Nursing A ConceptBased Approach to Learning VOLUME TWO
Nursing: A Concept-Based Approach to Learning VOLUME TWO EDITION VOLUME TWO| | SECOND EDITION MODULE 31 Stress and Coping Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Stress • Stress § Body's reaction to stimulus that • Demands change • Disrupts homeostasis Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Stressors • Four categories Table 31 -1 § § Acute, time limited Sequential events after initial stressor Chronic intermittent Chronic permanent Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
3 Types of Stressors, continued 1. Developmental stressors 2. Internal stressors § Physical, spiritual, cognitive, emotional, psychological § Daily hassles 3. External environmental stressors § Triggers outside the individual § Demand change or disrupt homeostasis § Eustress, distress Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Factors Affecting The Stress Response • Table 31 -2 • Individual Factors § Past experiences § Culture § Coping mechanisms • Environmental Factors § Support § Finances Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
The Coping Process • Cognitive appraisal § Primary appraisal • First impression § Secondary appraisal • Attempt to predict impact, intensity, duration Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
The Coping Process, continued • Maslow's hierarchy of needs § Explains how human beings prioritize needs Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
The Coping Process, continued • Types of coping Table 31 -3 1. Problem-focused coping 2. Emotion-focused coping Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
The Coping Process, continued • Reappraisal and adaptation § Coping mechanism successful • Adaptation • OR § Coping mechanism unsuccessful • Another response to stressor Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Theoretical Models of Stress and Coping • Stimulus-based stress models § Stress defined as: • Stressor: stimulus, life event, circumstances • Arouses physiological, psychological reactions § Holmes, Rahe SRRS scale to numerically rate stress § Degree of stress very individual Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Theoretical Models of Stress and Coping, continued • Response-based stress models § Stress considered response to a stressor § Hans Selye • Chain of physiological events: GAS and LAS • Three-stage response • Alarm reaction • Resistance • Exhaustion Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Theoretical Models of Stress and Coping, continued • Transactional model § Accounts for individual differences • Perceptions, responses § Cognitive appraisal § Hildegard Peplau • Nursing viewed as therapeutic interpersonal process Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Manifestations of Stress • Individual variation in internal, external manifestations • Physiological, psychological, cognitive domains • Let’s examine the next few slides to see how stress affects the body… Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiological Indicators • • • Pupils dilate Sweat production Heart rate, cardiac output increase Skin pallid Sodium, water retention Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiological Indicators, continued • • Rate, depth of respirations increase Urine output, peristalsis decreases Mouth may be dry Muscle tension, blood sugar, alertness increase • Multisystem Effects of Stress Page 1903 Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Psychological Indicators • • • Fear Anxiety Anger Depression Variety of other responses Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Cognitive Indicators • • • Problem solving Cognitive structuring Self-control Suppression Fantasizing Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Ego Defense Mechanisms • Unconscious psychological adaptations • Essential to psychological survival • Table 31 -6 Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Concepts Related to Stress and Coping Page 1906 -7 • • • Perfusion Metabolism Caring Interventions Oxygenation Perioperative Care Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Integrating the Concepts • Chronic exposure to stress § Increases susceptibility to illnesses § Affects caregivers, including nursing professionals Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Alterations From Normal Coping Responses • DSM-5 cites three classifications of disorders • Recognized as impairments in stress, coping § Anxiety disorders § Obsessive-compulsive and related disorders § Trauma- and stress-related disorders Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Genetic Considerations and Nonmodifiable Risk Factors • • Gender a significant factor Brain chemistry Genetic factors Certain life experiences § History of childhood sexual abuse § Rape victims Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Prevention • Traumatic events • Social factors § Limited, absent socialization • Family wellness promotion § Childhood abuse still increases risk decades later • Screenings § Identify many disorders Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Assessment • Help clients identify stressors that trigger unhealthy coping responses, potential effects of coping responses Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing Assessment • Nursing history § § § Illnesses Physical complaints Health history Stressors Stress, coping patterns Stress assessment checklist Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing Assessment, continued • Physical examination and observation § Clinical signs, symptoms • May not occur when cognitive coping effective § Laboratory tests not routinely performed • May be necessary to rule out medical condition Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Lifespan and Cultural Considerations • Age, developmentally-specific assessment § PTSD in children § Older adults who may have existing physical illness, cognitive changes • Take care not to inadvertently attribute normal, healthy cultural response as inappropriate Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Diagnostic Tests • Medical testing § Rule out other causes § Many signs, symptoms similar to anxiety • Evaluation for psychiatric disorder by trained mental health professional Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing Diagnosis • Nursing diagnoses for stress: § § Ineffective coping Anxiety Caregiver role strain Fear Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Planning • Goals and outcomes § Desirable outcomes frequently include • Effective coping, family coping, caregiver emotional health, and psychosocial adjustment • Setting priorities Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Interventions and Therapies • Use of therapeutic communication • Education regarding nonpharmacologic relaxation techniques Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Independent • Encourage client to maintain, achieve optimal health • Assist client in identifying strategies to help meet goals • Utilize therapeutic communication • Reinforce positive coping efforts Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Independent, continued § Regular exercise § Support systems § Time management: should do vs must do § Guided imagery and visualization § Progressive muscle relaxation § Assertiveness training § Journal writing § Stress management in the workplace § Sleep Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Independent, continued § Using a supportive internal message § Lifestyle changes § Addressing perfection Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved 34
Collaborative • Recognize own response to stress • Psychotherapy § Preferred method of treatment • Cognitive-behavioral therapy (CBT) § § Role of client's thoughts, attitudes Aimed at reappraisal process Exposure-based (triggers) Table 31 -4 • Thought stopping Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Collaborative, continued • Pharmacologic therapy § Most successful when combined with psychotherapy • Benzodiazepines • Alprazolam • Antidepressants • SSRIs: Prozac • Antipsychotics • Risperadal • Beta Blockers • Inderal Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Evaluation • Patient outcomes: § Measure outcomes for each diagnosis. § Continually assess needs for additional support. Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Stress and Coping Alterations Page 1908 -9 • • • GAD Phobias Panic disorder PTSD Acute stress disorder OCD Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
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