DNP-NT-YO
CONCEPT ANALYSIS
I select the word: Stressor for my Concept Analysis Paper Project from Betty Neuman’
System Model. A concept analysis paper for nursing involves conducting a literature review,
identifying the key characteristics or attributes of the concept, identifying its antecedents and
consequences and apply them to a model case.
Introduction
The exposure to stressful situations is the most common human experiences, the severity
of these situations, many times unexpected, elicits a stress response. The impact of stress is
different from one individual to other. The various types of emotional, physical, social, and
spiritual responses that a person has to stress are set in close relation by stress hormones.
Anything that poses a challenge or a threat to our wellbeing is a stress. Some stresses get you
going and they are good for you, however, when the stresses undermine both our mental and
physical health they are bad. In this Concept Analysis Paper, I will be focusing on stress that is
bad for us.
Stressor Self Concept
The term stress, from my perspective, better describe a disruption of the harmony or
equilibrium cause by a stimulus, phenomenon or event that trigger a response: emotional,
physical, mental or spiritual. Stress can be a positive or negative response, as a consequence of a
stimulus. Every response is different and unique, even in from of the same stimulus. The stressor
sources vary from internal and external.
Related Words
Literature Review
Psychology Definition of Stress:
Stress refers to the emotional and physiological reactions experienced when an individual
confronts a situation in which the demands go beyond their coping resources.
Medical Definition of Stress:
In a medical or biological context stress is a physical, mental, or emotional factor that
causes bodily or mental tension. Stresses can be external (from the environment, psychological,
or social situations) or internal (illness, or from a medical procedure).
Definition of stress by Merriam-Webster Dictionary:
Stress is a constraining force or influence: such as
a: a force exerted when one body or body part presses on, pulls on, pushes against, or tends to
compress or twist another body or body part; especially: the intensity of this mutual force
commonly expressed in pounds per square inch
b: the deformation caused in a body by such a force
c: a physical, chemical, or emotional factor that causes bodily or mental tension and may be a
factor in disease causation
d: a state resulting from a stress; especially: one of bodily or mental tension resulting from
factors that tend to alter an existent equilibrium.
e: strain, pressure <the environment is under stress to the point of collapse.
Chemical Definition of stressor:
A substance that forces change, usually damage, on living organisms or ecosystems, or
reduces their ability to cope with environmental changes. This occurs when the substance is
released unplanned and unwanted into an environment.
Stress is a dynamic process, a review of the literature revealed a variety of disciplines that
utilize the term stress. The majority of the literature was found in the disciplines of psychology
and medicine.
Identify Key Characters
1. Coping mechanism.
2. Adaptive response.
3. Problem solving.
4. Physical and mental equilibrium.
5. Self-esteem.
6. Interpersonal relationships.
7. Response to challenge.
8. Self-efficacy.
Identify Antecedents and Consequences
Stress is a multiplicative function of perceived consequences and the degree of disparity
between perceived demand and perceived ability to face it.
Antecedents:
The significant antecedent of stress is individual's perception of a situation.
1. Deficient development of psychological coping mechanism to confront stressful
situations.
2. Unable to acquire the maximum effective adaptive response to deal with complex and
unexpected circumstances.
3. Inability to improve the capacity to solve difficult situations stablishing strategies.
4. Impediment to keep an adequate mental and physical balance for health adjustment.
5. Decrease of self-perception, self-image, confidence and abilities to react
6. Inconsistent and negative relationships as support system.
7. Incapacity to face challenges properly.
8. Personal incompetence, negativism, demotivation and pessimism to deal with demanding
issues.
Consequences:
The significant outcomes or consequences of stress are effective coping, mastery, and
positive adaptation.
1. Ineffective coping mechanism.
2. Insufficient adaptive response.
3. Unsuccessful problem solving.
4. Disturbances of physical and mental equilibrium.
5. Self-esteem problems.
6. Inability to stablish interpersonal relationships as support system.
7. Inadequate response to challenge.
8. Incompetent Self-efficacy.
Concept Analysis Model Conclusion
Fall Risk is a recurrent problem in the Home Health setting, physical, psychological, and
cost related connotations are the most significant. This problem see under Betty Neuman’s
System Model (NSM) can be prevented. NSM uses primary, secondary, as well as tertiary
prevention mechanisms for maintenance, attainment, and retention for optimal patient system
wellness. The Model incorporated both the individual and the environment in determining client
safety. Neuman’s Model is holistic, universal, comprehensive, and flexible system. Its primary
objective is concentrate on the client response system, as a core, towards the potential or actual
environment stressors. When the client core structure is broken by stressors the normal defense
line, which represent client wellness or adaptation state, is invade compromising the client
equilibrium.
Study Case:
Mr. S. is a male client, 70 years/old, admitted to the facility 3 days ago from the Hospital.
His PMH: HTN, BPH, Glaucoma, and Vascular Dementia. Client is in normal weight range, no
history of alcohol, drug abuse or smoking. Client was considered high risk for falling after
assessment, and measures were instituted for falling precaution. Mr. S. complains of urinary
urgency due to BPH besides his regular treatment, besides of Glaucoma his vision is poor and he
is despair, yelling, irritable, and anxious to find the call light when need to call for assistance, as
a consequence he was seen going to the bathroom without supervision and assistance.
Based on NSM, stressors found to promote fall:
1. Intra-personal stressors: urinary urgency, anxiety, and poor vision.
2. Inter-personal stressor: Feel irritable and anxious when need to call for assistance and is
unable to see the call light. Lack of social, and family usual support.
3. Extra-personal stressor: Change to a new place, and lack of the confidence family
support for his necessities.
Mr. S. was invaded in too short time for multiples stressors (describe above) which
penetrates his lines of defenses, the system integrity was not maintained, and a variance for
wellness occurred with the risk for falling, and injury.
Prevention:
1. Primary: Education provide to a client to call for assistance when feel urinary urgency
and bathroom necessities leaving the call light within client reach. Providing staffing
rounds and supervision frequently to check client status. Request specialties consultation
to reevaluate client symptoms.
2. Secondary: Administering medications ordered for BPH and Glaucoma, to decrease
uncomfortable symptoms. Exploring anxiety and irritability triggers and decreasing
episode frequencies. Allowing that client to verbalize feelings: fears, anger, and desires to
provide adequate symptoms treatment and support. Allowing family to visit resident to
provide support. Providing adequate support system when assisting client necessities.
3. Tertiary: Reeducation, maintain the highest client wellness, achieiving goals in order to
maintain the client stability and avoid fall.
Reconstitution started after identification of stressors breaking client lines of defense,
appropriate Nursing interventions focus on retaining or maintaining system stability with the
application of primary, secondary and tertiary interventions in attempt to restore or maintain the
stability of the client system.
Through the Nursing Application of NSM is possible to achieve goals:
1. Nursing Diagnosis - Based on this assessment of stressors and physiological and
psychological findings, the nursing diagnosis of actual or perceived threat to variance in
wellness was disturbance due to decrease in vision, urinary urgency, anxiousness. The
nurse and patient reviewed the diagnosis and negotiated goals.
2. Nursing Goals - The expected outcome is that the patient will verbalize acceptance of
the idea of his vision loss, and decrease autonomy.
3. Nursing Outcomes - Primary and secondary planned interventions are done with a nurse
to explore the patient’s feelings about diagnosis, symptoms and meaning the disease has
and modifications of expectations and activities. The nurse evaluated the goals after
applying the interventions. The patient developed a therapeutic relationship with nurses.
The patient openly shared and displayed feelings with nurses, expressed fears, anxiety.
The nurses will work with patient to establish long term goals that relate to the
adjustment of having a serious illness with an uncertain impact in his wellness.
NSM is an efficient tool used to evaluate systems interactions, and prevent client injuries.
Health staffing can identify fall risk factors, same as, the stressors interactions breaking the
defense lines of the body. The Model application can be useful not only in the primary
prevention when the fall problem did not take place, and it is possible to reinforce the flexible
line of defense, but even in secondary prevention to assist in the system restoration, and in the
tertiary to maintain stability in order to avoid more damage in the progression to body
equilibrium. I can conclude, with this study case example, that we can successfully apply the
NSM in order to provide fall precaution and prevention.
References
Koolhaas JM et al. (2011). Stress revisited: a critical evaluation of the stress concept.
Neuroscience & Biobehavioral Reviews, 35 (5): 1291–1301
Lazarus R S and Folkman S (1984) Stress, Appraisal and Coping. New York, Springer
Schneiderman N, Ironson G & Siegel SD (2005). Stress and Health: Psychological, Behavioral,
and Biological Determinants. Annual Review of Clinical Psychology, Vol. 1: 607-628
Thoits, P. A. (1994). Stressors and problem-solving: The individual as psychological activist.
Journal of Health and Social Behavior, 35(2) 143-160
University of Kansas Medical Center: Concept Analysis Tutorial "Journal of Advanced
Nursing"; Rethinking Concept Analysis; M. Risjord; 2009
Ume-Nwagbo, P. N., DeWan, S. A., & Lowry, Lois W. (2006). Using the Neuman Systems
Model for Best Practices. Nursing Science Quarterly, 19 (1), 31-35