Stress Management
Objectives
O Define stress, adaptation,
O Discuss the physical,
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stressor, homeostasis, lack of
oriented
behaviors and
defense and coping
mechanisms.
2. List factors influencing
the response to stressors.
3. Compare and contrast the
Local Adaptation Syndrome
with the General Adaptation
Syndrome.
Describe the psychological
response to a stressor.
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psychological developmental
results of prolonged stress.
List behavioral, physical and
emotional indicators of
stress.
Discuss the role of the nurse
in the management of stress.
Identify the role of the nurse
in relieving stress.
Describe stress management
techniques that can benefit
nurses themselves.
Stress and Stressor
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Stress - physiological or psychological
tension that threatens homeostasis or a
person’s psychological equilibrium.
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Stressor – any event, situation, or other
stimulus encountered in a person’s external
or internal environment that necessitates
change or adaptation by the person.
Physiologic Homeostasis
O Local Adaptation System (LAS)—involves
only one specific body part
O Reflex pain response
O Inflammatory response
O General Adaptation Syndrome—biochemical
model of stress (Hans Selye)
O Alarm reaction
O Stage of resistance
O Stage of exhaustion
Psychological Homeostasis
O Love and belonging needs
O Safety and security needs
O Self-esteem needs
Question
Tell whether the following statement is true
or false.
The inflammatory response is a response of
the central nervous system to pain.
A. True
B. False
Answer
Answer: B. False
The reflex pain response is a
response of the central nervous
system to pain.
A Balance is Achieved (Homeostasis)
Defense Mechanisms and
Coping Mechanisms
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are unconscious psychological strategies
brought into play by various entities to cope
with reality and to maintain self-image.
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are commonly termed coping strategies or
coping skills. Unconscious or non conscious
strategies (e.g, defense mechanisms).
Defense Mechanisms
O Compensation
O Denial
O Displacement
O Introjection
O Projection
O Rationalization
Defense Mechanisms (cont.)
O Reaction formation
O Regression
O Repression
O Sublimation
O Undoing
Question
Which defense mechanism listed below
is portrayed in the following scenario?
After throwing his lunch tray on the
floor, a patient complains to the nurse
manager about the quality of the food
he is being fed during his hospital stay.
A. Denial
B. Displacement
C. Rationalization
D. Reaction formation
Answer
Answer: C. Rationalization
Rationale:
In rationalization, a person tries to give a logical or
socially acceptable explanation for questionable
behavior.
A person in denial refuses to acknowledge the
presence of a condition that is disturbing.
Displacement refers to a person transferring an
emotional reaction from one person to another.
Reaction formation occurs when a person develops
conscious attitudes or behaviors opposite to what
he desires to do.
Coping Mechanisms
O Crying, laughing, sleeping, cursing
O Physical activity, exercise
O Smoking, drinking
O Lack of eye contact, withdrawal
O Limiting relationships to those with
similar values and interests
Factors Affecting Response to
Stressor
Personal Characteristics
1. Ability to cope with stress
- support system
- perception of
stressor
- previous experience
2. Practices /norms of peer
group
3. Social environment
4. Available resources
Nature of Stressor
O Intensity
O Scope
O Duration
O Number and
nature of stressor
An Imbalance Occurs During a
Stressful Event
General Adaptation Syndrome and
Local Adaptation Syndrome
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GAS – response by whole body
- how the body reacts to a stressor, real
imagined, a stimulus that causes
stress.
or
LAS - the localized response of a tissue,
organ, or system that occurs as a reaction to
stress
Alarm Reaction
O Person perceives stressor, defense
mechanisms activated
O Fight-or-flight response
O Hormone levels rise, body prepares
to react
O Shock and counter-shock phases
Stage of Resistance
O Body attempts to adapt to stressor
O Vital signs, hormone levels, and
energy production return to normal
O Body regains homeostasis or
adaptive mechanisms fail
Stage of Exhaustion
O Results when adaptive mechanisms
are exhausted
O Body either rests and mobilizes its
defenses to return to normal or dies
The General Adaptation Syndrome
Diagram of the GAS Model
Emotional Responses to Stress
O Mind–body interaction
O Coping/defense mechanisms
O Anxiety (most common)
O Mild
O Moderate
O Severe
O Panic
Question
Tell whether the following statement
is true or false.
Mild anxiety narrows a person’s
perceptual fields so that the focus is
on immediate concerns, with
inattention to other communications
and details.
A. True
B. False
Answer
Answer: B. False
Moderate anxiety narrows a
person’s perceptual fields so that
the focus is on immediate concerns,
with inattention to other
communications and details.
Psychological Response to
Stress
O Psychological adaptive behaviors (coping
mechanisms) are directed at stress management
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1. Task-oriented behaviors – use direct
problem- solving technique
2. Ego-defense mechanisms – indirect
methods of coping
May be:
Constructive – accept challenge to resolve stress
Destructive – do not help with coping
Types of Task-Oriented
Behavior
O Attack behavior – action to
remove/overcome stressor
O Withdrawal behavior – physical or
emotional removal from stressor
O Compromise behavior – change usual
method of operating , substitute goals, omit
satisfaction of needs
Ego-defense mechanisms
O Unconscious behaviors that offer psychological
protection from stressor
Examples:
compensation
conversion
denial
displacement
identification
regression
projection
rationalization
Adaptation to Acute and Chronic
Illness
O General tasks—for example,
maintaining self-esteem and
personal relationships
O Illness-related tasks—for example,
handling pain and disability
Effects of Long-Term Stress
O Affects physical status
O Increases risk for disease or injury
O Compromises recovery and return to
normal function
O Is associated with specific diseases
Family Stressors
O Changes in family structure and
roles
O Anger and feelings of helplessness
and guilt
O Loss of control over normal routines
O Concern for future financial stability
Factors Affecting Stress and
Adaptation
O Sources of stress
O Types of stressors experienced
O Personal factors
Categories of Stress
O Developmental stress
O Occurs when person progresses
through stages of growth and
development
O Situational stress
O Does not occur in predictable
patterns
Question
Tell whether the following statement
is true or false.
An example of situational stress is
the stress related to a marriage or
divorce.
A. True
B. False
Answer
Answer: A. True
An example of situational stress is
the stress related to a marriage or
divorce.
Types of Stressors
O Physiologic
O Chemical agents, physical agents,
infectious agents, nutritional
imbalances, hypoxia, genetic or
immune disorders
O Psychosocial
O Includes real and perceived threats
Stressful Activities in Nursing
Profession
O Assuming responsibilities for which one
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is not prepared
Working with unqualified personnel
Working in environment in which
supervisors are not supportive
Caring for patient in cardiac arrest or
dying person
Experiencing conflict with peers
Teaching Healthy ADLs
O Exercise
O Rest and sleep
O Nutrition
O Use of support systems
O Use of stress management
techniques
O Time Management
O Problem-Solving Process
Stress Management Techniques
O Relaxation
O Meditation
O Anticipatory guidance
O Guided imagery
O Biofeedback
O Crisis intervention
Question
Tell whether the following statement
is true or false.
In the stress management technique
known as anticipatory guidance, a
person creates a mental image,
concentrates on the image, and
becomes less responsive to stimuli.
A. True
B. False
Answer
Answer: B. False
In the stress management technique
known as guided imagery, a person
creates a mental image,
concentrates on the image, and
becomes less responsive to stimuli.
Crisis Intervention
O Identify the problem
O List alternatives
O Choose from alternatives
O Implement the plan
O Evaluate the outcome
Evaluating the Plan of Care
O Patient verbalizes causes and effects of
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stress and anxiety.
Patient identifies and uses sources of
support.
Patient uses problem solving to find
solution to stressors.
Patient practices healthy lifestyle habits
and anxiety-reducing techniques.
Patient verbalizes decrease in anxiety
and increase in comfort.