Crisis, Stress, Anxiety - Istanbul Gelisim University PDF

# T.C. İSTANBUL GELİŞİM UNIVERSITY ## Faculty of Health Sciences - Website: https://www.gelisim.edu.tr - Phone: +90 212 422 70 00 - Website: https://www.sbf.gelisim.edu.tr # HEY441ET – MENTAL HEALTH AND DISEASES NURSING-T ## Week 4 ### Wednesday - 4 hour - Course Credit: 4 - ACTS: 5 - Course Type:...

# T.C. İSTANBUL GELİŞİM UNIVERSITY ## Faculty of Health Sciences - Website: https://www.gelisim.edu.tr - Phone: +90 212 422 70 00 - Website: https://www.sbf.gelisim.edu.tr # HEY441ET – MENTAL HEALTH AND DISEASES NURSING-T ## Week 4 ### Wednesday - 4 hour - Course Credit: 4 - ACTS: 5 - Course Type: Midterm Exam: 50%, Final Exam: 50% - Instructor: Assist. Prof. SUREYYA TURK OGUN - Email: [email protected] - Phone: 0212 422 70 70 - Room: B block Ground floor, room 027 - GBS Link: https://gbs.gelisim.edu.tr/ders-detay-17-319-17305-2 - ALMS Link: https://lms.gelisim.edu.tr/Account/LoginBefore - AVESIS Link: https://avesis.gelisim.edu.tr/suturk # 14 WEEKS'S COURSE CONTENTS ## Week 1 - The Fundamentals of Mental Health And Disease Nursing ## Week 2 - General Symptoms of Mental Illnesses ## Week 3 - Psychological Problems in Childhood and Adolescence ## Week 4 - Personality Disorders and the Nursing Approach ## Week 5 - Crisis, Stress, Anxeity, and the Nursing Approach ## Week 6 - Somatoform Disorders and the Nursing Approach ## Week 7 - Affective Disorders (Also Known As Mood Disorders) and the Nursing Approach ## Week 8 - EXAM ## Week 9 - Schizophrenia and Psychotic Disorders, and the Nursing Approach ## Week 10 - Alcohol and Substance Addiction, and the Nursing Approach ## Week 11 - Eating Disorders and the Nursing Approach ## Week 12 - Sexual Dysfunctions and the Nursing Approach ## Week 13 - Family and Community Mental Health Nursing ## Week 14 - Consultation Liaison Nursing in the Context of Mental Health and Disease Nursing ## Week 15 - Forensic Nursing in the Context of Mental Health and Disease Nursing ## Week 16 - FINAL EXAM # WEEKLY LEARNING OUTCOMES - Students will be able to **define** key terms related to mental health nursing, including anxiety, crisis, defense mechanisms, and stress. - Students will be able to **identify** common mental illnesses and **explain ** their causes, symptoms, and treatments. - Students will be able to **apply** the nursing process to plan and implement care for patients with mental health disorders. - Students will be able to **use** therapeutic communication techniques to establish a trusting relationship with patients and their families. - Students will be able to **evaluate** the effectiveness of nursing interventions and **modify** care plans as needed. - Students will be able to **educate** patients and families about mental health disorders, treatment options, and coping stategies. # DAILY FLOW - 09.00-09.50 / 1st Hour - 10.00-10.50 / 2nd Hour - 11.00-11.50 / 3rd Hour - 12.00-12.50 / 4th Hour # CRISIS, STRESS, ANXIETY, AND THE NURSING APPROACH ## Learning Objectives - Define crisis, stress, and anxiety. - Explain the different types of crises, stress, and anxiety. - Discuss the impact of crisis, stress, and anxiety on individuals and families. - Apply the nursing process to the care of individuals experiencing crisis, stress, and anxiety. # DEFINITION OF STRESS - Stress is a state of mental or emotional strain resulting for adverse or very demanding circumstances. - It can also be any person or situation that produces anxiety responses. # TYPES OF STRESSORS - Eustress: Stress from positive experiences. - Distress: Stress from negative experiences. - Examples of Stressors: Driving in rush hour, weddings, job promotions, death of a loved one. # THE STRESS RESPONSE - Fight-or-flight response: This is the body's automatic physiological reaction to a perceived harmful event, attack, or threat to survival. - General Adaptation Syndrome (GAS): This is a three-stage process that describes the physiological changes the body goes through when under stress. - **Alarm:** The initial reaction to the stressor, were the body's resources are mobilized.. - **Resistance:** The body adapts to the stressor and tries to cope. - **Exhaustion:** If the stressor continues, the body's resources become depleted, leading to potential health problems. # SIGNS AND SYMPTOMS OF STRESS - **Physical:** Headaches, fatigue, muscle tension, stomach upset, sleep problems. - **Emotional:** Anxeity, irritability, sadness, anger. - **Behavioral:** Social withdrawal, overeating, substance abuse. - **Cognitive:** Poor concentration, difficulty making decisions. # FACTORS INFLUENCING THE STRESS RESPONSE - **Perception of the stressor:** How an individual interprets the stressor can significantly impact their stress response. - **Coping Mechanisms:** The strategies used to manage stress can either be adaptive (helpful) or maladaptive (unhelpful). - **Social support:** Having a strong social network can buffer the effects of stress. - **Past experiences:** Previous encounters with stress can influence how someone responds to current stressors. # LONG-TERM EFFECTS OF STRESS - **Chronic illness:** Prolonged stress can contribute to the development of heart disease, high blood pressure, and diabetes. - **Mental Health Disorders:** Stress can trigger or worsen anxiety disorders, depression, and post-traumatic stress disorder (PTSD). - **Emotional Anguish:** Individuals may experience chronic fear, anxiety, anger, and depression. # CAN YOU DIFFERENTIATE BETWEEN EUSTRESS AND DISTRESS AND PROVIDE EXAMPLES OF EACH? - Eustress is stress stemming from positive experiences, such as getting married or being promoted. - Distress, on the other hand, is caused by negative events like experiencing the death of a loved one. # DESCRIBE THE THREE STAGES OF GENERAL ADAPTATION SYNDROME (GAS) - The GAS, our body's response to stress, involves these three stages: - **Alarm:** Characterized by the fight-or-flight response. - **Resistance:** Where the body attempts to adapt to the stressor. - **Exhaustion:** The final stage marked by depleted resources and potential illness. # LIST FIVE COMMON SIGNS AND SYMPTOMS OF STRESS, ENCOMPASSING PHYSICAL, EMOTIONAL, BEHAVIORAL, AND COGNITIVE MANIFESTATIONS - Stress can manifest in various ways, including - **Physical:** Fatigue, headaches, muscle tension. - **Emotional:** Irritability, anxiety, sadness. - **Behavioral:** Changes in appetite, social withdrawal. - **Cognitive:** Difficulty concentrating, poor decision-making. # DEFINITION OF COPING - Coping refers to the actions, thought processes, or series of actions employed to manage a stressful situation or modify one's reaction to it. - **Emotion-focused coping:** Involves stategies like mindfulness, meditation, or yoga to regulate emotional reponses to stress. - **Problem-focused coping:** Centers on actively addressing the source of stress, such as seeking counseling or cognitive-behavioral therapy. # ADAPTIVE COPING STRATEGIES - **Problem-focused coping:** Seeking professional help to address the stressor, taking steps to change the situation. - **Emotion-focused coping:** Engaging in relaxation techniques, exercise, and mindfulness practices. - **Seeking social support:** Reaching out to friends, family, or support groups for assistance. # MALADAPTIVE COPING STRATEGIES - **Avoidance:** Ignoring or suppressing the stressor. - **Withdrawal:** Isolating oneself from others and activities. - **Substance abuse:** Using drugs or alcohol to numb the feelings of stress. # DEFENSE MECHANISMS - Defense mechanisms are unconscious psychological stategies used to protect oneself from anxiety. - Common Defense Mechanisms: - Repression - Displacement - Regression - Sublimation # EXAMPLES - **Denial:** Refusing to acknowledge the reality of a stressful situation. - **Repression:** Blocking distressing thoughts and feelings from conscious awareness. - **Projection:** Attributing one's unacceptable thoughts and feelings to others. - **Displacement:** Redirecting emotions from the true source to a less threatening target. - **Rationalization:** Justifying one's actions or feelings with seemingly logical explanations. - **Regression:** Reverting to childlike behaviors in response to stress. - **Sublimation:** Channeling unacceptable impulses into socially acceptable activities. # THE ROLE OF THE NURSE IN PROMOTING COPING - **Assessment of coping skills:** Evaluate the patient's current coping stategies and their effectiveness. - **Education about stress management techniques:** Teach patients about different strategies to manage stress, such as relaxation techniques, exercise, and time management. - **Encouragment of adaptive coping strategies:** Help patients identify and use healthy coping skills. - **Referral to community resources and support groups:** Connect patients with appropriate resources, such as support groups, counselling services, or stress management programs. # WHAT IS THE KEY DISTINCTION BETWEEN PROBLEM-FOCUSED COPING AND EMOTION-FOCUSED COPING, AND PROVIDE EXAMPLES OF EACH STRATEGY. - **Problem-focused coping:** Aims to directly address the stressor. This could involve seeking professional help or taking steps to modify the situation. - **Emotion-focused coping:** Seeks to manage emotional responses to stress, often through techniques like exercise, relaxation, or mindfulness. # WHAT ARE DEFENSE MECHANISMS, AND HOW CAN THEY BE BOTH ADAPTIVE AND MALADAPTIVE? PROVIDE TWO EXAMPLES. - Defense mechanisms are unconscious psychological stategies that protect us from anxiety. - While they can be adaptive in the short term by reducing immediate distress, they can become maladaptive if they prevent individuals from confronting and resolving underlying issues. - For instance, **denial**, refusing to acknowledge a problem, might provide temporary relief but hinder seeking necessary help. - Similarly, **projection**, attributing one's unacceptable feelings to others, can damage relationships. # DEFINITION OF ANXIETY - Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure. - It can be a response to extreme or prolonged periods of stress. # LEVELS OF ANXIETY - **Mild:** Heightened alertness and awareness, which can enhance learning and performance. - **Moderate:** A narrowed perceptual field, decreased concentration, and some physical symptoms like increased heart rate and sweating. - **Severe:** Distorted perceptions, difficulty thinking clearly, and intensified physical symptoms like trembling and dizziness. - **Panic:** A feeling of overwhelming terror and loss of control, accompanied by intense physical symptoms like chest pain, shorthness of breath, and a sense of impending doom. # ANXIETY DISORDERS - The sources list various anxiety disorders, including: - **Separation Anxiety Disorder:** Excessive fear or anxiety about separation from attachment figures. - **Selective Mutism:** Consistent failure to speak in specific social situations. - **Specific Phobia:** Marked fear or anxiety about a specific object or situation. - **Social Anxiety Disorder (Social Phobia):** Fear or anxeity about social situations where one might be scrutinized or judged. - **Panic Disorder:** Recurrent unexpected panic attacks. - **Agoraphobia:** Fear or anxiety about situations where escape might be difficult or help unavailable. - **Generalized Anxiety Disorder:** Excessive worry and anxiety about a variety of things. # CAUSES OF ANXIETY DISORDERS - **Genetic predisposition:** Some individuals may be more genetically susceptible to developing anxiety disorders. - **Enviromental factors:** Traumatic experiences, stressful life events, and learned behaviors can contribute to anxiety. - **Neurochemical imbalances:** Dysregulation of neurotransmitters in the brain, like serotonin and norepinephrine, can play a role. # TREATMENT OF ANXIETY DISORDERS - **Psychotherapy:** Cognitive-Behavioral therapy (CBT) helps individuals identify and change negative thought patterns and behaviors. - **Medications:** Anti-anxiety medications and antidepressants can be prescibed to manage symptoms. - **Lifestyle changes:** Relaxation techniques, regular exercise, stress management, and good sleep hygiene can help improve anxiety symptoms. # HOW DO THE FOUR LEVELS OF ANXIETY - MILD, MODERATE, SEVERE, AND PANIC - DIFFER IN THEIR IMPACT ON AN INDIVIDUAL'S FUNCTIONING? - **Mild anxiety:** Can actually be beneficial, heightening alertness and facilitating learning. As anxiety increases to moderate levels, individuals experience a narrowed perceptual field and decreased concentration. - **Severe anxiety:** Significantly impairs perception and problem-solving abilities. - **Panic:** Is the most extreme level, marked by a complete loss of control, intense terror, and disorganized thinking. # DEFINITION OF CRISIS - A crisis is a sudden event that disrupts an individual's homeostasis, and their usual coping mechanisms are unable to resolve the problem. # TYPES OF CRISES - **Maturational:** Crises that occur during predictable transitions in life, such as adolescence, marriage, or retirement. - **Situational:** Crises triggered by unexpected events, such as job loss, illness, or accidnets. - **Social:** Large-scale events that affect entire communities or societies, such as natural disasters or war. # PHASES OF CRISIS - **Phase 1:** Exposure to the stressor. - **Phase 2:** Increased anxiety and attaempts to use existing coping mechanisms. - **Phase 3:** If coping is ineffective, anxiety escalates, and the individual may experience signifcant distress. - **Phase 4:** The crisis reaches a peak, and the individual may be at risk of harming themselves or others. # CRISIS INTERVENTION - **Goal:** The primary goal of crisis intervention is to help individuals regain their pre-crisis level of functioning. - **Focus on the immediate problem:** Address the most pressing issues causing distress. - **Provide a safe and supportive environment:** Ensure the indivudal feels safe and understood. - **Use active listening and empathy:** Validate the individual's feelings and experiences. - **Develop a plan of action:** Collaboratively create a plan to address the crisis and prevent future occurences. # EXPLAIN THE DIFFERENCE BETWEEN SITUATIONAL AND MATURATIONAL CRISES, PROVIDING EXAMPLES OF EACH. - **Situational crises:** Arise from unexpcted external events, such as a sudden job loss or a natural disaster. - **Maturational crises:** Are triggered by normal life transitions and developmental stages, such as starting a new job, getting married, or having a child. # WHAT ARE THE FOUR PHASES OF A CRISIS, AND WHAT CHARACTERIZES EACH PHASE? - The four phases of a crisis are: - **Phase 1:** Exposure to a stressor. - **Phase 2:** Rising anxiety and attempts to cope. - **Phase 3:** Escalating anxiety and failing coping mechanisms. - **Phase 4:** A full-blown crisis, often with potential danger. # WHAT ARE THE PRIMARY GOALS OF CRISIS INTERVENTION, AND WHAT PRINCIPLES GUIDE THIS INTERVENTION? - Crisis intervention aims to help indivduals regain their pre-crisis leve of functioning and prevent further deterioration. - Key principles include focusing on the immediate problem, establishing a safe environment, utilizing active listening and empathy, and collaborating with the individual to develop an action plan. # NURSING APPROACH TO CRISIS, STRESS, AND ANXIETY ## The Nursing Process - **Assessment:** Gather information about the patient's stress level, anxiety, and coping skills. This involves collecting subjective data (what the patient reports) and objective data (observable signs and symptoms). - **Diagnosis:** Identify the patient's nursing diagnoses related to crisis, stress, and anxiety. These diagnoses should reflect the patient's spsecific needs and problems. - **Planning:** Develop goals and interventions to help the patient manage their crisis, stress, and anxiety. Goals should be spsecific, measurable, attainable, relevant, and time-bound (SMART). Interventions should be evidence-based and tailored to the patient's individual needs. - **Implementation:** Carry out the planned interventions. This involves putting the care plan into aciton and providing the necessary support and resources to the patient. - **Evaluation:** Determine the effectiveness of the intervention. Assess whether the goals have been met and make adjustments to the care plan as needed. # NURSING INTERVENTIONS - **Therapeutic communication:** Use active listening, empathy, and clear communication to build rapport with the patient and facilitate expression of feelings and concerns. - **Enviromental manipulation:** Create a calm and supportive environment for the patient, minimizing stressors and distractions. - **Relaxation techniques:** Teach the patient techniques like deep breathing exercises, progressive muscle relaxation, or guided imagery to reduce anxiety. - **Medication administration:** Administer prescribed medications as ordered and monitor for therapeutic effects and side effects. - **Crisis management techniques:** Implement strategies to de-escalate crisis situations and ensure the safety of the patient and others. - **Safety planning:** Develop a plan with the patient to address potential risks and ensure their safety, especially if they are at risk of self-harm or harming others. # THE ROLE OF THE NURSE IN PATIENT EDUCATION - **Stress management techniques:** Provide information on healthy coping skills and stess reduction techniques. - **Coping stategies:** Teach the patient specific strategies to manage their anxiety and stress effectively. - **Medication information:** Educate the patient about their prescribed medications, including potentail side effects and how to take them safely. - **Community resources:** Provide informtion about avliable resources in the community, such as support groups, mental health services, and crisis hotlines. # DESCRIBE THREE NURSING INTERVENTIONS THAT CAN BE EMPLOYED TO SUPPORT INDIVIDUALS EXPERIENCING CRISIS, STRESS, OR ANXIETY. - Nurses can employ various intervention, including: - **Therapeutic communication:** To establish trust and facilitate expression of feeling. - **Environmental manipulation:** To create a calming and safe space. - **Relaxation techniques:** To manage pysical and emotional symptoms. # WHAT TO TAKE HOME? ## Key Concepts: Crisis, Stress, and Anxiety - Mental health and mental illness exist on a continuum; everyone experiences fluctuations in their mental health. - Stess is a universal experience. Eustress is positive stress that motivates us, while distress is negative stess that can lead to pysical and emtional problems. - Anxiety is a common response to stress that involves feelings of worry, nervousness, and apprehension. - Defense mechanisms are unconscious psychological stategies used to cope with stress and anxiety. - A crisis is a sudden event that overwhelms a person's usual coping mechanisms, leading to a state of disequilibrium. ## The Nursing Approach - Nurses play a crucial role in supporting individuals experiencing crisis, stress, and anxiety. - Therapeutic communication is essential for establishing trust, assessing needs, and providing emtional support. - Nurses apply the nursing process to plan and implement individualized care. - Effective nursing interventions aim to: - Reduce anxiety. - Promote relaxation. - Develop coping strategies. - Connect patients and families with community resources. - **Remember:** Self-care is vital for nurses to prevent burnout and maintain their own well-being. # RECOMMENDED WEEKLY STUDIES ## Deepen Your Understanding - **Read:** Reeview assigned chapters in your mental health nursing textbook, paying close attention to the sections on crisis, stress, anxiety, and the nursing approach. - **Reflect:** Consider how your own experiences with stress and anxiety influence your understanding of mental health. - **Research:** Explore resources on anxiety disorders and their treatments, including websites like the American Psychiatric Association (https://www.psychiatry.org/) and **the National Alliance on Mental Illness (https://www.nami.org/)**. - **Engage:** Participate actively in class discussions and group activities, sharing your insights and learning from others. - **Practice:** Apply therapeutic communication techniques with peers and during clinical rotations, focusing on active listening, empathy, and non-judgmental responses. - **Prepare:** Begin studying for exams early, reviewing key concepts. # REFERENCES - American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. - American Nurses Association, American Psychiatric Nurses Association, and International Society of Psychiatric-Mental Health Nurses. (2014). Psychiatric-Mental Health Nursing: Scope and Standards of Practice (2nd ed.). Nursebooks.org. - American Psychiatric Association. (2013). Desk reference to the diagnostic criteria from DSM-5. - Amnie, A.G. (2018). Emerging themes in coping with lifetime stress and implication for stress management education. SAGE Open Medicine, 6. https://doi.org/10.1177%2F2050312118782545 - Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder. (2017, July). What is cognitive behavioural treatment? American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behaviour - Gorman, L.M., & Anwar, R. (2010). Neeb's fundamentals of mental health nursing. F.A. Davis Company. - Ignativicius, V., & Silvestri, L. (2022). Preparing for the Next-Generation NCLEX (NGN): A "how-to" step-by-step faculty resource manual. Elsevier. https://evolve.elsevier.com/education/wp-content/uploads/sites/2/ NGN_FacultyGuide_Final.pdf - Kelly, J.F., & Coons, H.L. (2019, October 25). Stress won't go away? Maybe you are suffering from chronic stress. American Psychological Association. https://www.apa.org/topics/stress/chronic - Shaw, W., Labott-Smith, S., Burg, M.M., Hostinar, C., Alen, N., van Tilburg, M.A.L., Berntson, G.G., Tovian, S.M., & Spirito, M. (2018, November 1). Stress effects on the body. American Psychological Association. https://www.apa.org/topics/stress/body # SOMATOFORM DISORDERS AND THE NURSING APPROACH: NEXT WEEK - **Title:** Understanding Somatoform Disorders - **Next Week:** - We will discuss the various types of somatic symptom disorders, including conversion disorder and illness anxiety disoder. - We will explore the complex interplay of biological, psychological, and social factors that contribute to the development of SSD. - We will focus on the nursing approach to caring for individuals with SSD, emphasizing therapeutic communication, assessment, and interventions. - **Be prepared to:** - Consider how you would apply the nursing process to the care of a patient experiencing SSD. - Reflect on the challenges and rewards of providing care to patients with SSD. # HEY441ET – MENTAL HEALTH AND DISEASES NURSING - Since course presentations are private, using the texts and images contained herein on social media or else without permission from the course instructor is against the regulations Law No. 6698. # THANK YOU FOR YOUR ATTENDANCE...