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Chapter 13

Stress Management

Goal of Stress Management

To improve quality of life by increasing healthy, effective coping, thereby reducing unhealthy consequences of distress

Dynamic interaction of

Mind
Body
Spirit
Cognitive/emotional states and behavior

Sources of Stress

Stressor: any psychological, environmental, or physiological stimulus that disrupts homeostasis, thereby necessitating change or adaptation
Three categories stressors
Extrinsic factors: stressors over which individuals do not have control (e.g., death of spouse, weather)
Modifiable factors: individual can modify through change environment, interactions, behavior
Intrinsic factors: stressors created or exacerbated by individual response to stress (e.g., negative thinking, procrastination)

Sources of Stress (Cont.)

Stress: the physical, psychological, social, or spiritual effect of life’s pressures and events
Interactive process of appraisal/response
Eustress vs distress

Eustress: challenging and useful stress; not destructive

Distress: chronic or excessive stress; body unable to adapt; threatens homeostasis

Stressors

Textbook Figure 13-1

Homeodynamics

Describes continuously changing nature and interaction among life processes
Extends concept of homeostasis into more inclusive term
Stress threatens homeodynamics which triggers efforts to restore stability
Physiological responses
Behavioral responses
Social responses

Consequences of Stress

Multidimensional effects
Physical
Physiological
Socio-behavioral
Spiritual
General adaptation syndrome (Hans Selye)
Stress can be useful or harmful
Stress increases efficiency and productivity to a point
Point exists where stress has negative impact

Physiological Effects of Stress

Neuroendocrine activation/behavior changes
Fight-or-flight stress response: adaptive, short-term, acute
Hypothalamus signals sympathetic nervous system: epinephrine and norepinephrine
Increased metabolism, pulse, blood pressure, respiration, muscle tension
Maladaptive: cause/exacerbate disease or symptoms of disease

Physiological Stress Response

Textbook Figure 13-2

Psychological Effects of Stress

Contributory role in negative mood states
Anxiety, depression, hostility, anger
Elevated cortisol levels; immune system response
Affects health outcomes in key populations (e.g., elderly, terminally ill, caregivers)
Quality of life
Depressive symptoms
Degree of suffering

Sociobehavioral Effects of Stress (Cont.)

Stress response: individual reliance on less healthy behaviors
Overeating
Excessive use alcohol/drugs
Smoking
Social isolation
Unhealthy behaviors associated with increased morbidity/mortality

Spiritual Effects of Stress

Spirituality: “feelings, thoughts, experiences, and behaviors that arise from a search for meaning…”
Spirituality and religion not synonymous
Stress response: often feel disconnected from life’s meaning/purpose
Spirituality/religiosity: assists coping with stress
Promoting connection with life meaning and purpose: health benefits

Symptoms of Stress

Textbook Figure 13-3 part 1

Symptoms of Stress (Cont.)

Textbook Figure 13-3 part 2

Symptoms of Stress (Cont.)

Textbook Figure 13-3 part 3

Health Benefits of Managing Stress

Stress management is key to disease management and better health outcomes
Caregiver stress/burden is a major concern;
Being a caregiver is taxing
“Sandwich generation”; those caring for their parents while simultaneously raising children
Burnout (stress/burden) is a consequence of caregiver
Social support system protective vs stress-related symptoms and disease

Assessment of Stress

Primary appraisal: descriptions of perceived actual/potential positive and negative outcomes
Negative outcomes: harm (injury, disease, death)
Positive outcomes: challenges which can be managed (graduation, promotion)
Secondary appraisal: individual’s identification of choices to cope with stress
Internal or external resources and responses
Measurement tools:
Improve assessment of stress and coping
Promote accuracy: diagnosis, planning, and evaluating care

Stress-Management Interventions Self-Awareness

Recognize signs (muscle tension resulting in backache, headache)
Attend to cues to reduce negative mood states (anxiety symptoms) or symptoms (stretching for backache)
Nursing role: assist people to identify stress signals, change response (breathe/ relaxation), break stress cycle

Stress-Management Interventions Relaxation

Technique to help develop awareness/ counter-negative effects of stress
Reduces sympathetic arousal
Two components
Repetition of word/thought/activity
Passive disregard of everyday thoughts
Mini-relaxations
Can be used throughout day
Keep initial stress symptoms from intensifying

Stress-Management Interventions Alternative/Complementary Therapies

Developed outside of Western medicine
Acupuncture: ancient Chinese technique
Fine needles placed at specific meridian points on body
Used to reduce pain; prevent/manage disorders
Hypnosis: from Greek word “sleep”
Narrows consciousness; elicits relaxation, inertia, passivity; useful for smoking cessation, anxiety, pain
Reiki: Japanese “universal spirit”
Uses life force energy fields to affect health

Stress-Management Interventions
Additional Modalities

Expressive writing
Telling a story about life events/personal reactions; useful in disclosing/processing emotions; develops insights into problem-solving
Healthy diet
Positive influence on health, physical performance, state of mind; balance in diet improves functioning
Physical activity
Comprehensive health benefits; enhances well-being while decreasing stress

Stress-Management Interventions
Additional Modalities (Cont.)

Sleep hygiene
Altered sleep patterns can result from stress issues; sleep deprivation exacerbates depression/fatigue
Sleep techniques improve quality of life
Cognitive-behavioral restructuring
Modifies negative or exaggerated thinking to reduce stress
Evaluates, challenges thoughts; replaces with more rational responses
STOP, break the cycle, take a breath (relax), reflect, choose a more rational response

Stress-Management Intervention
Additional Modalities (Cont.)

Affirmations
Positive thought (short phrase or saying) that has meaning for person
Repeat affirmation through day—enhances self-esteem and reduces stress
Social support
Network of close family, friends, coworkers, and professionals
Number of supporters and quality of relationships important

Stress-Management Interventions
Additional Modalities (Cont.)

Assertive communication
Need to match statement with intention for effective communication; facilitated by cognitive restructuring
Nonjudgmental, expresses feelings and opinions, reaffirms perceived rights
Format: I feel [emotion] when you [behavior] because [explanation]
Empathy
Consider another person’s perspective and communicate understanding back to person
Active listening (conscious, nonjudgmental)
Reduces emotional arousal, defensive behavior, and conflict

Stress-Management Interventions
Additional Modalities (Cont.)

Engaging in healthy pleasures
Activities that bring feelings of peace, joy, and happiness
Breaking stress cycle more challenging if denied
Spiritual practice
Activities that help people find meaning, purpose, and feeling of connection
Examples: religious or altruistic activities, journal writing

Stress-Management Interventions
Additional Modalities (Cont.)

Clarifying values and beliefs
Identify what is important and meaningful
Implement values and habits to promote stress reduction
Realistic goals
Goal-setting dynamic process
Specific, concrete, measurable, achievable
Attainable goals increase sense of control and mediate negative stress effects
Humor
Laughter: physiological effects similar to exercise
Opens different perspectives and objectivity
Reframes perceptions of an event

Effective Coping

Effective coping: the art of finding a balance between acceptance and action, between letting go and taking control
Stress-management techniques
Differentiate between acceptance and action
Counter harmful effects of stress
Role of nurse—assist individual
To manage extrinsic and intrinsic stressors
To choose the right strategy at the right time