Stress and adaptation

Presenter: Thasleem Sabith.K

Moderator: Ms.Sandhya Gupta
History
1869- Neurasthenia
1900- British Society of Medical
Psychology
• Increase in mental illness-3 causes
• Industrialization
• Overstrain theory- Thermodynamics
• Esthesiometer
• Hans seyle- (1871-1945)
– Father of stress studies
Facts.
• 75-90% of adult visits to primary care
physicians are for stress related
problems.
• More heart attacks on Monday, 9:00
A.M. than at any other time of the week.
• 700% increase in workers compensation
claims related to work stress over a past
20 years
Stress and women
• Women who work full-time and have
children under the age of 13 report the
greatest stress worldwide
• Nearly one in four mothers who work full-
time and have children under 13 feel
stress almost every day
• Globally, 23% of women executives and
professionals, and 19% of their male
peers, say they feel "super-stressed"
Stress
Real or interpreted threat to the
physiological or psychological integrity of
an individual that results in physiological
and behavioral responses.
An internal state which can be caused
by physical demands on the body or by
social or environmental situation which
are evaluated as potentially harmful,
uncontrollable, or exceeding our demands
of coping.
Views
• Eastern philosophies have viewed
stress as an absence of inner peace.

• Western culture has more recently

viewed stress as a loss of control.
• Stress is a state of anxiety produced
when events and responsibilities
exceed one’s coping abilities. Richard
Lazarus
Holistic Medicine View of Stress

• Stress is the inability to cope with

a perceived or real (or imagined)
threat to one’s
– Mental
– Physical
– Emotional
– Spiritual well-being
Stressor
A stimulus or event that provokes a stress response
in an organism.

• Physiological
• Psychological
Internal
• Developmental
• Sociological
• Environmental
• Spiritual and External
cultural
Levels
• Eustress or positive stress occurs when
the level of stress is high enough to
motivate to move into action to get
things accomplished.
• Distress or negative stress occurs when
the level of stress is either too high or too
low and body and/or mind begin to
respond negatively to the stressors. Eustress

Neustress

Distress
 The Yerkes-Dodson Curve
Maximum Performance
Good Low
performance

illness
Eustress Distress

Poor poor performance poor performance

High
low moderatre high
underaroused- optimally overaroused-
bored aroused overwhelmed
Types of Stress
• General Stress:
– Generally resolves within a day or two
• Cumulative Stress:
– Prolonged stress which builds up after time and
can lead to adverse mental and/or physical
consequences
• Acute Traumatic Stress:
– Critical Incident Stress. Produces considerable
Psychological distress. Normal reaction to
abnormal events
• Post Traumatic Stress:
– Severe stress produced by severe psychological
trauma. Can produce lasting changes. Created
by unresolved Critical Incident Stress
General Adaptation Syndrome
• Hans seyle(1956,1976) termed the
body’s response to stressors as GAS –
general adaptation syndrome.

Stage 1
Alarm Reaction

Stage 2
Resistance

Stage 3
Exhaustion
Stages
• Alarm Stage
• It is the emergency response of the
body in response to the stressor
• Flight- or fight response
• Mainly mediated by sympathetic
nervous system
– anxiety or fear
– sorrow or depression
– shock or confusion
– Self-correcting
Resistance Stage
• If continuous stressor is present body tries
to resist the effects
• Hormonal responses of the body comes to
play (adrenocorticotropic-ACTH- axis)
– Cortisol
• But high level of Cortisol in the blood for
longer time causes immune
suppression,high BP
– aggression
– regression
– repression
– withdrawal
– fixation
Stages ..
• Exhaustion Stage
• Inability to defend against stressors
• Body’s capacity to respond to both
continuous and new stressors has been
seriously compromised.
• Person may become ill or can even die (due
to the high Cortisol)
– Physiological
• headaches, colds & flu
– Psychological
• severe depression
– Interpersonal
• end of relationships
Seyle’s GAS model
Seyle’s Model of stress

• All life events can cause some stress

• Stress is not bad per se, but excessive or
un necessary stress should be avoided
whenever possible
• The stress is the stimulus eliciting the
need for adaptation
• The nonspecific aspects of body's
reaction to an agent may not be as
obvious as specific effects
• Stress cannot be equated with ACTH,
corticoid, catecholamines secretion
• Removal of stressors eliminate stress
Stuart’s Stress Adaptation Model
Physiological Systems Involved in
Stress Response:
• Nervous system • Immune system
– SNS&PNS • Three pathways:
• Endocrine system – ACTH axis
– Pituitary – Vasopressin axis
– Thyroid – Thyroxine axis
– Adrenal glands
Research input
• the adrenal glands may be more sensitive
to ACTH in the morning. higher basal
salivary cortisol levels were related to a
lower stress-related net increase in
salivary cortisol, total plasma cortisol ,
and ACTH.
• Comparable HPA axis and heart rate
stress responses to psychosocial stress
can be measured in the morning and
afternoon
(psychoneuroendocrinology 2004)
Three Stages
• Immediate effects of stress
– Sympathetic nervous response
– Epinephrine & nor-epinephrine released
– 2 to 3 seconds
• Intermediate effects of stress
– Adrenal response
– Epinephrine & nor-epinephrine release from
adrenal medulla
– 20 to 30 seconds
• Prolonged effects of stress
– ACTH, vasopressin and thyroxine affect various
metabolic processes
– minutes, hours, days, weeks
Indicators of stress
• Physiological indicators
• Developmental indicators
• Psychosocial indicators
• Intellectual indicators
• Spiritual indicators
Early warning Signs of Stress

• Menstrual problems • Need more sleep

• Speech difficulties • Tired but can't sleep
• Headaches • Sudden weight loss
• Nail biting • Low /High blood
• Grinding teeth pressure
• Low /High blood sugar • Lack of coordination
• Forgetfulness • Repeated colds
• Lower back pain • Muscle aches
• Loss of appetite • Hair loss
• Chest pain
Physical signs and symptoms
• Urinary hesitancy
• Increased heart rate • Nausea, Vomiting
• Elevated blood • Sleep disturbances
pressure
• Fatigue
• Sweaty palms
• Shallow breathing
• Tightness of the chest,
• Dryness of the mouth
neck, jaw, and back
or throat
muscles
• Cold hands
• Headache
• Itching
• Diarrhea,Constipation
• Being easily startled
• Chronic pain
Emotional signs and symptoms

• Irritability • Lack of interest

• Angry outbursts • Tendency to cry
• • Being critical of others
Hostility
• Self-deprecation
• Depression
• Nightmares
• Jealousy
• Impatience
• Restlessness,insomnia
• Decreased perception of
• Withdrawal positive points
• Anxiousness • Narrowed focus
• Diminished • Obsessive rumination
initiativeness
Cognitive/Perceptual Signs and
Symptoms
• Forgetfulness • Decreased
psychomotor
• Preoccupation reactivity and
• Blocking coordination
• Blurred vision • Disorganization of
thought
• Errors in judging
distance • Negative self-esteem
• Diminished sense of
• Diminished or meaning in life
exaggerated fantasy • Lack of control/need
life for too much control
• Lack of concentration
Behavioral Signs and Symptoms
of Stress

• Increased smoking • Hostility

• Accident-proneness
• Aggressive behaviors • Nervous laughter
Compulsive behavior
(such as driving - •
Impatience.
•
road rage, etc.) • Over-eating
• Withdrawal
• Increased alcohol or
drug use
• Carelessness
• Under-eating
The Effects of Stress on Systems in
the Body
The Effects of Stress on Systems
Central Nervous System
• Anxiety
• Depression
• Fatigue
Cardiovascular System
• Impaired heart function; can cause angina
• Constriction of the peripheral blood vessels,
thereby raising blood pressure
The Effects of Stress on Systems

Digestive System
• Stomach upsets, ulcers
• Diarrhea
• Gastritis
• Peptic ulcers
• Irritable Bowel Syndrome
• Colitis
• Canker sores in the mouth
The Effects of Stress on Systems
Respiratory System
• Asthma
Musculoskeletal System
• Tension in skeletal muscles and joints, leading
to backache and muscular aches and pains
• Predisposition to arthritis; degenerative
diseases such as rheumatoid arthritis
The Effects of Stress on Systems

Immune System
• Weakened defenses, with lowered resistance to
infections
• Viral illnesses (often due to a depleted immune defense
system)
• Allergies, auto immune disorders
• Malignant cell changes; cancer
Endocrine System
• Menstrual disorders
• Thyroid disorders, thyroiditis
• Adrenal hypo function
 The Effects of Stress on Systems

Reproductive System
• Infertility
• Premature ejaculation
• Impotence
Skin
• Eczema
• Psoriasis
• Rashes
General
• Tissue degeneration
• Acceleration of aging process
STRESS RELATED ILLNESSES
• Psychosomatic illness
• Cardiovascular disease
• Immune system disease
• Asthma, Diabetes
• Digestive disorders
• Ulcers
• Skin complaints - psoriasis
• Headaches and migraines
• ASD,PTSD
• Pre-menstrual syndrome
• Depression
Management of stress related
illness
Dual treatment plan
• Psychological management
– Psychotherapy
– Stress management
– Life style modification
• Medical management
– Specific illness related treatment
Effects of stress on learning and
memory
• During stressful situation the attention
span tends to be narrowed to the most
salient stimuli in the situation,where as
more peripheral stimuli are neglected
• The hippocampus shut down under severe
stress thereby there will be an incomplete
encoding of the stressful situation
• The declaratory memory becomes
impaired whereas non declaratory
memory(procedural memory) remains
intact
Decision Making Under Stress
• The likelihood of choosing a risky
alternative.
• During crisis, the ability of a group to
handle difficult tasks requiring intensely
focused attention is decreased.
• The greater the tendency to make a
premature choice of alternatives for a
correct response.
• The less likely that individuals can
tolerate "ambiguity".
Decision Making Under Stress
• There is a decrease in productive thoughts and
an increase in distracting thoughts.
• The greater the distortion in perception of
threat and poor judgment often occurs.
• Frustration and hostility aroused by a "crisis",
the greater the tendency to aggression and
escape behaviors.
• In a stressful situation (whether real or
perceived stress), only immediate survival goals
are considered. Long term considerations are
sacrificed for short term goals
Stress in children
• Signs of stress in children
– Aggressive behavior
– Shyness
– Social phobia
– Lack of interest in enjoyable activities
Managing stress in children

• Talk with the child.

• Be honest and open with child.
• Don't burden them with problems. But, tell
children about the family's goals and discuss
difficulties in a friendly manner.
• Compliment children when they do well, and
don't forget hugs and kisses.
• Use humor to buffer bad feelings and situations.  
• Don't overload child with too many after-school
activities and responsibilities.  
• Set a good example. Demonstrate good self-
control and coping skills.  
• Get friends' or professional help when problems
seem unmanageable
Stress in adolescents
• Rapid physical transitions –puberty
(maturational crisis)
• Necessitate transition in a child's mental
make-up , its attitude towards people and
circumstances.  
• Identity crisis
• The perils of peer interaction
• Acceptance and rejection of—situations,
persons and.
• Choices about drinking, smoking, drugs and
sex, along with fears about violence, are
common stressors.
Managing stress in adolescents
• Parents need to be aware of possible stressors and
to recognize signs of stress.
• Be sensitive to changes in children's behavior and
respond to them.
• Provide opportunities for them to learn stress
management techniques.
• Have reasonable expectations and set manageable
goals in academic and extra curricular fields.
• When you are under extra stress, be sure that you
are not passing it along to your child.
• Physical exercise and sports are good stress
reducers 
• Spending time together
Stress young adults

• Work- family conflicts

• Overburden of working mothers- easy burnout
• Unrealistic expectation of perfect family
• Parents with full-time jobs have difficulty finding
family play-time
• Physical exhaustion by caring small children
• No support system –nuclear family
• Over expectation of love from children and vice
versa
• Future of kids
Managing stress in young adults

• Make time for self. Reserve time each week for

your own activities.
• Take care of health with a good diet and regular
exercise.
• Avoid fatigue, take rest in between the work
• Take a break from looking after the children..
• Look for community programs for parents and
children.
• Ventilate feelings
• Look for parenting courses and groups in
community.
• Perform stress management techniques
Stress in middle adulthood
• Too much of family responsibility
• Ill family member- caregiver burden
• Role conflicts
• Value conflict between parents and
children
• Support from family members, peer
group, community resources,
counselors etc.
Stress in old age
• Loss and bereavement
• Fear of death
• Value conflicts
• Abuse
• Chronic illness and dependency
• Loneliness
• Retirement
• Has to deal with family support, self-
help groups, counseling, legislation.
Stress and pregnancy
• Physiological changes
• Apprehension about childbirth
• Physical discomfort
• Fear of miscarriage
Managing stress in pregnancy
• Readjusting with the new life style
• Emotional vent out
• Relaxation exercises
• Proper preparation for child birth ;
physical,mental,financial etc
• Regular antenatal check ups
• Balanced diet and exercises
Research input
• Pregnancy subsequent to perinatal loss was
perceived as a threat, and threat appraisal
strongly predicted pregnancy anxiety.
• Pregnancy anxiety, reported at moderate levels
on average, decreased over time; threat
appraisal, coping, and other emotions were stable
across pregnancy.
• Coping was correlated with emotional status as
theorized, with problem-focused coping used
more than emotion-focused coping.
• Women find pregnancy after loss as stressful and
a threat, and this appraisal remains across
pregnancy. (nurs research
2007)
Acute stress disorder (ASD)
• Sense of detachment
• Reduced awareness of
surroundings
• Derealization
• Depersonalization
• Dissociated amnesia
Managing stress is ASD
• Encourage to ventilate feelings
• Be with the client
• Emotional reassurance
• Assistance from medical and
psychiatric professionals
• Spend time with family and
friends.
Disaster Related Stress (PTSD)
• Headaches/stomach problems.
• Difficulty communicating
• Tunnel vision/muffled hearing.
thoughts.
• Colds or flu-like symptoms.
• Difficulty sleeping. Disorientation or confusion.
•
• Low threshold of • Difficulty concentrating.
frustration. • Reluctance to leave home.
• Increased use of • Depression, sadness.
drugs/alcohol. • Fear of crowds, strangers, or
being alone.
• Limited attention span
• Mood-swings and easy
bouts of crying.
• Overwhelming guilt and
self-doubt.
Managing stress in PTSD
1. Encourage to Talk
2. Encourage them to seek help from professional
counselors
3. Do not hold themself responsible for the event
4. promote physical and emotional healing by
healthy eating, rest, exercise, relaxation, and
meditation.
5. Maintain a normal family and daily routine
6. Spend time with family and friends.
7. Participate in memorials.
8. Use existing support groups of family, friends,
and religious institutions.
9. Prepare them to deal with the same situation
in future
 Medically unexplained syndromes
Specialty Syndromes
Allergy Total allergy syndrome
Cardiology Atypical chest pain, effort syndrome

Dentistry Burning mouth syndrome, atypical

facial pain
ENT Globus syndrome
Gastro IBS, food intolerance
Infectious Myalgic encephalomyelitis
Military Gulf war syndrome
Occupational Electromagnetic sensitivity
Rheumatology Fibromyalgia
Adaptation
Adaptation
• Adaptation is the process by which
the physiological or psychological
change occur in order to maintain
optimal functioning
Dimensions of adaptation
• Physiological dimension
• Developmental dimension
• Emotional dimension
• Intellectual dimension
• Social dimension
• Spiritual dimension
Coping with stress
• By removing stressors- changing the
environment
• Not allow certain neutral events to become
stressors – handling the potential stressors
• By developing proficiency in dealing with
conditions we do not want to avoid –
finding adequate specific response
• Seeking relaxation or diversion from the
demand (Hans seyle)
Assessment

• Assess the indicators of stress in all

dimensions of adaptation
• Assess the health behavior in response to
stress
– Positive health behavior
• exercise, avoid high fat, sunscreen protection, breast self
examination, regular dental care etc
– Negative health behavior
• Smoking, drinking, overeating, unsafe sexual practices etc
• Assess the ego defenses used by the individual
and the resources
Nursing Diagnoses Related to
Stress(NANDA)

• Anxiety related to • Fatigue related to

– Change in health – Overwhelming
status psychological
demands
– Maturational or
– Excessive role
situational crisis
demands
• Altered growth • Hopelessness
and development
• Ineffective individual
related
or family coping
– to separation and
loss • High risk for injury
– Situational crisis • Sleep pattern
disturbances
Planning
• The plan of care is individualized to the
clients perception of the stressor and
response to stress
• Goals for the patients who require
Stress management techniques
– Reduction in frequency of stress- inducing
situations
– Decreased physiological response to stress
– Improved behavioral and emotional
response to stress
Intervention: Stress management
• A set of techniques and programs
intended to help people deal more
effectively with stress in their lives
by analyzing the specific stressors
and taking positive actions to
minimize their effects.
Physical exercise
• Physical exercise is a form of
stress; the enactment of all the
physiological systems that the
fight-or-flight response triggers for
physical survival.
• Very effective means to reduce
stress and a most natural means
to express the manifestations of
the stress response.
Phases of a Workout

warm-up period
(5-10 minutes)

stimulus
period
(20-30 minutes)
cool-down period
(5-10 minutes)
Psychological Effects of Physical
Exercise
• Improved self-esteem
• Improved sense of self-reliance, self-efficacy
• Improved mental alertness, perception, and
information processing
• Increased perceptions of acceptance by others
• Decreased feelings of depression and anxiety
• Decreased overall sense of stress and tension
Nutrition and Stress

• A malnourished diet is a stressor

on the body.
• some foods actually induce a state
of stress. Excess amounts of sugar,
caffeine, salt, and foods poor in
vitamins and minerals weaken the
body’s resistance to the stress
response.
Nutrition and Stress
guidelines :
– adequacy (of essential nutrients),
– moderation (limited sugar, fat, and salt),
– balance (of nutrients), caloric control, and variety

• Ability to Manage Stress

Behavioral techniques to manage
stress
• Behavioral Rehearsal
• Cognitive Restructuring/Reframing
• Systematic Desensitization
• Anger Management
• Thought Stopping Techniques
• Control and Perception of Control
• Self-Esteem Enhancement
• Goal Setting
• Active (Reflective) Listening
• Modification of Life-style (Nutrition, Sleep, etc.)
Stress management: Remedial
Actions • Change lifestyle
• Change thinking
– Reframing – Diet,exercise
– Positive thinking – Pet Therapy
• Change behavior – Meditation
– Deep Breathing
– Be Assertive
– Nature Walks and
– Get Organized/ Time
Imagery
Management
– Hydrotherapy: A
– Ventilation Warm, Hot Bath
– Humor – Music Therapy
– Sleep and leisure
Reframing
• Reframing is a technique used to change the
way we look at things in order to feel better
about them. The key to reframing is to
recognize that there are many ways to
interpret the same situation
– Spend more time focusing on the positive things
in your life - Accentuate the positive.
– Spend less time thinking negatively - Eliminate
the negative
– Enjoy each moment
Positive Thinking
• Avoid negative thoughts of
powerlessness, dejection, failure, and
despair. Chronic stress make us
vulnerable to negative suggestion. Learn
to focus on positives.
– Focus on your strengths
– Learn from the stress you are under
– Look for opportunities in the stressful situation
– Seek out the positive – make a change
Research input.

• Optimism, positive affectivity, and

salivary cortisol.
• Higher optimism exhibited less cortisol
secretion in the awakening period. This
effect was more apparent in men than in
women
• Higher generalized positive affect was
associated with lower cortisol levels during
the underlying period of diurnal decline
after the effects of negative affect and
mood states had been controlled.
( Thomas et al; br j health psychol 2005)
Problem solving
• Describe the problem or issue.
• Generate some viable ideas.
• select the best idea(s).
• Implement the best idea.
• Evaluate the outcome
The map of creative
problem solving Generating
ideas
Description
of the
problem
Idea
selection
and
refinement
Idea
implemen-
tation Evaluation
and analysis
of action
plan
Be Assertive
• Stand up for your personal rights and expressing your
thoughts, feelings and beliefs directly, honestly and
spontaneously in ways that don’t infringe on the rights
of others.
• Assertive people respect themselves and others.
• They take responsibility for their actions and choices.
• In case of failure, they will get disappointed; but their
self-confidence remain intact.
• Expressing negative feelings at the appropriate time
avoids the buildup of resentment.
• This will help to manage our stress more successfully.
 Time Management
• Keep a diary.
• Write lists of tasks to accomplish, prioritize them and
schedule when you will complete them.
• Try to decide which tasks truly require meticulous
attention to detail and which can be done casually.
• Don't start a second until you have finished the first.
• Try not to bring office work home.
• Set priorities and postpone less important tasks.
• Learn to delegate matters that cannot be put off.
• Deal with concerns on a day-at-a-time basis.
• Try not to make major decisions when you are overtired or
anxious
Learn to delegate Schedule personal
responsibilities time each day

Additional
time management
ideas
Learn to schedule Carry and use
interruptions an idea book
 Refine your
Edit your life
organization
skills
Additional
time management
ideas
Refine your Bring balance
networking skills back into your life
Communication
• Share your problems and concern with
others.
• Develop a support system of relatives,
• When you are frustrated write it down.
After you have vent the frustration,
destroy the writing so that it is
forgotten. Seek social support.
 Humor therapy

• Good laugh relaxes tense muscles, speeds more oxygen

into your system and lowers your blood pressure.
• laughter lowers serum cortisol levels, increases the
amount of activated T lymphocytes, increases the
number and activity of natural killer cells, and
increases the number of T cells that have helper/
suppresser receptors.
(lee berk 2001)
• Positive emotions can create neurochemical
changes(endorphins) that will buffer the
immunosuppressive effects of stress
Steps to initiate humor therapy
• Learn not to take yourself too seriously.
• Find one humorous thing a day.
• Work to improve your imagination and
creativity.
• Learn to hyper exaggerate when telling
a story.
• Build a humor library.
• Find a host of varied humor venues.
• Access your humor network.
• Boost your self-esteem daily.
Hydrotherapy

• Water seems to have special powers in getting rid of

stress and rejuvenating our body. It affects the skin
and muscles. It calms the lungs, heart, stomach, and
endocrine system by stimulating nerve reflexes on the
spinal cord.
• When submerge in a bath, a pool, or a whirlpool,
experience a kind of weightlessness. It has a massage-
like feeling as the water gently kneads your body.
Water, in motion, stimulates touch receptors on the
skin, boosting blood circulation and releasing tight
muscles.
Self-Hypnosis

• Hypnosis involves entering an altered state of

consciousness in which all concentration is
focused on a single objective or image, with
all other stimuli blocked out.
• Anyone who can lose him or herself totally in
an engrossing book or movie or become so
absorbed in a task that they are oblivious to
their surroundings is actually practicing a form
of self-hypnosis. Once a person learns self-
hypnosis, he or she can use it to relieve
tension and feelings of stress or anxiety.
Kinesiology

• Specific techniques for stress reduction,

emotional stress release and relief from
anxieties, fears and phobias.
– Vitamin B supplements.
– Checking the endocrine and immune systems
for any nutritional deficiencies.
– Providing adrenal support and nutrition for
stress.
– Tests for food sensitivities and the monitoring
of grain consumption.
– Regular kinesiology balancing.
Massages
• Massage helps to relax the mind, body and
spirit, providing time and space for self, and
a feeling of peace, calm and well being.
• It allows the nervous system to normalize
itself, and may reduce many stress-related
conditions, such as palpitations, negative
emotional feelings and raised blood pressure
• Types
– Shiatsu (acupressure)
– Swedish massage
– Rolfing
– Myofascial release
– Sports massage
Aromatherapy Pet Therapy

Complime
ntary
Therapies
Therapeutic
Hydrotherapy Touch
Meditation

• Meditation and Relaxation Response can help

combat stress and revitalize the mind.
Physiological Effects of Meditation
• Decreased oxygen consumption
• Decreased blood lactate levels
• Increased skin resistance
• Decreased heart rate
• Decreased blood pressure
• Decreased muscle tension
• Increased alpha waves
Transcendental meditation
• Begins from waking state to
experience a thought in a systematic
and natural way goes to state of lesser
excitation of consciousness least
excitation of consciousness where one
don’t experience any thought
(transcendental consciousness)
• It totally de-stresses and rejuvenates
our nervous system
Deep Breathing
• Deep breathing infuses the blood with extra
oxygen and also stimulates the body to
release tranquilizing endorphins.

• It is one of the simplest yet most effective

stress management techniques.
Music Therapy
• Listening to music does wonders to alleviate stress.
• Listen to the music that you feel comfortable.
• Music is a significant mood-changer and reliever of stress, working on
many levels at once.
• Music was found to reduce the pain during various invasive
procedures.
Naturopathy
• Naturopathy is excellent for treating
stress, including psychotherapy,
relaxation techniques, herbal and
homeopathic support, and osteopathic
soft tissue treatments where
appropriate.
• Supplements of vitamins and minerals
may be advised as these are used up
more quickly when the body is under
stress.
Osteopathy
• Osteopathy is a touch therapy, and, just like
massage, it uses a fine sense of touch and
relaxation to achieve some of the required
results with patients who are in pain or
overstressed.
• The muscles at the back of the skull that
connect the spine to the head can become
very tense and tight as we become stressed.
This can lead to headaches or neck pains, as
well as pain in the shoulders and back.
Reflexology

• Touching all of the major points of the

hands and feet, will help relax you and
ward off stress.
• To deal with extra tension, pay special
attention to the diaphragm, the spine
and the pituitary, parathyroid, thyroid
and adrenal gland reflexes.
Vitamin And Mineral Therapy
• The magnesium blocks the damaging
effects of excess adrenaline.
• the physical damage caused by stress is
minimized with B-complex and Vitamin
C.
Yoga

• Yoga offers gentle asanas, relaxation,

pranayama, meditation, shat kriyas and hand
mudras.
• Meditation helps calm your mind, teaching you
to relax at will and giving you a quick mental
vacation whenever you need one.
• daily practice of three or four yoga poses will
help ease knotted muscles.
• keep your interest high and to strengthen
different parts of your body.
Additional Coping Techniques
• social support groups
• avoidance
• hobbies
• forgiveness
• dream therapy
• prayer
Herbal Medicine Aids for stress

• St. John's Wort

• Kava Kava
• Ginkgo biloba
• Soothing herbal tea,
• Chamomile.
• Motherwort
Other techniques
• Imagery/ Guided Imagery
• Auricular training
• Autogenic training
• Aromatherapy.
• Bach Flower Remedies
• Therapeutic Touch
• Biofeedback
• Hypnotherapy
 STUDENT STRESS RATING SCALE

The following are events that occur in the life of a college

student. Place a check in the left-hand column for each of
those events that has happened to you during the last 12
months.
____ Death of a close family member - 100 points
____ Jail term - 80 points
____ Final year or first year in college - 63 points
____ Pregnancy (to you or caused by your) - 60 points
____ Severe personal illness or injury - 53 points
____ Marriage - 50 points
____ Any interpersonal problems - 45 points
____ Financial difficulties - 40 points
____ Death of a close friend - 40 points
____ Arguments with your roommate (more than every other day)
- 40
____ Major disagreements with your family - 40 points’
____ Major change in personal habits - 30 points
STUDENT STRESS RATING SCALE

____ Change in living environment - 30 points

____ Beginning or ending a job - 30 points
____Problems with your boss or professor - 25 points
____ Outstanding personal achievement - 25 points
____ Failure in some course - 25 points
____ Final exams - 20 points
____ Increased or decreased dating - 20 points
____ Changes in working conditions - 20 points
____ Change in your major
____ Change in your sleeping habits - 18 points
____ Several-day vacation - 15 points
____ Change in eating habits - 15 points
____ Family reunion - 15 points
____ Change in recreational activities - 15 points
____ Minor illness or injury - 15 points
____ Minor violations of the law - 11 points
Stress in nursing
7 Major Nurse Related Stressors
• Dealing with death and dying
• Criticism by physicians
• Dealing with emotional needs of patients
and their families
• Lack of staff support
• Workload
• Uncertainty of treatment plans
• Conflict with colleagues
(Cox, Cox, and Griffiths, 1996)
Research input
• Aromatherapy massage with music
significantly reduced emergency
nurses' anxiety. Relevance to
clinical practice.
J Clin Nurs. 2007 Sep;16(9)
Research input
Stress at work and mental health status among
female hospital workers
• Sleep impairment was mostly linked to shift
and strain due to schedule.
• mental health impairment increased
significantly with the levels of job stress,
mental load, and strain due to schedule.
• This evidence of association between work
involving an excessive accumulation of stress
factors and mental wellbeing
• working conditions of hospital workers need to
be improved .
• (smith etal Br j ind med
1993)
Coffee, stress and cortisol in nursing
staff
• There was no relationship between
psychosocial factors at work and cortisol
levels in the morning
• The cortisol level significantly decreased
due to the coffee intake.
• decision authority and coffee were
significantly related to lower cortisol levels
in the evening.
( colom etal; psychoneuroendocrinology
2007)
Coping Skills
• For use in acute situations….
• Count to 10
• Take a deep breath
• Take a walk
• Have a piece of candy
(http://www.icn.ch,
2003)
Burnout
• Stage One: High Expectations and Idealism

• Stage Two: Pessimism and Early job

dissatisfaction

• Stage Three: Withdrawal and Isolation

• Stage Four: Irreversible detachment and Loss of

Interest

(Beckstead, J. International Journal of Nursing

Studies, 2002)
Symptoms of Burnout
• Concentration and attention span decrease
• Short and long-term memory deteriorate
• Error rate increases
• Physical and psychological tensions increase
• Hypochondria increases
• Self-esteem falls sharply
• Interests and enthusiasms diminish
• Absenteeism increases
• Energy levels are low
• Sleep patterns are disrupted
(Kilfedder, C. J. Journal of Advanced Nursing,
2001)
Burnout Recovery
• Give your self permission to experience your
emotions
• Build healthy personal relationships, have
someone to talk to
• Learn to control your displaced aggressions;
reappraise your life and priorities
• Realize that most stress is caused from within,
not without; take time to smell the flowers
(Tairmina, R.J. Journal of Nursing Management, 2000)
Research inputs
• Increased glucocorticoids resulting
from stress can be regarded as a
risk factor for accelerated aging,
AD, or VD
• Higher cortisole level makes more
vulnerabe to develop dependence
and relapse in addiction.
Benget.B,Rolf.E(2005)stress in health
and disease
Summary
• History • Adaptation,
• Levels coping
• Types • Management
• strategies
GAS
• • Stress and nurses
Stages
• Indicators
• Stress in
developmental
stages