Stress, Coping, & Defense Mechanisms PDF

Stress, Coping, & Defense Mechanisms Stress - Psychological, emotional, or physical responses & adaptations to perceived changes and challenges Can be caused by physical, emotional, mental changes ○ Positive or negative depending on individual perceptions Not all stress is becaus...

Stress, Coping, & Defense Mechanisms Stress - Psychological, emotional, or physical responses & adaptations to perceived changes and challenges Can be caused by physical, emotional, mental changes ○ Positive or negative depending on individual perceptions Not all stress is because of negative stressors Eustress - positive stress ○ Produces feelings of well-being, motivation, or inspiration Distress - unhealthy stress ○ Can overwhelm and lead to emotional fatigue and ill health Stressors- Event, experience, or environmental stimulus causes stress or creates a change Perceived demands causing stress reaction Individuals perceptions determines positive or negative Physiological stress response Optimal stress response depends on well functioning body system Every stressors experienced are managed through homeostatic processes to minimize impact ○ Homeostasis - body’s compensation mechanisms that responds to changes, maintenances of relatively stable internal environment Minor stressors - physiological, psychological, & behavioral processes compensate, & homeostasis is maintained More serious stressors ○ Body system become disrupted, inappropriate behavior (eating unwisely, alcohol, smoking) Response is initiated by two body system Effects of Stress response HR, BP, RR, blood glucose, risk of infection, mental alertness increases Skin changes - temp, pallor Pupils dilate GI motility decreases Prolonged exposure to stress Sympathetic nervous system (SNS) Pupils dilated Increased heartbeat Relaxes airways Inhibits activity of the stomach Inhibits intestines Inhibits gallbladder Secrete epinephrine & norepinephrine  Bladder relaxes Sweat glands stimulate secretion General Adaptation Syndrome Alarm stage ○ Hormone and neurotransmitter released ○ Fight or flight response ○ If severe threat is prolonged, progresses to resistance stage Resistance stage ○ Body resists and seeks to counter stress ○ PNS attempts to bring body back to homeostasis ○ Need stress management & coping techniques to desensitize process Exhaustion stage ○ Body can no longer defend itself due to chronic exposure ○ Resources are exhausted ○ May result in illness or disease or even death Transactional Theory of Stress & Coping Describes stress as a dynamic process and transaction between person and their environment Describes how an individual appraises a stressor,determines how they will response to stressor Individual goes through 2 stages of appraisal: primary & secondary Appraisal is influenced by many factors: skills, abilities, resources ○ Skills: cognitive, physiological, psychological Sources of Stress Physiological (physical) ○ Associated with injury or illness (extreme temperatures, trauma, pain, diseases) ○ Acute stress responses are immediate and necessary for survival ○ Chronic stress can result in debilitating conditions Psychological (emotional) ○ More common and generate a state of emotional unease ○ An event, situation, comment, condition, or interaction that is perceived as threatening or negative Ex. work or academic pressure, financial difficulties, change in marital status, being a victim, fear of the unknown, family problems Acute Stress Most common type Usually brief Can be positive or negative Causes immediate reaction that triggers fight-or-flight response Ex. motor vehicle accident,loss of loved one, being a victim of a crime  Manifestations: irritability, chest tightness, headache, SOB, sweaty palms, GI disturbance Most episodes do not have lingering health effect Episodic Acute Stress Characterized by frequent bouts of acute stress Someone takes on more than they can handle, and frequently feels disorganized and rushed Manifestations: anxious, irritable, tension headaches, HTN, migraines, negative worldview Negatively impact relationships, work, and overall health Chronic Stress Disabling condition when levels are heightened, constant, and prolonged continuous activation of the nervous system Manifestations: anxiety, depression, CV diseases cancer, suicide, ↓ immune function, ↓ ability to make decisions Stress-related Disorders Acute Stress Disorder (ASD) ○ Results from overwhelming event that causes intense and dysfunctional reaction ○ Short-term condition, if > one month, PTSD ○ Exposure to a frightening or traumatic event: death of a loved one, threat of serious injury, exposure to war or violence ○ Manifestations: feelings of numbness, disconnectedness, disrupted sleep, irritability, difficulty concentrating, avoid people/places/things that remind them of stressor PTSD ○ Result from prolonged or heightened stress following the major disaster or traumatic event ○ Manifestations (varies): disruptive memories of the event, flashbacks of trauma, nightmares, sweating,exaggerated startle to certain experiences or noises, palpitations ○ Manifestations may be delayed for years, can become chronic and debilitating ○ High risk of developing dependence on drugs, alcohol Irritable Bowel Syndrome ○ Chronic GI condition: bloating, abdominal discomfort, constipation, diarrhea ○ Functional syndrome with no known cause, common trigger is stress ○ Impacts quality of life Crisis Threatening situation triggered by an event which an individual experiences strong behavioral, emotional, or psychiatric response Emotionally significant unexpected life event with insufficient time to prepare or respond  Pushes person beyond the ability to cope arising from various sources ○ Ex. death of loved one, traumatic injury, natural disaster, loss of financial security, internal fear Nurses must assess risk factors and warning signs related to potential acts of violences during crisis ○ May display highly erratic or unusual behavior (hostile, throwing/breaking items), misuse alcohol and other substances ○ Immediate actions needed whenever a risk of harm to self (suicide) or to other (homicide) is present Sources of Crisis Stressors Situational- Created by personal, family, work-related issues ○ Ex. living/diagnosed with chronic illness, financial strain, death of loved one, divorce, infertility, unwanted pregnancy, loss of job, change in work roles/responsibilities Developmental - Occur as individual moves through stages of life ○ Ex. physical appearance, relationships, going to college, marriage, retirement, accepting physical aging Adventitious - AKA disaster events ○ Generally rare and unexpected ○ Ex. floods, earthquakes, hurricanes, fire, war, terrorism, criminal activity Socioeconomic - Occurs from low socioeconomic status, poverty, homelessness ○ Adverse effects of low SES on mental and physical health are well documented Cultural ○ Occurs when living within a society that they do not culturally fit & when they receive care that ignores their cultural beliefs ○ stressor perceived as highly stressful in one culture may be viewed as a minor stressor within another culture ○ Coping strategies vary from culture to culture Crisis Interventions An action plan that requires a frequent or constant observation and intervention ○ Action and situation focused Goal: to help client identify precipitating events leading up to crisis utilizing skills, resources, available support system to deal with crisis Nurses should: ○ Conduct a crisis assessment ○ Establish and maintain therapeutic nurse-client relationship ○ Provide safe and calming environment ○ Use therapeutic and effective communication skills ○ Provide resources ○ Explore past coping strategies ○ Implement action plans  Defense Mechanisms Defense Mechanisms Psychological strategies that help individuals to protect an individual’s self-esteem ○ Mental operation that occurs unconsciously ○ “Unconscious resources used by the ego” Helps to put distance between themselves and unpleasant events, feelings, or thoughts ○ Helps to decrease internal stress ○ Like shields that protect from anxiety and fear Can be misused or distorted → unhealthy ways of coping (self-defeating) Managing Stress: The Four A’s Avoid - say “NO” take control of your surrounding by avoiding those who cause stress, avoid getting pulled into “hot topic” conversations Alter - assertive by expressing yourself, discussing your feelings, managing time efficiently, & practicing compromise Adapt - reframe your thinking (don’t use “worst case”), adjust standards, be positive Accept - is it something you can solve, if not accept uncertainty Role of Nurses Establish rapport and build trusting nurse-client relationship first Conduct a comprehensive assessment, Provide safe, confidential environment when sharing information Use Therapeutic communication skills Recognize manifestations of stress and health alterations Provide education and resources, Include caregivers Roles of the nurses: Nursing Process Assessment - presenting symptoms, current stressors Analysis - client’s problem or health alterations Planning - collaborate, establish short & long term goals Implementation - put plan into action to meet goals Evaluation - ongoing and continuous evaluation to determine effectiveness Healthy Coping Strategies Helps to reduce stress and manage stressful situations Form of health promotions to improve health ○ Maintain healthy diet ○ Increase physical exercise ○ Time management ○ Build personal resilience by practicing mindfulness ○ Rest and relaxation ○ Complementary and alternative therapies Mindfulness practice of healthy coping strategies Find a quiet place Sit in a comfortable position Take a deep breath through your nose with your eyes closed Open your mouth and exhale Focus on your breathing Refocus when your mind starts to wander Perform mediation for at least 10 minutes at 3 times per week 12 Defense Mechanisms 1. Compansations 7. Rationalization 2. Denial 8. Reaction formation 3. Displacement 9. Regression 4. Dissociations 10. Repression 5. Intojection 11. Sublimation 6. Projection 12. Undoing `