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Nursing Management : Stress & Coping

Assessment
1. Nursing History
1. Stressor 2. Coping strategy

2. Physical examination
1. Indicators of stress 2. Stress-related health problem

Nursing History
Assessment interview (stress & coping patterns):

On a scale 1-10, how would you rate the stress you are experiencing in the following area :
- home - work / school - finance - recent illness / loss of loved one - your health - family responsibility - relationship with friends - relationship with parents or children - relationship with partner - recent hospitalization - other (specify)

How long have you been dealing with these stressors ?

Nursing History
How do you usually handle stressful situations?
- cry - get angry - talk to someone - withdraw from the situation - control others or situation - go for a walk or perform physical exercise - try to arrive at a solution - pray - laugh, joke, or use some other expression of humor - meditate or use some other relaxation technique such as yoga, guided imagery

How well does your usually coping strategy work ?

Physical examination
Physical manifestation of stress (read)

Diagnosing
DOMAIN 9 (COPING/STRESS TOLERANCE) Post trauma syndrome Risk for Post trauma syndrome Rape trauma syndrome Relocation stress syndrome Risk for Relocation stress syndrome Anxiety Death anxiety Risk-Prone Health behavior Compromised family coping Defensive coping Disabled family coping Ineffective coping Ineffective community coping Readiness for enhanced coping Readiness for enhanced community coping Readiness for enhanced family coping Ineffective denial Fear Stress overload

NNN Linkages
NANDA NOC NIC

INEFFECTIVE Coping COPING Decision making ( Inability to form Impulse self control a valid appraisal Information control of the stressors, inadequate Social support
choices of practiced responses, and/or inability to use available resources)

Coping enhancement Decision making support Support system enhancement

NNN Linkages
NANDA NOC NIC

STRESS OVERLOAD
( excessive
amounts and types of demands that require action)

Anxiety level Caregiver stressors Stress level

Active listening Anger control assistance Anxiety reduction Aroma therapy Counseling Crisis intervention Emotional support Family integrity promotion Presence Support system enhancement

Implementing
Stress highly individual methods to reduce stress also individual ! Choose methods of intervention that will be the most effective for each individual !

Some methods : Health promotion strategies Minimizing anxiety Using relaxation techniques

Health Promotion
Physical exercise - promotes physical & emotional health - relief of tension, a feeling of well being, and relaxation Optimal nutrition - increasing body resistance to stress - avoid excesses of caffeine, salt, sugar, fat, and deficiencies in vitamins & mineral Adequate rest & sleep - restore the bodys energy levels essential aspects of stress management - adequate sleep may need help to attain comfort & technique that promotes peace of mind and relaxation Time management - people who manage the time effectively usually experience less stress because they fell more in control of their circumstances - help to prioritize and modify the tasks

Minimizing Anxiety
Encourage clients to take deep breaths Explain procedure before they are implemented Administer a massage to help the client to relax Offer support to clients and families during times of illness Quick action to avoid the contagious nature of anxiety

Relaxation Techniques
Breathing exercise Massage Yoga Imagery Meditation Therapeutic touch Music therapy Humor and laughter

Case
Ny. Putri, 55 thn, ibu dari 4 orang anak, MRS dg Ca. Mammae. Ny Putri dijadwalkan menjalani radikal mastectomy. Ny.Putri merasa sangat sehat, hingga 1 minggu lalu menemukan benjolan di payudara kanan. Ny. Putri dan suaminya sangat cemas dg pembedahan. Ny.Putri mengatakan pada perawat saya tidak bisa hidup dg satu payudara saja! Saya bahkan tidak bisa membayangkan melihat diri saya dg satu payudara! Suami Ny.Putri mengatakan, sejak divonis Ca.Mammae, Ny.Putri sering mengkonsumsi alkohol dan melalaikan tanggungjawabnya sebagai ibu rumah tangga. Ny.Putri sangat sedih, dan tidak tahu apakah dia bisa melanjutkan karirnya sebagai desainer busana nantinya.

Dx KEP Ketidakefekti fan koping

OUTCOMES / KRITERIA HASIL Koping Dibuktikan dg klien sering menujukkan kemampuan untuk : - Mengidentifikasi pola koping yg positif dan negatif - Mengontrol diri - Menurunkan perasaan negatif - Memodifikasi lifestyle - Keinginan untuk melibatkan orang lain untuk membantu - Menerima dukungan emosional dari orang lain Peningkatan Koping

INTERVENSI - Menciptakan suasana penerimaan - Menilai kemampuan klien untuk menerima perubahan body image - Mengidentifikasi kekuatan dan kemampuan klien - - Observasi tingkat dukungan keluarga - Libatkan keluarga, suami dalam perencanaan klien - Merujuk pada layanan komunitas dukungan penderita kanker payudara - ..

Suport sosial

Peningkatan support sistem / sistem pendukung