Stress And Coping

Stress and Coping

  Introduction:

Stress is a universal phenomenon. All people experience it. Parents refer to the stress of raising children, working people talk of the stress of their jobs and students at all levels talk of the stress of school.

   Concept of stress:

Stress is a condition in which t h e person experiences changes in the normal balanced state.

A stressor is any event or stimulus that causes an individual to experience stress.

When a person faces stressors, responses are referred to as coping strategies, coping responses, or coping mechanisms.

Sources of stress:

There are many sources of stress.

They can be broadly classified as

·        Internal

·       External Stressors

·        Developmental

·        Situational Stressors.

Internal stressors originate within a person, for example, infection or feelings of depression.

External stressors originate outside the individual, E.g. a move to another city, a death in the family, or pressure from peers.

Developmental stressors occur at predictable times throughout an individual's life.

Situational stressors are unpredictable and may occur at any time during life. 

Situational stress may be positive or negative. The following are examples of this type of stress: Death, Marriage or divorce, Birth of a child, Illness.

Effects of stress:

Stress can have physical, emotional, intellectual, social, and spiritual consequences.

·        Physically, stress can threaten a person's physiologic homeostasis.

·        Emotionally, stress can produce negative or non-constructive feeling about the self.

·        Intellectually, stress can. influence a person's perceptual and Problem solving abilities.

·        Socially stress can alter a person's relationships with others.

·        Spiritually, stress can challenge one's beliefs and values.

Indications of stress:

Indicators of an individual's stress may be physiologic, psychologic, or cognitive.

Physiologic Indicators:

·        The physiologic signs and symptoms of stress result from activation of the sympathetic and neuroendocrine systems of the body.

·        Clinical manifestations:

·        Pupils dilate

·        Sweat production (diaphoresis)

·        Heart rate and cardiac output increase

·        Skin is pallid

·        Sodium and water retention increase ---- increases blood volume

·        Rate and depth of respirations increase

·        Urinary output decrease

·        Mouth may be dry

·        Peristalsis of the intestine decreases ----- constipation, flatus

·        Muscle tension increases

Psychologic Indicators:

Psychologic manifestations of stress include anxiety, fear, anger, depression, and unconscious ego defense mechanisms

  Anxiety and Fear:

Anxiety, a state of mental uneasiness, apprehension, dread, or foreboding or a feeling of helplessness related to an impending or anticipated unidentified threat to self or significant relationships.

Anxiety can be experienced at the conscious, subconscious, or unconscious level.

Anxiety may be manifested on four levels:

I.Mild anxiety produces a slight arousal state that enhances perception, learning, and productive abilities.

II.Moderate anxiety increases the arousal state to a point where the person expresses feelings of tension, nervousness, or concern.

III.Severe anxiety the person, unable to focus on what is really happening, focuses on only one specific detail of the situation generating the anxiety

IV.Panic is an overpowering, frightening level of anxiety causing the person to lose control

· Fear is an emotion or feeling of apprehension aroused by impending or seeming danger, pain, or another perceived threat.

·        Anger is an emotional state consisting of a subjective feeling of animosity or strong displeasure.

·             Depression an extreme feeling of sadness, despair, dejection, lack of worth, or  emptiness.

Emotional symptoms can include feelings of tiredness, sadness, emptiness, or numbness.

Behavioral signs of depression include irritability, inability to concentrate, difficulty making decisions, loss of sexual desire, crying, sleep disturbance, and social withdrawal

Physical signs of depression may include loss of appetite, weight loss, constipation, headache, and dizziness

     Ego defense mechanisms are unconscious psychologic adaptive mechanisms.

Mental mechanisms that develop as the personality attempts to defend itself, establish compromises among conflicting impulses, and calm inner tensions. (Sigmund Freud (1946))

Cognitive Indicators:

Cognitive indicators of stress are thinking responses that include problem solving, structuring, self-control- or self-discipline, suppression, and fantasy.

Problem solving involves thinking through the threatening situation, using specific steps to arrive at a solution.

Structuring is the arrangement or manipulation of a situation so that threatening events do not occur.

Self-control (discipline) is assuming a manner and facial-expression that convey a sense of being in control or in charge.

Suppression is consciously and willfully putting a thought or feeling out of mind

Fantasy or daydreaming is likened to make-believe. Unfulfilled wishes and desires are imagined as fulfilled, a threatening experience is reworked or replayed so that it ends  differently from reality.

COPING

A coping strategy (coping mechanism) is a natural or learned way of responding to a changing environment or specific problem or situation

The cognitive and behavioral effort to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the (Folkman and Lazarus 1991)

Two types of coping strategies have been described: problem focused and emotion- focused coping.

Problem-focused coping refers to efforts to improve a situation by making changes or taking some action.

Emotion-focused coping includes thoughts and actions that relieve emotional distress.

Emotion-focused coping does not improve the situation, but the person often feels better.

Coping strategies are also viewed as long term or short term:

Long-term coping strategies can be constructive and realistic.

For example, in certain situations, talking with others and trying to find out more about the situation are long - term strategies.

Other long - term strategies include a change in lifestyle patterns such as eating a healthy diet, exercising regularly, balancing leisure time with working, or using problem - solving in  decision making instead of anger or other non - constructive responses.

Short-term coping strategies can reduce stress to a tolerable limit temporarily but are ineffective ways to permanently deal with reality. They may even have a destructive or detrimental effect on the person.

Examples of short - term strategies are using alcoholic beverages or drugs, daydreaming and fantasizing, relying on the belief that everything will work out, and giving in to others to avoid anger.

Coping can be adaptive or maladaptive.

      Adaptive coping helps the persn to deal effectively with stressful events and minimizes distress associated with them.

    Maladaptive coping can result in unnecessary distress for the person and others associated with the person or stressful event.

  Nursing diagnosis:

·        Anxiety

·        Caregiver role strain

·        Compromised family Coping

·        Disabled family coping

·        Fear

·        Impaired adjustment

·        Ineffective coping

  Nursing intervention:

·        Encouraging Health Promotion Strategies

·        Exercise

Regular exercise promotes both physical and emotional health.

Physiologic benefits include improved muscle tone, increased cardiopulmonary function, and weight control.

 Physiologic benefits include relief of tension, a feeling of well-being, and relaxation.

Optimal nutrition is essential for health and in increasing the body's resistance to stress. To minimize the negative effects of stress people need to avoid excesses of caffeine, salt; sugar, and fat and deficiency in vitamins and minerals

                  Sleep: 

     

Sleep restores the body's energy levels and is an essential aspect of stress management. To ensure adequate sleep, clients may need help to attain comfort and to learn techniques that promote peace of mind and relaxation.

Time management

People who manage their time effectively usually experience less stress because they feel more in control of their circumstances. Clients who feel overwhelmed often need help to prioritize tasks and to consider whether modifications can be made to decrease role demands

Minimizing anxiety:

Nurses carry out measures to minimize clients' anxiety and stress.

·        Listen attentively

·        Provide an atmosphere of warmth and trust; convey a sense of caring and empathy

·        Determine if it is appropriate to encourage client’s participation in the plan of care

·        Stay with clients as needed to promote safety and feelings of security and to reduce fear.

·        Control the environment to minimize additional stressors such as reducing noise, limiting the number. of persons in the room, and providing care by the same nurse as much as possible

·        Communicate in short; clear. Sentences

·        Teach clients about the importance of adequate exercise, a balanced diet, and rest and sleep to energize the body and enhance coping abilities.

Mediating anger:

Fontaine and Fletcher (2003) recommend the following strategies for dealing with client's anger:

·        Know and understand your own response to the feelings and expressions of anger.

·        Accept the client's right to be angry; feelings are real and cannot be discounted or ignored

·        Try to understand the meaning of the client's anger

·        Ask the client what contributed to the anger.  Let clients talk about their anger.

·        Listen to the client, and act as calmly as possible.

   Using relaxation techniques:

·        Breathing exercises

·        Massage

·        Progressive relaxation (E.g JPMR)

·        Imagery

·        Biofeedback

·        Yoga

·        Meditation

·        Therapeutic touch

·        Music therapy

·        Humor and laughter

      

Stress management for nurses:

·        Plan a daily relaxation program with meaningful quiet times to reduce tension

·        Establish a regular exercise program

·        Study assertiveness techniques

·        Learn to accept failures — your own and others—and make it a constructive learning experience.

·        Accept what cannot be changed

·        Develop collegial support groups to deal with feelings and anxieties generated in the work setting.

·        Participate in professional organizations to address workplace issues.

·        Seek counseling if indicated to-help clarify concerns

    Physical Benefits:

·        Decrease in blood pressure

·        Decrease in heart rate

·        Increase in bone mass and strength

·        Increase in lung capacity

·        Reduction in incidence of diabetes

·        Increase in muscle strength

·        Increase in sense of well – being

·        Increase in flexibility, balance and coordination

·        Improvement in immune system        

     Emotional Benefits:

·        Happiness

·        Life satisfaction

·        Morale

·        Self-concept

                    ·        Self-esteem

                    ·        Perceived sense of freedom 

·        Independence

·        Autonomy

·        Self-confidence

·        Leadership skills

·        Tolerance/Understanding

·        Problem solving skills

   Diversional therapy includes:

·       Massage

·        Acupuncture / acupressure / reflexology

·        Yoga/ Progressive relaxation

·        Meditation

·        Guided imagery

·        Faith and Prayer Music therapy

·        Humor and laughter

·        Horticultural therapy/ gardening/ healing garden

·        Color therapy