Chapter_007.pdf

Chapter 7 Stress Management  Stress  The inability to cope with perceived demands or threats to one’s mental, emotional, and spiritual well- being  All people have stress  Stress has a powerful effect on the mind  Stress has a significant effec...

Chapter 7 Stress Management  Stress  The inability to cope with perceived demands or threats to one’s mental, emotional, and spiritual well- being  All people have stress  Stress has a powerful effect on the mind  Stress has a significant effect on one’s health & well-being 2  Types of Stress  Many different sources of stress  Physiologic  Emotional/psychologic Positive or negative  Stress is more prevalent in women Anxiety and depression More likely to seek help for stress symptoms  Men are more likely to die from stress-related illness 3  Stressors Stressors can be physiologic or emotional/psychologic. Your perception of these stressors will determine whether they cause stress. Events or circumstances become stressful when you perceive them to be. 4  Perception  Perceived demands or threats can be real or imagined  Perception influences response 5  Stress—Bad or Good?  Tendency to consider stress as bad  Anything out of the ordinary can be considered a stressor  Even happy events can be stressors  Stress can be motivating or inspiring 6  Stress Is Stress  Our bodies react with the same stress response to  Bad or good stress  Real or imagined stress  Stress is key for survival  Too much stress is detrimental 7  Examples of Stressors Physiologic Emotional/Psychologic Skin burn Diagnosis of cancer Chronic pain Marital problems Hypothermia Failing an examination Infectious disease Inadequate financial resources Excessive noise to meet needs Starvation Grieving the loss of a family member Running a marathon Caring for a disabled child Birth of a baby Winning or losing an athletic event Winning the lottery 8  Case Study (1 of 9)  J.R. is 46 years old. His doctor just left the room before you walk in. At first he is quiet. After a few minutes he tells you that his doctor just told him that he has type 2 diabetes and will require treatment and changes in his lifestyle.  What can you say? 9  Factors Affecting Response to Stress (1 of 2)  Important stressor variables  Type  Duration Acute or chronic  Intensity Mild, moderate, severe 10  Factors Affecting Response to Stress (2 of 2)  Internal influences  Age, health status, personality, previous experience with stress  External influences  Cultural/ethnic and religious/spiritual influences, socioeconomic status, social support, timing, and number of stressors 11  Buffers  Key personal characteristics  Resilience Resourceful, flexible, good problem-solving skills  Hardiness Commitment, control, openness to change  Attitude  Being optimistic 12  Case Study (2 of 9) You walk into J.R.’s room after lunch. He says, “I can do this!” He asks for more information about diabetes and says his wife is coming to plan lifestyle changes they will need to make. 13  Case Study (3 of 9)  How are the personal characteristics of resilience, hardiness, attitude, and being optimistic being demonstrated in J. R.’s response to stress? 14 Interrelation of Body Systems Neurochemical links among the nervous, endocrine, and immune systems. The communication among these three systems is bidirectional. 15  Nervous System (1 of 4)  Cerebral cortex  Control of cognition, affect, and movement  Evaluates the stressor in light of past experiences and future consequences Perception of and response to a stressor 16  Nervous System (2 of 4)  Limbic System  Emotions and behavior  Ensure survival and self-preservation 17  Nervous System (3 of 4)  Reticular formation  Contains the reticular activating system or RAS Sends impulses to alert the limbic system and cerebral cortex Stress increases frequency of impulses  Increases degree of wakefulness  Can lead to sleep disturbances 18  Nervous System (4 of 4)  Hypothalamus  Central to connection between nervous and endocrine systems  Regulates the function of sympathetic and parasympathetic branches of the autonomic nervous system 19 Hypothalamic-Pituitary-Adrenal Axis FIGURE 7.4 20  Endocrine System (1 of 4)  Sympathetic nervous system (SNS)  Stimulates adrenal medulla to release epinephrine and norepinephrine Sympathoadrenal response Prepares body for fight-or-flight response 21  Case Study (4 of 9)  J.R.’s wife enters his room and begins to cry. She sits down and begins to tell you about the car accident she narrowly escaped on the way to the hospital.  What are some of the physiologic responses her body experienced at the time of the event? 22  Endocrine System (2 of 4)  Stress activates hypothalamic-pituitary-adrenal (HPA) axis  Hypothalamus releases corticotropin-releasing hormone (CRH)  Stimulates the anterior pituitary to produce adrenocorticotropic hormone (ACTH) Adrenal cortex secretes corticosteroids 23  Endocrine System (3 of 4)  Physiologic effects of cortisol  Increases blood glucose levels  Potentiates catecholamine action on blood vessels  Inhibits the inflammatory response  Corticosteroids are essential for the stress response 24  Endocrine System (4 of 4)  Corticosteroids  Support the body’s adaptive response to a stressor  Blunt aspects of stress response that could be self- destructive if uncontrolled 25  Stress Response  Increases  Cardiac output  Blood glucose levels  Oxygen consumption  Metabolic rate 26 Fight-or-Flight Response “Fight-or-flight” reaction. Alarm reaction responses resulting from increased sympathetic nervous system (SNS) activity 27  Immune System  Acute and chronic stress can cause immunosuppression  Decreasing number and function of natural killer cells  Decreasing lymphocyte proliferation  Altering production of cytokines  Decreasing phagocytosis 28  Mind-Body-Spirit FIGURE 7.7 - The connections among the mind, body, and spirit can lead to a person being healthy (A) or the effects of stress on the mind, body, and spirit connections can lead to illness (B) 29  A Weapon Against Stress  Our mind  Helps us conquer stress  Gives us the power to choose how we respond to a crisis or difficult time 30  Stress and Nursing  Sources of stress  Work environment  Physical demands  Potential for violence  Important to maintain your own balance between mind, body, and spirit to provide the best care for your patients and maintain a healthy, meaningful life for yourself 31 Effects of Stress on Health (1 of 3)  We are not meant to remain on high alert. Chronic, unrelieved stress is linked to  Leading causes of death (cancer, accidents, suicide)  Impaired cognitive function  Negative changes in lifestyle behaviors 32  Case Study (5 of 9)  Four months later you see J.R. in the E.D. with complaints of dyspnea, palpitations, and chest pain. He looks like he has gained weight. Lab tests, ECG, and chest x-ray are normal. MI and pulmonary embolism are both ruled out.  What might be happening to J.R.? 33 Effects of Stress on Health (2 of 3)  Long-term exposure to catecholamines from excessive activation of the SNS  Increases risk of CV diseases  Decreases control of metabolic conditions  Makes us more susceptible to infection 34 Effects of Stress on Health (3 of 3)  At the cellular level, stress may promote earlier onset of age-related diseases  Link between stress and telomere length—alter DNA  Accelerates rate at which cells age 35  Coping Strategies (1 of 4)  Behaviors and actions to help deal with stress  Everyone needs to recognize Importance of coping in managing stress Role of unhealthy behaviors in causing and exacerbating chronic health conditions Influence on health care costs (©Goodshoot/Thinkstock) 36  Coping Strategies (2 of 4)  Positive  May include exercise or spending time with friends and family  Negative  May include substance abuse or denial  Eventually lead to increased stress 37  Coping Strategies (3 of 4)  Emotion-focused coping: Managing emotions that one feels when a stressful event occurs  Situation is unchangeable or uncontrollable  Purpose: To help decrease negative emotions and help create a feeling of well-being  Examples: Discussing feelings with a friend or taking a hot bath 38  Coping Strategies (4 of 4)  Problem-focused coping: Finding solutions to resolve problems causing stress  Situation can be controlled or changed  Purpose: Allows one to look at a challenge objectively and take action to address the problem and reduce the stress  Examples: Setting priorities, collecting information, seeking advice 39  Relaxation Strategies (1 of 2)  Relaxation response is a state of physiologic and psychologic rest  Opposite of the stress response  Characterized by decreased sympathetic nervous system activity 40  Relaxation Strategies (2 of 2)  Relaxation response  Can be elicited through a number of relaxation strategies  An effective treatment for a wide range of stress- related disorders  Helps cope better with everyday life  Helps decrease stress levels in body and mind (©Comstock/Thinkstock) 41  Relaxation Strategies: Relaxation Breathing (1 of 2)  The way one breathes affects every aspect of life  Simple and effective way to stop the stress response is to breathe deeply and slowly 42  Relaxation Strategies: Relaxation Breathing (2 of 2)  Performed while sitting, standing, or lying down  Involves primary use of the diaphragm and less use of the upper chest and shoulders  Abdomen moves out while inhaling and in while exhaling  Becomes easier with practice 43  Case Study (6 of 9)  You have a minute to talk to J.R. and his wife. He begins to hyperventilate and expresses that he is worried he is having a heart attack.  What immediate intervention can you offer J.R.? 44  Relaxation Strategies: Biofeedback  Electrodes or sensors are used to measure breathing, heart rate, and muscle activity  Person uses their thoughts to control the body responses 45  Relaxation Strategies: Meditation  Concentrated focus on: a sound, object, visualization, the breath, or movement  Purpose: increase awareness, reduce stress, promote relaxation, and enhance personal and spiritual growth 46  Audience Response Question (1 of 2) The nurse teaches a patient about meditation. Which statement, if made by the patient, indicates an understanding of the instructions? a. “I can learn how to meditate in 20 minutes or less.” b. “I need to be in a quiet room without distractions.” c. “I will start out by meditating for about 20 minutes.” d. “I should practice meditation 3 times each week.” 47  Audience Response Question (2 of 2) Answer: A “I can learn how to meditate in 20 minutes or less.” 48  Relaxation Strategies: Imagery (1 of 2)  Generates images that have a calming effect on the body  Involves a focused mind and incorporates all senses to create physiologic and emotional changes  Guided imagery: Images are suggested by another person or technology  Benefits: Reduced anxiety, decreased muscle tension, improved comfort during medical procedures, immune system improvement, decreased recovery time following surgery, and reduction in sleeping problems 49  Relaxation Strategies: Imagery (2 of 2)  Imagery can be used to specifically target a disease, problem, or stressor  Mentally rehears a challenging situation Enhance performance Achieve greater success Deal with a stressful or painful procedures 50  Audience Response Question (1 of 2) The nurse plans to teach a patient how to use imagery to manage pain. Which statement by the nurse would be appropriate? a. “Place your pain in the image of a form you can destroy.” b. “Tell me what you hear, smell, or feel in your special place.” c. “Listen to music to divert your attention away from the pain.” d. “Visualize the distress until you feel more calm and relaxed.” 51  Audience Response Question (2 of 2) Answer: B “Tell me what you hear, smell, or feel in your special place.” 52  Relaxation Strategies: Massage  Range of techniques to reduce tension or pain, promote sleep, stimulate circulation  Important form of touch; consider cultural and social beliefs 53  Relaxation Strategies: Music  Diversion from a stressful situation  Music can improve your state of mind and trigger the relaxation response  Personal preferences—low-pitched tones; without words; fast tempo 54  Relaxation Strategies: Prayer  Prayer is a form of meditation  Spiritual communion with God or an object of worship  May relieve stress, increase perspective, strength, and inspiration 55  Case Study (7 of 9)  When J.R. is calmer, you ask about his lifestyle, and he reveals he is a business executive who works 14- to 16-hour days. He drinks an average of 5 cups of coffee/ day. He states that because of his busy lifestyle, he is unable to get any exercise.  What patient teaching is essential for him? 56  Assessment  Signs and symptoms of stress response  Physical Increased HR and BP, hyperventilation, pain, headache, changes in eating or sleep patterns  Behavioral Anxiety, irritability, impaired concentration or speech, crying, work-related changes  Cognitive Self-report or caregiver report of forgetfulness or indecision 57  Case Study (8 of 9)  What coping and relaxation strategies should you discuss with J.R.? 58  Clinical Problems  Clinical problems for the patient with stress include  Difficulty coping  Spiritual problem 59  Planning  Overall goals  Report decreased levels of stress  Demonstrate positive coping strategies  Be free from complications resulting from stress 60  Implementation (1 of 2)  Facilitate and enhance coping and adaptation  Interventions depend on severity of the stress experience 61  Implementation (2 of 2)  Most coping and relaxation strategies can be taught in 10 to 15 minutes  Choose a strategy to best suit the patient and situation  Give directions calmly and slowly in short, simple sentences 62  Tips  Handling stress  Help you personally  Enhance your own level of health and wellness  Care for yourself first before you can help others  Use your professional resources  Share ideas with your patients 63  Case Study (9 of 9)  When you begin to discuss meditation, J.R. becomes upset. He feels that meditation goes against his religious beliefs.  How should you handle the situation? 64  Audience Response Question (1 of 2) A patient who is newly diagnosed with cancer is scheduled to consult with an oncologist in several days. What would be the best coping strategy for the nurse to recommend at this time? a. Talk to family and friends about negative feelings. b. Go away for a few days to forget about the situation. c. Seek information about the cancer and treatment options. d. Wait to see what the oncologist recommends for treatment. 65  Audience Response Question (2 of 2) Answer: C Seek information about the cancer and treatment options. 66