The Stuart Stress The Stuart Stress Adaptation Model of Adaptation Model of

Psychiatric Nursing CarePsychiatric Nursing Care

Models provide a structure for Models provide a structure for thinking, observing, and thinking, observing, and interpreting what is seen. interpreting what is seen. Conceptual nursing models are Conceptual nursing models are frames of reference within which frames of reference within which patients, their environment and patients, their environment and health states, and nursing activities health states, and nursing activities are described. are described.

This textbook is based on the This textbook is based on the Stuart Stress Adaptation Model Stuart Stress Adaptation Model of psychiatric nursing care, of psychiatric nursing care, which integrates biological, which integrates biological, psychological, sociocultural, psychological, sociocultural, environmental, and legal-ethical environmental, and legal-ethical aspects of patient care into a aspects of patient care into a unified framework for practice.unified framework for practice.

Theoretical AssumptionsTheoretical Assumptions::

The first assumptionThe first assumption of the Stuart of the Stuart Stress Adaptation Model is that nature Stress Adaptation Model is that nature is ordered as a social hierarchy from is ordered as a social hierarchy from the simplest unit to the most complex. the simplest unit to the most complex. Each level also is a part of the next Each level also is a part of the next higher level, so nothing exists in higher level, so nothing exists in isolation. Thus the individual is a part isolation. Thus the individual is a part of family, group, community, society, of family, group, community, society, and the larger biosphere.and the larger biosphere.

The second assumption of the model is The second assumption of the model is that nursing care is provided within a that nursing care is provided within a biological, psychological, sociocultural, biological, psychological, sociocultural, environmental, and legal-ethical context.environmental, and legal-ethical context.

The nurse must understand each of them in The nurse must understand each of them in order to provide competent, holistic order to provide competent, holistic psychiatric nursing care. psychiatric nursing care.

The theoretical basis for psychiatric nursing The theoretical basis for psychiatric nursing practice is derived from nursing science as practice is derived from nursing science as well as from the behavioral, social, and well as from the behavioral, social, and biological sciences. biological sciences.

This means that a person with a This means that a person with a medically diagnosed illness may be medically diagnosed illness may be adapting well to it. An example of this adapting well to it. An example of this is the adaptive coping responses used is the adaptive coping responses used by some people who have chronic by some people who have chronic physical or psychiatric illnesses. In physical or psychiatric illnesses. In contrast, a person without a medically contrast, a person without a medically diagnosed illness may have many diagnosed illness may have many maladaptive coping responses. These maladaptive coping responses. These two continuums thus reflect the two continuums thus reflect the complementary nature of the nursing complementary nature of the nursing and medical models of practice. and medical models of practice.

The The fourth assumption is that the fourth assumption is that the model includes the primary, model includes the primary, secondary, and tertiary levels of secondary, and tertiary levels of prevention by describing four prevention by describing four discrete stages of psychiatric discrete stages of psychiatric treatment: crisis, acute, treatment: crisis, acute, maintenance, and health promotion. maintenance, and health promotion. For each stage of treatment the model For each stage of treatment the model suggest a treatment goal, a focus of the suggest a treatment goal, a focus of the nursing assessment, the nature of nursing assessment, the nature of nursing interventions, and the expected nursing interventions, and the expected outcome of nursing care. outcome of nursing care.

The The fifth assumption fifth assumption of the Stuart of the Stuart Stress Adaptation Model is that Stress Adaptation Model is that it is it is

based on the use of the nursing based on the use of the nursing process and the standards of care process and the standards of care and professional performance for and professional performance for

psychiatric nursespsychiatric nurses. Psychiatric nursing . Psychiatric nursing care is provided through assessment, care is provided through assessment,

diagnosis, outcome identification, diagnosis, outcome identification, planning, implementation, and planning, implementation, and

evaluationevaluation..

The The fifth assumption fifth assumption of the Stuart of the Stuart Stress Adaptation Model is that Stress Adaptation Model is that it is it is based on the use of the nursing based on the use of the nursing process and the standards of care process and the standards of care and professional performance for and professional performance for psychiatric nursespsychiatric nurses. Psychiatric . Psychiatric nursing care is provided through nursing care is provided through assessment, diagnosis, outcome assessment, diagnosis, outcome identification, planning, identification, planning, implementation, and evaluation.implementation, and evaluation.

Describing Mental Health Describing Mental Health and Illnessand Illness::

Defining Mental Health:Defining Mental Health: Mental Health is often said to be a Mental Health is often said to be a

state of well-being associated with state of well-being associated with happiness, contentment, happiness, contentment, satisfaction, achievement, optimism, satisfaction, achievement, optimism, or hope. These terms are difficult to or hope. These terms are difficult to define, and their meanings change define, and their meanings change as they relate to a particular person as they relate to a particular person and life situation. and life situation.

Criteria of Mental Health.Criteria of Mental Health. The The following six criteria are indicators of following six criteria are indicators of mental health: mental health:

Positive attitudes toward selfPositive attitudes toward self Growth, development, and self-Growth, development, and self-

actualizationactualization IntegrationIntegration Autonomy Autonomy Reality perceptionReality perception Environmental masteryEnvironmental mastery

Positive attitudes toward self include and Positive attitudes toward self include and acceptance of self and self-awareness.acceptance of self and self-awareness.

Growth, development, and self-Growth, development, and self-actualization mean that the individual actualization mean that the individual seeks new experiences to more fully seeks new experiences to more fully explore aspects of oneself.explore aspects of oneself.

Integration is a balance between what is Integration is a balance between what is expressed and what is repressed, between expressed and what is repressed, between outer and inner conflicts.outer and inner conflicts.

Anatomy involves self-determination, a Anatomy involves self-determination, a balance between dependence and balance between dependence and independence, and acceptance of the independence, and acceptance of the consequences of one's actions. consequences of one's actions.

Each person should be seen in both a group Each person should be seen in both a group and an individual context and an individual context

Dimensions of Mental Dimensions of Mental HealthHealth::

The Global Burden of Disease Study thus The Global Burden of Disease Study thus showed the true magnitude of the long showed the true magnitude of the long underestimated impact of mental health underestimated impact of mental health problems. Further, by the year 2020, mental problems. Further, by the year 2020, mental disorders are projected to increase, and major disorders are projected to increase, and major depression is predicted to become the second depression is predicted to become the second leading cause in disease burden worldwide. leading cause in disease burden worldwide. The Global Burden of Disease Study has thus The Global Burden of Disease Study has thus been eye opening in regard to public health in been eye opening in regard to public health in terms of mainstreaming mental health and terms of mainstreaming mental health and high-lighting the public significance of mental high-lighting the public significance of mental disorders. disorders.

Biopsychosocial Biopsychosocial ComponentsComponents::

The Stuart Stress Adaptation Model The Stuart Stress Adaptation Model of psychiatric nursing care views of psychiatric nursing care views human behavior from a holistic human behavior from a holistic perspective that integrates biological, perspective that integrates biological, psychological, and sociocultural psychological, and sociocultural aspects of care. aspects of care.

The holistic nature of psychiatric The holistic nature of psychiatric nursing practice examines all aspects nursing practice examines all aspects of the individual and the environment. of the individual and the environment.

Predisposing FactorsPredisposing Factors::

Predisposing factors are risk factors Predisposing factors are risk factors that influence both the type and that influence both the type and amount of resources the person can amount of resources the person can use to handle stress and are use to handle stress and are biological, psychological, and biological, psychological, and sociocultural in nature. sociocultural in nature.

Biological Biological predisposing factors include genetic predisposing factors include genetic background, nutritional status, biological sensitive, background, nutritional status, biological sensitive, general health, and exposure to toxins. general health, and exposure to toxins.

PsychologicalPsychological predisposing factors include predisposing factors include intelligence, verbal skills; morale; personality; past intelligence, verbal skills; morale; personality; past experiences; self-concept, motivation; psychological experiences; self-concept, motivation; psychological defenses; and locus of control, or a sense of control defenses; and locus of control, or a sense of control over one's own fate. over one's own fate.

Sociocultural Sociocultural predisposing factors include age, predisposing factors include age, gender, education, income, occupation, social gender, education, income, occupation, social position, cultural background, religious upbringing position, cultural background, religious upbringing and beliefs, political affiliation, socialization and beliefs, political affiliation, socialization experiences, and level of social integration or experiences, and level of social integration or relatedness. relatedness.

Precipitation StressorsPrecipitation Stressors::

Precipitating stressors are stimuli that are Precipitating stressors are stimuli that are challenging, threatening or demanding to the challenging, threatening or demanding to the individual. They require excess energy, and individual. They require excess energy, and produce a state of tension and stress. They may produce a state of tension and stress. They may be biological , psychological, or sociocultural in be biological , psychological, or sociocultural in nature, and they may originate either in the nature, and they may originate either in the person's internal or external environment. person's internal or external environment.

Besides describing the nature and origin of a Besides describing the nature and origin of a stressor, it is important to assess the timing of stressor, it is important to assess the timing of the stressor. A final factor to be considered is the stressor. A final factor to be considered is the number of stressors an individual the number of stressors an individual experiences. experiences.

Appraisal of StressorAppraisal of Stressor Appraisal of a stressor involves determining Appraisal of a stressor involves determining

the meaning of and understanding the the meaning of and understanding the impact of the stressful situation for the impact of the stressful situation for the individual. It includes cognitive, affective, individual. It includes cognitive, affective, physiological, behavioral, and social physiological, behavioral, and social responses. responses. Appraisal is an evaluation of Appraisal is an evaluation of the significance of an event in relation to the significance of an event in relation to a person's well-being. a person's well-being. The stressor The stressor assumes its meaning, intensity, and assumes its meaning, intensity, and importance as a consequence of the unique importance as a consequence of the unique interpretation and significance given to it by interpretation and significance given to it by the person at risk. the person at risk.

Coping ResourcesCoping Resources::

Coping resources are options or strategies Coping resources are options or strategies that help determine what can be done as that help determine what can be done as well as what is at stake. well as what is at stake.

Coping resources include economic assets, Coping resources include economic assets, abilities and skills, defensive techniques, abilities and skills, defensive techniques, social supports, and motivation. Other social supports, and motivation. Other coping resources include health and energy, coping resources include health and energy, spiritual supports , positive beliefs, spiritual supports , positive beliefs, problem-solving and social skills, social and problem-solving and social skills, social and material resources, and physical well-being. material resources, and physical well-being.

Coping MechanismsCoping Mechanisms:: Coping mechanisms are any efforts directed at stress Coping mechanisms are any efforts directed at stress

management. The three main types of coping mechanisms management. The three main types of coping mechanisms are as follows: are as follows:

Problem-focused Problem-focused coping mechanisms, which involve coping mechanisms, which involve tasks and direct efforts to cope with the treat itself. tasks and direct efforts to cope with the treat itself. Examples include negotiation, confrontation, and seeking Examples include negotiation, confrontation, and seeking advice.advice.

Cognitively focused Cognitively focused coping mechanisms, by which the coping mechanisms, by which the person attempts to control the meaning of the problem and person attempts to control the meaning of the problem and thus neutralize it. Examples include positive comparison, thus neutralize it. Examples include positive comparison, selective ignorance, substitution of rewards, and the selective ignorance, substitution of rewards, and the devaluation of desired objects.devaluation of desired objects.

Emotion-focusedEmotion-focused coping mechanisms by which the coping mechanisms by which the patient is oriented to moderating emotional distress. patient is oriented to moderating emotional distress. Examples include the use of ego defense mechanisms, Examples include the use of ego defense mechanisms, such as denial, suppression, or projection. A detailed such as denial, suppression, or projection. A detailed discussion of coping and defense mechanisms. discussion of coping and defense mechanisms.

Coping mechanisms can be constructive or destructiveCoping mechanisms can be constructive or destructive. .

Patterns of ResponsePatterns of Response::

According to the Stuart Stress According to the Stuart Stress Adaptation Model an individual's Adaptation Model an individual's response to stress is based on specific response to stress is based on specific predisposing factors, the nature of the predisposing factors, the nature of the stressor, the perception of the stressor, the perception of the situation, and an analysis of coping situation, and an analysis of coping resources and mechanisms. Coping resources and mechanisms. Coping responses of the patient are then responses of the patient are then evaluated on a continuum of evaluated on a continuum of adaptation/ maladaptation. adaptation/ maladaptation.

Responses that support Responses that support functioning are seen adaptive. functioning are seen adaptive. They lead to growth, learning, and They lead to growth, learning, and goal achievement. goal achievement.

Responses that block integrated Responses that block integrated functioning are seen as functioning are seen as maladaptive. maladaptive. They prevent growth, They prevent growth, decrease autonomy, and interfere decrease autonomy, and interfere with mastery of the environment. with mastery of the environment.

Treatment Stages and Treatment Stages and ActivitiesActivities::

The final aspect of the Stuart Stress The final aspect of the Stuart Stress Adaptation Model is the integration of the Adaptation Model is the integration of the theoretical basis, biopsychosocial components, theoretical basis, biopsychosocial components, patterns of response, and nursing activities patterns of response, and nursing activities based on the patient's treatment stage. Once based on the patient's treatment stage. Once patterns of coping responses have been patterns of coping responses have been identified, the nurse determines which identified, the nurse determines which treatment stage the patient is in and treatment stage the patient is in and implements the most appropriate nursing implements the most appropriate nursing activities. activities.

The model identifies four possible treatment The model identifies four possible treatment stages: (1) crisis, (2) acute, (3) maintenance, stages: (1) crisis, (2) acute, (3) maintenance, an (4) health promotion. an (4) health promotion.