PSYCHOLOGICAL ASPECTS OF STRESS AND ADAPTATION

AIM: At the end of seminar, group will be able to know psychological aspects of
stress and adaptation.

OBJECTIVES
At the end of seminar, group will be able to .
1) Define stress and adaptation.
2) Explain general adaptation syndrome.
3) Enlist factors influencing response to stressors and types of stress.
4) Discuss integration of stress theory with nursing theory.
5) Describe critical thinking model for stress and adaptation assessment.
6) Describe critical thinking model for stress and coping planning.
7) Describe crisis intervention model.
8) Describe critical thinking model for stress and coping evaluation.

INTRODUCTION:
Knowledge about stress in general is important to health care professionals can
recognize stress in clients and families and intervene effectively. In addition, health care
professionals are affected by stressful events that occur in the course of clinical practice. Nurses
must recognize the signs and symptoms of stress and be knowledgeable about stress management
technique to aid personal coping as well as to design stress management interventions for their
clients and families.
Stress and adaptation are universal and dynamic. Everyone experiences stress and attempts to
adapt to life stressors. Stressors and stress response are physiological and behavioral, as a result
that models that explain the stress response are usually bio-behavioral and provide framework
for care of clients experiencing stress.
DEFINITION OF STRESS
The term stress has many definitions (Lazarus & Folk man, 1984).
It is an internal state which can be caused by physical demands on the body (disease conditions,
exercise, extremes of temperature etc) or by environmental and social situations which are
evaluated as potentially harmful, uncontrollable or exceeding our responses for coping.
The physical, environmental and social causes of stress state are termed stressors.
DEFINITION OF ADAPTATION
We consider some behaviors abnormal because they pose a threat to adaptation.
Adaptation means meeting the performance requirements or role demands of ones situation.
Adaptation occurs when a person is able to change motor response when unexpected problems
arise.
FIGHT AND FLIGHT SYNDROME ( SUSTAINED STRESS RESPONSE)

Hypothalamus

Stimulates

Pituitary gland

Release

ACTH

Vasopressin

Adrenal

B.P.

Cortex

fluid retention

GH

Thyrotrophic hormone

Direct effect
protein, CHO,
Lipid metabolism

BMR

Gonadotropin

Sex hormone
libido, frigidity, impotence

The GAS is an immediate physiological response of body to stress and involves several body
systems (fig.1). when physical demand is made on the body such as an injury the GAS is
initiated by pituitary gland, the pituitary closely related to hypothalamus, which secrets
endomorphins. These are hormones that act on the mind like morphine and opiates producing a
sense of well being and reducing pain (Lazarous 1999). In this way, GAS defends against stress
both by activating the neurons endocrine system and by providing endomorphines that decreases
awareness of pain.
During alarm reaction, rising hormone levels epinephrine and nor epinephrine amounts, heart
rate, blood flow to muscles, O2 intake and mental alertness. In addition, the pupils of eyes
dilated to produce a greater visual field. This change in body system prepares an individual for
flight and fight and may last from 1 min to many hours, if stressors poses an extreme threat to
life or remains for long time, the person progresses to second stage. Resistance
During the resistance stage, the body stabilizes and responds in an opposite manner to alarm
reaction. Hormone levels, heart rate, blood pressure and cardiac output returns to normal and
body repairs any damage occurred, if stressors remains, there is no adaptation the person enters
the third stage, exhaustion.
The Exhaustion stage occurs when body can no longer resists the effects of stressors and when
energy necessary to maintain adaptation is depleted. The physiological response to intensified
but person energy level is compromised and adaptation to stressors diminishes. The body is
unable to defend itself against the impact of the event, physiological regulation diminishes and if
the stress continues, death may result.
Selye (1991) noted that a prolonged state of stress can cause disease. Stress can make people ill
as a result of --1) Increased levels of powerful hormones that change our bodily processes.
2) Coping choices that are unhealthy such as not getting enough rest or proper diet or use of
tobacco, alcohol, other substances or caffeine.
3) Neglect of warming signs of illness or failure to adhere to prescribed medicines. (Monat
&Lazarus, 1991)

FACTORS INFLUENCING STRESSORS

-

Intensity:- level of personal control.

Availability of social supports

Feeling of competence

Cognitive appraisal

TYPES OF STRESS
Selye identified two types of stress
1) Distress of damaging stress
2) Eystress (Motivating energy such as hopefulness, purposeful movement) idea of healthy
stress has become controversial because it is difficult to tell whether a person has
benefited from stress or is coping by denying stress.
There are several types:1) Work stress
2) Family stress
3) Chronic stress
4) Acute stress
5) Daily hassle
6) Trauma and crisis

NURSING THEORY AND ROLE OF STRESS

Nurses have proposed theories related to stress and coping because stress plays a central role in
vulnerability of disease, symptoms of stress often require nursing intervention.

Neumann system model is based on concepts of stress and reaction to stress. The nursing theory
views nursing as being responsible for developing interventions to prevent or reduce stressors on
the client or to make them more bearable for the client because neuman model is a system
model, it is applied to not only understands clients individual response to stressors but families
and communities responses as well.
Examples of stress may include intra personal stressors such as an argument or misunderstanding
between two people or extra personal stressors such as financial concern that impinges on person
from life circumstances every person has developed set of responses to stress that constitute the
normal line of defense. This line of defense helps to maintain health and wellness however
when physiological, psychological, sociocultural, developmental or spiritual influences are
unable to buffer stress, the normal line of defense is broken and disease can result.
In this belief, Neumann system model coincides with Selyes general adaptation syndrome.
Neumann system Model stresses the importance of accuracy in assessment and intervention that
promote optimal wellness using primary, secondary and tertiary prevention.
According to Neumann theory,
-

The goal of primary prevention is to promote client wellness and stress prevention and
reduction of risk factors.

Secondary prevention occurs after symptoms appear

Tertiary prevention begins when the client system is becoming more stable and
recovering.

Neumann model of nursing views person, family or community are constantly changing in
response to stressors and environment.
According to Penders health promotion model, proposes that health promotion is directed
towards increasing the level of well being of individual or group.
-

Primary, secondary, tertiary prevention (health protection) focus on avoiding negative

events.

Penders consider stress reduction strategies important to give important to reduce threats
to wellbeing. Based on these assumptions of capability and desire of people to be healthy.
Pender suggests strategies for prevention and health promotion related to stress
management.

Assessment of client stress level and coping resources requires that the nurse first establish a
trusting nurse client relationship because the nurse will be asking client to share personal and
sensitive information. The nurse learns from client both by asking questions and by making
observations of non verbal behavior and client environment.
The nurse synthesizes the information and adapts critical thinking attitude while observing and
analyzing client behaviors, often client has difficulty expressing exactly what bother about the
situation is.
Subjective finding: the nurse arranges non threatening physical environment without desk as a
barrier for interaction.

Objective finding: the nurse obtains findings related to stress and coping through observation of
appearance and non verbal behavior of the client.
EVALUATION
Client care: - by evaluating the goals and expected outcome of care, the nurse knows if nursing
intervention were effective and if client is coping with identified stress.
To evaluate the client experiencing stress, observe client behavior and talk the client and family,
if appropriate. Remembers that coping with stress can take time. If contact with client must end
before resolution of goals has been achieved it is important to refer client to appropriate
resources so that progress is not delayed or interrupted.
Client expectation: - it is crucial to maintain ongoing communication with the client regarding
the plan of care. Clients under severe stress or trauma often experience feelings of
powerlessness, vulnerability and loss of control. The nurse can help to reduce these feelings by
actively involving clients and families in the progress of problem identification prioritizing and
goal setting and evaluation. Engaging client as a partner in health care stage for open
communication. In such an environment the client can feel more freedom to give important
feedback about intervention that are successful and can help the nurse better understand why
some interventions fail to meet established goals.

TRANSACTIONAL MODEL OF STRESS/ADAPTATION

Precipitating events

Precipitating factors, genetic influence

Past experience, existing conditions

Cognitive appraisal

Primary

Irrelevant

No response

benign positive

pleasurable response

stress appraisal

harm/loss Threat

Challenge

Secondary

Quality of response

Adaptive

maladaptive

ADAPTIVE COPING STRATEGIES

1) Awareness
The initial step in managing stress is awareness. It can be controlled only when one
recongnizes that it is being experienced as one become aware, he/she can omit, avoid, or
accept them

2) Relaxation;
Individual experience relaxation in differtient ways. Some individuals relax by engaging
in large motor activities such as sports,jogging and exercise still other techniques llije
breathing exercises and progressive relaxation

3) Meditation:
Practiced for 20 min. once or twice daily. It has been shown to produce a lasting
reduction in blood pressure and other symptoms. Meditation involves assuming
comfortable position, closing the eyes, casting off all other thoughts and concentrating on
single word, sound etc.

4) Problem solving:

assess

the facts of situation, formulate goals, stud the alternatives, determine the risk, selects
alternatives, implementation of alternatives. If first fails selects the second opinion

5) Pets: Recent psychological studies have began to uncover evidence that those who care
pets (Dogs & Cats) are better able to cope stressors of the life.

6) Music:
it can decreases depression, stimulates motivation, enjoyment and relaxation

CONCLUSION

Stress has become a chronic and pervasive condition in unuted states today. We live in
world of uncertainties. In our own country life in the fast lane. A continuous drive for
advancement, competativeness and search for good life have created stress. Adaptive
responses protect individual from harm and help to restore homeostasis of body. adaptive coping
strategies used for the management of the stress. Nurses are in unique position to assist
individual in identifying coping strategies.

BIBLIOGRAPHY
Aladin CM, Stress, coping and development, New York, 2000
Aguilera DC, Crisis intervention- theory & methodology, 8th edition, st.louis, 1998, Mosby
publication,
Potter & Perry, fundamental of nursing, 6th edition, Mosby publication, Missouri, pp. 597-616

Mary C..Townsend, Psychiatric mental health nursing, Jaypee publications, New Delhi, pp 3-9