Stress

Stress

The word stress was originally used by Selyle in 1956 to describe the pressure experienced by a person in response to life demands. These demands are referred to as stressors. Stress can be positive or negative.

  • “Stress as the nonspecific response of the body to any demand  for change. (HansSelye)                                                                                                                    
  • “Stress is considered to the process of adjusting to circumstances that disrupt, or threaten to disrupt, a person’s equilibrium.                                 ” Lazavus& Forlmen(1984)
  • Stressor is defined as an internal or external event or situation that creates the potential for physiologic, emotional, cognitive, or behavioral changes in an individual (Brunner and Suddarth)

 

Types of Stress                                                                                                                                                                    

According to “selye” there are two types –

  • Distress or damaging stress.
  • Eustress or stress that protects health.

1. Distress-Stress due to an excess of adaptive demands placed upon us. The demands are so great that they lead to bodily and mental damage. e.g-unexpected death of a loved one.

  • An example of distress would be stress experienced during a funeral.
  • Distress – negative stress

2. Eustress-The optimal amount of stress, which helps to promote health and growth. e.g- praise from a superior for hard working.

  • Eustress is motivating energy, such as happiness, hopefulness and purposeful movement.
  • An example of eustress would be stress experienced during a wedding.
  • Eustress – positive stress

Types of Stress

On the Basis of Time Duration, Stress can be-

  • Acute(Short Term)
  • Chronic(Long Term)

Acute stress- This type of stress is also called as the fight-or-flight response. Acute stress is body's instant reaction to a perceived fear, threat or challenge. Examples of acute stressors include having a job interview, traffic jam, and an argument with spouse, criticism from boss, etc.

Chronic stress- It is defined as a constant and prolonged feeling of stress that can negatively affect health if it goes untreated.

Persistent chronic stress can lead to health issues, such as headaches, gastrointestinal problems, loss of sleep, loss of appetite and even cardiovascular disorders like hypertension, atherosclerosis, etc.

Other Types of Stress

1. Developmental stress- This type of stress accompanies normal growing experiences of any individual. It is based on one's physical and emotional needs and expected outcomes at any given point of time.

For example, limitations placed on a toddler's exploration to the environment may be stressful to a toddler, physical and verbal violence.

2. Situational stress- Unpredictable, unexpected, random or scary incidents, which have no control can lead to situational stress. This is an emergency situation.

For example, motor vehicle accidents, sudden company to situational crisis. crisis, loss of spouse, etc. can lead

3. Eustress- The term Eustress is derived from Greek word, consisting of eu, i.e., 'good' and stress. It was first given by an endocrinologist Hans Selye. It is a type of healthy stress. Eustress is the positive cognitive stress. Eustress is uncomfortable, but leads to positive personal growth.

For example- strict discipline in school may lead to punctuality in students.

4. Distress- Distress is an unpleasant type of stress in which a person is unable to adapt to stressors and manifests maladaptive behaviors. Distress can be evident in the presence of various phenomena, for example, inappropriate social interaction (e.g., aggression, passivity, or withdrawal).  Example of distress is absenteeism of a student due to his highly disciplined teacher

Stressor

  • Stressor is any person or situation that produces anxiety response to the body. A stressor is a chemical or biological agent, environmental condition, external stimulus or an event that causes stress to an individual.
  • Anything  that is perceived as challenging, threatening or demanding that triggers a stress reaction.
  • Stressor is the stimuli proceeding or precipitating a change. It may be internal (fear, guilt) or external (trauma, peer pressure, etc).


Types of stressor

1. Physiological stressors- 

  • Chemical agents
  • Physical agents Illness, injuries, hormonal fluctuations, inadequate sleep or nutrition
  • Infectious agent
  • Nutrition imbalances
  • Genetic or immune disorders

2. Psychological stressor

  • Accidents can cause stress for the victim, the person who caused the accident and the families of both
  • Stressful experiences of family members and friends
  • Fear of aggression or mutilation from others such as murder, rape, terrorist and attacks.
  •  Events that we see on T.V. such as war, earthquake, violence
  • Developmental and life events
  • Rapid changes in our world, including economic and political structures and technology

Sources of Stress

There are many sources of stress, these are broadly classified as

  • Internal stressors- They originate within a person, unrealistic expectations,fear and uncertainty e.g-cancer, feeling of depression.
  • External stressors- it originates outside the individual e.g- moving to another city, death in a family, work stress.
     

Indicators/Manifestations of Stress

It may be physiological, psychological and cognitive

A. Physiological indicators- The physiological signs and symptoms of stress result from activation of sympathetic and neuro- endocrine systems of body.

  • Sweat production increases
  • Heart rate and cardiac output increases
  • Skin is pallid due to peripheral blood vessel constriction
  • Mouth may be dry
  • Increased  rate and depth of Respiration 
  • Dilation of pupils increase visual perception
  • Hyperglycemia 
  • Urine output decreases

B. Psychological Indicators- The manifestations of stress includes anxiety, fear, anger, depression and unconscious ego defense mechanism.

  • Anxiety- State of mental uneasiness, apprehension, dread or feeling of helpless. It can be experienced at conscious, subconscious or unconscious level
  • Fear- It is an emotion/ feeling of apprehension aroused by impending or seeming danger, pain or threat.
  • Depression- It is an extreme feeling of sadness, despair, lack of worth or emptiness.
  • Unconscious ego defense mechanism- It is a psychological adaptive mechanism developing as the personality attempts to defend itself and allay inner tensions.

C. Cognitive Indicators- 

  • Problem solving- The person assesses the situation or problem analyzes, chose alternatives, carries out selected alternatives and evaluates.
  • Structuring- Arrangement/ manipulation of a situation so that threatening events do not occur.
  • Self-control- Assuming a manner and facial expression that conveys a sense of being in control or in change.
  • Suppression- Willfully putting a thought or feeling out of mind.
  • Day dreaming/Fantasy- Unfulfilled wishes and desires are imagined as fulfilled or a threatening experience is re worked or re played so that it ends differently from reality.

D. Behavioral Manifestations of Stress

  • Inability to concentrate
  • Nail biting
  • Smoking
  • Unnecessary crying
  • Sleep disturbance
  • Isolation or social withdrawal
  • Difficulty in making decisions
  • Loss of sexual desire

Stages of Stress

Hans Selye explained stress through GAS (General Adaptation Syndrome), a way that the body tries to keep balance.

The GAS stages are-

  • The alarm reaction stage.
  • Stage of resistance.
  • Stage of exhaustion.

1. The alarm reaction stage -

  • Alarm is the first stag.
  • When the stressor is identified or realized, the body’s stress response is a state of alarm.
  • During this stage, adrenaline will be produced in order to bring about the fight or flight responses.

2. Stage of resistance -

  • Resistance is the second stage.
  • If the stressor persist, it become necessary to attempt some means of coping with the stress.
  • Although the body begins to try to adapt to the strains or demands of the environment, the body cannot keep this up indefinitely, so its resources are gradually depleted.

3. Stage of exhaustion -

  • Exhaustion is the third stage and final stage in the GAS model.
  • At this point, all the body’s resources are eventually depleted and body is unable to maintain normal function.
  •  If stage three is extended, long term damage may result as the capacity of gland, specially the adrenal gland.
     

Stress Control-ABC Strategy

A-Awareness

  • Awareness-what causes you stress?
  • How do you recat?

B-Balance-

  • There is a fine line between positive/negative stress.
  • How much can you cope with before it becomes negative?

C-Control

  • What can you do? to help yourself  combat the negative effect of stress?

 

Stress  Management 

1. Awareness- The initial step in managing stress is awareness. As one becomes aware of stressors he or she can omit, avoid or accept them.

2. Relaxation-Individual experience relaxation in different ways. Some individuals relax by engaging in large-motor activities such as sports, jogging and physical exercises. Others are using the technique such as breathing technique.

3. Compromise-
Consider co-operation or compromise rather than confrontation. A little give and take on both sides may reduce the strains and help you feel more comfortable.

4. Have a Good Cry-
A good cry during periods of stress can be a healthy way to bring relief to your anxiety, at it might prevent a headache or other physical consequences of “botting” things up.

5. Inter-personal  Communication-
         With a caring others the strength of one’s available support system is an existing condition that significantly influences the adaptiveness of coping with stress sometimes just “ talking the problem out” with an individual who is empathetic is sufficient to interpret escalation

6. Think Positively

    Refocus the negative to be positive. Make an effort to stop negative thoughts. Managing stress is all about taking charge-

  • Taking charge of your thoughts,
  • Your emotions,
  • Your schedule,
  • Your environment,
  • The way you deal with problems.

7.Laugh

Maintain your sense of humor, including the ability to laugh at yourself.

8. Avoide Self Medication 

Alcohol and other drugs do not remove the conditions that stress. Although they may seem to offer temporary relief, these substances only mask or disguise problems. In the long run, alcohol use increase rather than decreases stress, by changing the way you think and solve problems and by impairing your judgment and other cognitive capacities. Medications should be taken only on the advice of doctor.

9. Know your Limits 
There are many circumstances in life beyond your control, consider the fact that we live in an imperfect world. Know your limits. If a problem is beyond our control and cannot be changed at the moment, don’t fight the situation. Learn to accept what is, for now, until such time when you can change things.

10. Clarify your Values and develop a sense of life meaning
Clarify your values and deciding what you really want out of your life, can help you feel better about yourself and have that sense of satisfaction and centeredness that helps you deal with the stresses of life. A sense of spirituality can help with this.

11. Connect with Others
A good way to combat sadness, boredom and loneliness is to set out activities involving others.

12. Manage Time

  • Make a list What Must be done What Should  be done What would you LIKE to do
  • Cut out time wasting
  • Learn to drop unimportant activities
  • Say no or delegate

13. Talk it out

When you feel something, try to express it. Share your feelings. “Bottled up” emotions increase frustration and stress. Talking with someone else can help clear your mind of confusion so that you can focus on problem solving. Also consider writing down thoughts and feelings. Putting problems on paper can assist you in clarifying the situation and allow a new perspective.

14. Take a Minute Vacation
Imagining a quiet country scene can take you out of the turmoil of a stressful situation. When you have the opportunity, take a moment to close your eyes and imagine a place where you feel relaxed and comfortable. Notice all the details of your chosen place, including pleasant sounds, smells and temperature or change your mental “channel” by reading a good book or playing relaxing music to create a sense of peace and tranquility.

15. Problem Solving
An extremely adaptive coping strategy is to view the situation is to view the situation objectively. After an objective assessment of the situation the problem solving decision making model can be instituted as follow-

  • Assess the fact of the situation
  • Formulate the goal for resolution
  • Study the alternatives
  • Determine the risks and benefits
  • Select an alternative
  • Implement the alternative selected
  • Evaluated the outcome.

16. Rest and sleep-

 Rest and sleep helps the body maintain homeostasis and restore energy levels. Each person has individual sleep needs, but 7-9 hours of sleep a day is the usual recommendation.

17. Prayer-

 This method is effective especially for people, who are spiritual and follow religion. People are also advised to silently repeat a short prayer or phrase from a prayer with breathing exercises.

18. Music therapy-
 Many researches have shown that listening to soothing music can lower heart rate, blood pressure, and anxiety. Allow mind to focus on the different sounds, melodies, instruments, or singers in the piece.

Nursing Diagnosis

According to NANDA guidelines for nursing diagnosis, possible nursing diagnosis for a patient with stress is as follows-

  • Stress overload related to stressors, insufficient resources, chronic illness as evidenced by changes in vital signs, gastrointestinal changes, tension, feeling of pressure, impaired decision making, anger behavior, impatience, etc.
  • Anxiety related to conflicts about the ambition and goals in life, threat to self-concept, threat of death, threat of or change in health status, threat to or change in environment or role, situational/ maturational crisis, or unmet needs.
  • Imbalanced nutrition- Less than body requirements related to inadequate caloric intake while striving to excel in gymnastics, as evidenced by intentional weight loss, verbalizations of needing to lose weight', intake-output chart or decreased mid-arm circumference.
  • Hopelessness related to presence of disabling physical injuries, as evidenced by statement "I give up... it's just not worth it," apathy, visible lack of engagement.
  • Caregiver role strain related to long-term stress of care for patient with Alzheimer's disease, as evidenced by statement "I am just at my wits end trying to keep mom safe!"
  • Social isolation related to feelings of worthlessness and apprehension following failure in school, as evidenced by no accessible friends, rarely leaving the house.

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