Concept of stress and coping

Muhammad Rizwan
RN Officer
DHQ, MTI Bannu
Ex-Lecturer
NICE College of Nursing Peshawar
 Objectives
1. Define stress ,coping , tolerance pattern
2. Differentiate the concept of stress as a stimulus ,r
esponse, and transaction
3. Identify physiological and psychological manifest
ations of stress
4. Describe various types of coping pattern
5. Discuss factors affecting coping pattern during ho
spitalization
6. Discuss the nursing process related to stress and c
oping pattern
Stress and coping
 Stress

 Stress is a condition in which an individual

experience changes in the normal balanced stat
e.
A stressor is any event or stimulus that causes a
n individual to experience stress.

Stress can be result from both posative and neg

ative experiences........
Examples ;
• A bride preparing for her wedding
• A graduate preparing to start new job
• A husband concern about caring of his wife and fam
ily
• Diagnosis of cancer
• Lossing of special object ,person or any other things
all experiences stress reactions.
 Coping

 "The cognitive and behavioral efforts to ma

nage specific internal demands (infection ,feeli
ng of depression ) or external demands (move t
o another city ,death in family ) that are apprai
sed as exceeding the resources of a person".
Folkman and Lazarus(1
991)
 OR
When a person faces stressors ,then the responses o
f the person are referred as coping strategies ,copin
g responses or coping mechanisms.
 Tolerance

 The ability to thrive in stressful situations and to cope w

ith uncertainly changes and performance demands.

 It is effective adaptation to stress that allow us to live.

.....OR

 Stress tolerance is the ability to withstand adverse eve

nts and stressful situations without developing physical or
emotional symptoms by actively and positively coping wi
th stress.
 MODELS OF STRESS

Models of stress assist nurses to predict stressor in a particular

situation and understand the individual's responses.

Nurses can use these models to assist clients in strengthening

healthy coping responses and adjusting unhealthy and unprodu
ctive responses.

Three main models of stress are;

• Stimulus based model
• Response based model
• Transaction based model
 1. Stimulus Based Model

• Stress is defined as a stimulus , a life event or a set

of circumstances that arouses physiological and/or p
sychological reactions that may increase the individ
ual's vulnerability to illness.
Response Based Model

• Stress is considered as a response . (selye 1956)

• The non-specific response of the body to any kind

of demands
• Saleye's stress response explanation (1976)
 General Adaptation Syndrome. (GAS)

• Also known as stress syndrome

• A chain or pattren of physiological events
• Occurs with the release of certain adaptive h
ormones and subsequent changes in the stru
cture and chemical composition of the body
 Local Adaptive Syndrome (LAS)

• Body reacts locally to stress

• One organ or a part of the body react alone to the str
ess
• E.g. ;
• Inflammation
Three Stages of GAS & LAS

a. Alarm Reaction

b. Resistance

c. Exhaustion
a. Alarm Reaction
• Initial reaction of the body
• Alert the body's defense

• Classified into two phases

1. Shock phase
2. Counter shock phase
1. Shock Phase

• Stressor's stimulate the sympathetic nervous system

,stimulate adrenal medulla to secrete epinephrine
• Fight or flight responses
• Increased myocardial contractility
• Bronchial dilation
• Increase blood clotting
• Increase cellular metabolism
2.Counter Shock Phase

• The changes produced in the body during shock pha

se are reversed.
b. Stage of Resistance

• When the body adaptation take place

• Then the body attempts to cope with the stressors an
d to limit the stressor to the smallest area of the bod
y that can deal with it.
c. Stage Of Exhaustion
• The adaptation that the body made during the s
econd stage cannot be maintained

• The ways used to cope with the stressors have

been exhausted .
• Results:
• Rest and return to normal
• Death
 3. Transaction based model

• Stimulus theory and response theory do not conside

r individual differences
• People and groups differ in their sensitivity and vul
nerability to certain types of events as well as interp
retation and reactions
Indicators of stress

Physiological Indicators

Psychological Indicators
 Physiological Indicators

• The physiological sign & symptoms of stress result

from the activation of sympathetic and neuroendocri
ne systems of the body
• Clinical manifestations lists physiological indicators
of stress
CLINICAL MENIFESTATIONS OF STRESS ;

• Pupils dilates
• Sweat production
• Heart rate increase
• Cardiac output increase
• Skin is paled (because of constriction of periph
eral blood vessels)
• Sodium and water retention increase which inc
rease blood volume
 .
• Rate and depth of respiration increase (because of di
lation of bronchioles)
• Urinary output decrease
• Mouth may be dry
• Peristalsis of intestine decrease
• Muscles tension increase
 Psychological Indicators

• Anxiety

• Fear

• Anger

• Depression
• Unconscious Ego Mechanism
Anxiety
 Anxiety

• Common reaction to stress

• A state of mental uneasiness ,apprehension, or a feel
ing of helplessness related to an impending or antici
pated unidentified threat to self or significant relatio
nships.
Four levels of anxiety

1. Mild Anxiety

2. Moderate Anxiety

3. Severe Anxiety

4. Panic
MILD ANXIETY

• Produced slight arousal that enhance percep

tion , learning and productive abalities.

• MODERATE ANXIETY
• Increases the arousal to a point where the person
express feeling of tension, nervousness or conce
rn
• Perceptual abilities are narrowed.
• SEVERE ANXIETY

• Consumes most of the persons energies and require

interventions
• Perception is further decreased
• Unable to focus on what is really happening
PANIC

• An overpowering ,frightening, level of anxiety causi

ng the person to loss control
• Less frequently experienced than other levels of anx
iety
FEAR
 Fear

• An emotion or feeling of apprehension aroused by i

mpending or seeming danger ,pain or another percei
ved threat
Anxiety and Fear differ in four ways;

• The source of anxiety may not be identified

• Anxiety is related to mainly future, to an anticipated
event ,fear is related to past ,present and future
• Anxiety is uague, whereas fear is definite
• Anxiety results from psychological or emotional co
nflicts ,fear results from a specific physical or psych
ological entity
ANGER
 Anger

• An emotional state consisting of a subjective feeling

of animosity or strong displeasure
Depressio
n
 Depression

• A common reaction to events that seem overwhelmi

ng or negative
• An extreme feeling of sadness, despair ,dejection ,la
ck of worth ,or emptiness
Unconscious Ego
Unconscious Ego Mechanisms

• Unconscious psychological adaptive mechanism or

mental mechanisms that develop as the personality a
ttempts to defend itself ,establish compromises amo
ng conflicting impulses and calm inner tensions
Coping
COPING PATTREN

• The cognitive and behavioral efforts to manage spec

ific external or internal demands that are appraised a
s exceeding the resources of the person
• OR
• A natural or learned way of responding to a changin
g environment or specific problem or situation
TYPES OF COPING PATTREN

1. Problem-focused coping
2. Emotion-focused coping
3. Long-term coping strategies
4. Short-term coping strategies
5. Adaptive coping
6. Maladaptive coping
7. Care-giver burden
1. Problem-focused coping
• Refers to efforts to improve a situation by making c
hanges or talking actions (Lozarus 2006)

• 2. Emotion-focused coping
• Include thoughts and actions that relieve emotional
distress
• Doesn't improve the situation but the person often fe
els better (Lozarus 2006)
3.Long-term coping Strategies

• Can be constructive and practical

• In certain situations talking with others and trying to
find out more about the situation are long term strat
egies
• Other long term Coping strategies include
• Lifestyle pattern
• e.g,,,,, .Eating a healthy diet
• Exercising regularly
• Decision making
4.Short -Term Coping Strategies

• Can reduce stress to a tolerable limit temporarily bu

t are ineffective ways to permanently deal with reali
ty.
• These may even have destructive or detrimental effe
ct on the person
• Examples;
• Using Alcohol
• Using drugs
5. Adaptive Coping

• Helps the person to deal effectively with stressful ev

ents and minimizes distress associated with them

• Effective coping result in adaptations

6. Maladaptive Coping

• Can cause unnecessary distress for the person and ot

hers associated with the person or stressful events
• Ineffective coping result In maladaptation
7. Care Giver Burden
• Reaction to a long term stress is seen in family mem
bers who undertake the Care of a person in the hom
e for long time period
• Produces responses such as chronic fatigue , sleepin
g difficulties and high blood pressure
 Factors affecting coping pattern during ho
spitalization

• Many factors can affect coping pattern of patient ,

family members and nurses in hospital

• Anxiety and depression are common in hospitalize

d patients especially those waiting for surgery and
with chronic or hard to treat conditions.
• The family members also have to face these con
ditions for their significant one's

• Fear also arises for patients due to lack of privac

y.
• The possibility of harming a patient is the bigges
t fear for nurses.
• The family members of the patients are also at fear c
ondition because there are many chances of paralysi
s or even death for the patient.

• Unfortunately the hospital environment is often poo

rly conducive to sleep .
• Pain ,anxiety ,medication effects, medical interventi
ons, environmental noise and light ,and the acute or
chronic illness itself all contribute to decrease qualit
y and quantity of sleep in hospitalized patients .
• Then they cannot manage such stress
• Isolation from parents and admitted to hospital effec
t coping pattern of child mostly .
• Change in nutrition
• The lower economy level and poverty can affect cop
ing of patient and their family.
Nursing Management of stress
  ASSESSING

• Nursing assessment of clients stress and coping patt

ern includes;
• Nursing History
• Physical Examination
• During Nursing History the nurse have to poses que
stions ,,I.e
• Client perceived stressors or stressful incidents
.
• Manifestations of stress
• Past coping strategies
• Present coping strategies
• During physical examination the Nurse observe fo
r;
• Verbal and cognitive manifestations
• Indicators of stress such as,
..
• Nail biting
• Nervousness
• Weight changes
• Stress related health problems such as,
• Hypertension
• Hyperthyroidism
• Dyspnea
  NURSING DAIGNOSIS

• Anxiety related to unconscious conflict's about esse

ntial goals and values of life , threat to self concept ,
positive or negative self talk ,or physiological factor
s (E.g., hyperthyroidism ,dysrhythmias ,dyspnea )
 Planning

• The overall clients goals for individual experienci

ng stress related responses are;
• Decrease or resolve anxiety
• Increase ability to manage or cope with stressful e
vents or circumstances
• Improve role performance
 Implementing

• Although stress is a part of daily life ,it is also highl

y individualize
• Some methods help to reduce stress will be effectiv
e for one person
• Other methods are appropriate for a different person
• A Nurse who is sensitive to clients needs and reactio
ns can choose those methods of interventions that w
ill be most effective for each individuals
.
• Several health promotion strategies are often approp
riate as interventions for clients with stress related
Nursing diagnosis
• Among these are;
• Physical exercise (relief mention, feeling of well bei
ng, relaxation)
 . • Optimal Nutrition (balanced diet)
• Adequate rest and sleep
(sleep restore bodies energy levels and is essential as
pect of stress management)
• Time management
(people who manage their time effectively usually ex
perience less stress because they feel more in control
of their circumstances)
 EVALVATING

• How does the client perceive the problems?

• Is there an underlying problem not identified?
• Have new stressors occur that interfere with su
ccessful Coping?
• Were existing coping strategies sufficient to m
eet intended outcomes?
.
• How does the client perceive the effectiveness of ne
w coping strategies?
• Did the client implement new coping strategies prop
erly?
• Did the client access and use available resources?
.
• Have family members and significant ot
hers provided effective support?
Stress management for nurses
Stress management for nurses

• Nurses like client's are susceptible to experiencing

anxiety and stress
• Nursing practice involves many stressors e.g;
• Increasing severity of client illness
• Adjusting to various work shifts
.
• Inadequate support from supervisors
• Caring for dying client etc.
• Although most Nurses cope effectively with physica
l and emotional demands of nursing
• But some Nurses become overwhelmed and develop
Burnout
.
• BURNOUT
• A complex syndrome of behavior
• The Nurses with Burnout manifests physical and em
otional depletion
• A negative attitude and self concept
• Feeling of helplessness and hopelessness
Steps to reduce stress for nurses

• Plan daily relaxation programs to reduce tension

(e.g read novels ,listen to music or other favorite
activities)

• Establish regular exercise program

• Learn to accept failure's

.
• Seek counseling if indicated

• Support each others as a team

• Take time to relax
• Eat properly
• Learn something New