Stress

RNSG 2213 Mental Health

Nursing
 Stress
• Stress is a universal experience
• Stress and coping are related to a
person’s health status
• The perception of a recent life event
determines the person’s reactions to it
including mediating factors such as age,
sex, culture, life experiences, life style,
spirituality, and social support
 Adaptation
• Adaptation is the person’s capacity to
survive and flourish. Adaptation affects
three important areas: health,
psychological well-being, and social
functioning
Biopsychosocial Adaptation
Psychological

Biologic Social
 Biologic functioning
• Health/wellness
• Positive physical functioning in all systems
(cardiovascular, immune, etc.)
• Adequate sleep and rest
• Adequate nutrition
 Social Functioning
• Social functioning
• Positive interpersonal relationships
• Positive work experience
• Maintenance of social activities
 Psychological Functioning
• Psychological well-being
• Positive self-esteem
• Confidence
 Reactions to stress
• Psychological reactions (Selye)
– Distress
– Eustress
• Physiological reactions (Cannon)
– Acute- adaptive “fight-or-flight”
– Prolonged (chronic)- maladaptive responses
 Stressors
• Physical (environmental conditions such
as cold, trauma, excessive heat & physical
conditions such as infection, hemorrhage,
hunger, or pain
• Psychological (divorce, job loss,
unmanageable debt, death of a loved one,
retirement, marriage, unexpected success
 Assessing Stress
• Life-Changing Events Questionnaire
assesses your stress level for the past 6-
12 months which can be affected by:
• Perception of the events
• Cultural influences
• Different thresholds for the events
• Questionnaire equates change with stress
 Coping Styles
• Health-sustaining habits (medical
compliance, proper diet, relaxation, pacing
one’s energy…)
• Life satisfactions (work, family, humor,
spiritual solace, arts, nature…)
• Social supports
• Effective and healthy responses to stress
 Holistic Stress Management
• Behavioral • Cognitive approaches
approaches – Journal keeping and
– Benson’s relaxation writing
– Meditation – Priority restructuring
– Guided imagery – Cognitive reframing
– Breathing exercises – Humor
– Therapeutic touch – Assertiveness training
– muscle relaxation and
exercise
– Biofeedback
 Benson’s relaxation technique
• Allows clients to switch from the
sympathetic mode of autonomic arousal to
the parasympathetic mode of relaxation
– Not appropriate for depressed, hallucinating,
or delusional clients, or by those in severe
pain
 Meditation
• Mind training to develop greater calm,
increased relaxation, and the ability to
access inner resources for both healing
and operating more effectively in the world
 Guided Imagery
• Used in conjunction with the relaxation
response by leading a person to envision
images that are calming and health
enhancing. These techniques are useful
for pain relief; and reducing levels of
cortisol, epinephrine, and catecholamines
and supporting the immune system and
producing beta-endorphins which increase
pain threshold and enhance lymphocyte
proliferation
 Breathing Exercises
• Abdominal breathing can be helpful in the
modification of stress and anxiety
reactions
 Therapeutic Touch
• Special training required
• Employs the steps of centering, scanning,
and rebalancing to manipulate a client’s
energy field for pain relief or promotion of
healing
 Muscle Relaxation & Exercise
• Yoga reduces stress and relieves muscle
tension and pain
• Progressive muscle relaxation achieves
deep relaxation by systematically tensing
and releasing various muscle groups
 Biofeedback
• Special training required
• Uses sensitive instrumentation that gives
a person information on his or her
physiological functioning such as brain
waves, skin temperature, blood pressure,
etc., help the individual gain control over
what had been considered involuntary
functions
 Journal Keeping and Writing
• Keeping an informal diary of daily events
and activities helps identify sources of
daily stress which gives the individual a
chance to modify or eliminate the
stressors.
 Priority Restructuring
• The individual can shift the balance from
stress-producing to stress-reducing
activities once the stressful events are
identified. The addition of daily pleasant
events has a positive effect on the
immune system
 Cognitive Reframing
• Reframing is reassessing a situation with
restructuring irrational beliefs and
replacing worried self-statements with
more positive self-statements. The client
receives a sense of control, reduces
sympathetic nervous system stimulation,
and thus reduces secretion of cortisol and
catecholamines by restructuring a
disturbing event into one less disturbing.
 Assertiveness Training
• Learning behavior that allows one to stand
up for one’s rights without violating the
rights of others
– Simple assertion via a direct statement
– Empathic assertion, showing understanding of the
other’s feelings and assertively stating what one needs
– Nonaccusingly describing the situation, stating one’s
feelings about the situation, and asking for change
– Confrontational assertion
 More effective Stress Busters
• Sleep
• Exercise (Aerobic)
• Reduction or cessation of caffeine intake
• Music (classical or soft melodies of
choice)
• Pets
• Massage
 Outcomes
• Lowering the effects of chronic stress can
alter the course of many physical
conditions which includes decrease in
some medications, bolster immune
system diminish or eliminate the urge for
unhealthy and destructive behaviors and
increase a person’s cognitive functioning