Stress Management Allan Sanders, MN, ARNP [email protected].
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Transcript of Stress Management Allan Sanders, MN, ARNP [email protected].
Objectives
o Explore the biological, psychological, and social aspects of the human stress response.
o Describe the difference between adaptive and maladaptive coping strategies.
o Understand coping strategies that increase resilience to promote productive living and healthy aging.
Common Stress Associated Diseases
o Diminished Immunityo Headacheo Fatigueo Weight gaino Dyslipidemiao Hypertensiono Heart Diseaseo Psoriasis/Eczemao Digestive problems
o Anxietyo Depressiono Alcoholismo Substance abuseo Insomniao Irritable bowel
syndromeo Fibromyalgiao Decreased sex drive
Overview of Terminology
o Stress: A state of disharmony or a threat to homeostasis– Physiological changes increase alertness,
focus, and energy– Perceived demands may exceed the perceived
resources
o Coping: The ability to maintain control, think rationally, and problem solve
o Resilience: Resistant quality that permits a person to recovery quickly and thrive in spite of adversity
Stress
o Eustress– Manageable Stress can lead to growth and
enhanced competence
o Distress– Uncontrollable, prolonged, or overwhelming
stress is destructive.
o Acute Stress– Immediate response to a threat or challenge
o Chronic Stress– Ongoing exposure to stress, may seem
unrelenting
Causes of Stress
o External causes
– Family, work, economics, work, school,
major life changes, unforeseen events,
etc.
o Internal causes
– Worry, uncertainty, fear, attitudes,
unrealistic expectations, etc.
Sources of Clinical Stress
For patientso Uncertaintyo Fearo Paino Cost o Lack of
knowledgeo Risk for harmo Unknown
resources
For nurseso Poor patient
outcomeso Risk of making an
erroro Unfamiliar
situationso Excessive
workloado Inadequate
resources
Stages of the Stress ResponseGeneral Adaptation Syndrome of Hans Selye (1907-1982)
o Alarm—when one feels threatened– Activation of the fight or flight reaction
o Resistance—mobilization of resources to solve the problem– Continued stress causes adaptation
o Exhaustion– Adaptation fails and level of function
decreases
ALARM: Activation of Hypothalamic Pituitary Adrenal
Axis
Catecholamines
o Increases cardiac output
o Dilates airwayso Dilates pupilso Mobilizes glucoseo Causes vasomotor
changeso Decreases digestiono Enhances coagulation
Cortical Steroids
o Elevates glucoseo Increases amino acidso Increases NA resorptiono Increases extracellular
fluid volumeo Inhibits histamine and
bradykinino Suppresses the
immune response
Resistance
o Adaptation occurs
– Activation of the hypothalamic pituitary adrenal axis continues
o The stressor may be resolved
– The body returns to homeostasis
o May progress to exhaustion
– Stress continues as resources are depleted
Exhaustion
o Occurs when the demands of the stress exceeds the persons ability to adapt.
o Functioning declines
o May result in health problems
– Physical symptoms
–Mental symptoms
Signs & Symptoms of Stress
o Cognitive– Decreased concentration, comprehension, &
memory o Behavioral– Irritability, withdrawal, violence
o Emotional– Fear, anxiety, depression, fatigue
o Physiological– Increased BP, HR, Respirations, etc– Somatic symptoms– Decreased immune response
Genetics & Development
Genetics
o Genes control the stress response– Individuals have
different responses to stress
o There is a genetic component to:– fearful behavior– anxiety disorders– Neurobiological
response
Development
o Life experiences can affect a person's stress response
o Social support– Strong support is
protective
o Early life stress– Increases stress
reactivity as an adult
Coping & Resilience
Coping
o Ability to control emotions
o Ability to perceive reality
o Ability to think rationally
o Ability to problem solve
o Culturally defined
Resilience
o The ability to bounce back
o The positive capacity to cope with stress
o Provides resistance to negative events– Hardiness, – Resourcefulness
Coping
Adaptive Coping
– Contribute to resolution of the stress response
Maladaptive Coping
– Strategies that cause further problems
Active Coping
– Actively seeking resolution to the stress
Promote Adaptive Coping
o Realistic expectations– Set realistic goals
o Planning– Anticipate problems, have a backup plan
o Reframing– Change the way you look at things
o Relaxation– Learn relaxation techniques, take time-out for
leisure
o Discuss the problem– Utilize existing social supports to problem solve
Promote Adaptive Coping
o Training– Prepares for stressful events
o Nutrition– Eat healthy, avoid skipping
mealso Exercise– Include regular exercise
o Sleep– Get adequate sleep—avoid
fatigue
Avoid Maladaptive Coping
o Blurring of boundaries
o Avoidance/withdrawalo Negative attitudeo Anger outburstso Alcohol/Drugso Hopelessnesso Negative self-talko Resentmento Violence
Promote Resilience Factors
o Positive Role Models
o Optimismo Humoro Moral Compasso Altruismo Religion &
Spiritualityo Social Support
Positive Role Models
Transmit:
o Attitudes
o Values
o Skills
o Patterns of thoughts and behaviors
Optimism
o Positive Beliefs
– Associated with well being– Cognitive reframing– Positive thinking– Refute the negative thinking– Believe in a meaningful cause
o It is important to acknowledge relevant negative factors
Humor
o Highly effectiveo Mature coping mechanism
“Another of the souls’ weapons for the fight for self-preservation, it is well known that humor, more then anything else in the human makeup, can provide an aloofness and the ability to rise above any situation, even for a few seconds.”
Viktor Frankl
Moral Compass
o Conduct a moral inventory– “Look not for any greater harm then this,
destroying the trustworthy, self-respecting, well-behaved man within you.” Epicetus
o Maintain your integrity– “Between stimulus and response there is a
space. In that space is our power to choose our response. In our response lies our growth and our freedom.”
Viktor Frankl
Altruism
o Unselfish regarding the welfare of others
o Believe in a meaningful cause
o Mutual cooperation
– Activates of the brain’s reward center
Religion & Spirituality
o Associated with psychological and physical well being
o Guards against despair
o Provides social support
o Provides positive role models
o Provides a positive mission
Social Support
o Social support has a profound effect on life expectancy
o Patients have better outcomes with strong social support
o Isolation and poor social support are associated with a poor stress response
o Few hardy individuals “go it alone”
Signature Strengths
o Recognize skills and talents
– Inventory strengths
o Use your strengths and talents
– Decide what works
o Actively cope
– Apply concepts to enable active coping.
Reviewo Stress is part of everyday life
– It can promote growth and competency
– If unrelenting or overwhelming it can cause adverse effects
o Adaptive coping enhances resilience
o Maladaptive coping causes additional problems
o Enhanced coping increases resilience while diminishing the adverse affects of stress, thus promoting health
Review: Practical Tips
o Set realistic expectations
o Exercise regularly
o Eat healthy
o Get adequate sleep
o Maintain a work-leisure balance
o Positive Reframing & optimism
o Enhance social support
Internet Resourceso Building resilience:
http://www.slideshare.net/3dogMcNeill/building-resilienceo Diet, exercise, stress and the immune system:
http://my.clevelandclinic.org/disorders/chronic_fatigue_syndrome/hic_diet_exercise_stress_and_the_immune_system.aspx
o Exercise: Rev up your routine to reduce stress: http://www.mayoclinic.com/health/exercise-and-stress/SR00036
o Positive thinking: Reduce stress, enjoy life more: http://www.mayoclinic.com/health/positive-thinking/SR00009
o Stress management for patient and physician: http://www.mentalhealth.com/mag1/p51-str.html
o Stress management: Understand your sources of stress: http://www.mayoclinic.com/health/stress-management/SR00031
o Stress reduction techniques: A must for a healthy lifestyle: http://www.managestresstips.com/category/stress-reduction/
Learning Exercise
1. List your current sources of stress.2. Conduct an inventory of coping strategies
that you use or have used in the past.– Include maladaptive strategies
3. List your signature strengths and factors that may enhance your resilience.
4. While considering the above, develop a personalized stress management plan to enhance your coping and resilience.
ReferencesAhern, N., Ark, P., Byers, J. (2001). Resilience and coping strategies in adolescents.
Paediatric Nursing. 28(10).Beckmann-Murray, R., Proctor-Zentner, J., & Yakimo, R. (2009). Health promotion
strategies through the life span. New Jersey: Prentice HallBhui, K., King, M., Dein, S., & O’Conor, (2008). Ethnicity and religious coping with
mental distress. Journal of Mental Health. 12(2).Copstead, L. C. & Banasik, J. L. (2010). Pathophysiology: Biological and behavioral
perspectives (2nd ED.) USA: W. B. Saunders CompanyFielding, R (Undated) Retrieved September 25, 2007
from:http://www.pitt.edu/~super1/lecture/beh0091/img007.GIF&imgrefurlHildon, Z., Smith, F., Netuveli, G. & Blane, D. (2008). Understanding adversity and
resilience at older ages. Sociology of Health & Illness. 30(5).Posen, D. B. (1995). Stress management for patient and physician. Retrieved
September 21, 2007 from: Http://Serendip.brynmawr.edu/bb/neuro/neuro00/web3/edmundson.html
Pranulis, M. S. (1975). Coping with acute myocardial infarction. Psychological Aspects of Myocardial infraction. Mosby: St. Louis
Southwick, S. M. (2007). Cleveland Clinic’s posttraumatic stress disorder symposium. California: Audio-digest
Steinhardt, M. & Dolbier, C. (2008). Evaluation of a resilience intervention to enhance coping strategies and proctitive factors and decrease symptomatology. Journal of American College Health. 56(4).
Images retrieved from Microsoft: http://office.microsoft.com/en-us/images/?CTT=97
