Stress and coping.pptx fundamental of nursing

Fundamental of nursing 2

1. Stress and coping By Rubina Yasmin Nursing Instructor CON, FJMU.

2. CONCEPT OF STRESS Stress is a condition in which an individual experiences changes in the normal balanced state.

3. Stressor Is any event or stimulus that causes an individual to experience Stress. Coping mechanisms. When a person faces stressors, responses are referred to as coping strategies, coping responses.

4. Sources of Stress Internal stressors External stressors Developmental stressors Situational stressors

5. Internal stressors Originate within a person, For example , Infection or Feelings of depression.

6. External stressors Originate outside the individual, For example, A move to another city, A death in the family, Or pressure from peers.

7. Developmental stressors Occur at predictable times Throughout an individual’s life

8. Selected Stressors Associated with Developmental Stages Developmental Stage Stressors Child Beginning school Establishing peer relationships Peer competition Adolescence Changing physique Relationships involving sexual attraction Exploring independence Choosing a career Young adult Marriage Leaving home Managing a home Getting started in an occupation Continuing one’s education Children Middle adult Physical changes of aging Maintaining social status and standard of living Helping teenage children to become independent Aging parents Older adult Decreasing physical abilities and health Changes in residence Retirement and reduced income Death of spouse and friends

9. Situational stressors Unpredictable and may occur at any time during life. May be positive or negative. Examples: • Death of a family member • Marriage or divorce • Birth of a child • New job • Illness.

10. Effects of Stress Physical Emotional Intellectual Social Spiritual

11. MODELS OF STRESS Stimulus based models Response based model Transaction based model Stimulus based models Is defined as a stimulus, a life event, or a set of circumstances that arouses physiological and/or psychological reactions that may increase the individual’s vulnerability to illness.

12. Response-Based Models Stress may also be considered as a response. The non specific response of the body to any kind of demand made upon it. Transaction based model Model encompasses a set of cognitive, affective & adaptive (coping) responses that arise out of person-environment transactions.

13. General adaptation syndrome (GAS) This response of the body, the stress syndrome or GAS, occurs with the release of certain adaptive hormones and subsequent changes in the structure and chemical composition of the body.

14. Local adaptation syndrome (LAS). Body reacts locally to stress One organ or a part of the body reacts alone to stress e.g. inflammation.

15. 3 stages of GAS & LAS Alarm reaction Resistance Exhaustion

16. Alarm Reaction Initial reaction of the body Alerts the body’s defenses. Classification into 2 phases Shock phase Counter shock phase

17. Shock phase Stressors stimulate the sympathetic nervous system, Stimulates adrenal medulla to Secrete epinephrine & norepinephrine Fight or flight response Increased myocardial contractility, which increases cardiac output and blood flow to active muscles 2. Bronchial dilation, which allows increased oxygen intake 3. Increased blood clotting 4. Increased cellular metabolism

18. Counter shock phase The changes produced in the body during the shock phase are reversed.

19. Stage of Resistance If the stressor persist, it becomes necessary to attempt some means of coping with the stress. In this stage The body keeps making continuous efforts To cope with stress.

20. 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. Result: Rest and return to normal Death

21. Physiological Indicators The physiological signs and symptoms of stress result from activation of the sympathetic and neuroendocrine systems of the body.

22. Psychological Indicators Anxiety Fear Anger Depression Unconscious Ego mechanisms

23. Anxiety A common reaction to stress is, a state of mental uneasiness, apprehension, dread, or a feeling of helplessness related to an impending or anticipated unidentified threat to self or significant relationships.

24. Levels of anxiety Mild anxiety Moderate anxiety Severe anxiety

25. Mild anxiety produces a slight arousal that enhances perception, learning, and productive abilities.

26. Moderate anxiety Increases the arousal to a point where the person expresses feelings of tension, nervousness, or concern. Perceptual abilities are narrowed.

27. Severe anxiety: Consumes most of the person’s energies and requires intervention. Perception is further decreased. The person, unable to focus on what is really happening,

28. Fear: An emotion or feeling of apprehension aroused by impending or seeming danger, pain, or another perceived threat.

29. Anger: An emotional state consisting of a subjective feeling of animosity or strong displeasure.

30. Depression: A common reaction to events that seem overwhelming or negative. An extreme feeling of sadness, despair, rejection, lack of worth, or emptiness.

31. Cognitive Indicators: Problem solving Structuring Self control/self discipline Suppression fantasy

32. Problem solving: Involves thinking through the threatening situation, using specific steps to arrive at a solution.

33. Structuring: The arrangement or manipulation of a situation so threatening events do not occur.

34. Self control/self discipline: Assuming a manner and facial Expression that convey a sense of being in control or in charge.

35. Suppression: Consciously and willfully putting a thought or feeling out of mind: “I won’t deal with that today. I’ll do it tomorrow.”

36. Fantasy or daydreaming: To make-believe Unfulfilled wishes and desires are imagined as fulfilled, or a threatening experience is reworked or replayed so it ends differently from reality.

37. Ego defense mechanisms: unconscious psychological adaptive mechanisms or, according to Anna Freud (1967), mental mechanisms that develop as the personality attempts to defend itself, establish compromises among conflicting impulses, and calm inner tensions.

38. Coping: The cognitive and behavioral effort to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person”

39. Coping strategy/coping mechanism: A natural or learned way of responding to a changing environment or specific problem or situation.

40. Two types of coping strategies: Problem-focused coping Emotion focused coping

41. Problem-focused coping: Refers to efforts to improve a situation by making changes or taking action. Emotion focused coping: includes thoughts and actions that relieve emotional distress. does not improve the situation, but the person often feels better

42. Long-term coping strategies: Can be constructive and practical. Examples: Lifestyle patterns Short-term coping strategies can reduce stress to a tolerable limit temporarily but are ineffective ways to permanently deal with reality. They may even have a destructive or detrimental effect on the person.

43. Adaptive or maladaptive coping: Adaptive coping Helps the person to deal effectively with stressful events and minimizes distress associated with them. (Effective coping)

44. Maladaptive coping: Can cause unnecessary distress for the person and others associated with the person or stressful event. (Ineffective coping)

45. Caregiver burden: Reaction to long term stress is seen in family members who undertake the care of a person in the home for a long term period. produces responses such as chronic fatigue, sleeping difficulties, and high blood pressure

46. Crises: A crisis is an acute, time-limited state of disequilibrium resulting from the interaction of an event with the individual’s or family’s coping mechanism, which are inadequate to meet the demands of the situation.

47. Crisis Intervention Is a technique used to help an Individual or family to understand and cope with the intense feelings that are typical of a crises.

48. Aims of crises Crisis Intervention technique To provide a correct cognitive perception of the situation. To assist the individual in managing the intense and overwhelming feelings associated with the crises.

49. Principles of crises intervention Be specific, use concise statement and avoid over whelming the patient with irrelevant questions or excessive detail. Encourage the expression of feelings. A calm, controlled presence reassures the person that the nurse can help. Listen for facts and feelings: seeking clarification, paraphrasing and reflection are effective strategies. Allow sufficient time for the individuals involved to process information and ask question. Help patients legitimize feelings by letting them know that others in similar situations have experienced comparable emotions.

50. Cont. 7. Clarify distortions by getting persons to look at the situation realistically. 8. Empower person by allowing them to make informed choices. 9. Assist the person in confronting reality. 10. Encourage the person to focus on one implication at a time.

51. References: Erb , G. K. , B . (2015) Fundamental of Nursing: concepts, process and practice (11 th ed.) Addison: Wesley. Potter, P. A & Perry , A. G. (2016). Basic Nursing Essentials for practice (9 th ed.) St. Louis: Mosby.