STRESS AND MANAGEMENT

BHAGYASREE N P 2ND MSC NURSING GOVT COLLEGE OF NURSING ALAPPUZHA

STRESS IN THE CHANGING WORLD Pressure at work College stress Stress and retired population Too many obligations Negative thoughts Poor skills to deal with conflicts Pessimism Too many commitments

STRESS Stress is a condition in which the human respond

to change in normal balanced state. Stress is a process of adjusting to or dealing with

circumstances that disrupt or threats to disrupt a persons physical or psychological functioning- Hans Selye

TYPES OF STRESS

Acute stress Chronic stress Episodic stress Eustress Distress

STRESSORS

Stressors are psychological or physical stimuli that are precipitating a change.

Stressors are anything that is perceived as challenging, threatening or demanding

TYPES OF STRESSORS

STRESSORS RELATED TO PERSONALITY Irrational beliefs, values and attitudes Type A personality Perfectionistic attitude Poor time sense Poor decision making Poor habits

PERSONAL STRESSORS

Improper life style Loneliness Marital conflicts Poor physical health Financial problems

ENVIRONMENTAL STRESSORS

Pollution Noise Overcrowding Extreme heat or cold

STRESSORS RELATED TO JOB Poor knowledge of job Unwanted job Shift work Low salary Job insecurity

CAUSES OF STRESS

Internal causes External causes

INDICATORS OF STRESS

Physiologic indicators

Pupil dilates to increase visual perception

Sweat production increased to control the elevated body heat

The heart rate and cardiac output increase

The rate and depth of respirations increase

Urinary output decreases. Blood sugar increase because of release of

glucocorticoids. Muscle tension increases.

PSYCHOLOGICAL INDICATORS Anxiety -state of mental uneasiness, apprehension or

a feeling of helplessness related to an impending or anticipated threat.

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

Depression -Depression is a common reaction to events that seem overwhelming or negative

COGNITIVE INDICATORS Problem solving Problem solving involves thinking through the

threatening situation, using specific steps to arrive at a solution.

Structuring Structuring is the arrangement or manipulation of

situation so that threatening events do not occur. For example a nurse can structure or control the interview with client by asking only

Self-control/self-discipline assuming a manner and facial expression that convey a sense of being in control or in charge

Suppression Suppression is consciously and wilfully

putting a thought or feeling out of the mind

Fantasy. Fantasy or day dreaming is likened

make believe unfulfilled wishes and desires and imagined as fulfilled or a threatening experiences reworked or replace so that it ends differently from reality.

ADAPTATION

Adaptation is an on-going process as a person strives to maintain balance in his / her internal or external environments.

GENERAL ADAPTATION SYNDROME

STUART STRESS ADAPTATION MODEL

PREDISPOSING FACTORS Biological, Psychological Socio cultural PRECIPITATING FACTORS APPRAISAL OF STRESSOR COPING RESOURCES COPING MECHANISM Repression Denial compensation Regression Constructive Destructive CONTINUUM OF PSYCHOLOGICAL RESPONSES Adaptive responses maladaptive responses Alarm Resistance Exhaustion

TRANSACTIONAL MODEL OF STRESS

Precipitating event Predisposing factors Genetic influences Past experiences Cognitive appraisal Primary 

Irrelevant benign positive Stress appraisal No response Pleasurable response Harm/loss Threat Challenge Secondary Availability of coping strategies Perceived effectiveness of coping strategies Perceived ability to use coping strategies effectively Quality of response Adaptation Maladaptation

SIGNS AND SYMPTOMS OF STRESS

Physiological and Physical Increased heart rate Increased blood pressure Dilated pupil Muscle tension Nausea and dizziness Aches and pain

Cognitive symptoms

Memory problem Inability to concentrate Anxious thoughts Constant worrying

Emotional symptoms

Moodiness Irritability and short tempered Agitation or inability to relax Sense of loneliness

Behavioral symptoms

Eating more or less Sleeping too much or too little Isolating yourself from others Neglecting responsibilities Using alcohol, cigarettes, or drugs to relax Nervous habits (e.g. nail biting, pacing)

STRESS ASSESSMENT SCALE

HOLMES AND RAHE STRESS SCALE

Social Readjustment Rating Scale (SRRS)

Score of 300+: At risk of illness.Score of 150-299: Risk of illness is moderate (reduced by 30% from the above risk).Score <150: Only have a slight risk of illness.

DEPRESSION ANXIETY STRESS SCALES (DASS)

DASS, the Depression Anxiety Stress Scales is made up of 42 self-report items to be completed over five to ten minutes, each reflecting a negative emotional symptom.

The main purpose of the DASS is to isolate and identify aspects of emotional disturbance

PERCEIVED STRESS SCALE

The Perceived Stress Scale (PSS) is the most widely used psychological instrument for measuring the perception of stress. It is a measure of the degree to which situations in one’s life are appraised as stressful.

For each question choose from the following alternatives:

0 –never 1 -almost never 2 –sometimes 3 -fairly often 4 very often

Scores ranging from 0-13 would be considered low stress.

Scores ranging from 14-26 would be considered moderate stress.

Scores ranging from 27-40 would be considered high perceived stress.

 

KINGSTON CAREGIVER STRESS SCALE (KCSS)

The Kingston Caregiver Stress Scale (KCSS) is primarily a scale used to monitor change in a family caregiver’s stress level over time. 

Adaptive coping strategies

AWARENESS

RELAXATION

MEDITATION

INTERPERSONAL COMMUNICATION WITH CARING OTHERS

PROBLEM SOLVING

PETS

MUSIC

BREATHING EXCERCISES Find a comfortable position. Relax your shoulders and chest; let your body relax.

Shift to relaxed, abdominal breathing. Take a deep breathe through your mouth, expanding the abdomen, Hold it for 3 seconds and then exhale slowly through the nose; exhale completely and telling yourself to relax.

With every breath turn attention to muscular sensation that accompanies the expansion of belly.

As you concentrate on you breathing, you will start to feel focused.

Repeat this exercise for 2-5 minutes.  

GUIDED IMAGERY Sit or lie down in a comfortable position Close your eyes Imaging that you and someone you love are

walking along the seashore. No other people are in sight in any direction.

. The sun is shining, the sky is blue, and a gentle breeze is blowing. You lie on the sand and close your eyes.

You hear the sound of the wave as they splash against the shore.

The sun feels warm on your face and body. The sand feels soft and warm against your back.

An occasional wave, splash you with a cool mist that dry rapidly in the warm sun. You lay in this quiet place for what seems like a very long time, talking in the sounds of the wave, the warmth of the sun and the cooling sensation of the mist and ocean breeze. It is very quiet and warm.

You feel relaxed contented. This is your special place whenever you want to relax

MEDITATION Select a quiet place and a comfortable

position. Sitting in a chair with feet flat on the floor,

arms resting comfortably in your lap.

Crossed leg on the floor or on a cushion.

In the lotus yoga position, sitting on the floor with your legs flexed at the knees. The ankle are crossed each foot rests top of the opposite thigh.

Select an object word or thought on which to dwell. During meditation individual become preoccupied with selected focus. This total preoccupation serves to prevent distractions from interrupting attention.

Counting ones breath- all attention focussed on breathing in and out.

Mantra- A mantra is syllable, word or name that repeats much time as the mind is cleared of thought.

A thought that has special meaning to you- With eyes closed focus total attention on a specific thought or idea.

Practice directing attention you selected focus for 10-15 minutes a day for several weeks

RELAXATION EXCERSISES

1938 Edmund Jacobson developed Progressive Muscle Relaxation technique

Each muscle group is tensed for 5-7 seconds and then relaxed for 20-30 seconds during which the individual concentrates on the difference in sensation between the two conditions. Soft, slow back ground music may facilitate relaxation.

Next tense the muscles of the thigh and buttocks, and hold for a count of 5.

Now release the hold. Feel the tension drain away and be aware of the difference in sensation.

Next tense the abdominal muscles. Hold for a count of 5. Now release the hold. Concentrate on the feeling of

relaxation in the muscles. You may feel a warmth sensation. Hold on to that feeling for 15-20 seconds.

Next tense the muscles in the back and hold for a count of 5. Now release the hold and feels the sensation of relaxation. Now tense the muscle of your hands, biceps and forearm and

clench your hands into a tight fist. Hold for a count of 5.

Sit in a comfortable chair with your hands in your lap, your feet flat on the floor and your eyes closed.

Begin by talking three deep, slow breaths, inhaling through nose and releasing air slowly through the mouth.

Now starting with the feet, pulls the toes forward toward the knees, stiffen your calves, and hold for a count of 5.

Now release the hold. Let go of the tension. Feel the sensation of relaxation and warmth as the tension flow out of the muscle.

Now release the hold. Notice the sensations. You may feel tingling, warmth or a tight airy feeling. Recognise these sensation as tension leaves the muscle.

Next tense the muscle of the shoulders and neck. Shrug the shoulders tightly and hold for a count of 5.

Now release the hold. Sense the tension as it leaves the muscle and experience the feeling of relaxation.

Next tense the muscle of the face. Wrinkle the forehead, frown, squint the eyes and purse the lips. Hold for a count of 5.

Now release the hold. Recognize a light, warm feeling flowing into the muscles.

Now feel he relaxation on your whole body. As the tension leaves your entire being, you feel completely relaxed.

Open your eyes and enjoy renewed energy.

STRESS MANAGEMENT FOR NURSES Alter the situation Avoid unnecessary stress Adapt to the stressor Accept the things you can’t change

Set aside relaxation time. Exercise regularly. Eat a healthy diet. Get adequate sleep Be organized Breathe Talk

Learn to identify the feeling Evaluate and relies on spirituality Acquire skills in needed areas