Stress management in health and illness2007

STRESS : It is an unpleasant psychological and physiological state caused due to some internal and or external demands that go beyond our capacity.

1. Stress management in Health and Illness: Role of the Healthcare Provider SAIMA HABEEB Ph.D (N) SCHOLAR

2. Basic concepts of Stress and Adaptation STRESS : It is an unpleasant psychological and physiological state caused due to some internal and or external demands that go beyond our capacity.

3. Types of Stress Good stress [Eu stress] Bad stress [Chronic stress] Survival stress Internal stress:

4. STRESSORS Any factor that causes a person experience stress is a stressor . [ Ivancevich & Matteson] Types are : Internal stressor   External stressor

5. ADAPTATION : The change that take place as a result of the response to a stressor is adaptation .

6. HOMEOSTASIS: Various physiologic mechanisms within the body responds to internal changes to maintain relative constancy in the internal environment , which is called Homeostasis.

7. CRISIS: When stress overwhelms , a person’s existing coping mechanism disequilibrium occurs and thus causes a crisis

8. SOURCES OF STRESS: Environmental Social Thoughts Any kind of change Individual personalities Inter personal issues System [family, job, school, club, organization issues]  

9. MODELS OF STRESS: Psycho somatic model Adaptation model Social environmental model Process model

10. Psychosomatic Model The psychosomatic model is based on the premise that stressors affecting the client in one dimension can have pathological effect in other dimensions.

11. Adaptation model Ability of a person to cope with stress. Practices and norms of the person’s peer group. The means that the social environment provides an individual to adapt to a stressor. Nature of the process that determines where and how an individual can use resources in the social environment to deal with stress.

12. Social environmental model This model is concerned with the effects of a person’s work role on health. When assessing the wellness level of the client, nurses should identify the actual and potential stressors in work environments to help the client modify or adapt to them.

13. PROCESS MODEL Outcome Cognitive Performance Appraisal Process Procedure Decision Situation Behaviour Perceived Decision Decision Response Selection

14. NORMAL RESPONSES TO STRESS Physiological response Local adaptation syndrome [LAS] : It is a localized response of the body to stress. It involves only a specific body part [tissue or organ] instead of the whole body. The stress precipitating the LAS may be traumatic or pathologic. LAS includes 2 main responses that influence nursing care are the reflex pain response and inflammatory response

15. General adaptation syndrome[GAS] It is a biochemical model of stress developed by Hans Selye [1976]. The GAS describes the body’s general response to stress by the stimulation of hypothalamus.

16. Three stages in the GAS are Alarm reaction Resistance reaction Exhaustion

17. Alarm reaction stressor Stimulates Hypothalamus Stimulates Sympathetic nervous system Stimulates Adrenal medulla Release Catecholamine Produce Alarm reaction

18. Resistance Reaction Stressor Hypothalamus CRH, GHRH, TRH Anterior pituitary ACTH HGH TSH Adrenal cortex Glucocorticoids & Liver Thyroid gland Mineralocorticoids Glyconeogenesis CHO &Fat breakdown breakdown

19. Psychological responses Mind-Body interaction Anxiety Coping mechanisms Defense mechanisms

20. EFFECTS OF STRESS Individual response to stress The stressful personality type: Friedmann & Roseman [1974] classified individuals into 2 groups according to personality characteristics. Type A group : Type B group :

21. Post Traumatic Stress Disorder (PTSD) It is defined as a “delayed and/or protracted response to a stressful situation [either short or long lasting] of an exceptionally threatening nature which is likely to cause pervasive distress in almost anyone”.

22. Stress and basic human needs Physiologic Safety / security Love or Belongingness Self esteem Self actualization

23. Stress in computer users The demands of the job & assignments Increasing competition Long duty hours Computer defects, etc

24. Stress in healthy individuals Circulatory system : Fight or flight responses causes increase in heart rate, peripheral vasoconstriction and that causes, increased BP & respiration . The long term stress may damage the heart & arteries and thus causes hypertension, CHD, etc.

25. Stress in healthy continues..... Immune system Other systems Gastrointestinal systems Respiratory system Skin Aches Migraine Substance misuse Mental illness Accidents or unsafe behavior

26. Stress in illness Stress associated with hospitalization Family stress Prolonged stress Stress in older adults Stress of patient in ICU Stress in Maternal and child health

27. Stress in Nursing profession Nursing involves activities and interpersonal relationships that are often stressful. This result in a complex of behaviors called “ BURNOUT ”. Burnout is a state of exhaustion that results from repeated emotional pressure. The three Signs are: Emotional exhaustion Depersonalization Decreased sense of personal accomplishment

28. THE NURSING PROCESS FOR THE MANAGEMENT OF STRESS ASSESSMENT : Nursing History Physical assessment Assessment of the person Assessment of the family Assessment of the environment

29. Hospital anxiety and depression scale The hospital anxiety and depression scale [Zigmond & Snaith 1983]is a selfadministered questionnaire and consist of 14 questions . 7 questions measure traits of anxiety, and next 7 traits of depression. With a score greater than 8 indicates a pathological state

30. Social readjustment rating scale This is put forward by Holmes &Rahe [1967] It is a fixed number of life events and assumes that these invoke similar stress response in everyone. It is possible to use this instrument within a nursing assessment.

31. Self reporting Stress is a psychological construct, and because only the individual experiencing it knows its true meaning. A self reporting method may prove more effective.

32. Stress points / Bio dots /Stress cards The Bio dots or Stress squares are commercially available liquid crystal materials that change colors for stress related temperature changes

33. NURSING DIAGNOSIS

34. OUTCOME IDENTIFICATION AND PLANNING Decrease in the level of anxiety Develop effective coping skills Describe a reduction in anxiety and an increase in comfort.

35. IMPLEMENTATION Non-Pharmacological methods

36. Teaching Healthy Activities of Daily Living Exercise: Exercise improves one’s general sense of wellbeing, relieves tension, and enables one to cope better with day-to-day stressors .

37. Rest and sleep : Adequate rest and sleep can provide “insulation” against stress Nutrition: Nutrition plays an active role in maintaining the body’s homeostatic mechanisms and in increasing reactions to stress

38. Encouraging use of support systems Support systems provide emotional support that helps a person identify and verbalize feelings associated with stress.

39.   Encouraging use of Stress management techniques   Keeping a stress- awareness diary This diary helps to discover and chart their own personal stressful events and characteristics reactions

40. Relaxation techniques Deep Breathing Progressive Muscle Relaxation

41. Meditation Meditation is a kind of self discipline that helps one achieve inner peace and harmony by focusing uncritically on one thing at a time.

42. Yogasanas This is exercising different parts of the body, combined with controlled breathing. The postures are stretch & hold, compress & hold. It creates flexibility, hollowness, lightness and helps in flow of oxygen, food, water, electric signals and flow of energy in the body freely.

43. Music Therapy Breathing Exercise Deep breathing Awareness of breathing Ten - To-One Count Alternated - Nostril Breathing

44. Anticipatory guidance Anticipatory guidance focuses on psychologically preparing a person for an unfamiliar or painful event

45. Guided Imagery Guided imagery or positive visualization uses a person’s own imagination and positive thinking to create powerful mental pictures or images to reduce stress or promote healing

46. Body Scanning Autogenic Training Self Hypnosis Therapeutic Touch

47. Providing Crisis Intervention The steps are: Identify the problem List all possible solutions Choose the right one Implement the plan Evaluate the outcome

48. Pharmacological Methods Anxiolytics: These drugs provide immediate relief from the unpleasant feelings associated with stress. Antidepressants : These drugs are prescribed for prolonged periods of distress. These will also helps to improve self esteem, helps in positive thinking, and empower them to address the cause of their problem.

49. C omplementary Remedies: Hypericum perforatum (St John’s wort): It is a widely prescribed medication. It is thought to work in a similar way as the SSRI’s work Valerian : It is used as an Anxiolytics agent and having sedative properties.

50. Stress management strategies for you

51. Take a Deep Breath Manage Time Connect with Others

52. Talk it Out Take a “Minute” Vacation Monitor Your Physical comfort

53. Get Physical Take Care of Your Body Laugh

54. Know your limits Think Positively Develop a Sense of Life Meaning

55. Compromise Have a Good Cry Avoid Self Medication Look for the “Pieces of Gold” Around you

56. EVALUATION Verbalize causes and effects of stress and anxiety Identify and use sources of infection Use problem solving to find solution to stressors Practice healthy lifestyle habits and anxiety reducing techniques. Verbalizes a decrease in anxiety and an increase in comfort

57. THANK YOU….