CONCEPT OF STRESS AND COPING

CHAP 11

Objectives

At the end of this unit learners will be able to:

1.Discuss the stress and coping

2. Identify different stressors and different types of stress

3. List the different Symptoms of Stress.

4. Identify different techniques of stress management.

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Stress

Stress is a person response to stressor such as an environmental condition or a stimulus.

OR

Mind and body response or reaction to a real or imagined threat, event or change.

OR

Stress is condition in which the person experience changes in the normal balance state.

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Stress

• Stressor-----as any event or stimulus that cause the individual to experience stress.
• Coping strategies, coping response, coping mechanism-----person response to stress

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Stress

Stress can result from both positive and negative experiences........

Examples ;

• A bride preparing for her wedding
• A graduate preparing to start new job
• A husband concern about caring of his wife and family
• Diagnosis of cancer
• Lossing of special object ,person or any other things all experiences stress reactions.

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Stress Coping

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"The cognitive and behavioral efforts to manage specific internal demands (infection ,feeling of depression) or external demands (move to another city ,death in family ) that are appraised as exceeding the resources of a person". Folkman and Lazarus(1991)

OR

When a person faces stressors ,then the responses of the person are reffered as coping strategies ,coping responses or coping mechanisms.

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Indicators of stress

1. Physiological indicators
2. Psychological indicators

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Stress indicators

1. Physiological indicators

• The physiological sign & symptoms of stress result from the activation of sympathetic and neuroendocrine systems of the body
• Clinical manifestations lists physiological indicators of stress

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Clinical Manifestation Of Stress

• Pupils dilates
• Sweat production
• Heart rate increase
• Cardiac output increase
• Skin is pailed (because of constriction of peripheral blood vessels)
• Sodium and water retention increase which increase blood volume

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Clinical Manifestation Of Stress/Physiological indicators

• Rate and depth of respiration increase (because of dilation of bronchioles)
• Urinary output decrease
• Mouth may be dry
• Paristalsis of intestine decrease
• Muscles tension increase

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Psychological Indicators

• Anxiety
• Fear
• Anger
• Depression
• Uncounsious Ego Mechanism

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Psychological Indicators

1. Anxiety: Common reaction to stress

• A state of mental uneasiness ,apprehension, or a feeling of helplessness related to an impending or anticipated unidentified threat to self or significant relationships.

Four levels of anxiety

• Mild Anxiety
• Moderate Anxiety
• Severe Anxiety
• Panic

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Psychological Indicators

2. FEAR

An emotion or feeling of apprehension aroused by impending or seeming danger ,pain or another percieved threat

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Psychological Indicators

Anxiety and Fear differ in four ways

1. The source of anxiety may not be identified

2. Anxiety is related to mainly future, to an anticipated event ,fear is related to past ,present and future

3. Anxiety is Vague, whereas fear is definite

4. Anxiety results from psychological or emotional conflicts ,fear results from a specific physical or psychological entity.

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Psychological Indicators

3.Anger

An emotional state consisting of a subjective feeling of animosity or strong displeasure

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Psychological Indicators

4. Depression

• A common reaction to events that seem overwhelming or negative
• An extreme feeling of saidness ,dispair ,dejection ,lack of worth ,or emptiness

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Psychological Indicators

5. Unconscious Ego Mechanisms

Unconscious psychological adaptive mechanism or mental mechanisms that develop as the personality attempts to defend itself ,establish compromises among conflicting impulses and calm inner tentions

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Coping Pattern

• The cognitive and behavioral efforts to manage specific external or internal demands that are appraised as exceeding the resources of the person

OR

• A natural or learned way of responding to a changing environment or specific problem or situation

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Types of coping

1. Problem- focused coping
2. Emotion-Focused coping
3. Long term coping strategies
4. Short term coping strategies
5. Adoptive coping
6. Maladaptive coping
7. Care-giver burden

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Types of coping

1. Problem- focused coping

Refers to efforts to improve a situation by making changes or talking actions (Lozarus 2006)

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2. Emotion-focused coping

• Include thoughts and actions that relieve emotional destress
• Doesn't improve the situation but the person often feels better (Lozarus 2006)

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Types of coping

3. Long term coping strategies

• Can be constructive and practical
• In certain situations talking with others and trying to find out more about the situation are long term strategies
• Other long term Coping strategies include
• Lifestyle pattern

e.g. Eating a healthy diet

Exersicing regularly

Decision making

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Types of coping

4. Short term coping strategies

• Can reduce stress to a tolerable limit temporarily but are ineffective ways to permennently deal with reality.
• These may even have destructive or detrimental effect on the person
• Examples;
• Using Alcohol
• Using drugs

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Types of coping

5. Adaptive coping

• Helps the person to deal effectively with stressful events and minimizes distress associated with them
• Effective coping result in adaptations

6. Maladaptive coping

• Can cause unnessasary distress for the person and others associated with the person or stressfull events
• Ineffective coping result In maladaptation

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Types of coping

7. care giver Burden

• Reaction to a long term stress is seen in family members who undertake the Care of a person in the home for long time period
• Produces responses such as chronic fatigue , sleeping difficulties and high blood pressure

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Factors affecting copping pattern during hospitalization

• Many factors can affect the copping pattern of patient,family members and nurses in hospital.
• Following are the main factors which affect the copping pattern during hospitalization.

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Conti…

Anxiety:Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.

Anxiety in hospital: Depression and anxiety are common in hospitalized patients especially those waiting for surgery and with chronic or hard-to-treat conditions. Psychological disorders are not only related to a poor adjustment to hospitalization distress, but is associated with adverse events and unsatisfactory outcomes.

• Hospitalization exacerbates patients' emotions, and increases feelings of depression and anxiety.
• By this way copping is affected by admitted into hospital.

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Conti ..

• Fear: More prosaic issues might result in the fear of hospitals, such as smells, sick roommates, and a complete lack of privacy. Media reports surrounding medical mishaps often result in fear among patients.
• The fear from doctor or nurse during the intervention steps by applying nursing processs affect the copping

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Conti …

• Example of fear.The most common examples of fear a nurse encounter are patient in the community, a patient may also have fear during diagnostic testing in an outpatient setting, or during hospitalization. The nurse’s role is to identify when patients are experiencing fear and must find ways to help them in a respectful way to face these feelings. The nurse must also learn to distinguish when fear becomes persistent and pervasive that it affects the individual’s ability to perform his or her activities of daily living. Referral to a reliable support system and programs increase the chances of successfully managing, treating, and overcoming phobias and other fears.

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Conti…

• Possibility of fear for nurse: the possibility of harming a patient is their biggest fear. “We are the gatekeepers of health.
• For family:Family member of the patient are also at fear condition because there may be chance of paralysis or even death may be cause of their patient .

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Conti…

Sleep: Unfortunately, the hospital environment is often poorly conducive to sleep .

Pain, anxiety, medication effects, medical interventions, environmental noise and light, and the acute illness itself all contribute to decreased quality and quantity of sleep in hospitalized patients.then the patient cannot mannage such stress.

• Sleep loss in the hospital is associated with worse health outcomes, including cardio-metabolic derangements and increased risk of delirium

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Conti.

• Isolation from parents: to separate the child frome parents and admitted them into hospital it will affected the copping of the childs mostly .it this stages child are totally dependent to their parents .
• Change in nutrition
• The following factors can also contribute to malnutrition:
• teeth that are in poor condition, or dentures that do not fit properly, which can make eating difficult or painful.
• a physical disability or other impairment that makes it difficult to move around, cook or shop for food.
• living alone and being
• These all are including in changing the copping of clints.

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Conti…

• Economic:the lower economy level and poverty can affect copping of patient and their family . some time when patient require surgery of heart and other serious surgery but they cannot afford and sustain their cost that s way the copping pattern is affected .
• Social culture :the Clint of various culture are admitted into hospital .
• They affect decisions about a patient's treatment and who makes the decisions. Cultural differences create problems in communication, rapport, physical examination and treatment compliance and follow through. The special meaning of medicines and diet requires particular attention.

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Nursing Management of stress

Assessing

Nursing assessment of clients stress and coping

pattern includes;Nursing History & Physical Examination. During Nursing History the nurse have to poses questions ,,i.e Client perceived stressors or stressful incidents

Manifestations of stress

Past coping strategies

Present coping strategies

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Nursing Management of stress

During physical examination the Nurse observe for;

• Verbal and cognitive manifestations
• Indicators of stress such as,Nail biting,Nervousness,Weight changes
• Stress related health problems such as,

Hypertension

Hyperthyroidism

Dyspnea

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Nursing Management of stress

2.Nursing diagnosis

• Anxiety related to unconscious conflict's about essential goals and values of life , threat to self concept , positive or negative self talk ,or physiological factors (E.g hyperthyroidism ,dysrhythmias ,dyspnea )

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Conti..

Planning

• The overall clients goals for individual experiencing stress related responses are;
• Decrease or resolve anxiety
• Increase abality to manage or cope with stressful events or circumstances
• Improve role performance

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Nursing Management of stress

Implementation

• Although stress is a part of daily life ,it is also highly individualize
• Some methods help to reduce stress will be effective for one person
• Other methods are appropriate for a different person
• A Nurse who is sensitive to clients needs and reactions can choose those methods of interventions that will be most effective for each individuals

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Nursing Management of stress

• Several health promotion strategies are often appropriate as interventions for clients with stress related Nursing daignosis
• Among these are;
• Physical exercise (relief mention,feeling of well being, relaxation)

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Nursing Management of stress

Optimal Nutrition (balanced diet)

• Adequate rest and sleep (sleep restore bodies energy levels and is essential aspect of stress management)
• Time management (people who manage their time effectively usually experience less stress because they feel more in control of their circumstances)

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Nursing Management of stress

Evaluation

• How does the cleint perceive the problems?
• Is there an underlying problem not identified?
• Have new stressors occur that interfare with successful Coping?
• Were existing coping strategies sufficient to meet intended outcomes?

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Nursing Management of stress

• How does the client perceive the effctiveness of new coping strategies?
• Did the client implement new coping strategies properly?
• Did the client access and use available resources?
• Have family members and significant others provided effective support?

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Stress Management for Nurses

• Nurses like client's are susceptible to experiencing anxiety and stress
• Nursing practice involves many stressors I.e;
• Increasing severity of client illness
• Adjusting to various work shifts
• Inadequate support from supervisors
• Caring for dying client etc

Although most Nurses cope effectively with physical and emotional demands of nursing But some Nurses become overwhelmed and develop Burnout

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Stress Management for Nurses

BURNOUT

• A complex syndrome of behavior
• The Nurses with Burnout manifests physical and emotional depletion
• A negative attitude and self concept
• Feeling of helplessness and hopelessness

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Stress Management for Nurses

STEPS TO REDUCE STRESS FOR NURSES

Plan daily relaxation programs to reduce tention (I.e read novels ,listen to music or other favorite activities)

Establish regular exercise program

Learn to accept failure's

• Seek counseling if indicated

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• Support each others as a team

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• Take time to relax
• Eat properly
• Lern something New

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References

• Kozier & Erb’s Fundamental of Nursing Book, 8^th edition.
• Potter and Perry (2005) “Fundamentals of nursing” published by most by an imprint of Elsevier, 6th edition. New Delhi. Page no 1068 – 1071 
• www.google.com

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