Stress and adaptation

Stress and adaptation

1. STRESS AND ADAPTATION Presented by, Ms Flavia . Dass M.Sc Nsg 1 st year KIMS, Hubli Presented to, Mr S.M. Badiger Professor KIMS, Hubli ADVANCE NURSING PRACTICE Presentation on

2. INTRODUCTION Stress is a part of life. Everyone feels stress at one time or another. The experience of stress & the way one response to it are unique to each individual. The process of responding to stress is constant & dynamic & essential to the person’s physical, emotional & social well being.

3. TERMINOLOGIES STRESS It is a condition in which the human responds to changing in its normal balanced state. Stress results from a change in the environment, that is presided as a challenge a threat or a danger and can have both negative & positive effects. - Pender & Parsons 2006

4. STRESSORS stressors are themselves neither positive or negative but they can have positive or negative effects as the persons responds to the changes.

5. ADAPTATION when person is in a threatening situation immediate response occur, those response are often involuntary called coping response. The change that takes place as a result of the response to a stressor is adaptation

6. CONCEPT OF STRESS & STRESSORS Stress is any situation in which a non – specific demands requires an individual to response or take action Selye 1976 It involves physiological & psychological responses.

7. Stress can lead to negative or counter productive feelings or threaten emotional well being. It can threaten the way a person normally perceives reality, solve problems, thinks in general; & a person’s relationship & sense of belonging. in addition, stress can threaten a person’s general outlook on life, attitude towards loved one & health status.

8. TYPES OF STRESS

9. EUSTRESS The optimal amount of stress, which helps to promote health & growth e.g. Praise from a superior for hard working DISTRESS Stress due to an excess of adaptive demands placed upon us. The demands are so great that they lead to bodily & mental damage e.g. unexpected death of a loved one

10. TYPES OF DISTRESS ACUTE STRESS It’s our body’s immediate reaction to a new challenge event or demand & it triggers your fight or flight response e.g. Pressures of a near miss automobile accident or arguments with family..

11. EPISODIC ACUTE STRESS when acute stress happens frequently, it’s called episodic acute stress CHRONIC STRESS If acute stress isn’t resolved & begins to increase lasts for long period of time, it becomes chronic stress. This stress is constant & doesn’t go away.

12. TYPES OF STRESSORS

13. PSYCHOLOGICAL STRESSORS Accidents can cause stress for the victim, the person who caused the accident & the families of both Stressful experiences of family members & friends Fear of aggression or mutilation from others such as murder, rape, terrorist & attacks Events that we see on TV such as war, earthquake, violence Developmental & life events Rapid changes in our world, including economic & political structures & technology

14. PHYSIOLOGICAL STRESSORS Chemical agents Physical agents Illness, injuries, hormonal fluctuation, inadequate sleep or nutrition c) Infection agents d) Nutrition imbalance e) Genetic or immune disorders

15. SCOURCES OF STRESS They are many sources of stress, these are broadly classified as Internal stressors: They originate with in a person like- Inability to accept uncertainty negative self talk unrealistic expectations perfectionism lack of assertiveness

16. EXTERNAL STRESSORS It originates outside the individual like- →Major life changes →work →Relationship difficulties →financial problems →being too busy →children & family

17. PHYSIOLOGY OF ADAPTATION Physiological adaptation to stress is the body’s ability to maintain a state of relative balance. This ability is a dynamic form of equilibrium in the body’s internal environment The internal environment constantly changes, & the body’s adaptive mechanism continually function to adjust to these changes & thus to maintain equilibrium or homeostasis

18. The body makes adjustments in heart rate, respiratory rate, blood pressure, temperature, fluid & electrolyte balance, hormone secretion & level of consciousness all directed at maintaining adaptation.

19. MECHANISM OF PHYSIOLOGY OF ADAPTATION Physiological mechanisms of adaptation functions through negative feedback , a process by which the controlling mechanism senses an abnormal state, such as lowered body & makes adaptive response, such as initiating shivering to generate body heat

20. MECHANISMS USED IN ADAPTING STRESSORS MEDULLA OBLONGATA The medulla oblongata control vital functions necessary to survival. These include heart rate, blood pressure & respiratory. Impulses traveling to & from the medulla oblongata can increase or decrease these vital functions.

21. RETICULAR FORMATION The reticular formation is a small cluster of neurons in the brainstem & spinal cord. It also controls vital functions & continuously monitors the physiological status of the body through connections with sensory & motor tract

22. PITUITARY GLAND The pituitary gland produces hormones necessary for adaptation to stress. In addition, the pituitary gland regulates the secretion of thyroid gonadal & parathyroid hormones. Hormones secretion like other homeostatic mechanisms is normally regulated, by a feedback mechanism that continuously monitors hormone level in blood. When hormone level drops, the pituitary gland receives a message to increase hormone secretion. When hormone level rise, the pituitary gland decreases hormone production

23. MODELS OF STRESS RESPONSE BASED MODELS OF STRESS Selye stress response is characterized by a chain or pattern of a physiologic events called General adaptation syndrome

24. GENERAL ADAPTATION SYNDROME (Dr. Hans Selye ) A homeostatic mechanism is aimed at counter acting the everyday stress of living. If they are successful, the internal environment maintains normal physiological limits of temperature, chemistry & pressure If stress is extreme or long lasting, the normal mechanism may not be sufficient. In this case the stress triggers a wide-ranging set of bodily changes called GAS

25. A. Alarm reaction or fight or flight response It is the body’s initial reaction to a stressor. It is a set of reactions include

26. A stress response is characterized by alarm reaction include Increased heart rate Increased blood supply to organs active in stress response Increased production of RBC leading to increase in ability of blood to clot Increased rate of breathing The liver converts glycogen to glucose & release into the bloodstream which provides energy to fight Decrease production of saliva & digestive enzymes

27. B . Resistance Reaction It is the 2 nd stage in stress response

28. C . Exhaustion stage In this, the cells start to die & the organs weakens. Long term resistance reaction put a heavy demand on the body

29. GENERAL ADAPTATION SYNDROME

30. STIMULUS BASED MODEL The stimulus – based model focuses on the following assumptions Life change events are normal & they require the same type & duration of adjustment People are passive recipients of stress & their perception of the events are irrelevant All the people have a common threshold of stimulus & illness results at any point after the threshold

31. As the stimulus based model does not allow for individual differences in perception & response to stressors. Nurses may experience difficulty when attempting to use this model in stress management because of the lack of flexibility for individual adaptation

32. Transaction Based Model The transaction based model views the person & environment in a dynamic, reciprocal interactive relationship This model was developed by Lazarus & Folkman , views the stressor as an individual perceptual response rooted in psychological & cognitive processes

33. Stress originates from the relationship between the person & the environment This model focuses on stress related processes such as cognitive appraisal & coping

34. Adaptation Model Factors determine whether a situation is stressful (Mechanic, 1962) The ability to cope with stress The practice & norms of the person’s peer group Resources that can be used to deal with the stressor

35. The adaptation model is based on the understanding that people experience anxiety & increased stress when they are unprepared to cope with stressful situation Using this model & appropriate interventions, nurses can help the client & families to promote health in all human dimensions

36. FACTORS INFLUCING RESPONSE TO STRESSORS The response to any stressor depends on physiological accounting, personality & behavioral characteristics , as well as the nature of the stressor The nature of the stressor involves the following factors Intensity . Duration Scope . Number & nature of stressors

37. ADAPTATION TO STRESSORS Adaptation is the process by which the physiological of psychosocial dimensions change in response to stress An adaptative response occurs when a stimulus from the internal or external environment causes a departure from the balances state of organism Adaptation is an attempt to maintain the optimal functioning

38. Adaptation involves Reflexes Automatic body mechanisms for protection Coping mechanisms Leading to adjustment or mastery of a situation A stressor that stimulates adaptation may be Short term such as fever Long term such as paralysis of limb

39. DIMENSIONS OF ADAPTATION Physical dimension Adaptative resources : Local adaptation syndrome e.g. Fever Unsuccessful outcome can result in death Successful outcome results in resolution

40. Developmental dimension Adaptive resource : successful coping in the past developmental task/ stages or successful adaptation to past stressors e.g. Retirement Unsuccessful outcome can result in depression Successful outcome results in alteration of role functions to other meaningful activities

41. Emotional dimension Adaptive response are : psychological defense mechanisms, individual personality changes e.g. Rape Unsuccessful outcome can result in irrational fear of me Successful outcome can result in integration of traumatic memory

42. Intellectual dimension Adaptive responses are: Formal education, ability to solve problem, communication skills , positive coping strategies e.g. diagnosis of cancer Unsuccessful outcome can result iin denial of cancer & fore goes for treatment Successful outcome can result in using of an active problem solving approach to make decisions about care

43. Social dimension Adaptive response are : social network provides support, others may direct person to needed resources e.g. Alcoholism in a family member Unsuccessful outcome can result in withdrawal from family & other social contacts Successful outcome can result in active participation of all the family members in alcoholic anonymous support group

44. Spiritual development Adaptive response are : Prayer group, support from priests, rabbi & minister e.g. Family member feels that he has abandoned by god Unsuccessful outcome can result in withdrawal from church activities not mingling with church people Successful outcome can result in seeking friends from the church, becoming volunteers for in church activities

45. RESPONSE TO STRESS Characteristics of the Stress Response Stress response is natural, protective & adaptive There are normal response to stressors; stressors encountered in everyday circumstances increase catecholamine excretion, which causes an increase in heart rate & blood pressure Physical & emotional stressors trigger similar responses. Magnitude & patterns may differ

46. There are limits in ability to compensate Magnitude & duration of stressors may be so great that homeostatic mechanism for adjustment fail. Leading to death Repeated exposure to stimuli results in adaptive changes; that is, tissue level of the enzyme trysine hydrolase increase which increase capacity for the body to produce nor epinephrine & epinephrine There are individual differences in response to same stressors

47. PHYSIOLOGICAL RESPONSE The classic research by Selye (1946,1976) has identified 2 physiological responses to stress: The local adaptation syndrome (LAS) The General adaptation syndrome (GAS)

48. THE LOCAL ADAPTATION SYNDROME The LAS is are response of a body tissue, organ or part to the stress of trauma, illness or other physiological change The body produces many localized responses to stress which include blood clotting ,wound healing ,accommodation of the eye to light & response to pressure

49. All the forms of LAS share the following characteristics The response is localized; it does not involve entire body system The response is adaptive , meaning that a stressor is necessary to stimulate it The response is short term. It does not persist in definitely The response is restorative, meaning that the LAS assist in restoring homeostasis to the body region or part Two localized responses, the reflex pain response & the inflammatory response

50. THE GENERAL ADAPTATION SYNDROME (GAS) The GAS is a defense response of the whole body to stress. It involve several body system primarily the autonomic nervous system & endocrine system. The GAS consists of the Alarm reaction, The resistance stage & exhaustion stage

51. PSYCHOLOGICAL RESPONSE Exposure to a stressor results in psychological & physiological adaptive response As people are exposed to stressors, their ability to meet their basic needs is threatened This threat, whether actual or perceived; produce frustration anxiety & tension psychological adaptive behaviors assist the person’s ability to cope with stressors Psychological adaptive behaviors can be constructive or destructive

52. Constructive behaviors help accept the challenge to resolve conflict, even anxiety can be constructive Destructive behaviors affect reality ,orientation problem, solving abilities, personality & in severe circumstances, the ability to function. Anxiety can also referred to be destructive Psychological adaptive behaviors are also referred to as coping mechanism

53. TASK ORIENTATION BEHAVIORs The task oriented behaviors involves using cognitive abilities to reduce stress, solve problems, resolve conflicts & gratify needs Task oriented behavior enables a person to cope realistically with demands of a stressor The 3 general types of task – oriented behavior are Attack behavior, Withdrawal behavior & Compromise

54. EGO DEFENSE MECHANISMS Ego defense mechanism, first described by Sigmud Freud,are unconscious behaviors that offer psychological protection from stressful events They are used by everyone & help protect against feelings of worthlessness & anxiety Occasionally a defense mechanism can become distorted & is no longer to assist the person in adapting to a stressor

55. PLANNING In most situations, stress management plans are long term & are conducted in the clients home or on an outpatient basis. The general goals for clients who require stress management include the following: Reduction in frequency of stress – inducing situation Decreased physiological response to stress Improved behavioral & emotional response to stress

56. COPING WITH STRESS Bio feedback Using thought process to control a physiological response A person is taught a series of exercise designed to help them learn how to gain control over the physiological response that is being monitored Bio feedback can be beneficial in helping people mange stress related problems such as high BP, chronic pain & migraines

57. Meditation or relaxation A deeply relaxed state; reduces psychological & physiological tension When in a relaxed or meditative state, people typically report. Feeling calm A low level or absence of anxiety Response associated with low level of overall physiological arousal such as lower heart rate, slower breathing rate & loss of muscle tension

58. Physical exercise Engaging in physical activity A physical exercise is physical activity that is usually planned & performed to improve or maintain one’s physical condition Aerobic exercise is the best for physical & mental health, although anaerobic exercise is better than no exercise at all

59. Social support Is helper assistance from other people when needed Appraisal support – Person is helped to realistically appraise the stressor Tangible support – Person is given tangible support e.g. food , financial support etc Informed support- Person is given information Emotional support – Person is given warmth, care & nurturing

60. NURSING DIAGNOSIS FOR STRESS Anxiety related to : Change in health status Maturational or situational crisis Altered growth & development related to: Separation from significant others Situational crisis (unplanned pregnancy) Caregiver role strain related to: Adjustment to medical diagnosis Adjustment to decrease level of physical function

61. Fatigue related to: Overwhelming psychological demands Excessive role demands Hopelessness related to: Long term stress Lost belief in values Ineffective family coping: compromised or disabling or ineffective individual coping related to: Inadequate coping methods Prolonged stress

62. Risk for injury related to : Impaired problem- solving abilities Sleep pattern disturbance related to: Maturation or situational

63. IMPLEMENTATION The nurse is responsible for implementing thoughtful interventions that are caused out in several nursing domains

64. HEALTH PROMOTION Before specific stress management techniques are taught to the client, the nurse must establish a helping role Presenting or just being there for the client fosters sense of support that facilities personal growth When helping the client reduces stress the nurse reduces stressful situations, decreases the physiological response to stress & improve the behavioral & emotional responses to stress Creating a trusting caring environment serves as a foundation for any change

65. REDUCING STRESSFUL SITUATION There are several methods that assist in stress reduction Structure Illness, crises or change in living arrangements disturb a client’s routine, thereby disturbing the pattern of living & resulting in greater energy expenditure A plan that assist a client to renew a familiar life structure or develop a new routine consistent with a changed life situation can reduce stress

66. Time management Persons who use time efficiently generally experience less stress because they feel more in control of their lives. A nurse acting in the teaching – coaching domain may assist client to prioritize tasks if they are feeling over whelmed or immobilizes Environmental modification Although all stress cannot be avoided, those life changes that are under the client’s control can be deliberately postponed so more energy is available for coping with unavoidable stressors

67. STRESS MANAGEMENT Regular exercise Almost any form of exercise or movement can increase your fitness level while decrease your stress. The most important thing is to pick an activity you enjoy. Exercising regularly can have a positive effect on your mood by relieving the tension, anxiety, anger & mild depression that often go hand in hand with stress.

68. Humor Adopting a humorous view towards life situations can take the edge off everyday stressor. Being able to laugh stress away is the smartest way to ward off its effects Provides good cardiac condition Reduce stress hormones ( epinephrine, cortisol , dopamine & growth hormone) Boast immune function Produces a general sense of well being

69. Nutrition & Diet Good nutrition is an important stress management tool. When our bodies are poorly fed, stress takes an even greater toll on our health Eating fruits & vegetables, complex carbohydrates ( whole grain bread, brown rice), nuts ( almonds , walnuts), dairy ( yogurt & cheese)

70. Relaxation techniques To effectively combat stress, you need to activate your body’s natural relaxation response. You can do this by practicing Deep breathing exercise Mindfulness meditation – meditation helps you to switch your focus on the present rather than dwelling on the past or worrying about the future

71. Yoga – yoga reduces stress & anxiety. Yoga helps in increasing flexibility, stamina & strength. It should be done morning to start the day with more energy & feeling refreshed Aromatherapy – it is a holistic healing treatment that uses aromatic essential oils medicinally to improve the health of the body, mind & spirit. It enhances both physical & emotional health Spirituality – spirituality & religious people find various ways to express these qualities by praying, attending religious services, interacting with people who share the same beliefs, visiting nature

72. Have a good cry A good cry during period of stress can be healthy way to bring relief to your anxiety Connect with others A good way to combat sadness, boredom & loneliness is to set out activities involving others

73. Crisis intervention Is a short term management technique designed to reduce potential permanent damage to an individual affected by a crisis Enhancement of self esteem Is a type of motivation hat works to make people feel good about themselves. It involves a preference for positive over negative views.

74. PROMOTING STRESS MANAGEMENT FOR NURSES Most nurses experience stress in their work environment Job stress frequently results in a condition called burnout, characterized by decreased concern for the people with whom one is working During burnout the client experiences physical & emotional exhaustion

75. Nurse should identify specific stressors at work & strive to eliminate them It is also helpful to gain social support from other nurses in order to maintain a caring attitude to wards clients

76. THANK YOU