STRESS

State Of Being Out Of Balance

 Types Of Stressors
• Must be perceived as a threat
– Distress vs. eustress
– Developmental stress vs. situational stress
– Physiological stress vs. psychological stress
 Responses To Stressors
• Alter , adapt or avoid stressors
– Change the way the stressor is viewed

– Be a positive thinker

– Surround yourself with positive people

– The straw that broke the camel’s back

 Concepts of Stress
• Stimulus-based models
• Transaction-based models
• Response-based models (Selye)
 Stress Models
Stimulus-based Transaction-based
• Any set of circumstances (Lazarus )
positive or negative that
arouses • Set of cognitive, affective,
physiologic/psychologic and adaptive (coping)
reaction responses that arise out
of person-environment
• may increase vulnerability transactions
to illness
 Stress Models
• Response-based (Selye’s) GAS
• Stress may be considered a response
• Selye (1956, 1976) defined as nonspecific
response of body to any kind of demand
made upon it
Body tries to No more
adapt or energy. Body
return to becomes ill or
homeostasis dies

Body is able
to return to
homeostasis

Fight Or Flight

Response-based (Selye’s)
General Adaptation Syndrome
Local - Reflex pain or Inflammatory responses
Disorders
Caused by
Stress
 Physiologic Causes of Stress

Increase
• Sweat production
increases
• Heart rate
• Cardiac output increase
• Skin is pallid Decrease
• Respiration rate and • Urinary output
depth • Salivation
• Mental alertness • Intestinal Peristalsis
• Blood sugar • Excretion of Sodium and
• Pupils dilation water
 Cognitive Indicators of Stress
• Problem solving
• Structuring
• Self-control or self-discipline
• Suppression
• Fantasy
 Psychologic Indicators
of Stress

• Anxiety and Fear

• Anger and Depression
• Unconscious ego defense mechanisms
 Defense Mechanisms
• Avoidance • Projection
• Compensation • Rationalization
• Denial • Reaction formation
• Displacement • Regression
• Identification • Repression
• Intellectualization • Sublimation
• Introjection • Substitution
• Minimization • Undoing
 Four Levels of Anxiety
Mild Moderate
Increased questioning Voice tremors, pitch
Mild restlessness changes
Sleeplessness Shakiness, muscle tension
Use learning to adapt Narrowed focus of attention
Severe Panic
Increased motor activity Increased motor activity
Inability to relax Unpredictable responses
Fearful facial expression Trembling
Hyperventilation Chest pain/pressure
HA, Dizziness, Nausea Feeling of impending doom
 Coping
• Dealing with change (either successfully
or unsuccessfully)
– natural or learned way of responding to
changing environment or specific problem or
situation
– Internal vs. external
– Problem focus vs. emotional focus
 Assessing Stress and Coping
Patterns
• Nursing History
– Client-perceived stressors or stressful
incidents
– Manifestations of stress
– Past and present coping strategies
– Developmental transitions
 Assessing Stress and Coping
Patterns
• Assessment interview
– Scale to rate specific stressors
– Duration of stressful situation
– Usual strategy for handling stressful situations
– Effectiveness of these strategies
 Nursing Diagnoses Related to Stress

• Anxiety • Fear
• Caregiver Role Strain • Impaired Adjustment
• Compromised Family • Ineffective Coping
Coping • Ineffective Denial
• Decisional Conflict • Post-Trauma
(Specify) Syndrome
• Defensive Coping • Relocation Stress
• Disabled Family Syndrome
Coping
 Interventions to Minimize and
Manage Stress
• Physical Exercise
• Optimal Nutrition
• Adequate Rest and Sleep
• Time Management
 Interventions
• Physical exercise • Optimal nutrition
– Promotes physical and – Essential for health
emotional health – Increases resistance
– 30 minutes/day to stress
recommended – Avoid excesses of
caffeine, salt, sugar,
fat
– Avoid vitamin
deficiencies
 Interventions
• Sleep • Time Management
– Restores body’s – Must address what is
energy level important and
– May need to use achievable
relaxation techniques – Reexamine “should
do”, “ought to do”,
“must do”
 Reducing Client Stress
• Other methods include:
– Listen attentively
– Provide atmosphere of warmth and trust
– Convey sense of caring and empathy
– Include client in plan of care
– Promote feeling of safety and security
– Minimize additional stressors
– Help with recognition of stressors and coping
mechanisms
 Sensory
Perception
Making sense of the environment
 The Sensory Experience

• Stimulus – any that wakes up a nerve receptor

• Sensory reception - Process of receiving stimuli or data

• Sensory perception - Conscious organization and translation of data

into meaningful information

• Arousal mechanism – gives meaning to stimulus

 Sensory Alterations
• Sensory deprivation – not enough stimulation to
keep the Reticular Activating System alert

• Sensory overloads – to much stimuli

 Risk Factors for Sensory Overload

• Pain or discomfort

• Admission to an acute
care facility

• Monitoring in intensive
care units

• Invasive tubes

• Decreased cognitive
ability
 Factors Influencing Sensory Function

• Developmental stage
• Culture
• Level of stress
• Medications and illness
• Lifestyle
Orientation Strategies for Client
with Acute Confusion/Delirium
 Sensory Alterations
• Sensory Deprivation
– Impaired vision, hearing – sensory aids

– Impaired taste – incr seasoning, not salt

– Impaired smell – aroma therapy

– Impaired tactile perception (neuro)

– Impaired kinesthetic sense – dance walking

 Promoting Structured Sensory
Stimulation for Unconscious Client
• Auditory
– Introduce yourself to the client
– Orient the client to time, month, year, location
– Inform client beforehand the care to be
provided
– Read literature to client
– Play a tape recording of familiar voice
– Converse directly to client
 Sensory Alterations
• Sensory Overload
– Decrease light , noise

– Use calm voice tone

– Control pain

– Decrease TV and radio use

– Do not communicate with others in the

patient's room
Promoting Structured Sensory Stimulation for
Unconscious Client
• Visual • Tactile
– Sit client upright in a chair – Incorporate during bath
or bed activities
• Olfactory • Kinesthetic
– Provide aromatic stimuli – Perform range-of-motion
that may include client’s exercises
favorites – Change client’s position
• Gustatory
– Provide mouth care
– Place different tastes on
tongue
 NANDA Nursing Diagnoses
• Disturbed Sensory Perception (Specify:
Visual, Auditory, Kinesthetic, Gustatory,
Tactile, Olfactory)
• Acute Confusion
• Chronic Confusion
• Impaired Memory
 NANDA Nursing Diagnoses
• Examples for which sensory-perceptual
disturbances are the etiology:
– Risk for Injury
– Impaired Home Maintenance
– Risk for Impaired Skin Integrity
– Impaired Verbal Communication
– Self-Care Deficit: Bathing/Hygiene
– Social Isolation
Health And
Illness
 Health And Illness Defined
• Subjective
– Health is ideal stated of physical and mental
well being
– Illness is absence if physical and mental well
being
– Hardiness is a strong will to live
 Health / Illness Continuum
Health Illness
• Biological factors • Physical disease
• Nutrition • Injury
• Physical activity • Mental illness
• Sleep and rest • Pain
• Meaningful work • Loss
• Lifestyle choices • Impending death
• Family relationships • Competing demands
• Religion and spirituality • The unknown
• Environmental factors • Imbalance
• Finances • isolation
 Stages of Illness Behavior
• Experiencing symptoms
• Sick role behavior
• Seeking professional care
• Dependence on others
• Settle in – Understand the
situation

• Attune – pay attention to cues

from the patient

• Acceptance – respecting the

patient’s choice of coping

• Enjoying – accept the patient for

who they are
 Self Concept
Product Of Social Interaction
 Gender
Developmental
level

Peer Family
relationship Relationships
AFFECTS
SELF CONCEPT

Socio
Internal
economic
influences
status
 Four Dimensions of Self-Concept
• Self-knowledge
• Self-expectation
• Social self
• Social evaluation
 Four Components of
Self-Concept
• Personal identity -
unique self

• Body image – what you

see

• Role performance –
things you do to reach
where you are going

• Self-esteem - how
satisfied with self
 STRESSORS
AFFECTING
SELF CONCEPT

ROLE
BODY IMAGE SELF ESTEEM
IDENTITY
 Assessing Role Relationships
• Assess satisfaction and dissatisfaction
with role responsibilities and relationships
• Tailor questions to individual, culture, age,
and situation
 NANDA Nursing Diagnoses
• Disturbed Body Image
• Ineffective Role Performance
• Chronic Low Self-Esteem
• Disturbed Personal Identity
• Impaired Adjustment
• Anticipatory Grieving
• Hopelessness
• Parental Role Conflict
 NANDA Nursing Diagnoses
• Social Isolation
• Disturbed Thought Processes
• Readiness for Enhanced Self-Concept
• Anxiety
• Ineffective Coping
• Dysfunctional Grieving
• Powerlessness
• Disturbed Sleep Pattern
• Spiritual Distress
 Nursing Interventions for
Clients with Altered Self-Concept

• Help client to identify areas of strength

• Assist clients to evaluate themselves and make

behavioral changes

• Framework for identifying personality strengths

 Specific Strategies to Reinforce
Strengths
• Stress positive thinking
• Notice and verbally reinforce client strengths
• Encourage the setting of attainable goals
• Acknowledge goals that been attained
• Provide honest, positive feedback
 Enhance Client Self-Esteem

• Encourage clients to appraise situations and express

feelings
• Encourage clients to ask questions
• Provide accurate information
• Become aware of distortions, inappropriate or unrealistic
standards, and faulty labels in clients’ speech
• Explore clients’ positive qualities and strengths
 Enhance Client Self-Esteem
• Encourage clients’ positive qualities and
strengths

• Encourage clients to express positive self-

evaluation more than negative self-evaluation

• Avoid criticism

• Teach clients to substitute negative self-talk with

positive self-talk
Family
 Family Nursing
• Not just one but many
• Longer visiting hours
• Allowing more than one visitor at a time
• Chapel
• Allowing the family to assist in nursing
• Teaching the family
• Nurse must know the family structure of the
patient
 Family Nursing
Family structure
• Who is in charge?
• Characteristics of the family
• Single head – young children, teenager
• Low income
• Mature family
• Young family
 Family’s View Of Medical Treatments

• Acceptance of invasive treatments

• Receiving blood
• Nutritional choices
• Usage of medications
• Personal definition of health
 Religion and Spirituality
• Religion- the practicing of rituals and beliefs
associated with particular denomination

• Spirituality is a sum total of a person’s

experiences that provides insight to life

• Spiritual distress- the disruption of an

individual’s “life principle”
 Increased Time of Spiritual Need

• Acute Illness
• Chronic Illness
• Terminal Illness
• Individuation
• Near-Death experience
– Nurse must incorporate spiritual need in the
care of the patient
 Assessment
• Faith/Beliefs
• Life and self responsibility
• Life satisfaction
• Culture
• Support systems
• Rituals or practices
• Client Expectations
 Nursing Diagnosis

• Spiritual distress related to….

• Ineffective coping related to …..
• Hopelessness related to……
 Goals
• The patient will achieve balance between
life values, goals,belief systems, and their
relationship within themselves and others

• The patient will utilize support system

 Implementation
• Caring behaviors
• Assessing need for clergy; knowing how to
contact hospital chaplain
• Prayer and rituals
• Integration of care with family- provide
meals, assist with care, and support
 Evaluation

• Review specific goals set for patients

• Determine whether they were met?
• Were clients expectations met?

Future of Nursing and Spirituality -Parish Nursing

Sexuality
 Sexual Development:

• From birth - External genitals are sensitive to touch.

Males have penile erections, Females have vaginal
lubrication

• Toddler (1-3 Years) - Can identify own gender

• Preschooler (4-5 Years) -Explores own and classmates’

body parts, Focuses love on parent of opposite sex
 Sexual Development:

• School Age (6-12 Years) - Strong identification with

parent of same gender, Friends of same gender,
Increasing awareness of self

• Age 8 or 9 often have specific concerns about sexuality

and Sexual Development:

• Adolescence (12-18 Years) = Primary and secondary

sexual characteristics develop
• Masturbation common, May experiment with
homosexuality
 Sexual Development

• Young Adulthood - Establishes own lifestyle and

values, Homosexual identity established in mid-
20s

• Middle Adulthood - Decreased hormone

production, Menopause in women between 40-
55 years, Quality rather than number of
occurrences becomes important
 Varieties of Sexuality
• Sexual Orientation
• Gender Identity
• Erotic Preferences
 Influences on Sexuality
• Family
• Culture
• Religion
• Personal expectations and ethics
Male and Female Sexual Response
Cycle

• Excitement/Plateau
• Orgasmic
• Resolution
 Sexual Dysfunction
• May be related to:
– Past and current factors
– Sexual desire disorder
– Sexual arousal disorder
– Orgasmic disorder
– Sexual pain disorder
– Problem with satisfaction
 NANDA Nursing Diagnoses
• Diagnoses relating specifically to
sexuality:
– Ineffective Sexuality Pattern
– Sexual Dysfunction
 NANDA Nursing Diagnoses
• Sexual problems as etiology of other
diagnoses:
– Deficient Knowledge
– Pain
– Anxiety
– Fear
– Disturbed Body Image
 Health Promotion Teaching
• Sex Education
• Teaching Self Examinations
– Self-breast examination (BSE)
– Testicular self-examination (TSE)
• Responsible Sexual Behavior
– Prevention of sexually transmitted disease
– Prevention of unwanted pregnancies
– Avoidance of sexual harassment and abuse