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SEMINAR ON STRESS AND ITS MANAGEMENT
Presented by, Premnath R I year MSc Nursing Govt. CON Kottayam
History
• ‘Stringere’ means ‘to draw tight’
• Walter Cannon refer it as external
factors that disrupted homeostasis.
• The term stress coined by Hans
Selye.
Stress - Definition
• The non-specific response of the body to any demand placed upon it.
(Hans Selye) Stress should be restricted to conditions where
an environmental demand exceeds the natural regulatory capacity of an organism.
(Bruce McEwen and Jaap Koolhas)
Relationship between the person and the
environment that is appraised by the
person as taxing or exceeding his or her
resources and endangering his or her
well-being.
(Lazarus and Folkman , 1984)
EUSTRESS
Eustress or positive stress occurs
when your level of stress is high
enough to motivate you to move into
action to get things accomplished.
DISTRESS
Distress or negative stress occurs
when your level of stress is either too
high or too low and your body and/or
mind begin to respond negatively to
the stressors.
CONCEPTS OF STRESS
• Stress as a biological
response.
• Stress as an environmental
event.
• Stress as a transaction
between the individual and
the environment.
Stress as a biological response
• In 1956, Selye described the syndrome of
symptoms as the “fight or flight syndrome”.
He described the reaction in 3 different stages.
1. Alarm reaction stage- during this stage, the
physiological response of the “fight or flight”
syndrome are initiated.
2. Stage of resistance- the individual uses the physiological response of the first stage as a defence in the attempt to adapt to the stressor.
3. Stage of exhaustion- this stage occurs when there is a prolonged exposure to the stressor to which the body has adjusted. The adaptive energy is depleted and the individual can no longer draw from the resources for adaptation. Diseases of adaptation (eg., headache, mental disorders, coronary artery diseases, ulcers) may occur.
General Adaptation Syndrome
Alarm reaction stage
Stress responses in alarm reaction
• Heart rate and strength of cardiac muscle contraction increases
• Blood vessels supplying to the skin and viscera constrict; at the same time blood vessels supplying to skeletal muscles and brain dilate; thus decreasing blood supply to organs which do not assume an immediate active role.
• RBC production is increased leading to an increase in the ability of the blood to clot. This helps to control bleeding.
• Liver converts glycogen into glucose and
releases it into he blood stream; this
provides energy needed to fight the stressor.
• The rate of breathing increases and
respiratory passages widen to accommodate
more air.
• Production of saliva and digestive enzymes
reduces.
The General Adaptation Syndrome: Alarm Phase
Figure 3.2
STRESS - BODY RESPONSE
Resistance Reaction
• It is initiated by regulating
hormones secreted by
hypothalamus.
• It is a long-term reaction.
• Regulating hormones are
• Corticotropin Releasing Hormone (CRH)
• Growth Hormone Releasing Hormone
(GHRH)
• Thyrotrophic Releasing Hormone(TRH)
• CRH stimulates the anterior pituitary to increase its secretion of adrenocorticotrophic hormone(ACTH). The action of these hormones helps to control bleeding, maintain blood pressure etc.
• GHRH stimulates anterior pituitary to secrete human growth hormone(HGH).
• TRH causes the anterior pituitary to secrete thyroid stimulating hormone (TSH). The combined action of HGH and TSH help to supply additional energy to the body.
Exhaustion stage
• At this stage, cells start to die, and the organs weaken.
• A long – term resistance reaction put heavy demand on the body, particularly on the heart, blood vessels, and adrenal cortex, which may suddenly fail under strain.
• Immune system is exhausted and
function is impaired resulting in
decompensation.
• The result can manifest itself in obvious
illnesses such as ulcers, depression,
diabetes, trouble with the
digestive system or even cardiovascular
problems, along with other mental
illnesses.
Stress as an environmental event
• Stress as the “thing” or “event” that triggers the adaptive physiological and psychological response in the individual.
• The event is one that create change in the life pattern of the individual, requires significant adjustment in the life style, and taxes available personal resource.
• The change can be either positive, such as accomplishing an outstanding personal achievement, or negative, such as being fired from a job.
• Holmes and Rahe(1967) devised the
social readjustment rating scale.
Numerical values were assigned to
various events, or changes, that are
common in people’s lives.
• Holmes and Rahe concluded that the
higher the score on the social
readjustment rating scale, the
greater the susceptibility of the
individual to physical or
psychological illness.
Stress as a transaction between the individual and the environment
• Personal characteristics as well as
the nature of the environmental
event are considered.
(Lazarus&
Folkman,1984)
Precipitating event
A precipitating event is a stimulus arising from
the internal or external environment and is
perceived by the individual in a specific manner.
Determination that a particular
person/environment relationship is stressful
depends upon the cognitive appraisal of the
situation by the individual.
• Cognitive appraisal is the
individual’s evaluation of the personal
significance of the event or occurrence.
The event precipitates a response on the
part of individual, and the response is
impacted by the individual’s perception of
the event.
Predisposing factors
Types of precipitating factors
include genetic influences, past
experiences and existing conditions.
• Genetic influences are those circumstances
of an individual’s life that are acquired by
heredity. Examples include family history of
physical and psychological conditions and
the individual’s temperament.
• Past experiences are occurances that result
in learned patterns that can influence an
individual’s adaptation response.
• They include previous exposure to the
stressor, learned coping responses, and
degree of adaptation to previous experiences.
• Existing conditions incorporate vulnerabilities
that influence the adequacy of the individual’s
physical , psychological and social resources
for dealing with adaptive demands.
• Examples include current health status,
motivation, developmental maturity, severity
and duration of the stressor, financial and
educational resources, age, existing coping
strategies, and a support system of caring
others.
STRESS ADAPTATION MODELS
1. Stuarts Stress Adaptation Model
2. Transactional model of stress and
coping
3. Psychosomatic model
Stuarts Stress Adaptation Model
TRANSACTIONAL MODEL OF STRESS AND COPING
PRECIPITATING EVENTPREDISPOSING EVENT
COGNITIVE APPRAISAL
IRRELEVANT BENIGN POSITIVE STRESS APPRAISAL
NO RESPONSE PLEASURABLE RESPONSE
STRESS APPRAISAL
HARM THREAT CHALLENGE
SECONDARY RESPONSE
AVAILABILITY OF COPING STRATEGIES
PERCEIVED EFFECTIVENESS OF COPING STRATEGIES, PERCEIVED AVAILABILITY TO USE COPING STRATEGIES
EFFECTIVELY
QUALITY OF RESPONSE
ADAPTIVE MALADAPTIVE
PSYCHOSOMATIC MODEL
• Psychic phase: It is marked by mild, but
persistent psychological and behavioral
symptoms of stress like irritability, disturbed
sleep, anorexia etc.
• Psychosomatic phase: If stress condition
continues, these symptoms become more
pronounced along with beginning of
generalized physiological symptoms like
occasional hypertension, tremors etc.
• Somatic phase: It is marked by increased
function of organ. At this stage, one begins
to identify beginning of a disease stage.
• Organic phase: It is marked by full
involvement of a so called disease state
with physiological changes like ulcerated
stomach or chronic hypertension.
PSYCHOSOMATIC MODEL
CAUSES OF STRESS
• 1.Catastrophs
• 2.Major life changes
• 3.Daily hassles
CatastropheA catastrophe is a sudden, often
life-threatening calamity or disaster that pushes people to the outer limits of their coping capability.
Catastrophes include natural disasters—such as earthquakes, tornadoes, fires, floods, and hurricanes—as well as wars, torture, automobile accidents, violent physical attacks, and sexual assaults.
Catastrophes often continue to affect their victims’ mental health long after the event has ended.
Major life changes
The most stressful events
involve major life changes, such as
death of a spouse or family member,
divorce, imprisonment, losing one’s
job, and major personal disability or
illness.
Daily hassles• living in a noisy neighborhood• commuting to work in heavy traffic• disliking one’s fellow workers• worrying about owing money• waiting in a long line• misplacing • losing things.
When taken individually, these hassles may feel like only minor irritants, but cumulatively, over time, they can cause significant stress.
Symptoms of stress
• Feelings
• Behavior
• Physiology
Feelings
• The individual becomes anxious and is scared.
• The person feels that he has got something to loose or something wrong will take place.
• The person becomes irritable and moody.
• Individual develops a negative frame of mind and suffers from low self-esteem.
• The person loose faith in his capabilities and is afraid of the failures.
• Not able to concentrate and is involved in his own plans and thoughts.
PHYSIOLOGICAL AND BEHAVIORAL CHANGES
• Speech problems. • Impulsive Behavior • Crying for no apparent reason. • Laughing in a high pitch and nervous tone of
voice. • Grinding of teeth • Increasing smoking and use of drugs and
alcohol. • Being accident-prone • Perspiration /sweaty hands • Increased heart beat • Trembling • Nervous ticks
PHYSIOLOGICAL AND BEHAVIORAL CHANGES
• Dryness of throat and mouth. • Tiring easily • Urinating frequently • Sleeping problems • Diarrhea / indigestion / vomiting/ nausea • Butterflies in stomach • Headaches • Premenstrual tension • Pain in the neck and or lower back • Susceptibility to illness • Loss of appetite or over eating
EFFECTS OF STRESS
• Stress response
• Disease
• Decreased immune response
• Mental illness
STRESS MANAGEMENT
• Become aware of stressors and emotional
and physical reactions.
• Relaxation
• Meditation
• Interpersonal relation with caring other
• Problem solving
• Pets
STRESS MANAGEMENT
• Music
• Recognize what we can change
• Reduce the intensity of emotional reactions to
stress
• Learn to moderate physical reactions to stress
• Build physical reserves.
• Maintain emotional reserves
STRESS MANAGEMENT TECHNIQUES
1. Stress Diary - Finding Optimum Stress Levels
2. Psyching Up' - Raising Stress Levels to
Improve Performance
3. Anticipating Stress - Managing Stress by
Preparing For It
4. Get a hobby or two, relax and have fun: Talk
with friends or someone you can trust about
worries/problems.
STRESS MANAGEMENT TECHNIQUES
5.Other Techniques:
• Meditation can also be a good effort to bring down the stress levels.
• Taking exercise • Effective time Management • Good Food and nutrition.
THE NURSING PROCESS FOR THE MANAGEMENT OF
STRESSASSESSMENT: Nursing History
Physical assessment
Assessment of the person
Assessment of the family
Assessment of the environment
NURSING
DIAGNOSIS
OUTCOME IDENTIFICATION AND PLANNING
• Decrease in the level of
anxiety
• Develop effective coping
skills
• Describe a reduction in
anxiety and an increase in
comfort.
IMPLEMENTATION• Non-Pharmacological methods
A TO Z OF STRESS MANAGEMENT
• Always take time for yourself, at least 30
minutes per day.
• Be aware of your own stress meter: Know
when to step back and cool down.
• Concentrate on controlling your own
situation, without controlling everybody else.
• Daily exercise will burn off the stress
chemicals.
A TO Z OF STRESS MANAGEMENT
• Eat lots of fresh fruit, veggies, bread and water; give your body the best for it to perform at its best.
• Forgive others, don't hold grudges and be tolerant -- not everyone is as capable as you.
• Gain perspective on things, how important is the issue?
• Hugs, kisses and laughter: Have fun and don't be afraid to share your feelings with others.
A TO Z OF STRESS MANAGEMENT
• Identify stressors and plan to deal with them better next time.
• Judge your own performance realistically; don't set goals out of your own reach.
• Keep a positive attitude, your outlook will influence outcomes and the way others treat you.
• Limit alcohol, drugs and other stimulants, they affect your perception and behavior.
A TO Z OF STRESS MANAGEMENT
• Manage money well, seek advice and save
at least 10 per cent of what you earn.
• No is a word you need to learn to use
without feeling guilty.
• Outdoor activities by you, or with friends
and family, can be a great way to relax.
• Play your favorite music rather than
watching television.
A TO Z OF STRESS MANAGEMENT
• Quit smoking.• Relationships.• Sleep well.• Treat yourself once a week with a
massage, dinner out, the movies.• Understand things from the other
person's point of view.• Verify information from the source
before exploding.
A TO Z OF STRESS MANAGEMENT
• Worry less.
• Xpress.
• Yearly goal setting.
• Zest for life.
Stress Management Strategies
Remove the Stressor
Withdraw from the Stressor
Change Stress Perceptions
Receive Social Support
Control Stress Consequences
Stress Management Strategies
Inverted-U Hypothesis:
Stress and Performance:
Who Wants to Get Rid of All the Stress in Your
Life?Only One Group of
People Have No Stress
The Key Word Is….Balance
DISCUSSION QUESTION
Self management of stress
Stress management strategies for you
• Take a Deep Breath
• Manage Time
• Connect with Others
• Talk it Out
• Take a “Minute” Vacation
• Monitor Your Physical comfort
• Get Physical
• Take Care of Your Body
• Laugh
• Know your limits
• Think Positively
• Develop a Sense of Life Meaning
•Compromise
•Have a Good Cry
•Avoid Self Medication
• Look for the “Pieces of Gold” Around you