Chapter 13 Stress Management Copyright 2014 by Mosby

Goal of Stress Management To improve quality of life by increasing healthy, effective coping, thereby reducing unhealthy consequences of distress Dynamic interaction of Mind Ø Body Ø Spirit Ø Cognitive/emotional states and behavior Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

Sources of Stressor: Any psychological, environmental, or physiological stimulus that disrupts homeostasis, thereby necessitating change or adaptation Ø Three categories • Extrinsic factors: Stressors over which individuals do not have control (e. g. , death of spouse, weather) • Modifiable factors: Individual can modify through change environment, interactions, behavior • Intrinsic factors: Stressors created or exacerbated by individual response to stress (e. g. , negative thinking, procrastination) Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 3

Sources of Stress (Cont. ) Stress: The physical, psychological, social, or spiritual effect of life’s pressures and events Interactive process of appraisal/response Ø Eustress vs. distress Ø • Eustress: challenging and useful stress; not destructive • Distress: chronic or excessive stress; body unable to adapt; threatens homeostasis Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 4

Physical, Physiological, Sociobehavioral, and Spiritual Consequences of Stress Neuroendocrine activation/behavior changes Fight-or-flight stress response: Adaptive, short-term, acute Ø Hypothalamus signals sympathetic nervous system: Epinephrine and norepinephrine Ø Increased metabolism, pulse, blood pressure, respiration, muscle tension Ø Maladaptive: Cause/exacerbate disease or symptoms of disease Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 5

Psychological Effects of Stress Contributory role in negative mood states Ø Anxiety, depression, hostility, anger Elevated cortisol levels; immune system response Affects health outcomes in key populations (e. g. , elderly, terminally ill, caregivers) Quality of life Ø Depressive symptoms Ø Degree of suffering Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 6

Sociobehavioral Effects of Stress response: Individual reliance on less healthy behaviors Overeating Ø Excessive use alcohol/drugs Ø Smoking Ø Social isolation Ø Unhealthy behaviors associated with increased morbidity/mortality Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 7

Spiritual Effects of Stress Spirituality: “Feelings, thoughts, experiences, and behaviors that arise from a search for meaning…” Spirituality and religion not synonymous Stress response: Often feel disconnected from life’s meaning/purpose Spirituality/religiosity: Assists coping with stress Promoting connection with life meaning and purpose: Health benefits Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 8

Health Benefits of Managing Stress Promoting stress management is key to disease management and better health outcomes Caregiver stress/burden is a major concern; described as the appraisal of the experience of caregiving including the taxing nature of being a caregiver Particular concern of the “sandwich generation”; those caring for their parents while simultaneously raising children Ø Burnout is a consequence of caregiver stress/burden Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 9

Assessment of Stress Primary appraisal: Descriptions of perceived actual/potential positive and negative outcomes Negative outcomes: Harm (physical injury, disease, death) Ø Positive outcomes: Challenges individual perceives can be overcome (graduation, promotion) Ø Secondary appraisal: Individual’s identification of choices to cope with stress Ø Choices: Internal or external resources/responses Measurement tools: Ø Ø Improve assessment of stress/coping Promote accuracy in diagnosis, planning, and evaluating care Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 10

Stress Management Interventions: Self-Awareness Monitoring stress warning signs Recognizing signs (e. g. , daily muscle tension resulting in backache, headache) Ø Attending to cues to reduce negative mood states (e. g. , anxiety symptoms) or symptoms (stretching to decrease backache) Ø NURSING ROLE: Assist people to identify stress signals, change response (breathe/ relaxation), break stress cycle Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 11

Stress Management Interventions: Relaxation Technique to help develop awareness/ counter negative effects of stress Reduces sympathetic arousal Two components Repetition of word/thought/activity Ø Passive disregard of everyday thoughts Ø Mini-relaxations Can be used throughout day Ø Keep initial stress symptoms from intensifying Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 12

Stress Management Interventions: Alternative/Complementary Therapies Developed outside of Western medicine Acupuncture: Ancient Chinese technique Fine needles placed at specific meridian points on body Ø Used to reduce pain; prevent/manage disorders Ø Hypnosis: From Greek word “sleep” Ø Narrows consciousness; elicits relaxation, inertia, passivity; used for conditions such as smoking cessation, anxiety, pain Reiki: Japanese “universal spirit” Ø Uses life force energy fields to affect health Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 13

Stress Management Interventions Expressive writing Ø Healthy diet Ø Telling a story about life events/personal reactions; useful in disclosing/processing emotions; develops insights into problem-solving Positive influence on health, physical performance, state of mind; balance in diet improves functioning Physical activity Ø Comprehensive health benefits; enhances well-being while decreasing stress Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 14

Stress Management Interventions (Cont. ) Sleep hygiene Altered sleep patterns can result from stress issues; sleep deprivation exacerbates depression/fatigue Ø Sleep techniques improve quality of life Ø Cognitive-behavioral restructuring Modifies negative, exaggerated thinking to reduce stress Ø Helps people evaluate their thoughts, challenge them, and replace them with more rational responses Ø STOP, break the cycle, take a breath (relax), reflect, choose a more rational response Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 15

Stress Management Interventions (Cont. ) Affirmations Positive thought (short phrase or saying) that has meaning for person Ø Repeat affirmation through day—enhances self-esteem and reduces stress Ø Social support Network of close family, friends, co-workers, and professionals Ø Number of supporters and quality of relationships important Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 16

Stress Management Interventions (Cont. ) Assertive communication Need to match statement with intention for effective communication; facilitated by cognitive restructuring Ø Nonjudgmental, expresses feelings and opinions, reaffirms perceived rights Ø Format: I feel [emotion] when you [behavior] because [explanation] Ø Empathy Ability to consider another person’s perspective and communicate understanding back to person Ø Facilitated through Active Listening (conscious, nonjudgmental) Ø Reduces emotional arousal, defensive behavior, and conflict Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 17

Stress Management Interventions (Cont. ) Engaging in healthy pleasures Activities that bring feelings of peace, joy, and happiness Ø If denied, makes breaking stress cycle more challenging Ø Spiritual practice Activities that help people find meaning, purpose, and feeling of connection Ø Examples: religious or altruistic activities, journal writing Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 18

Stress Management Interventions (Cont. ) Clarifying values and beliefs Ø Ø Realistic goals Ø Ø Ø Identify what is important/meaningful Evaluate consistencies between values/living habits to make stress-reducing changes Goal-setting dynamic process Specific, concrete, measurable, achievable Attainable goals increase sense of control and mediate negative stress effects Humor Laughter: physiological effects similar to exercise Opens different perspectives on problems; facilitates objectivity Ø Reframes perceptions of an event Ø Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 19

Effective Coping Effective coping: The art of finding a balance between acceptance and action, between letting go and taking control Stress management techniques help individuals: Differentiate between acceptance and action Ø Counter harmful effects of stress Ø Nurses use stress management strategies to assist individuals: To manage extrinsic and intrinsic stressors Ø To choose the right strategy at the right time Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 20