframing: Reframing is a general method of changing the meaning of

something and thereby changing minds.
 Affirmations: Affirmations care positive statements that describe a desired
situation and which are repeated many times, in order to impress the
subconscious mind and trigger it into positive action.
 Homeostasis: The process by which the body remains in balance.
 Burn out: Burn out is a psychological term for the experience of long term
exhaustion and diminished interest.
 Fantasy (Day dreaming): It is likened to make- believe- unfulfilled wishes
and desires are imagined as fulfilled or a threating experience is reworked.
 Exhaustion: Exhaustion is the state of being so tired, that the person has
no energy left.
 Trembling: Shake involuntary as from excitement or anger.

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  Tics: Tic is a sudden, repetitive, non-rhythmic motor movement involving
muscle groups.
 Fidgeting: The act of moving about restlessly.

OBJECTIVES.

At the end of the seminar, the student will able to

 define stress, stressor, coping, adaptation, stress response, stress

management.
 enlist the types of stress.
 enumerate the source of stress.
 identify the causes of stress.
 explain the stress cycle.
 describe the stages of stress.
 explain the models of stress.
 describe the theories of stress.
 list the warning signs of stress.
 identify the clinical manifestation and effects of stress.
 describe the stress assessment.
 explain the stress adaptation.
 enumerate the models of stress adaptation.
 identify the healthy ways to adopt and maladaptive behaviors.
 list the types of coping mechanism.
 explain the stress management.
 list the stress management techniques.
 explain the stress management for nurses.
 explain the nursing management of stress.
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CONTENT.

Definition.

Stress:

 Stress is a demand made upon the adaptive capacities of the mind and body.
 Stress is a scientific concept which has suffered from the mixed blessing of
being too well known and too little understands.
 Stress is the non- specific response of the body to any demand, whether it is
caused by or results in pleasant or unpleasant conditions.
-Hans Selye, 1936.
 Stress is the body’s reaction to a change that requires a physical, mental or
emotional adjustment or response.
-Angela Morrow, 2011.
 Stress is defined as a physical, mental or emotional response to events that
causes bodily or mental tension.

Stressor:

 An agent, condition, or other stimulus that causes stress to an organism.

- Farlex, 2009.
 A stressor is a stimulates that the person perceives as a challenge or threat, it
disturb the person’s equilibrium by initiating a physical or emotional
response.
 A stressor is a situation, activity or event that produces stress.

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Coping:

 Coping is defined as constantly changing cognitive and behavioural efforts

to manage specific external and internal demands.
 Coping refers to the things thoughts and action people do to deal with stress
and distress.
 Coping is a process that a person uses to manage events that he or she
encounters, perceives and interprets as stressful.

Adaptation:

 The changes that take place as a result of stress and coping are called
adaptation.
 Adaptation is generally considered a person’s capacity to flourish and
survive even with adversity.

Stress Response:

 Stress response is the compensatory reaction the body makes to the

disturbance caused by the stressor.
 Physiologic response to stress comprises three phases. The fight-or-flight
response is the first phase, in which the sympathetic nervous system is
active, increasing heart rate, respiration and blood pressure. In the second
phase the organism adapts to the source of stress. The third and final phase is
exhaustion, also called general adaptation syndrome.

Stress Management:

 Stress management encompasses techniques intended to equip a person with

effective coping mechanism for dealing with psychological stress.
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  Stress management can be defined as interventions designed to reduce the
impact of stressors in the work place.
 A set of techniques and programs intended to help people deal more
effectively with stress in their lives by analyzing the specific stressors and
taking positive actions to minimize their effects.
Examples: include progressive muscular relaxation, guided imaginary,
biofeedback, breathing techniques and active problem-solving.

TYPES OF STRESS.

1.Distress or bad stress.

Stress due to an excess of adaptive demands placed upon the person. The
demands are so great that they lead to bodily and mental damage.

For Example.

Unexpected death of a loved person.

2.Eustress (Or) Good Stress.

The optimal amount of stress which helps to promote health and growth.

For Example.

Praise from a teacher for a well-written assignments.

3.Acute Stress (Or) Short Term Stress

Acute stress is the temporary type of stress. Acute stress is the result of
short term stresses. Acute stress occurs, is usually quite intense, and then

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disappears quickly. (ie) immediate reaction to the stressor. This is also known as
fight and flight response.

Acute stress happens when something happens to excite the brain and
body.

For Example.

The person seeing snake in the middle of the road, increases the blood
pressure, heart rate and respiratory rate and oxygen and glucose enter the thigh and
back muscles, making body to run away or to beat the snake. Once the snake just
leaves, the body goes back to homeostasis, in which the blood pressure, breathing
rate, body temperature and glucose in the blood stress to normal level.

4.Episodic acute stress.

Episodic acute stress is a more severe type of acute stress. People who
suffer from this type of stress experience symptoms every day, not just once in a
while. Episodic stress, if not properly managed, can lead to chronic stress.

For Example.

Deserve the raise or promotion but don’t act on the feelings.

Life spins out of control with one disaster after another an illness, a
divorce, and loss of employment within a short time span.

Symptoms like recurring headaches, indigestion, fatigue and insomnia

are vivid warning signs of episodic acute stress.

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5.Chronic Stress or Long Term Stress.

Chronic stress comes when a person never sees a way of miserable

situation. Chronic stress destroys bodies, minds and lives. Chronic stress is
difficult to treat and may require extended medical as well as behavioral treatment
and stress management. Chronic stress kills the person through suicide, violence,
heart attack and perhaps even cancer. Long term stress results in stress related
disease and reduces the quantity of life.

For Example.

 Emotionally draining relationships.

 Unfulfilled job.
 Stress of poverty.
 Traumatic childhood experiences.

SOURCE OF STRESS.

The source of stress or stressors can be broadly classified as,

1. General classification.

 Internal stressor.

 External stressor.

 Developmental stressor.

 Situational stressor.

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2.According to location.

 Physical.

 Physiologic.

 Psychosocial.

3.According to involved persons.

 Day to day stressors.

 Major complex occurrences involving large groups.

 Less frequent stressors.

4.According to duration.

 Acute time limited stressor.

 Stressor sequence.

 Chronic Intermitted Stressor.

 Distant Stressors.
5.Others.

 Post-traumatic stress.

 Background stress.

 Imaginative.

 Vicarious.

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1. General classification.

 Internal Stressors.

Internal stressors originate with in a person.

For Example

 Infection.
 Diseases,
 Anxiety
 Nervous anticipation of event.
 Negative self-talk.

 External Stressors.

External stressors originate outside the individual.

For Example

 Death of a family member.

 Hurricane.
 Excessive heat in aroom.
 Move to another city.
 Pressure from peer.

 Developmental stressors.

Developmental stressors are those that can be predicated to occur at

various stages of a person’s life. In a sense, developmental stressors may be easier

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to lope with because they are accepted and the person has some time to prepare for
them.

Selected stressors associated with developmental stages.

Developmental stage Stressors

Child Absence of parents.

Beginning school.
Establishing peer relationship.
Peer competition.

Adolescent Changing physique.

Relationship including.
Sexual attraction.
Exploring independence.
Choosing a career.

Young Adult Marriage.

Starting college.
Leaving home.
Managing home.
Getting starting in occupation.

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Developmental stage Stressors

Continuing education.
Parenting children.

Middle Adult Career challenges.

Child rearing continues marriage of the
children.
Grand parenting.
Empty-nest syndrome when the children
leaves home.
Being sandwiched between caring for aging
parents as well as children or grandchildren.
Mid-life crisis (wanting to escape from one’s
present life) Eg. Buying new sports car, day
dreaming about ideal life in retirement.

Older Adults
Decreasing physical abilities and health.
Changes in residence.
Major life changes (Retirement, loss of life
partner, loss of friends).
Loss of income.
Cost of health care.
Adjusting to loss of independence.

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 Situational stressors.

Situational stressors are unpredictable and can affect infant, children

and adults equally. Situational stressors may be positive or negative.

For Example.

 Marriage.
 Birth of a child.
 New job.
 Death of a family member.
 Divorce.
 Illness.
 Automobile accident.
 Natural disaster.

2.According to location.

 Physical stressors.

Physical stressors are those events which produce physical insults.

For Example.

Cold, heat, chemicals.

 Physiological stressors.

Physiological stressors are those that affect body structure or function.

They may be

 Chemical. (Eg. Poisons, medications).

 Physical or mechanical. (Eg. Trauma, cold, pain).
 Nutritional. (Eg. Vitamins deficiency).
 Biological. (Eg. Viruses, bacteria).
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  Genetic. (Eg. Inborn error of metabolism).
 Psychosocial stressors.

Psycho social stressors are external stressors that arise from the work,
family dynamics, living situation, social relationships and other aspects of daily
lives.

For Example.

Work stress, marital stress, failing exam, losing job.

3.According to involved persons.

 Day to day stressors.

The day-to-day stressors include common occurrences such as traffic jam,

computer downtime, and having an argument with a spouse. These daily stressors
have been shown to have a greater health impact than major life events because of
the cumulative effect they have over time. They can lead to high blood pressure or
palpitations.

 Major complex occurrences involving large groups.

The term complex trauma describes the problem of children's exposure to
multiple or prolonged traumatic events and the impact of this exposure on their
development. Typically, complex trauma exposure involves the simultaneous or
sequential occurrence of child maltreatment including psychological maltreatment,
neglect, physical and sexual abuse, and domestic violence that is chronic, begins in
early childhood, and occurs within the primary caregiving system. Exposure to
these initial traumatic experiences and the resulting emotional deregulations and
the loss of safety, direction, and the ability to detect or respond to danger cues
often sets off a chain of events leading to subsequent or repeated trauma exposure
in adolescence and adulthood.

 Less frequent stressors.

Work injuries were appraised as the most stressful but least frequent
stressor and job pressure was reported the least severe but most frequent stressor.
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Females experienced job stressors less frequently, but appraised them as more
severe than men did.

4.According to duration.

 Acute time limited stressor.

Acute time-limited stressors are ones given in a controlled environment
such as a lab. If you are part of a study, the tech may present you with a stimulus
that causes some level of anxiety for you. This could be presenting you with
something that you have a phobia of or making you do something you don't feel
comfortable doing. The stressor sparks intense stress but only for the time it takes
to illicit a response.

 Stressor sequence.
Stressful events sequences happen when there is a traumatic event that
causes additional stressors. An example of this is if you are a victim of a natural
disaster and then have to deal with the loss of loved ones, belongings, and pulling
your life back together.

 Chronic Intermitted Stressor.

Chronic stressors are situations that happen that force you to change
your identity or social roles. If you become disabled, you will need to adjust your
life to accommodate your disabilities.

 Distant Stressor.

Distant stressors are stress that happened a long time ago but continue to
affect your immune system negatively because of emotional and cognitive issues.
Some examples of distant stressors include

 Child abuse
 Prisoner of war
 Loss of a loved one
 War trauma.

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5.Others.

 Post-traumatic stress.
Posttraumatic stress is exposure to any event those results
in psychological trauma. This event may involve the threat of death to oneself or to
someone else, or to one's own or someone else's physical, sexual, or psychological
integrity, overwhelming the individual's ability to cope.

 Background stress.
Background stressors are hassles of everyday life, they are the
persistent nagging, irritations at home, school and work that affect as all.

For Example.
While in sleep the phone bell constantly rings and it is repeatedly a
wrong number.
 Imaginative.
Feeling stressed causes the body to undergo changes in levels of certain
hormones.
For Example.
Acne, hair loss.

 Vicarious.
Taking the place of another person or thing acting or serving as a substitute.

Causes of stress.

 Not having enough time.

 Unhealthy life style. (Lack of sleep, smoking, alcoholism, drug addiction).

 Talking on too much.

 Conflicts in the workplace or at home.

 Inability to accept things as they are.

 Failure to take time out and relax.

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  Non work related problems, moving house or debt problems.

 Failure to see the humors in situations.

 Particular situations that cause stress, workplace, struck in traffic and need to

get somewhere quickly.

 Major life changes (job changes).

STRESS CYCLE.

Stress follows a cycle of events which circle around and around, each step
increasing the severity of next step. The stress cycle can be interrupted at any point
with stress management program.

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 Stressor.

The thing that causes the stress avoids the stressors to manage them.

 Reaction to stress.

Once there is a stressor the next step is the reaction to it. The body
begins a huge chemical change to prepare the person to confront stressor.

The techniques to break the stress cycle by changing the reaction to stress
are cognitive-behavioral therapy, reframing, affirmation, visualization and spiritual
practices.

 Wear And Tear On The Body And Organ Systems:

Stress and its effects on the body. The effects are tightness of neck
muscles, headache, exhaustion, irritability, increased colds and insomnia.

Diet, exercise, yoga, aromatherapy, herbal supplements can all help

both the emotional and physical effects of stress.

 Reduced Optimum Health:

After a sustained period of chronic stress with little or no relief, the body
will wear down. This can invite more serious diseases like high blood pressure,
heart problems, diabetes, skin conditions, asthma, arthritis, depression and even
cancer.

Homeopathy, acupuncture, naturopathy, help to regain health breaking

the cycle at this point requires effort.

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 Increased sensitivity to stress:

When the body is fighting diseases, the emotions are worn and exhausted
and sensitivity to stress increases. Overtime, smaller and smaller stressor will
initiate the same stress reaction that a big event used to get.

Natural stress relief helps to reduce sensitivity. Deep breathing,

medication, taking walks or talking with an objective friend help to reduce
sensitivity.

 And Finally-Another Stressor.

If the cycle is not breaked, the cycle continues and produces now another
stressor.

Stages of Stress.

Hans selye characterized the stress reaction into three stages.

 Alarm stage.
 Resistance stage.
 Exhaustion stage.
 Alarm stage.

The first stage is initiated with a threat. This is short term reaction. All the
bodily activity is increased in response to a stressor. This starts the body’s “fight-
fight” reaction, causing the release of adrenalin.

 Resistance stage.

If the threat persists with the person, he enters the second stage. In the
resistance stage he makes much effort to cope up with his level of stress.

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 Exhaustion stage.

It leads to illness and injury. Burn out is the effect of this stage. If the
stressful situation is not resolved, he may become chronically stressed. The body’s
needs for energy resources exceed its ability to produce them.

Models of Stress.

Models of stress assist nurses to identify the stressor in a particular situation,

and to predict the individual’s responses. Nurses can use these models to assist
clients in strengthening healthy coping responds and in adjusting unhealthy,
unproductive response.

Stimulus Based Model.

In stimulates based models, stress is defined as a stimulates, a life event, or a set of

circumstances that arouses physiological and/or psychological reactions that may
increase the individuals vulnerability to illness. Both positive and negative events
are considered stressful.

Transaction based models.

Transaction model was given by Lazarus (1966) WHO stated that the
stimulus theory and the response theory don not consider individual differences.

Although Lazarus recognizes that certain environmental demands and pressures

produce stress in substantial numbers of people, he emphasizes that people and
groups differ in their sensitivity and vulnerability to certain types of events as well
as in their interpretations and reactions.

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For Example.

Interims of illness, one may respond with denial, another with anxiety and
still another with depression. In contrast to selye, WHO focuses on physiologic
components or responses as part of his concept of stress.

The Lazarus transactional stress theory encompasses a set of cognitive,

affective and adaptive (coping) responses that arise out of person-environment
transactions.

Psychosomatic model.

Udupa (1977) reported that psychosomatic diseases appear to progress

through four distinct phases.

 Psychic phase.

This phase is marked by mild, but psychological and behavioral symptoms of

stress such as irritability, disturbed sleep, loss of appetite etc.

 Psychosomatic phase.

If the stress condition continues these symptoms become more

pronounced, along with the beginning of generalized physiologic symptoms such
as occasional hypertension and tremors.

 Somatic phase.

This phase is marked by increased function of the organs, particularly the

target or involved organ,. At this stage one begins to identify the beginning of a
disease state.

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  Organic phase.

This phase is marked by the full involved of a so-called disease state, with
physiological changes such as an ulcerated stomach or chronic hypertension
becoming manifest.

For Example.

Psychological illnesses pass through following four stages.

Stage 1 (irritability).

Stage 2 (hypertension).

Stage 3 (palpitation)

Stage 4 (chronic hypertension).

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Social Environmental Model.

Pestonjee (1983) attempted to explain the three important sectors of life

in which stress originates.

Job and organization-job and organization refers to the totality of the

work environment (task, atmosphere, colleagues, compensations, politics etc

Social sector refers to the social cultural context of one’s life. It may include
religion, caste. Language, dress and other such factors.

Intrapsychic sector encompasses those things which are intimate and

personal like personal like temperament values, abilities and health.

Stage-1.

The magnitude of stress emanating from the three sector of life is in

consonance with the stress. Tolerance limit (STL) of the individual indicates
balanced stat.

Stage-2.

Job and organizational loads have increased causing minor changes that
are quite manageable.

Stage-3.

Job and organizational loads have become unmanageable and interact with
intrapsychic loads. This is the stage at which the negative consequences of stress
become apparent. Most of the stress related diseases emerges at this point.

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Stage -4.

If unchecked the situation may culminate in complete disintegration of

personality. At this stage the person requires proper psychological and medical
care.

Bounce Model.

Pestonjee (1983) has also developed a model to explain how one lope with stress
reactions. It is called the bounce model because the behavioral decompensating
taking place due to stress tends to get reflected in interpersonal and other reactions.
The reactions are received and analyzed by the environment, which in turn bounces
back signals to the individual to bring about a change either at organism level or at
the response level.

e
n
Stressors v
i
Intrapsychic organism Response r
o
n
External (physical)
m
e
External (social) n
t

 Responses can be adjustive, effective and good.

 Responses can be adoptive.
 Responses can be maladaptive leading to decompensation.
 Responses can be devastating.

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 Cognitive Response.

Cognitive indicators are thinking responses that include

 Problem solving
 Structuring.
 Self-control or self-discipline.
 Suppression.
 Fantasy.

 Natural response.

 Cortisone.
 Thyroid.
 Endorphin.
 Sex hormones.
 Digestive tract.
 Sugar and insulin.
 Cholesterol.
 Racing heart beat.
 Air supply.
 Blood.
 Skin.
 Senses.

 Emotional Response.

 Coping mechanism exhaustion.

 Irritability.
 Irritability.
 Muscular tension.
 Inability to concentrate.
 Headache.

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  Behavioral Response.
 Anxiety.
 Fear.
 Ego defense mechanism.
 Anger.
 Depression.

THEORIES OF STRESS.

1) Systemic theory : selye’s theory.

Defines stress as a state manifested by a syndrome which consists of all
the non-specifically induced changes in a biologic system.

2) Psychologic stress: Lazarus theory.

Defines psychological stress as relationship with the environment that the

person appraises as significant for his or her wellbeing and in which the demands
tax or exceed available coping resources.

3) Cognitive appraisal theory: Richard lazarces.

Cognitive appraisal is a mental process by which people assessed two

factors.

Whether a demand threatens their well-being.

Whether a person considers that they have the resources to meet the
demands of the stressor.

There are two types of appraisal.

a) Primary appraisal.

Primary appraisal stage will be seeking answers as to the meaning of

the situation.

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Example.

It is irrelevant or good or stressful.

b) Secondary appraisal.
It includes feelings of not being able to deal with problems.

Example.

I can’t do it – I know I’ll fail.

4) Resources theories of stress.

A bridge between systemic and cognitive viewpoints.

Four categories of resources are prepared.

Object resources.

Physical objects such as home clothing, or access to transportation.

Condition resources.
Employment, personal relationships.

Personal resources.

Skill or self-efficacy.

Energy resources.

Money, credit, knowledge. Assumptions of categories of resources are

Loss of stress is the primary source of stress.

Resources act to preserve and protect other resources.

o Phobia.
o Anxiety.

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Phobia-Phobia is intense and irrational fears that are associated with specific
events and situations.

Example: claustrophia.

Anxiety- Anxiety is a vague feeling of uneasiness or apprehension.

Example: person awaiting surgery or the outcome of diagnostic tests generally

experience high levels of anxiety.

Stress can lead to feeling of depression.

Example: long-term illness.

5) Social behavioural theory.

When stress is accompanied by anger, negative social behaviours tend to increase.

Stress-produced anger increases aggressive behavior and increases aggressive
behaviour and these negative effects continue after the following stressful
circumstances individuals have an increasingly depleted resource pod to combat
further stress.

6) Cognitive theory.

A high level of stress impairs people’s memory and attention during

cognitive activities thoughts can perpetuate stress and make it chronic.

Example.

People living near nuclear power plant who had difficulty in coping with
the stress that was produced by the fear that the nuclear emissions would affect
their health, found it difficult to keep their minds from thinking about the
accidents. When taking examinations.

7) Emotional theory.

Fear is a common emotional reaction that can be classified into two

categories.Stressful event is over.

Example.

Child abuse is often related to parental stress.

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STRESS WARNING SIGNS.

 Headache
 Upset stomach
 Dry mouth
 Chest pain.
 Difficulty falling sleep.
 Fatigue.
 Loss of appetite or overeating.
 Lack of concentration.
 Memory problems.
 Irritability.
 Short-temper.
 Anxiety.
 Abusive behavior.
 Depression.
 Damaged relationships.

Clinical manifestations of stress.

 Physiological.

 Pupils dilate to increase visual perception when serious threats to the

body arise.
 Sweat production (diaphoresis) increases to control elevated body heat
due to increased metabolism (hand, forearm, body)
 Heart rate and cardiac output increase to transport nutrients and by
products of metabolism more efficiently. (pounding of heart)

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  Skin is pallid because of constriction of peripheral blood vessels, an
effect of norepinephrine.
 Sodium and water retention increase due to release of minerals cortiliods
which increases blood volume.
 Rate and depth of respiration increase because of dilation of the
bronchioles promoting hyperventilation.
 Urinary output decreases.
 Stooping posture.
 Trembling.
 Teeth grinding.
 Twitching.
 Tics.
 Fast, shallow or difficulty in eating.
 Pain and tension in muscles giving rise to headache.
 Migration.
 Eye pain.
 Neck pain.
 Low back pain and pain in the limbs.
 Pain in the limbs.
 Tiredness and ready fatigable.
 No or reduced menstrual bleeding.
 Lack of interest in sex or frank impotence.
 Mouth may be dry.
 Peristalsis of the intestines decreases resulting in possible constipation
and flatus.
 For serious threats, mental alertness improves.
 Muscle tension increases to prepare for rapid motor activity or defense.
 Blood sugar increases because of release of glucocorticoids and
gluconeogenesis.

 Psychological. (Mental or Emotional.)

 Anxiety.
 Mild anxiety produces a slight around state that enhances perception
learning and productive abilities.
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 Example. Person seeks information and asks questions.
 Moderate anxiety increases the around state to a point where the person
expresses feelings of tension.

Example. Attention is focused more on a particular aspect of a situation

than on peripheral activities.

 Severe anxiety consumes most of the person’s energies and requires

intervention.
Example. A person unable to focus on what is really happening.
 Panic is an over powering, frightening level of anxiety.
Example. Person loss control.
 Anger – anger is an emotional state consisting of a subjective feeling of
animosity or strong displeasure.
 Depression-depression is a common reaction to events that seems
overwhelming or negative. Depression, an extreme feeling of sadness,
despair, dejection, lack of worth.
 Crying for no reason.
 Lack of concentration.
 Low short term memory.

 Behavioural.

 Refusal to eat in spite of good appetite.

 Overeating by forcible vomiting.
 Fidgeting.
 Nail biting.
 Hair pulling.
 Addiction to smoking, alcohol.
 Addiction drugs.

 Sociological.

 Reduced job satisfaction.

 Loss job.

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  Family discord.
 Assault.
 Act of violence.
 Fits of rage.
 Unreasonable fears.
 Anxieties.
 Listlessness.
 Hyperactivity and irritability.
 Dizziness.
 Fainting.
 Ringing in the ears.
 Insomnia.
 Recurrent vivid dreams of post tragic events.
 Lethargy.
 Lack of interest in food.
 Withdrawal from human interactions.

EFFECTS OF STRESS.

 Skin disorders
 Eczema
 Pruritus.
 Urticarial.
 Psoriasis.

 Respiratory disorders.
 Asthma.
 Hay fever.
 Tuberculosis.
 Cardio vascular disorders.
 Coronary artery disease.

32
  Essential hypertension.
 Congestive heart failure.

 Gastro intestinal disorders.

 Constipation.
 Diarrhea.
 Duodenal ulcer.
 Anorexia nervosa.
 Obesity.
 Ulcerative colitis.

 Metabolic disorders.
 Hyper thyroidism.
 Hypothyroidism.
 Diabetic mellitus.
 Cushing syndrome.
 Gout.

 Musculo skeletal disorder.

• Rheumatoid arthritis.
• Low back pain.
• Migraine headache.
• Muscle tension.

 Cancer.
 Accident proneness.
 Decreased immune response.
 Menstrual irregularities.

STRESS ASSESSMENT.

Stress Risk Assessment

 Work
 Organisation
 Resources
33
  Roles and relationships
 individual
 Environment
 Demands

Stress Assessment Scales.

 Kessler Psychological Distress Scale.

It is widely recommended as a simple measure of psychological distress

and as a means to monitor progress following treatment for common mental health
disorders such as anxiety and depression.

There are 10 questions that ask you about your feelings and thoughts during the
last month. In each case, you will be asked to respond by selecting one of five
responses indicating how often you felt or thought a certain way.

 Global Assessment of Recent Stress (GARS).

Scale was developed to assess current stress perception. Most
measurements of environment are derived from life event scales that capture
amount of stress or change associated with stressful events that have occurred over
the past six to twenty-four months. A scale that provides a more immediate
estimate of stress is needed when physiological tests and perceived stress are
studied together. The GARS has been subjected to a series of studies concerning its
reliability, validity, and factor structure. Results suggest that it may be a useful
instrument for helping individuals assess their current feelings of stress.

 Depression Anxiety stress scale (DASS).

It is the 42 item self-report measure of anxiety depression and stress developed

by lovibond 1995.

 Life event stress scale.

In the past it measures the life event taken place in life past 12 months.

34
STRESS ADAPTATION.

Adaptation refers to individual’s ability to adjust to changing life

situations using various strategies.

Defense mechanisms are the unconscious mind working to protect the

person from anxiety.

1. Avoidance.

Unconsciously staying away from events or situations that might open

feelings of aggression or anxiety.

Example.

I can’t go to the class reunion to night. I am too tired, I have to sleep.

2. Compensation.

Making up for a perceived inadequacy by developing or emphasizing some

other desirable trait.

Example.

A small boy who wants to be on the football team instead becomes a great
singer.

3. Denial.

Transforming reality by refusing to acknowledge thoughts, feelings or

impulses.

Example.

An alcoholic states “I can quit any time I want to”.

35
4. Displacement.

The transferring or discharging of emotional reactions from one object or

person to another object or person.

Example.

A husband and wife are fighting and the husband becomes. So angry he hits a
door instead of his wife.

5. Identification.
An attempt to manage anxiety by initiating the behavior of someone feared or
respected.

Example.

A student nurse imitates the behaviours she observes one of her instructions
using with clients.

6. Conversion.

Emotional conflict is changed into physical symptoms that have no physical

basis. The symptoms often disappear after the threat is over.

Example.

Developing nausea that causes the person to miss the major exam. Feeling back
pain when it is difficult to continue carrying the pressures of life.

7. Intellectualism.

Cognitive reasoning is used to block or avoid feelings about a painful

incident.

36
Example.

When her husband dies, the wife relieves her pain by thinking, it’s better
this way, he was in so much pain.

8. Introjection.

A form of identification that allows for the acceptance of other’s norms and
values into oneself.

Example.

A seven year old tells his little sister. Don’t talk to strangers. He has
interjected this value from the instructions of patients and teachers.

9. Minimization.
Not acknowledging or accepting the significance of one’s own behavior,
making it less important.

Example.

A person says don’t believe everything my wife tells you.

10.Projection.

A process in which blame is attached to others or the environment for

unacceptance desires, thoughts, shortcomings and mistakes.

Example.

A husband forgets to pay a bill and blames his wife for not giving it to him
earlier.

37
11.Rationalization.

Justification of certain behaviours by faculty logic and ascribing motives

that are socially acceptable but did not in fact inspire the behavior.

Example.

A mother spanks her toddler too hard and says it was all right because
he couldn’t feel it through the diaper’s anyway.

12.Reaction formation.
A mechanism that causes people to act exactly opposite to the way they
feel.

Example.

An executive resents his bosses for calling in a consulting firm to make

recommendations for change in his department but verbalizes complete support of
the idea and is exceedingly polite and co-operative.

13.Regression.
Resorting to an earlier more comfortable level of functioning that is
characteristically less demanding and responsible.

Example.

An adult throws a temper tan drum when he does not get his own way. A
critically in client allows the nurse to bathe and feed him.

14.Repression.

An unconscious mechanism by which threatening thoughts, feelings and

desires are kept from becoming conscious.

Example.

38
 A teenager seeing his friend killed in a car accident becomes amnesic about
the circumstances surrounding the accident.

15.Sublimation.
Displacement of energy associated with more primitive sexual or aggressive
drives into socially acceptable activities.

Example.

A person with excessive sexual drives invests psychic energy into a well-
defined religious value system.

16.Substitution.

The replacement of a highly valued unacceptable or unavailable object by a

less valuable, acceptable or available object.

Example.

A women wants to marry a man exactly like her dead father and settles for
someone who looks a little bit like him.

17.Undoing.

An action or words designed to cancel some disapproved thoughts,

impulses or acts in which the person relieves quit by making reparation.

Example.

A father spanks his child and the next evening brings home a present for
him.

Models of stress adaptation.

Hans selye developed this model to describe how people respond to stress.

39
Physiological response.

Selye’s stress response is characterized by a chain or pattern of

physiological events called the general adaptation syndrome (GAS) or stress
syndrome. To differentiate the cause of stress from the response of stress, selye
(1976) used the term stressor to denote any factor that produces stress and disturb
body’s equilibrium. The general adaptation syndrome, occurs with the release of
certain adaptive hormones and subsequent changes in the structure and chemical
composition of the body parts of the body particularly affected by stress are the
gastro intestinal tract, the adrenal glands and the lymphatic structures. With
prolonged stress, the adrenal glands enlarge considerably, the lymphatic structures
such as the thymus, spleen and lymphatic. Atrophy (shrink) and deep ulcers appear
in the lining of the stomach.

In addition to adopt globally, the body can also react locally, that is one
organ or a part of the body reacts alone. This is referred to as the local adaptation
syndrome (LAS). One example of this LAS is inflammation.

40
 2.RESISTANCE

3. EXHAUSTION

HOMEOSTASIS RECOVERY

DEATH

1. ALARM

Homeostasis 1. Alarm 2. Resistance 3.Exhaustion Death Recovery

All systems Stressor is Adaptation Adaptation and In extreme or Stressful situations

are reactive to perceived resources are energy stores chronic cases. that are well or
everyday homeostatic mobilized to are depleted. Exhaustion partially managed
stressors in a slightly drops combat When can become result in a complete
balanced and as the mind stressor. replenished. so or partial return to
healthful and body Endocrine body returns to pronounced homeostasis and
manner. temporarily system comes homeostasis. that death can normal functioning
lose balance. into play. occur.

Stock phase

Epinephrine Nor epinephrine Cortisone

Tachycardia.Myocardia
lcontractility.bronchial Blood to kidney. Protein catabolism.
dilation. Blood Renin Gluconeogenesis
clotting.metabolism

Counter shock phase

41
Selye (1976) proposed that both the gas and LAS have three stages.

 Alarm Reaction.
 Resistance Reaction.
 Exhaustion Reaction.

 Alarm Reaction.

The initial reaction of the body’s the alarm reaction, which alerts the body’s
defenses. Selye (1976) divided this stage into two parts.

 Shock phase.
 Counter shock phase.
 Shock phase.

The stressor may be perceived consciously or unconsciously by the person.

During times of stress, the adrenal medulla secretes epinephrine and
norepinephrine is response to sympathetic stimulation significant body responses
to epinephrine include the following.

Increased myocardial contractility which increases cardiac output and blood

flow to active muscles.

Bronchial dilation, which allows increased oxygen intake.

Increased blood clotting.

Increased cellular metabolism.

Increased fat mobilization to make energy available and to synthesize

other compounds needed by the body.

 Counter shock phase

42
 The second part of the alarm reaction is called the counter shock phase.
During this time, the changes produced in the body during the shock phase are
reversed. Thus a person is best mobilized to react during the shock phase of the
alarm reaction.

 Resistance Reaction

The second stage in the GAS and LAS syndromes, the stage of resistance,
is when the body’s adaptation takes place. In other words, the body attempts to
cope with the stressor and to limit the stressor to the smallest area of the body that
can deal with it.

 Exhaustion Reaction.

During the third stage, the stage of exhaustion, the adaptation that the body
made during the second stage cannot be maintained. This means that the ways used
to cope with the stressor have been exhausted. If adaptation has not overcome the
stressor, the stress effects may spread to the entire body. At the end of this stage,
the body may either rest and return to normal or death may be the ultimate
consequence.

HEALTHY WAYS TO ADOPT STRESS.

 Eating healthy diet.

Nutrition is important for maintaining physical homeostasis and resisting

stress. Well nourished bodies are better prepared to cope with stress.

Adequate nutrition is essential to maintain the integrity of the immune

system.

 Exercise.

43
Regular exercise promotes physical homeostasis by improving muscle tone and
controlling weight.

It improves the functioning of the heart and lungs. During exercise,

endogenous opiods are released, creating a feeling of well being.

 Sleep and rest.

Sleep and rest restore energy levels, allows the body to repair itself, and
promote mental relaxation.

 Leisure activities.

Leisure activities are activities that provide joy and satisfaction. Making
time for and relaxation reduces stress.

 Healthy way to relax.

 Go for a walk.
 Spend time in nature.
 Spend time with positive people.
 Play with pet.
 Work in garden.
 Curl up with good book.
 Listen to music.
 Watch a comedy.
 Keep the sense of humor by laughing.
 Take leisure time in between work.
 Practice yoga.

 Time management.

44
 People who manage their time efficiently and organize their life routines feel
more in control and therefore less stressed. Time management also includes
saying no, a need to be liked, strong sense of responsibility. Try to make everyone
happy by agreeing to all requests for assistance.

MALADAPTIVE WAYS TO ADOPT STRESS.

Drinking more than two alcoholic beverages per day.

 Consuming excess caffeine. (example. Coffee, tea, colas).

 Eating large quantities of nutrient poor food, such as sweets.
 Smoking or chewing tobacco.
 Using illegal street drugs.
 Abusing ever-the-counter mediations.
 Avoiding social interaction.

Coping.

Coping may be described as dealing with change successfully

unsuccessful. A coping strategy coping mechanism is a natural or learned way
of responding to a changing environment or specific problem or situation.

Types.
 Problem focused coping.
 Emotion focused coping.
 Escape coping.
 Long term coping strategies.
 Short term coping strategies.
 Effective or adaptive coping.
 Ineffective or maladaptive coping.

 Problem focused coping.

45
 Problem focused coping refers to efforts to improve a situation by making
changes or taking some action.

 Emotion focused coping

Emotion-focused coping includes thoughts and actions that relieve
emotional distress. Emotion – focused coping does not improve the situation,
but the person often feels better.

 Escape coping.

In psychology, avoidance coping, or escape coping, is a kind of

generally maladaptive coping, characterized by the effort to escape from having
to deal with a stressor. Coping refers to behavior that protects people from
being psychologically harmed by problematic social experience, a behavior that
importantly mediates the impact that societies have on their members.

 Long term coping strategies.

It can be construction and realistic uses problem solving in decision making

instead of anger or other non- construction responses.

Example.

Change in life style patterns, eating healthy diet, exercising regularly.

 Short term coping strategies.

It can reduce the stress to a tolerable limit temporarily but are ineffective
wags to permanently deal with reality.

 Adaptive coping.

Adaptive coping helps the person to deal effectively with stressful events and
minimizes distress associates with them.

 Maladaptive coping.

46
 Maladaptive coping can result in unnecessary distress for the person and
others are associated with person or stressful event.

STRESS MANAGEMENT.

Identify the source of stress.

Look closely at the habits, attitude and excuse.

Identify whether they are accepting their role to play.

Identify the stressors.

Ask them to write in a diary what caused stress?

How much felt physically and emotionally?

How they acted in response?

Learning healthier ways to manage stress.

Changing the situation Changing the reaction

Avoid the Adopt to the

stressor stressor

4 A’S

Alter the
stressor Accept the
stressor

Avoid the stressor.

47
  Learn how to say No

Refusing to accept the added responsibilities taking more than to handle is the
receipe for stress.

 Avoid the people who cause stress.

If someone consistently causes stress limit the time spending with him or
end the relationship entirely.

 Take control of the environment.

If anything makes anxious, turn the TV off.

 Avoid hot button topics.

Avoid the conversation that makes to upset like religious, political.

Conversation. If any argument occurs stop or excuse from the topic of discussion.

 Pare down to do list.

Analyze the schedule, responsibilities and daily tacks, distinguish between

the should and must and drop the tasks that aren’t truly necessary to the bottom of
the list or eliminate them entirely.

Alter the situation.

 Express the feelings instead of bottling them up.

If something or someone bothers communicate the concern in an open and

respectful way.

 Be willing to compromise.

If they are expecting someone to change the behavior, bend a little to find
happy ground.

 Be more assertive.

Deal with the problem and doing the best to anticipate and prevent them.

 Managing the time better.

48
 Poor time management cause lot of stress plan a head and act accordingly.

 Adopt the stressor.

If unable to change the stressor change themselves to adopt to the stressful

situations and regain sense of control.

 Reframe problems.

Try to view the stressful situations from a more positive perspective.

Example.

In traffic, listening to favorites radio station or enjoy some alone time. Look at
the big picture.

Ask themselves whether worth getting upset over.

 Adjust the standards.

Perfectionism is a major source of avoidable stress. Set reasonable standards

for themselves and others and learn to be okay with good enough.

 Focus on the positive.

When stress is making to down that take a moment to reflect. Appreciate

positive qualities and gifts.

Adjusting the attitude.

Eliminate the words such as always, never, should and must. These are marks
of self-defeating thoughts.

Accept the things that can’t change. Accept the things as they are.
Acceptance may be difficult. It’s easier against the situation that can’t change.
Don’t try to control the uncontrollable.

Many things in life are beyond the control, particularly the behaviour of
other people.

 Look for the upsides.

49
 When facing major challenges look at them and learn from the mistake.

 Share the feelings.

Talk to a trusted friend or make an appointment with the therapist about

the stressful situation.

 Learn to forgive.

Accept the fact that we live is an important world and that people make
mistakes. Free from negative energy by forgiving and moving on.

PREVENTION OF STRESS.

Primary Prevention.

 Health education.
 Environment change.
 Social support.
 Community wide programme.
 Mile stone programme.
 High risk.

Secondary prevention.

 Screening and early detection.

 Emergency treatment, counseling, Crisis intervention and
psychotherapy.

Tertiary prevention.

 Promoting vocational training and rehabilitation.

 Organizing after care programme.
 Providing partial hospitalization.

STRESS MANAGEMENT TECHNIQUES.

50
 Stress management techniques focus on discharging tension or
simplifying one’s life to modify stressors or control stress responses.

• Nutrition.

Balanced nutritious meal is encouraged, and advice to reduce caffeine,

sugar (coffee, tea, cols, chocolate).

Exercise.

Teach bout aerobic exercise strengthening, stretching, deep breathing

exercise and yoga. Encourage to exercise regularly at least 30 minutes 3 times/
week.

• Relaxation technique.

Teaching relaxing the muscle groups.Progressive relaxation and

contracting muscle groups. Passive relaxation include relaxation of muscle group
without interaction.

• Medication.

Regular meditation increases harmony between mind, body and spirit,

thereby reducing anxiety and giving the person control.

• Guided imagery.

Guided imaginary is a program of thoughts and suggestions that guide the

imagination toward relaxed, focused state.

• Bio feedback.

Bio feed backis method that uses the mind to control the body function
that the body normally regulates automatically.

• Acupuncture.

Acupuncture involves insertion of the needle into meridian points to

regulate the flow of energy throughout the body.

• Chiropractic adjustment.

51
 It involves manual realignment of the vertebrae.

• Therapeutic touch.

Healing energy is channeled through a practitioner’s hands to improve

well being. Energy and blood to flow through muscles and soft tissues more
readily.

• Massage.

Manipulation of the soft tissues relaxes muscles, release body tension,

improves circulation, and allowsenergy and blood to flow through muscles and soft
tissues more readily.

• Reflexology.

It is the application of pressure to specific points on the feet, hands or ears

which are thought to correspond with certain organs of the body.

• Humor.

Reading and telling jokes, viewing fusty movies help release tension and
anger and increase coping abilities.

• Listening to music.

Music soothes and relaxes when its vibrations are in harmony with body
frequencies.

• Engaging in art activities.

Painting, working with day and engaging in other art activities help to
express emotions and release endorphins.

• Dance and sports.

Like other forms of exercise release pent-up physical tension and emotions.

• Journal writing.

52
 Helps the person to reflect on experiences and express emotions.

PREVENTION OF STRESS.

 Primary Prevention.
 Health education.
 Environment change.
 Social support.
 Community wide programme.
 Mile stone programme.
 High risk.

 Secondary prevention.
 Screening and early detection.
 Emergency treatment, counseling, Crisis intervention and
psychotherapy.
 Tertiary prevention.
 Promoting vocational training and rehabilitation.
 Organizing after care programme.
 Providing partial hospitalization.

STRESS MANAGEMENT FOR NURSES.

 Common stresses understanding.

 Increasing severity of client illness.
 Adjusting to various work shift.
 expected to assume responsibilities for which one is not prepared.
 Inadequate support from supervisors and peers.
 Visiting homes that are depressing.
 Caring for drying.

 Effects.

53
  Overwhelmed (fatigue, anger, overwhelmed)
 Burn out.
 Complex syndrome of behaviours.
 Exhaustion.
 Physical and emotional depletion.
 Negative attitude.
 Self-concept.
 Feeling of helplessness and hopelessness.

 Techniques to manage stress.

 Plan a daily relaxation program with meaningful quiet times to reduce
tension. (Eg). Listen to music, read so ale in tab or medicine.
 Establish a regular exercise program to direct energy outward.
 Study assertiveness techniques to overcome feelings of powerlessness.
 Learn to say No.
 Learn to accept failures.
 Learn to ask for help.
 Shown your feelings with colleagues.
 Support the colleagues in times of need.
 Develop collegial support groups.
 Participate in professional organizations to address work place issues.
 Seek counseling if indicated to help clarify concerns.

NURSING PROCESS.

 Nursing Assessment.
 Identify the person verbalization on coping and inability to cope.
 Assess the problem solving ability.
 Find out if the client denies problems or weakness unspite of
evidence to contrary.
 Recognize the non-acceptance of health status changes.
 Rule out the family physical and emotional support for the client.
 Evaluate the neglect of the client on health.
 Assess the community participation.

54
  Identify the possible stressors from the community.
 Categorize the level communication with different situations.
 Subjective data.

In subjective data the client tells about the steps.

 Objective data.
 Careful observation made on the following.
 Stress.
 Uncomfortable.
 Irritable.
 Sleepless with bun ken eyes.
 Anxiety.

 Nursing Diagnosis.
 Physical domain.
 Constipation.
 Delayed growth and development.
 Diarrhea.
 Disturbed energy field.
 Disturbed sleep pattern.
 Fatigue.
 Imbalanced nutrition.(less than or more than)
 Nausea.
 Pain (back ache)
 Risk for imbalanced fluid volume.
 Risk for injury.
 Sleep deprivation.
 Behavioural Domain.
 Ineffective health maintenance.
 Ineffective therapeutic regimen management.
 Cognitive domain.
 Disturbed thought processes.
 Impaired memory.

55
 Emotional domain.
 Anxiety.
 Decisional conflict.
 Defensive coping.
 Fear.
 Grieving (anticipatory or dysfunctional).
 Impaired adjustment.
 Ineffective coping.
 Ineffective denial.
 Low self esteem. (chronic or situational)
 Interpersonal relationships domain.
 Caregiver role strain.
 Compromised or disabled family coping.
 Impaired Parenting.
 Impaired social interaction.
 Ineffective community coping.
 Interrupted family process.
 Post-trauma syndrome.
 Relocation stress syndrome.
 Social isolation.
 Spiritual domain.
 Hopelessness.
 Spiritual domain.
 Interventions.
 Establish therapeutic relationship.
D – decision making.
E – empathy and encouragement.
A – answering the questions immediately and honestly.
R – respect the eluent values.
 Explain about stress illness, treatment and prognosis. Give
positive support to the client.
 Encourage the client to ask questions.
 Assess the coping ability and new mechanism used by the client.
 Advice the client by formulation.

56
  Assist the client in finding alternative life style modification,
participation, spiritual needs, learning new activates and
behaviors.
 Encourage the client on self care activities.
 Identify the strength and weakness and give appropriate rewarding
on the client strength.
 A-Z of stress intervention.

 Attitude (positive attitude)

 Breathing exercises.
 Caffeine intake should be limited.
 Do the things with high level of coping.
 Encourage the intake of vitamin C.
 Frequent breaks during the activities.
 Get in to regular dietary habits.
 Healthy life style.
 Increase the intake of anti-oxidants.
 Learn the new things and outcome.
 Maintain balancedactivityand rest.
 No alcohol.
 Organization of the work pln.
 Physical exercise.
 Quit smoking.
 Rest adequately.
 Speak positively and respectively.
 Take adequate vitamin and supplements.
 Utilization of support group.
 Vinayasa yoga (flow yoga/breath movement yoga)
 Water intake should be encouraged. (hydration)
 Yes to democracy and yoga.
 Zero exposure to chemical and radiation.

57
  Evaluation.

Nurse collects the data needed to determine whether the client gols and
outcomes have been achieved, like identifying nursing diagnosis, outcomes and
interventions.

 Questions for evaluation.

 How does the client perceive the problems?
 Is there an underlying problem that has not been identified.
 Have new stressors occurred that interfere with successful coping.
 Were existing coping strategies sufficient to meet intended outcomes?
 How does the client perceive the effectiveness of new coping strategies?
 Did the client implement new coping strategies property?
 Did the client access and use available resources.
 Have family members and significant others provided effective support.

EVIDENCE BASED PRACTICE.

 Researchers studied (blau,g,tatum 2003) studied 196 medical technological

to determine work related demands.
 Increased levels of perceived interference of work with family.
 Heavy task load.
 Lower organizational support.

JOURNAL ABSTRACT.

Gracia, c (2010) conducted a study to examine the conceptualization and

measurement of coping in adolescents and concluded that coping is an important
construct in understandings how adolescent react to the stressors and adjustments
that there is a need to clarify how coping processes are conceptualized and
measured.

Parikh, p.Taukari, A. bhattacharya, T (2004) conducted a study on

occupational stress and coping among nurses, the occupational stressors very, they
perceived stressors are workload ambiguity, interpersonal relationships and death

58
and dying concern. Prophylactic and curative measures are important for nurses at
both personal s well as organization level.

A cross cultural research aimed to explore the relationship of stress and

coping with psychological illness among university students in Canada and India
and food out Indian students reported more symptoms than Canadian students.

CONCLUSION.

Stress management techniques are implemented in daily lives. Stress is inevitable,

but it doesn’t make tense, irritable, upset and unhappy. The choice is in the hands
GET BETTER OR BITTER. Make the commitment to manage stress and enhance
the health and happiness. Every stress leaves an indelible scar and the organism
pay for its survival after a stressful situation by becoming little older.

AUDIO VISUAL AIDS

 Black board
 Chart
 Overhead projector.
 Flannel board.
 Flash card.
 Power point.

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De stress helpline for class X, XII students, May, 27,2012. New Delhi.

Stress on coping with Academic Pressures Teaching and Learning. Tamilnadu.

Oct 7, 2009.

Helping children cope with stress. The Hindu Andhra Pradesh. April 19, 2011.

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