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Course: Fundamentals of Nursing

Topic: Stress and Adaptation

The Nurses International Community

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COPYRIGHT

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Module Goals

Learners will be able to:

List out the different types of stressors.
Describe the stages of General Adaptation syndrome.
Detail the stress management techniques for coping with stress.
Describe the nurse’s role in management of stress.

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Introduction

Center for Studies of Human Stress, 2019

The term stress was borrowed from the field of physics by one of the fathers of stress research Hans Selye.

In physics, stress describes the force that produces strain on a physical body such as bending a piece of metal until it snaps because of the force, or stress, exerted on it).

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Definition of Stress

Medlineplus, 2021

Stress is a feeling of emotional or physical tension.
Stress is the body's reaction to a challenge or demand.
It can come from any event or thought that makes to feel:

Frustrated,
Angry, or
Nervous

Stress can be positive, such as when it helps you avoid danger or meet a deadline. However, when stress lasts for a long time, it may harm the health.

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Good Stress

According to Selye (1974) stress can sometimes be a positive, motivating force that improve the quality of lives.
Called eustress (from the Greek eu = “good”)

Associated with positive optimal health, and performance.
A moderate amount of stress can be beneficial in challenging situations
Example:

Athletes may be motivated and energized by pregame stress.
Students may experience similar stress before a major exam.

Openstax, 2019

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Types of Stress

Acute Stress:

Stress resulting from specific events or situations that involve novelty, unpredictability, a threat to the ego, and leave us with a poor sense of control².
Short-term stress that goes away quickly².

Example:²

Almost getting into a car accident or
Giving a speech in front of people

Medlineplus, 2021

Centre for Studies on Human Stress, 2019

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Types of Stress

Chronic Stress

Results from repeated exposure to situations that lead to the release of stress hormones².
Lasts for a longer period of time and goes on for weeks or months¹.
Can cause wear and tear on your mind and body.
Chronic stress has been linked to:²

Heart disease
High blood pressure
High cholesterol, type II diabetes, and depression

Medlineplus, 2021
Centre for Studies on Human Stress, 2019

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Critical Thinking Question

Miss Rama in a nursing student and she expresses that she is very anxious about her exam which she will be taking in two days.

What is this type of stress called?

Answer:

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Stressors

Center for Studies of Human Stress, 2019

A stressor is anything that causes the release of stress hormones.
Many things that can lead to stress:

Bereavement
Divorce or separation
Losing a job or unexpected money problems

There are two broad categories of stressors:

Physiological (or physical) stressors and
Psychological Stressors

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Stressors

Center for Studies of Human Stress, 2019

Physiological (or physical) stressors:

These are stressors that put strain on our body such as very cold/hot temperatures, injury, chronic illness, or pain.

Psychological Stressors:

These are events, situations, individuals, comments, or anything we interpret as negative or threatening such as not being able to find a babysitter for your sick child when you cannot take time off work.

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Stressors

Center for Studies of Human Stress, 2019

Classification of stressors

Absolute Stressors

Stressors that everyone exposed to them would interpret as being stressful
These are objective stressors that are universal (Earthquakes, a tsunami)

Relative Stressors

Stressors that only some exposed to them would interpret as being stressful
These are subjective stressors that cause different reactions in different people (time pressure at work, traffic, paying taxes, writing an exam)

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Critical Thinking Question

Mr Alex has recently lost his father in a car accident.

He is in severe level of stress.

What might be the signs and symptoms of too much of stress?

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Signs of Too Much of Stress

Medlineplus, 2021

Diarrhea or constipation
Forgetfulness
Frequent aches and pains
Headaches
Lack of energy or focus
Sexual problems
Stiff jaw or neck
Tiredness
Trouble sleeping or sleeping too much
Upset stomach
Use of alcohol or drugs to relax
Weight loss or gain

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General Adaptation Syndrome (GAS)

Healthline, 2018

GAS describes the physiological changes the body through when under stress
In Hans Selye’s theory, GAS has three stages:

Stage 1: Alarm Reaction stage
Stage 2: Resistance stage
Stage 3: Exhaustion stage

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General Adaptation Syndrome (GAS)

Healthline, 2018

Alarm Reaction

This is the immediate reaction to a stressor.
In the initial phase of stress, humans exhibit a “fight or flight” response.
Heart rate increases,
Adrenal gland releases cortisol (a stress hormone).

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General Adaptation Syndrome (GAS)

Healthline, 2018

Resistance Stage

After the initial shock of fight-or-flight response, the body begins to repair itself and releases a lower amount of cortisol:

Heart rate and blood pressure begin to normalize.

Some stressful situations continue for extended periods of time and the stress hormone and your blood pressure remains elevated.

Signs of the resistance stage include

Irritability
Frustration
Poor concentration

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General Adaptation Syndrome (GAS)

Healthline, 2018

Exhaustion Stage

Results after long-term exposure to stressors.
Can drain the physical, emotional, and mental resources to the point where your body no longer has strength to fight stress.

Signs of exhaustion include:

Fatigue
Burnout
Depression
Anxiety
Decreased stress tolerance
Also weaken your immune system and put at risk for stress-related illnesses

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Critical Thinking Question

While Miss Rana was taking her morning walk she came across a snake and stepped on it. When she realized it she ran away screaming.

Her respiratory and heart rate increased, and she began sweating.

In which stages of General Adaptation Syndrome Miss Rama is in?

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Techniques of Stress Management

American Heart Association, 2014

Positive Self Talk

Can help to calm down and control stress
Learn to shift negative thoughts to positive ones
Example: Negative to positive:

"I can't do this."> "I'll do the best I can. I’ve got this."
"Everything is going wrong." > "I can handle this if I take one step at a time."
"I hate it when this happens." > "I know how to deal with this; I've done it before."

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Top Ten Emergency Stoppers

Actions to help to defuse stress in the moment

Count to 10 before you speak or react
Take a few slow, deep breaths until the body unclench a bit
Go for a walk, even if it’s just to the restroom and back
It can help break the tension and give a chance to think things through
Try a quick meditation or prayer to get some perspective
If it’s not urgent, sleep on it and respond tomorrow especially for stressful emails and social media trolls

American Heart Association, 2014

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Top Ten Emergency Stoppers

Walk away from the situation for a while, and handle it later once things have calmed down.
Break down big problems into smaller parts, and take one step at a time, instead of trying to tackle everything at once.
Turn on some chill music or an inspirational podcast to help you deal with road rage.
Take a break to pet the dog, hug a loved one or do something to help someone else.
Work out or do something active as exercise is great antidote for stress.

American Heart Association, 2014

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Stress Busting Activities

American Heart Association, 2014

Make art -- draw, color, paint, or play a musical instrument
Work on a scrapbook or photo album to focus on good memories
Meet a friend for coffee or a meal
Play a favorite sport like golf, tennis, or basketball
Play with your kids or pets – outdoors if possible
Listen to music or watch an inspiring performance
Take a walk in nature
Take a relaxing bath and feel the stress wash away
Meditate or practice yoga
Go for a run or bike ride to clear your head

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Nurses Responsibilities for the Client with Stress

Assess the level of anxiety.
Assess the stressors for the client and family.
Conduct interview/ observe the behaviours.
Allow the client or family member to express their feelings.
Assess for any substance use.

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Nurses Responsibilities for the Client with Stress

Assist clients to identify feelings and begin to deal with problems:

Establish a therapeutic relationship
Be available to client for listening and talking.
Assist client to develop self-awareness of verbal and nonverbal behaviors
Clarify meaning of feelings and actions by providing feedback.
Most of all, acknowledge anxiety and fear.
When dealing with children, be truthful and avoid bribing.

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Nurses Responsibilities for the Client with Stress

Promote Wellness:

Assist client with identifying new methods of coping with disabling anxiety.
Assist in developing skills (awareness of negative thoughts, saying “Stop”, and substituting a positive thought).

Discharge Teaching:

Relaxation techniques (deep breathing, imagery,).
Maintaining positive coping strategies.
Avoidance of triggers.
Stress management techniques (Mediation, Yoga).
Strict adherence to medication (if prescribed).

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What would the nurse do?

You are a nurse caring for a client with chronic kidney disease and who is stressed about his prognosis of disease. What are the stress management techniques will you advice the client to manage his stress?

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References:

American Heart Association, (2014). 3 Tips to Manage Stress. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/3 s-to-manage-stress -tip

Centre for Studies of Human Stress, (2019). Stress. https://humanstress.ca/stress/

Hugera, V. (2018). What is General Adaptation Syndrome?. Healthline. https://www.healthline.com/health/general-adaptation-syndrome

Medlineplus, (2021). Stress and Health. https://medlineplus.gov/ency/article/003211.htm

OpenStax, Psychology. OpenStax CNX. Jul 19, (2019). http://cnx.org/contents/4abf04bf-93a0-45c3-9cbc-2cefd46e68cc@10.24

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