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Health Promotion Stress Management and Health Promotion Stress - inevitable human experience in any modern society characterized

d y rapid and accelerating change. - The nonspecific response of the body to any demand made on it (Selye, 1977). - Internal & external manifestations of stress are referred to as the General Adaptation Syndrome (GAS) or the fight-or-flight response. Specific physiologic or behavioral changes that occur in response to stressors include:
Dilation of pupils Increased respiratory rate Increased heart rate Peripheral vasoconstriction Increased perspiration Increased blood pressure Increased muscle tension Increased gastric motility Released of adrenalin Increased blood glucose level Raising of body hair Cold and clammy hands

threatening, primary appraisal serves to reduce its significance for the person experiencing it. b) Secondary appraisal the person evaluates what, if anything may be done to overcome or prevent harm, or to improve the prospects of benefit. (Altering the situation, accepting it, seeking more information, or holding back from acting in an impulsive way. Coping regulates stressful emotions (emotionfocused coping) and alters the personenvironment relationship that is causing the distress (problem-focused coping.) It is imperative that nurses and other providers ensure that all adults are screened and treated for mental health disorders. Professional nurses in community settings including schools, clinics and work sites have a responsibility to promote and conduct early and intervention for stress related problems. Stress Across the Life Span Children are mostly concerned about daily events that relate to school, peers, parents and self. Environmental and social stressors that place children and adolescents at high risk for poor adjustment include personal safety concerns, community violence, prolonged poverty, increased availability of drugs homelessness and AIDS Personal resilience and environmental protective factors that mediate the relationship between risk factors and healthy development need to be identified and incorporated into family, community, and school interventions. Nurses and other heath professionals may find that the best approach to avoidance of substance abuse and other risky behaviors is to assist children and adolescents in learning effective stress-coping processes to apply across a variety of life circumstances. Children (stressors) feeling sick, have nothing to do, not having enough money to spend, being

Major Sources of stress experienced by individuals in modern society originate in interpersonal relationships (communication) and performance demands (action) rather than from direct physical threat. Stressors environmental and internal demands and conflicts among them, which tax or exceed a persons resources. Some stressors viewed as challenges stimulation and excitement Others viewed negatively undesirable, uncontrollable, or emotionally distressing. Coping process -> cognitive appraisal 2 Phases of cognitive appraisal: a) Primary appraisal - the person evaluates whether he has anything at stake in the encounter. If an encounter is

pressured to get good grades, and feeling left out of the group. Work source of stress (lack of control over job environment, or production demands, being caught in the middle between supervisors and customers, being underprepared for the job, lack of clarity about job expectations, unexpected transfers across dept. or company locations, feeling trapped in a particular job& lack of positive relationships with coworkers. Employees were able to better accept undesirable thoughts and feelings by learning to modify stressors in the workplace. Stress-management programs that address changing work and home environments to minimize stress and developing effective coping strategies best meet the needs of young and middle age adults. Elderly- vulnerable to negative life events (death of a close family member, personal injury or illness, heath change of a family member, and retirement). Hassles of daily living ,ay increase as a result of diminished sensory acuity, decreased dexterity and strength, loss of flexibility an increased fatigue. Elderly- increased morbidity and mortality associated with years of daily hassles and cumulative major life events particularly where coping strategies have been ineffective. Nurses familiar with the problems of aging and capabilities of older adults can equip them to manage the stressors that they encounter more effectively and efficiently, thus conserving valuable personal resources. Approaches to Stress Management The primary modes of intervention for stress management consist of the ff: Minimize the frequency of stress-inducing situations Increase resistance to stress Countercondition to avoid physiologic arousal resulting from stress

1st line of defense changing the environment or interpret stress as a challenge, increase resilience against stress. Minimizing the Frequency of Stress-Inducing Situations 1. Changing the environment most proactive approach to minimizing the frequency of stressinducing situations. Stresses may be avoided by becoming more aware of those persons or experiences that create personal stress and minimizing contact to the extent possible. 2. Avoiding Excessive Change if a family is experiencing the illness of one of its family members and a subsequent job loss, this may not be the time to consider geographic relocation, pregnancy, or any other change in lifestyle. Each time a distressing change occurs, the potency of previous change for upsetting stability Is increased. Increasing positive sources of tension that promote growth and self-actualization can offset the deleterious effects of negative tension. 3. Time Control to set aside specific time for adaptation to various stressors. Major advantage of time control is that it ensures that important goals or concerns are addressed and critical tasks are accomplished. This strategy reduces the sense of urgency and lack of time, the level of anxiety and associated feelings of frustration and failure. 4. Time Management organizing oneself to accomplish those goals most important in life within the time available. Important approach to time management is the reduction of a task into smaller parts. A task as a whole may appear as an overload; however if a task is broken down into smaller segments, accomplishment becomes feasible. Breaking it down into component parts allows mastery and feelings of competence.

Increasing resistance to Stress Promoting Exercise 4 processes: 1. Psychologic changes byproduct of cardiorespiratory fitness.(not correlated) 2. Changes in exercise-related self efficacy and mastery generalize to other situations, resulting in improvements in self-concept and coping ability. 3. Underlie decreased stress responses following periods of exercise is a blunting of the psychophysiologic responsiveness to stressors. 4. Exercise might help the brain deal better with stress by enhancing the bodys response. In general, people who are inactive are twice as likely to be depressed whereas people who exercise regularly report feeling of well-being. Enhancing Self-Esteem o Self-esteem value attributed to self or how the person feels about self. o Nurse practitioners and school nurses have excellent opportunities to promote positive self-concepts and healthy levels of self-esteem for adolescents as a basis for healthy functioning throughout life. Enhancing Self-Efficacy if peoples beliefs in their efficacy are strengthened, they approach situations more assuredly and make better use of the skills that they have. o The nurse should help clients identify areas of skill most important to them and then help them augment their efficacy in these highly valued areas. Increasing assertiveness: o Making deliberate effort to greet others and call them by name o Maintaining eye contact during conversations o Commenting on the positive characteristics of others o Initiating conversation o Expressing opinions o Expressing feelings

Disagreeing with others when holding opposing viewpoints o Taking initiative to engage in a new behavior or learn a new activity Setting Realistic Goals clients must not only set goals but understand why accomplishment of those goals is rewarding. o Useful rule: plan to change one behavior at a time. Building Coping Resources o Self-Disclosure predisposition to share ones feelings, troubles, thoughts, and opinions with others. o Self-Directedness degree to which a person respects his or her own judgment for decision making and therefore, demonstrates assertiveness in interpersonal relationships o Confidence ability to gain mastery over ones environment and to control ones emotions in the interest of reaching personal goals. o Acceptance degree to which persons accept their shortcomings and imperfections and maintain a positive and tolerant attitude toward others and the world at large. o Social Support availability and use of network of caring others. o Financial Freedom extent to which persons are free of financial constraints in their lifestyles. o Physical Health - overall health condition including absence of chronic disease and disabilities. o Physical Fitness conditioning resulting from personal exercise practices. o Stress Monitoring awareness of tension buildup and situations that are likely to prove stressful. o Tension Control ability to lower arousal through relaxation and thought control.

Structuring ability to organize and manage resources such as time and energy. o Problem Solving ability to resolve personal problems. After assessing the extent to which the various coping resources are present, nurses should assist clients in maximizing existing strengths and in developing additional resistance resources. Counterconditioning to Avoid Physiologic Arousal Goal of counterconditioning: replace muscle tension and heightened sympathetic nervous system activity produced by stress with muscle relaxation and increased parasympathetic functioning. a) Progressive Relaxation Through tensionrelaxation Techniques Relaxation is a way of turning off the bodys response to the sympathetic nervous system and decreasing neurohormonal changes that take place in reaction to the experience of negative tension states. Overreaction or underreaction of the immune system may result in disease or illness. Relaxation is suggested to result in the following changes: o in the bodys oxygen consumption o metabolism o respiration rate o heart rate o muscle tension o premature ventricular contractions o systolic and diastolic blood pressures o alpha brain waves o Enhanced immune function Muscle Group Sequence for Tension-Relaxation Cycle Muscle Group 1. Right hand and forearm 2. Right upper arm 3. Left hand and forearm Abbreviated Functions Make a fist. Pull elbow tightly into side Make a fist

4. Left upper arm 5. Forehead 6. Upper cheeks and nose 7. Lower cheeks and jaws 8. Neck and throat 9. Chest, shoulders and upper back 10. 11. 12. Upper abdomen Lower abdomen Right upper leg

13. Right lower leg and foot 14. Left upper leg 15. Left lower leg and foot

Pull elbow tightly into side Wrinkle brow Squint eyes and wrinkle nose Place teeth together and make a forced smile Pull chin toward chest Take a deep breath. Push shoulder blades toward each other. Pull stomach in and hold Bear down against the seat of the chair. Push down against the foot of the chair. Point toes toward head and body Push down against the foot of the chair Point toes toward head and body.

Some common problems that clients report include: o o o o o Overly rapid self-pacing through the relaxation sequence. Distraction by environment noise. Difficulty keeping attention on own monologue. Interruption of distraction thoughts during relaxation. Residual tension in some muscles after tension-relaxation.

Progressive Relaxation Without Tension Phrases that might be repeated to facilitate relaxation include: o I feel quiet. o I am beginning to feel quite relaxed. o My feet feel heavy and relaxed. o My ankles, my knees, and my hips feel heavy. o My solar plexus and the whole central portion of my body feel relaxed and quiet.

My hands, my arms, and my shoulders feel heavy, relaxed, and comfortable. o My neck, my jaw, and my forehead feel relaxed. They feel comfortable and smooth. o My whole body feels quite heavy, comfortable, and relaxed. o I am quite relaxed. o My arms and hands are heavy and warm. o My whole body is relaxed and my hands are warm- relaxed and warm. o My hands are warm. o Warmth is flowing into my hands. They are warm, warm. o I can feel the warmth flowing down my arms into my hands. o My hands are relaxed and warm. o My whole body feels quite, comfortable, and relaxed. o My mind is quiet. o I withdraw my thoughts from the surroundings, and I feel serene and still. o My thoughts are turned inward, and I am at ease. o Deep within my mind, I can visualize and experience myself as relaxed, comfortable, and still. o I am alert, but in an easy, quiet, inwardturned way. o My mind is calm and quiet. o I feel an inward quietness. Relaxation Through Yoga use of both physical exercise and meditation Relaxation through Imagery benefits of imagery include its influence on physiological and immunological responses of the autonomic nervous system that result in stress reduction. Prepared By: Lea Nizza M. Santillan, RN