Stress, Anxiety, Adaptation, Loss, and Grief PDF

- S T R E S S , A N X I E T Y, A D A P T AT I O N - LOSS AND GRIEF D R. S E R P İ L TO P Ç U 1  INTRODUCTION Stress /distress is a part of life: Everyone feels stress at one time or another Stress: A disturbance in an...

- S T R E S S , A N X I E T Y, A D A P T AT I O N - LOSS AND GRIEF D R. S E R P İ L TO P Ç U 1  INTRODUCTION Stress /distress is a part of life: Everyone feels stress at one time or another Stress: A disturbance in an individual’s physical and/or emotional state that affects the body’s “normal” physiological state and to which the body must try to adapt 2  INTRODUCTION Stressor: is any event or stimulus that causes an individual to experience stress. Stressors may be internal (e.g., an illness, a hormonal change, or fear) or external (e.g., loud noise or cold temperature) 3 SOURCE OF STRESS There are many sources of stress; Internal Stressors External stressors Developmental stressors Situational stressors 4 INTERNAL STRESSORS: Originate within a person; Infection, Feelings of depression, Worry Fear 5 EXTERNAL STRESSORS Originate the outside the individual; A move to another city, A death in family, Pressure from peers 6  DEVELOPMENTAL STRESSORS Occur at predictable time throughout an individuals life Child: beginning school Adolescent: changing physics Young adult: marriage, leaving home Middle adult: physical change on aging Older adult: Decreasing physical ability 7  SITUATIONAL STRESSORS Unpredictable and may occur at any time during life. Marriage or divorce Birth of a child Illness or traumatic injury Loss (belongings, relationships, family member) New job Role change 8 EFFECT OF STRESS Physically- stres can threaten a persons physiologic homeostazis. Emotionally- stress can produce negative or noncontructive feelings about the self. Intellectualy- stress can influence a persons perceptual and problem-solving abilities. Socially- stress can alter a persons relationships with others. Spiritually- stress can challenge one’s beliefs and values. 9 SOURCES OF CLINICAL STRESS FOR PATIENTS FOR NURSES Uncertainty Poor patient outcomes Fear Risk of making an error Pain Unfamiliar situations Cost Excessive workload Lack of knowledge Inadequate resources Risk for harm Unknown resources 10 WHAT KINDS OF HARM CAN STRESS CAUSE? Cardiovascular disease risks, including heart rate, blood pressure, heart attack, and stroke Immune system function impairment—too much stress over a long period can negatively regulate cellular immune responses. Varied physical effects such as weight gain, hair and skin problems, diabetes, digestive problems, and loss of libido Mental disability, including depression, anxiety, and post-traumatic stress disorder (PTSD) 11  INTRODUCTION Anxiety is a constant feeling of worry or fear about something. There is a close relationship between stress and anxiety Stress is the person’s physiological response to a stimulus, whereas anxiety is the psychological response to a threat 12  INTRODUCTION MILD ANXIETY; Mild anxiety is present in day-to-day living It increases alertness and perceptual fields (e.g., vision and hearing) and motivates learning and growth. Mild anxiety may interfere with sleep, but it facilitates problem solving 13  INTRODUCTION MODERATE ANXIETY Moderate anxiety is manifested by a quavering voice, tremors, increased muscle tension, a complaint of “butterflies in the stomach,” and slight increases in respirations and pulse SEVERE ANXIETY The person has impaired learning ability and is easily distracted. It is manifested by difficulty verbally communicating, increased motor activity, a fearful facial expression, headache, nausea, dizziness, tachycardia, and hyperventilation. 14  QUESTION Mrs. Jones usually gets coffee with his friend but today all she can think about is her sick brother. She can’t cook or clean. Which degree of anxiety does Mrs. Jones represent? A. Mild B. Moderate C. Severe D. Panic 15 CORRECT ANSWER C. Severe anxiety Mrs. Jones has disassociated herself from the rest of the world. Severe anxiety requires intervention. 16  INTRODUCTION Adaptation; When a person is in a threatening situation, immediate responses occur. Those responses are often involuntary which are called coping responses Adaptation is necessary for normal growth and development, the ability to tolerate changing situations, and the ability to respond to physical and emotional stressors 17 Adaptation is to some degree, an ongoing process as a person strives to maintain balance in his or her internal and external environments disturbed balance 18  FACTORS AFFECTING COPING PATTERNS Lifestyle considerations Diet- body better equipped to handle stress with the right nutrients and balance Activity and Exercise- can be used as defense mechanism, physiological benefits Sleep- need at least 6-9 hours, can cope with stress better Safety and Security- security is based on perception, safety can affect coping ability 19  FACTORS AFFECTING COPING PATTERNS Previous Experience Previous experiences can shape how a person reacts to stress Positive experiences can build resilience, while negative ones might make stress harder to manage. 20 QUESTION Mr. Smith smokes 1 pack of cigarettes/day. He’s complaining of having frequent colds. He states he has gained 10 kg in 6 months. He also states that the blister on his hand won’t heal. Mr. Smith is likely undergoing… A. Flight or fight response B. Mild anxiety C. Chronic stress D. Repression 21 CORRECT ANSWER C. Chronic stress Altered coping patterns > chronic stress > decreased immune response and poor wound healing 22  ASSESSMENT Risk Identification – Moving – Divorce, child custody, prison, hospitalization – Fatigue, malnutrition and illness Dysfunction Identification – What people consider stressful varies from person to person – Identify typical coping behaviors, are they being used at this time? 23  PHYSICAL ASSESSMENT Do not assume that the only cause of some physical findings is stress Cardiovascular System – Directly effected by epinephrine and norepinephrine – Increased heart rate – Increased blood pressure (systolic and/or diastolic) – Irregular heartbeat and rhythm changes – Angina – Headaches 24  PHYSICAL ASSESSMENT Respiratory System – Norepinephrine increases breathing rate and bronchodilates – hyperventilation – “air hunger” – dizziness – tingling of hands and feet 25 PHYSICAL ASSESSMENT Gastrointestinal System – Loss of appetite – Nausea/vomiting – Increased peristalsis hyperactive bowel sounds Increased of bowel movements hydrochloric acid  ulcers or gastritis 26  PHYSICAL ASSESSMENT Musculoskeletal System – Increased tension in larger muscles – Shakiness/tremors in smaller muscles – Prolonged tension can lead to muscle spasms in back, shoulders and neck 27  NURSING DIAGNOSES Observe for nonverbal signs of anxiety, fear, anger, irritability, and tension in a patient who is experiencing ineffective coping. Stress often results in multiple nursing diagnoses 28  NURSING DIAGNOSES Examples of these diagnoses include but are not limited to the following - Anxiety - Caregiver role strain - Ineffective coping - Fear - Risk for post-trauma syndrome - Insomnia - Situational low self-esteem - Stress overload 29  IMPLEMENTATION 1- Health Promotion Regular Exercise A regular exercise program improves muscle tone and posture, controls weight, reduces tension, and promotes relaxation In addition, exercise reduces the risk of cardiovascular disease and improves cardiopulmonary functioning 30  IMPLEMENTATION 1- Health Promotion Support Systems A support system of family, friends, and colleagues who listen, offer advice, and provide emotional support benefits a patient experiencing stress Time Management Good time management can reduce stress by helping you prioritize tasks and avoid last-minute rushes. Planning your day effectively allows you to stay organized and feel more in control 31  IMPLEMENTATION 1- Health Promotion Guided Imagery and Visualization Guided imagery is based on the belief that a person significantly reduces stress with imagination It is a relaxed state in which a person actively uses imagination Progressive Muscle Relaxation Once the patient is breathing deeply, direct him or her to alternately tighten and relax muscles in specific groupings 32  IMPLEMENTATION 2- Acute Care Crisis Intervention A crisis creates a turning point in a person’s life because it changes the direction of his or her life in some way. Generally a person resolves the crisis in some way within approximately 6 weeks. The basic approach is problem solving, and it focuses only on the problem presented by the crisis. 33  IMPLEMENTATION 2- Acute Care Restorative and Continuing Care A person under stress recovers when the stress is removed or coping strategies are successful If a person has successfully coped with a crisis and its consequences, he or she becomes more mature and healthy 34 QUESTION Which patient does the nursing diagnosis, “Ineffective Coping” most apply? A. Single 32 y/o female caring for her mother with end-stage Alzheimer’s B. 28 y/o male has been in therapy for 2 years coping with his history of child abuse C. 13 y/o male with history of child abuse has been skipping class to drink D. 28 y/o mother of 3 works full time while helping her husband manage Multiple Sclerosis 35 CORRECT ANSWER C. 13 y/o male with history of child abuse has been skipping class to drink A. and D. represent Caregiver Role Strain and B. would benefit most from Readiness for Enhanced Coping 36  LOSS, DEATH AND GRIEF 37 INTRODUCTION Nurse have a primary duty to prevent injury and help patients return to health They also play a vital role in helping patients and families cope with things that cannot be changed and facilitate a peaceful death Patients and families need expert nursing care through loss, grief and death, perhaps more than at any other time. 38  WHAT IS LOSS? Loss: Loss refers to the experience of losing someone or something significant, such as the death of a loved one or the end of a relationship. People can experienced the loss of body image, a significant other, a sense of well-being, a job, personel possessions, or beliefs Illness and hospitalization often produce losses. 39  TYPES AND SORCES OF LOSS Actual loss: Death of a loved one Perceived loss: Occurs when a sense of loss is felt by an individual but is not tangible to others Physical loss: Loss of an extremity in an accident, scarring from burns, permanent injury Psychological loss: Such as a woman feeling inadequate after menopause and resultant infertility 40 WHAT IS GRIEF? “Grief is the emotion people feel when they experience a loss.» There are many different types of loss, and not all of them are related to death 41  GRIEF Recognizing that there are different types of grief can help nurses plan and implement appropriate care - Normal Grief - Anticipatory Grief - Dysfunctional Grief - Complicated Grief 42 GRIEF Normal (uncomplicated) grief; is a common, universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual responses to loss and death. 43 GRIEF Anticipatory Grief When grief extends over a long period of time, people absorb loss gradually and begin to prepare for its inevitability. 44  GRIEF Dysfunctional grief Dysfunctional grief causes extreme sadness and overwhelming feelings of loss Some of the more common symptoms of dysfunctional grief include: Inability to re-establish relationships Emotional instability Crying, Sadness Unresolved denial and anger Unable to lessen the intensity of grief Changes in eating and sleeping habits Unable to function 45  GRIEF Complicated grief Complicated grief is experiencing symptoms of grief that continue for a year after a loss. You may feel intense emotions or have trouble accepting the loss. Complicated grief can affect your physical health, interpersonal relationships and daily responsibilities. 46 TYPICAL PHYSICAL SYMPTOMS OF GRIEF Difficulty going to sleep, or waking in the middle of the night Weight loss or gain; over- or under-eating Low energy or fatigue Headaches, chest pain, or racing heart Upset stomach or digestive problems Hair loss 47  STAGES OF GRIEF Denial : Refuses to believe that loss is happening. Is unready to deal with practical problems, such as prosthesis after the loss of a leg. Anger: client or family may direct anger at nurse or staff about matters that normally would not bother them. Bargaining: seeks to bargain to avoid loss. May express feelings of guilt or fear of punishment for past sins, real or imagined. Depression: Grieves over what has happened and what cannot be. May talk freely. Acceptance: comes to terms with loss. May have decreased interest in surroundings and support people. May wish to being making plans. 48  FACTORS INFLUENCING LOSS AND GRIEF Human Development; Patient age and stage of development affect the grief response Personal Relationships; When loss involves another person, the quality and meaning of the lost relationship influence the grief response Nature of the Loss; Exploring the meaning a loss has for your patient helps you better understand the effect of the loss on the patient’s behavior, health, and well- being Coping Strategies; Life experiences shape the coping strategies that a person uses to deal with the stress of loss 49  FACTORS INFLUENCING LOSS AND GRIEF Socioeconomic Status; Socioeconomic status influences a person’s ability to access support and resources for coping with loss and physical responses to stress Culture and Ethnicity; Expressions of grief in one culture do not always make sense to people from a different culture, Nurses Try to understand and appreciate each patient’s cultural values related to loss, death, and grieving Spiritual and Religious Beliefs; Spiritual resources include faith in a higher power, communities of support, friends, a sense of hope and meaning in life, and religious practices. 50  DYING AND DEATH The medical criteria used to certify a death are: Cessation of breathing No response to deep painful stimuli Lack of reflexes (such as the gag or corneal reflex) and Spontaneous movement The traditional clinical signs of death were cessation of the apical pulse, respirations and blood pressure. 51  CARE AFTER DEATH Caring for the deceased body and meeting the needs of the grieving family are nursing responsibilities. Care of the Body The body of the deceased needs to be treated in a way that respects the human body. Nursing care includes maintaining privacy and preventing damage to the body 52  CARE AFTER DEATH Legal Aspects It is important for nurses to know their legal responsibilities, which are defined by their state or provincial board of nursing or hospital Legal Aspects- Autopsy An autopsy (postmortem examination to determine the cause of death) is mandated in situations in which an unusual death has occurred 53  CARE AFTER DEATH Legal Aspects- Organ Donation Health care institutions are required to have policies related to the referral of potential donors to organ procurement agencies. It is important that families of the deceased know the importance of and process for organ donation. Care of the Family At the time of death, the nurse provides invaluable support to the family of the deceased 54  GOOD DEATH A good death is one that allows a person to die on his or her own terms, relatively free of pain with dignity. The definition of a good death varies for each patient, but there are factors important for a good death; - control of symptoms, preparation for death, opportunity to have a sense of completion of one’s life, and a good relationship with healthcare professionals Nurses play a critical role in focusing the the needs of dying persons and their families 55  NURSING PROCESS Implementation Developing a trusting nurse–patient/family relationship Explaining the patient’s condition and treatment Teaching self-care and promoting self-esteem Teaching family members to assist in care Meeting the needs of dying patients Meeting the needs of the family Providing postmortem care 56