STRESS AND ADAPTATION

INTRODUCTION

Stress is a common problem that affects all of us at some point in our lives. We generally used
the word stress when we feel that everything seems to have become too much, we are overloaded
and wonder whether we really can cope with the pressures placed upon us. Anything that poses
a challenge or a threat to our well-being is a stress. It is a very individual thing like the situation
that one person find stressful may not bother someone else.

DEFINITION

 Stress is the body’s way of responding to any kind of demand. It can be caused by both
good and bad experiences.
 Stress is the body’s reaction to a change that requires a physical, mental or emotional
adjustment or response.
 A physical, mental and emotional response to events that causes bodily or mental tension.

 “Selye(1958) defined stress as the non specific response of the body to any demand. The
nonspecific response is always the same, it is the degree of the response that changes.’

TYPES

Stress can be of two types

 Positive stress
The stress that comes from good source:
 Marriage
 Birth of a baby
 Winning the lottery
 Negative distress
The stress that comes from bad source
 Difficult work environment
 Overwhelming sights
 Threat of personal injury.

CAUSES OF STRESS

 Survival stress
 Internal stress
 Environmental stress
 Fatigue or overwork
 Emotions
 Relations
 Conflict
 Social situation
 Unemployment
 Post-traumatic stress
 Financial problems
 Irritants
 Health

MANIFESTATION OF STRESS

 Physiological Symptoms
 Muscle cramps
 Skin color white
 Pale lips
 Fist gripping
 Shakes or tremors
 Dilation of pupil
 Tachycardia
 Tachypnea
 Sweating
 Nausea

PSYCHOLOGICAL SYMPTOMS

 Memory problems
 Inability to concentrate
 Poor judgement
 Negativity
 Irritation
 Agitation
 Hostile
 Overacting
 Sense of loneliness and isolation
 Depression
 Constant worrying
 Nail Biting
 Yawning
 Anxious
STRESSORS

‘ A stressor is a chemical or biological agent, environmental condition, external stimulus or an

event that causes stress to an organism’.

TYPES OF STRESSORS

 Internal
- Frustration
- Conflict
- Pressures
 External
- Environmental
- Health
- Financial problems
- Psychosocial
- Workplace stress
- Personal relationships

Stressors related to job/work

 Poor knowledge of job
 Work overload
 Shift work
 Poor leadership
 Low salary
 Job insecurity
 Transfer

Stressor related to personality:

 Misperception of events, situation and people
 Poor decision
 Poor habits
 Irrational beliefs, values and attitudes
 Perfectionist attitude

Other stressors:
 Injury
 Death of loved ones
 Hospitalization
 Fear
 Being abused or neglected
  Legal problems

BASIC CONCEPT OF STRESS OR STAGES OF STRESS

There are three stages a person goes through while suffering from stress

 ALARM STAGE : Look at a student’s face just before he is going to give an exam. Is
not the fear and tension clearly evident? When something has just started stressing you
and you feel a fight of flight kind of attitude, then you are in the alarm stage of stress. It is
the start-up stage which defines the first reaction to the stressor.
This stage experiences an over-acting of the sympathetic nervous system where in
adrenaline and cortical increase and blood flows away from the brain to the muscles. As a
result, dendrites shrink back in the brain to moderate the flow of information, slowing or
closing down the non essential body functions. The whole body starts preparing itself to
fight against the reason of stress. The fear, excitement or pressure is evident on the
sufferer’s face.
 RESISTANCE STAGE: When a child is sitting in the examination hall and writing his
exam, he is bothered about completing it in time. He is making full efforts to cope with
the situation and his whole body is engaged in fighting against the condition. This is the
resistance stage. In this stage, the body keeps making continous efforts to cope with stress
and therefore feels run down and exhausted. The person starts feeling irritated, over-
reacts to minor situations and gets mentally and physically weak. Psychological, physical
and behavioral changes are also clearly visible.
 EXHAUSTION STAGE: If a student is preparing for his exam and despite every
possible effort, he is not able to relate to his studies, he is bound to get stressed. The
stress could reach a height where he/she may feel completely exhausted and helpless to
the extent of committing suicide. This is the exhaustion stage. This stage is further
divided divided into two phases:

- Initial phase – The stress persists and due to lack of appropriate measures the person
is not able to concentrate and work efficiently.
- Burnout – The person is completely exhausted and drained of all energy reserves.
There is a complete physical, psychological and emotional breakdown. This requires
immediate attention.

PSYCHOLOGICAL ADAPTATION TO STRESS ( GENERAL ADAPTATION

SYNDROME)

General adaptation syndrome, or GAS is a term used to describe the body’s short-term and
long-term reactions to stress. Stressors in humans include such as physical stressors as starvation,
being hit by a car or suffering through severe weather.
The general adaptation syndrome represents a three stage reaction to stress:

Stage 1. The alarm reaction(ar): The first stage of the general adaptation stage, the alarm
reaction, is the immediate reaction to a stressor. In the initial phase of stress, humans exhibit a
“fight or flight” response which prepares the body for physical activity. However, this initial
response can also decrease the effectiveness of the immune system making persons more
susceptible to illness during this phase.

Stage 2. Stage of resistance(sr): Stage 2 might also be named the stage of adaptation, instead of
the stage of resistance. During this phase, if the stress continues, the body adapts to the stressors
it is exposed to. Changes at many levels take place in order to reduce the effect of the stressor.

For example: the stressor is starvation, the person might experienced a reduced desire for
physical activity to conserve energy.

Stage 3. Stage of exhaustion(se): At this stage, the stress continued for some time. The body’s
resistance to the tress may gradually be reduced, or may collapse quickly. Generally this means
the immune system, and the body’s ability to resist disease, may be almost totally eliminated.
People who experience long term stress may succumb to heart attacks or severe infection.

STRESS AS A BIOLOGICAL RESPONSE

In 1956, Hans Selye published the result of his research concerning the physiological response of
a biological system to a change imposed on it. Since his initial publication, he has revised his
definition of stress, calling “ the state manifested by a specific syndrome which consist of all the
non specifically- induced changes within a biologic system”. This syndrome of symptoms has
come to be known as “ fight or flight syndrome”. Selye called this general reaction of the body
to stress the general adaptation syndrome. He described the reaction in three distinct stages:

1. Alarm Reaction Stage: During this stage, the physiological responses of the “ fight or
flight syndrome” are initiated.
2. Stage of Resistance: The individual uses the physiological responses of the first stage as
a defense in the attempt to adapt to the stressor. If adaptation occurs, the third stage is
prevented or delayed. Physiological symptoms may disappear.
3. Stage of Exhaustion: This stage occurs when there is a prolonged exposure to the
stressor to which the body has become adjusted. The adaptive energy is depleted, and the
individual can no longer draw from the resources for adaptation described in the first two
stages.

THE BRAIN’S RESPONSE TO ACUTE STRESS

In response to seeing the bear, a part of the brain called the hypothalamic-pituitary-
adrenal(HPA)system is activated
 Release of steroid hormone and the stress hormone cortisol: The HPA system trigger
the production and release of steroid hormones(glucocorticoids),including the primary
stress hormone cortisol. Cortisol is very important in organizing systems throughout the
body(including the heart, lungs, circulation, metabolism, immune systems and skin) to
deal quickly with the bear
 Release of catecholamine: The HPA system also releases certain
neurotransmitters(chemical messengers) called catecholamine, particularly those known
as dopamine, norepinephrine and epinephrine(also called adrenaline)
 Catecholamines activate an area inside the brain called the amygdale, which appears to
trigger an emotional response to a stressful event.

EFFECTS ON LONG-AND SHORT TERM MEMORY: During the stressful event,

catecholamines also suppress activity in areas at the front of the brain concerned with short-
term memory, concentration, inhibition, and rational thought. This sequence of mental events
allows a person to react quickly, either to fight the bear or to flee from it. It also interferes
with the ability to handle difficult social or intellectual tasks and behaviors during that time.

RESPONSE BY THE HEART,LUNGS AND CIRCULATION TO ACUTE STRESS

 The stress response also affects the heart, lungs and circulation.
 As the bear comes closer, the heart rate and blood pressure increase instantaneously.
 Breathing becomes rapid, and the lungs take in more oxygen.

THE IMMUNE SYSTEM’S RESPONSE TO ACUTE STRESS: The effect of the

confrontation with the bear on the immune system is similar to mobilizing a defensive line of
soldiers to potentially critical areas. The steroid hormone reduce activity in parts of the
immune system, so that specific infection fighters or other immune molecules can be
repositioned.

THE ACUTE RESPONSE IN THE MOUTH AND THROAT: As the bear gets closer,
fluids are diverted from nonessential locations, including the mouth. This causes dryness and
difficulty in talking. In addition, stress can cause spasm of the throat muscles, making it
difficult to swallow.

THE SKIN’S RESPONSE TO ACUTE STRESS: The stress effect moves blood flow
away from the skin to support the heart and muscle tissues. This also reduces blood loss in
the event that the bear causes a wound. The physical effect is a cool, clammy, sweaty skin.
The scalp also tightens so that the hair seem to stand up.
 METABOLIC RESPONSE TO ACUTE STRESS: Stress shuts down digestive activity, a
non-essential body function during short-term periods of hard physical work or crisis.

THE RELAXATION RESPONSE:THE RESOLUTION OF ACUTE STRESS

Once the threat has passed and the effect has not been harmful (for example: the bear has
not wounded the human), the stress hormones return to normal. This is known as the
relaxation response.in turn, the body’s system also return to normal

STRESS AS AN ENVIRONMENTAL EVENT

Stress is the ‘ event that triggers the adaptive physiological and psychological responses in an
individual’s. the events create change in life that requires adjustment in lifestyle. The changes
can be positive or negative.

Stress overload merely predisposes a person to illness. Life changes questionnaires have
been criticized because they do not consider the individuals perceptions of the events and these
variations are related to the degree to which the change is perceived as stressful. Positive coping
mechanisms and strong social support can reduce the intensity of the stressful life change and
promote more adaptive response.

STRESS AS A TRANSACTION BETWEEN THE INDIVIDUAL AND THE

ENVIRONMENTS

This definition of stress emphasizes the relationship between the individuals and environment.
Personal characteristics and the nature of the environmental event are considered. This
illustration parallels the modern concept of etiology of disease.

Precipitating Event: A precipitating event is a stimulus arising from the internal or external
environment and is perceived by the individuals in a specific manner. The cognitive response
consist of a primary appraisal and a secondary appraisal.

INDIVIDUAL’S PERCEPTION OF THE EVENT

Primary Appraisal : Lazarus and Folkman (1984) identified three type of primary appraisal :
Irrelevant, benign-positive and stressful. An event is judge irrelevant when the outcome holds no
significance for the individuals. A benign positive outcome is perceived as producing pleasures
for the individuals. Stress appraisal includes harm/loss, threat and challenge. Harm appraisal
refers to damage when an event is appraised challenging the individual is focuses on potential for
gain or growth rather than on risk challenge produces stress, although the emotion associated
with it. Challenge and threat may occur together when an individual experiences this positive
emotion along with fear or anxiety over possible risk associated with the challenging event.
When stress is produced in response to harm/loss threats or challenge, a secondary appraisal is
made by the individual.

Secondary Appraisal: It is an assessment of skill, resources and knowledge that a person

possesses to deal with situation. The individual evaluates by following:

 What coping strategies are available to me?

 Will the option I choose be effective in this situation?
 Do I have the ability to use that strategy in an effective manner?

The interaction between the primary appraisal of the event that has occurred and the
secondary appraisal of available coping strategies determines the individual’s quality of
adaptation response to stress.

Predisposing factors

A variety of elements influence how the individual perceives and response to stressful events:

 Genetic influence
 Past experience
 Existing condition

This transactional model of stress/adaptation serves as a framework for the process of

nursing.

HEALTH PROBLEMS LINKED TO STRESS

 Heart attack
 Hypertension
 Stroke
 Cancer
 Diabetes
 Depression
 Obesity
 Eating disorders
 Substance abuse
 Ulcer
 Memory loss
 Autoimmune disease
 Insomnia
 Thyroid problems
 Infertility
 CRISIS AND ITS INTERVENTION
INTRODUCTION

Stressful situations are part of everyday life. Any stressful situationscan precipitate crisis.crisis
result in a disequilibrium from which many individuals require assistance to recover. Crisis
intervention requires problem-solving skills that are often diminished by the level of anxiety.
Therefore assistance is required to solve the problem and preserve the self esteem. In recent
years people in India have faced a number of of catastrophic events, e.g. earthquake in Sikkim,
floods in Orissa this year etc. the priority of crisis intervention/counseling is to increase
stabilization. Crisis are temporary, no longer than a month, although the effects may become
long lasting.

DEFINITION

Crisis is a sudden event in one’s life that disturbs homeostatsis, during which the individual’s
usual coping ,mechanism cannot resolve the problem. (Lagerquist, 2001)

TYPES OF CRISIS

 Natural disaster
 Technological crisis
 Confrontation
 Malevolence
 Organizational misdeeds
 Workplace violence
 Rumors
 Terrorist attacks/ man made disaster

PHASES OF CRISIS

Caplan (1964) outlined four phases

 Phase I :
 The individual is exposed to a precipitating stressor.
 Anxiety increases and the previous problem-solving techniques are used
 Phase II:
 When the previous problem-solving techniques do not relieve the stressor, anxiety
increases further.
 The individual begins to feel great deal of discomfort at this point
 Coping techniques that have worked in the past are attempted
 When they are not successful, that will create feeling of helplessness
 Feeling of confusion and disorganization prevails.
  Phase III:
 All possible resources both internal and external are called onto solve the prolems
and relieve the discomfort
 The individual may try to look at the problem from different perspectives
 New problem-solving techniques may be used
 If effective, the individual will come out of the stressful situation
 Phase IV:
 If resolution does not occur, the tension mounts beyond the threshold and
individual reaches to a breaking point
 Anxiety will reach to a panic level
 Cognitive functions get disordered
 Behavior may reflect presence of psychotic thinking

CRISIS INTERVENTION

DEFINITION
Crisis intervention is an immediate and short term psychological care aimed at assisting
individuals in a crisis situation to restore equilibrium to their biopsychosocial functioning and
to minimize the potential for long term psychological trauma.

PURPOSE:
 To reduce the intensity of an individual’s emotional, mental, physical and behavioral
reactions to a crisis.
 To help individuals return to their level of functioning before the crisis.
 To assist the individual in recovering from the crisis and to prevent serious long-term
problems from developing.

GOALS OF CRISIS INTERVENTION:

 Reduction in disequilibrium or relief of symptoms of crisis.
 Restoration to precrisis level of functioning.
 Some understanding of the relevant precipitating events.
 Identification of remedial measures.
 Connecting the current situation with past life experiences and conflicts.
 Initiating new modes of thinking, perceiving feeling and developing new
adaptive and coping responses.

Phases of Crisis Intervention: The Role of the Nurse Phase

Phase 1: Assessment
Phase 2: Planning of therapeutic intervention
Phase 3: Interventions
Phase 4: Evaluation of crisis resolution and anticipatory planning.
Phase 1: Assessment
 Ask the individual to describe the event that precipitated the crisis.
 Determine when it occurred.
 Assess the individual's physical and the mental status.
 Determine if the individual has experienced this stressor before. If so, what method of coping
was used? Have these methods been tried this time?
 If previous coping methods were tried, what was the result?
 If new coping methods were tried, what was the result?
 Assess suicide and homicide potential, plan and means.
 Assess the adequacy of support systems.
 Determine level of precrisis functioning.
 Assess the usual coping methods, available support systems and ability to problem solving.
 Assess the individual's perception of personal strengths and limitations.
 Assess the individual's use of substances.

Phase 2: Planning of Therapeutic Intervention

 In planning the interventions, the type of crisis, as well as the individual's strengths and
available resources for support, are taken into consideration.
 Goals are established for crisis resolutions and a return to, or increase in, the precrisis level of
functioning.

Phase 3: Interventions
 Use a reality: Oriented approach. The focus of the problem is on the here and now.
 Remain with the individual who is experiencing panic anxiety.
 Establish a rapid working relationship by showing unconditional acceptance, by active
listening, and by attending to immediate needs.
 Discourage lengthy explanation or rationalization of the situation, promote an atmosphere for
verbalization of true feelings.
 Set firm limits on aggressive, destructive behaviors.
INTERVENTIONS ACCORDING TO TYPES OF CRISIS:

Class 1: Dispositional crisis

Definition: An acute response to an external situational stressor.

Interventions

The mental health counselor provided support and guidance in terms of presenting
alternatives to him/her.
 Needs and issues were clarified and referrals for agency assistance were made.
Class 2: Crises of Anticipated Life Transitions
Definition: Normal life-cycle transitions that may be anticipated but over which the
individual may feel a lack of control.
Interventions
 Physical examination should be performed and ventilation of feelings encouraged.
 Reassurance and support should be provided as needed.
 Services that can provide financial and other types of needed assistance.
Class 3: Crisis Resulting from Traumatic Stress
Definition: Crises precipitated by unexpected external stresses over which the individual has
little or no control and from which he or she feels emotionally overwhelmed and defeated.
Interventions
 The nurse should encourage her to talk about the experience and to express her feelings
associated with it.
 The nurse should offer reassurance and support.
 Discuss stages of grief and how rape causes a loss of self-worth, triggering the grief response.
 Identify support systems that can help her to resume her normal activities.
 Explore new methods of coping with emotions arising from a situation with which she has
had no previous experience.
Class 4: Maturational/Developmental Crises
Definition: Crises that occur in response to situations that trigger emotions related to
unresolved conflicts in one's life. These crises are of internal origin and reflect underlying
developmental issues that involve dependency, value conflicts, sexual identity, control,
capacity for emotional intimacy.
Interventions
 The primary intervention is to help the individual identify the unresolved developmental
issue that is creating the conflict.
 Support and guidance are offered during the initial crisis period.
 Then assistance is given to help the individual work through the underlying conflict in an
effort to change response patterns that are creating problem in his current life situation.
Class 5: Crises Reflecting Psychopathology
Definitions: Emotional crises in which pre existing psychopathology has been instrumental in
precipitating the crises or in which psychopathology significantly impairs or complicates
adaptive resolution. Examples of psychopathology that may precipitate crises include
borderline personality, severe neuroses or schizophrenia.
Interventions
 The initial intervention is to help bring down the level of anxiety that has created the feeling
of unreality in him/her.
 After the feelings of panic anxiety have subsided, she should be encouraged to verbalize the
feelings of abandonment.
 Regressive behavior should be discouraged.
 Positive reinforcement should be given for independent activities and accomplishments.
 Referral to the long-term care facility may be required.
Class 6: Psychiatric Emergencies
Definition: Crisis situations in which general functioning has been severely impaired and the
individual rendered incompetent or unable to assume personal responsibility. Examples
include acutely suicidal individuals, drug overdoses, and reactions to hallucinogenic drugs,
acute psychoses, uncontrollable anger and alcohol intoxication.

Interventions
 Monitor vital signs.
 Maintenance of an adequate airway.
 Initiate gastric lavage.
 Administer activated charcoal to minimize absorption.
 Encourage to ventilate her feelings.
 Establish more adaptive ways of coping with the stressfid situations.

Techniques
 Catharsis.
 Clarification.
 Suggestions.
 Support of defenses.
 Raising self-esteem.
 Exploration of the solutions.
Medications
 Benzodiazepines .
 Antianxiety .
 Sedative hypnotic agent.
 Phase 4: Evaluation of Crisis Resolution and Anticipatory Planning
During the evaluation period, the nurse and client summarize what has occurred during the
intervention. They review what the individual has learned and "anticipated" how he or she
will respond in the future. A determination is made regarding follow-up therapy; if needed,
the nurse provides referral information.
CONCLUSION
Stress can be confronted and reduced if and only if we understand ourselves better, analyze
the behavior and identify the stressors. The stress management techniques will work if we
are honest with ourselves and adopt the techniques in their fullest spirit. But then stress is
necessary for human progress. It is like the strings of a musical instrument where an
optimum amount of stress is necessary to produce good music. Loose wires (less stress)
would not produce the notes and too much of tension (excessive stress) would lead to
screening.

REFERENCES

1. Vati Jogindra, Principles and Practice of nursing management and administration. 1 st ed.
Delhi; Jaypee brothers medical publishers (P) Ltd, 2013 p 560-568
2. Brar kaur Navdeep, Rawat HC, Textbook of advanced nursing practice. 1 st ed. New
Delhi; Jaypee Brothers Medical publishers(P) Ltd: 2015. p 1000-1009
 3. Smeltzer C Suzanne, Bare G Brendon, Brunners and Siddarth’s textbook of Medical and
surgical nursing. 11th ed. New Delhi; Wolters Kluwer publisher(P) Ltd: 2008. P 900-915
4. Basavanthappa BT, Medical Surgical Nursing. 2nd ed. New Delhi; Jaypee Brothers
Medical Publishers(P) Ltd: 2009.p 750-755
5. Samta soni, Textbook of Advance Nursing Practice. 1 st ed. New Delhi; Jaypee Brothers
Medical Publishers(P) Ltd: 2013.p 118-125
6. Townsend C. Mary, Psychiatric Mental Health Nursing.1st ed. New Delhi; Jaypee Brother
Medical Publishers(P) Ltd: 2010.p 3-5.

JOURNAL ABSTRACT

A study of Learning stress and stress management strategies of the students of post
graduate level:

Author: Qadir Bukhsh, Muzammil Nisa, Abid Shahzad

Abstract:

This study was design to Study Learning Stress and Stress management Strategies for University
students. The objective of the study were to find out the common symptoms of stress, causes of
stress and to suggest stress management strategies used by students for coping with stress. For
collecting data, survey method was adopted . this survey was completed by following the
procedure of descriptive method of research. 39 questions were used for for data collection.200
students from different departments of the Islamia University of Bahawalpur were chosen as a
sample of the study. This study concluded that majority of the students felt fatigue during stress.
Burden of study, assignments were major causes of stress and they agreed that they reduce stress
by watching T.V/Movies, listening to music or take part in other leisure time activities. It was
recommended that burden of study may be reduced by conducting co curricular activities in
academic area.

INTRODUCTION
According to the WHO, "Reproductive and sexual ill-health accounts for 20% of the global
burden of ill-health for women and 14% for men.
It is closely related to other aspects of health. Love, affection and sexual intimacy, all play a
role in healthy relationships. Sexual health is not just limited to the absence of disease or
dysfunction during the reproductive years, it impacts on sexual practice and actions and must
be practiced free from sexual abuse, or discrimination and requires integration into the whole
life cycle.
The word "Sex denotes whether a person is male or female or the sex difference". But
sexuality is related to sexual behavior, gender consciousness, sexual nature, etc.
Sex: Sex is the term most commonly used to identify biologic male or female status.
Sexual Health: Like health, "sexual health" is difficult to define. For most people, sexual
health is a phenomenon that is not considered until its absence or impairment is noticed.

DEFINITION
In 1975, WHO defined sexual health as, "integration of the somatic, emotional,
intellectual, and social aspects of sexual being, in ways that are positively enriching and that
enhance personality, communication, and love." This definition recognizes the biologic,
psychological, and sociocultural dimensions of sexuality.

COMPONENTS OF SEXUAL HEALTH

Four critical components of sexual health are:
1. Self-concept
2. Body image
3. Gender identity
4. Sexual orientation.
1. Self-concept
It means how one values oneself as a sexual being, determines with whom one will have
sex, the gender and the kind of people person is attracted to. A positive sexual self-concept
enables people to form intimate relationship throughout life. A negative sexual self-concept
may impede the formation of relationships.
2. Body Image
A central part of the sense of self, is constantly changing, pregnancy, aging, trauma,
disease, and therapies can alter an individual's appearance and function, which can affect body
image. How a person feels about her or his body is related to one's sexuality. People who feel
good about their bodies are likely to be comfortable with and enjoy sexual activity. People
who have a poor body image may respond negatively to sexual arousal.
3. Gender Identity

It is ones self-image as a female or male. More than just the biologic component, it also
includes social and cultural norms. Gender identity is the result of a long series of developmental
events that may or may not conform to one's apparent biologic sex. Once gender identity is
established, it cannot be easily changed.
4. Sexual Orientation
The preference as well as the physical and emotional attraction one develops for a partner of
particular gender. Sexual orientation, e.g.
Heterosexuality: Sexual activity between male and female
Homosexuality: Between two members of same sex
Bisexuality: It is having an equal or almost equal preference for partner of either sex

SEXUAL GROWTH AND DEVELOPMENT

Human sexuality is based on the genetic determination of gender at the moment of
conception when either the X or the Y chromosome in the sperm unites with the X chromosome
of the egg.
Chromosomal Linkage
XX Chromosomes combination produces a female
XY Combination is a male.
Hormonal action has an effect on genetic programming. Sometimes, between 4th and 8th week
after conception, testosterone (the male sex hormone) is secreted by the embryos rudimentary
testes. If it is not secreted, the embryo will develop as a physical female despite the presence of
the male chromosomes.

Establishment of Gonadal Sex

Second stage of sexual differentiation occurs by about the 10th to the 12th week of
gestation. All fetuses, at conception, are considered dimorphic. The male determining factor in
the Y chromosome leads to the development of the internal testes from the gonad medulla;
without the male factor, there is development of the internal ovary from the gonad cortex.
Establishment of Phenotypic Sex
When the additional internal and external genital organs develop and result in the actual
characteristics of biologic sex. This is a critical time in sexual differentiation because each fetus
develops both the Wolffian and Mullerian genital duct systems, one of which must develop and
other regresses to produce actual male or female external genitalia.

The Wolffian duct system in the presence of testosterone gives rise to the epididymis,
the vas deferens, and the seminal vesicles in male
The Mullerian duct gives rise to the female Fallopian tubes, the uterus, and the upper part of the
vagina. Sexual development throughout life:

AGE GROUP AND SEXUAL HEALTH BEHAVIOR

Childhood Sexual Behavior

 Curiosity regarding the sex organ of opposite sex
 Masturbation
 Questions regarding pregnancy, child birth and questions related to sexual matters.
Adolescence Sexual Behavior
 Self masturbation
 Sex experimentation
 Desire for partner
 Love affair
 Chatting or surfing on computer .
 Problems related to marriage, unwed mother or rape.

Adult Sexual Behavior

 Problems of adjustment in sexual behavior

 Extramarital relations.
 Divorce
 Sexually transmitted diseases
 Unwanted pregnancy.
Old Age Sexual Behavior
 Lack of sexual stimulation
 Degeneration of organs
 Death of life partner
 Diseases related to sexual glands
 Divorced or widow also have to face many sexual problems.
CHARACTERISTICS OF SEXUALLY HEALTHY PERSON
  The person who has the knowledge about sexuality and sexual behavior
 One who has the positive attitude towards body image
 Ability to express one's full sexual potential
 Ability to make autonomous decisions about one's sexual life
 Experience of sexual pleasure as a source of physical, psychological, cognitive and
spiritual well-being
 Capability to express sexuality
 Right to make free and responsible reproductive choices
 Ability to access sexual healthcare
 Maintain balance between life style and sexual behavior
 Capacity to develop effective interpersonal relations with both sexes.
FACTORS AFFECTING SEXUAL HEALTH
The factors affecting sexual health are:
1. Biological factors
2. Psychological factors
3. Environmental factors
4. Hormonal factors
5. Medications
6. Sexual health history
7. Stress
1. Biological Factors
 Congenital abnormalities
 Old age and sickness
 Injuries (affecting nerves, physical or reproductive system, etc.)
 Less secretion of hormones or reasons related to endocrine glands
 Pain, fatigue, etc.

2. Psychological Factors
Pre-disposing Factors

 Disturbance/obstacles in family relationship

 Incomplete sexual knowledge
 Initial sexual experience being bitter
 Disinterest or disliking for partner.
Assisting and Maintaining Factors
 Unnecessary hopes and expectations from the partner
 Tension and pressure
 Sense of guilt regarding sexual relationship
 Death of beloved one
 Wrong notions and superstitions regarding sexual relationships.

Environmental Factors
 Change in lifestyle
  Lack of poor place and privacy
 Incidents in life.

Hormone/Genetic Factors

 Can affect sperm quality

 Production and ovulation (e.g. failure to ovulate regularly, or irregular menstrual
cycle, may be caused by problems with the hypothalamus and pituitary gland)
 Congenital factors may impede ability to conceive (e.g. born without uterus).

Sexual Health History

 Lack of understanding of one's own reproductive biology and a lack of awareness of

factors that can impact fertility
 Multiple sexual partners increase the risk for STTs, pelvic inflammatory disease and
cervical cancer
 Sexually transmitted and pelvic conditions, if left untreated, can cause conditions
in both males and females which can impair fertility
 Infectious diseases such as mumps after puberty can cause sterility.

Stress

 Psychological stress (e.g. depression, difficulty sleeping, anxiety)

 Physiological stress (increased muscle tension, lack of energy, nervousness) affect libido
 Stress affects the ability to make healthy lifestyle choices (e.g. alcohol, other
substance use, smoking, decrease in physical activity or sedentary living, poor
nutrition) which in turn also affects fertility.

Effect of Medication

Medication Possible effects

Viagra (Siidenafil) Restores and increases efficiency of erectile functions in males

Alcohol Moderate amounts: Increased sexual functioning

Chronic use: Decreased sexual desire, orgasmic dysfunction and impotence

Alpha-blockers Inability to ejaculate

Amphetamines Increased sex drive, delayed orgasm

Anabolic steroids Decreased sex drive, shrinking of testicles and infertility in men

Anti-anxiety agents Decreased sexual desire, orgasmic dysfunction in women; delayed ejaculation

Anti- convulsants Decreased sexual desire; reduced sexual response.

Anti-depressants Decreased sexual desire; orgasmic delay or dysfunction in women;

delayed or failed ejaculation; painful erection

Anti-histamines Decreased vaginal lubrication; decreased desire

Anti-hypertensive Decreased sexual desire; erectile failure; ejaculation dysfunction
Anti-psychotics Decreased sexual desire; orgasmic dysfunction in women; delayed
ejaculation or ejaculatory failure
Barbiturates In low doses, increased sexual pleasure; in large doses, decreased sexual
desire, orgasmic dysfunction, and impotence
Beta-blockers Decreased sexual desire
Cocaine Increased intensity of sexual experience; with chronic use, decreased
sexual desire, orgasmic dysfunction, and impotence
Diuretics Decreased vaginal lubrication, decreased sexual desire; erectile
dysfunction.
Marijuana Prolonged use reduces testosterone levels and reduces sperm production
Narcotics Inhibited sexual desire and response; erectile and ejaculatory
dysfunction

NURSE'S ROLE IN SEXUALITY AND SEXUAL HEALTH

Reproductive and sexual health care (including abortion and reproductive and genetic
technologies) is an integral part of individual, family and community services provided by
professionals and others in the health care system. Over the past decade, nurses have advanced
their roles within sexual and reproductive health care services, leading to improved service
delivery and modernization.
Nurses have a professional responsibility to provide high quality, nonjudgmental
reproductive and sexual health care for their clients. Provision of services appropriate to the
needs and welfare of the client/family takes precedence over the nurse’s personal beliefs.
Factors such as the client's health status, race, religion or absence thereof, ethnic origin, social
or marital status, sex or sexual orientation, age or occupation must not be permitted to
compromise the nurse's commitment to that client's care.
There is now a high incidence of teenage pregnancy and STIs. Nurses are in an ideal
position to give sexual health advice to this age group, because they often have contact with
teenagers for other reasons, such as chronic disease management and routine vaccination, in
particular the new HPV immunization campaign.
TEACHING SELF-EXAMINATION
  Monthly breast self-examination for women and monthly testicular self-examination for
men. Clients need to be assured that most lumps discover are not cancerous, but that it is
essential that all the lumps or other detected abnormalities be checked by the client's
primary care provider for accurate diagnosis
 For BSE a regular time is best: Such as 1 week following menstruation, when breast
tenderness and fullness caused by the fluid retention subsided, or on the same day of the
month for postmenopausal women

 TSE should also be performed on same day of each month, starting at the age of 15. The
best time for the TSE is after a warm bath or shower when the scrotal sac is relaxed.
SEXUAL EDUCATION AND COUNSELING
 Nurses can assist clients to understand their anatomies and how their bodies function.
The importance of open communication between partners should also be encouraged
 Details about physiological changes. For example, puberty, pregnancy, menopause and
male climacteric on sexual function
 Parents often need assistance to learn ways to answer questions and what information to
provide for their children starting in the preschool years.

REPRODUCTIVE AND GENETIC TECHNOLOGIES

Nurses with expertise in the field of reproductive health have the necessary knowledge
and holistic approach to contribute to well-informed decisions about: which technologies are
available, who should use reproductive and genetic technologies, and how these technologies
will be monitored and evaluated. Nurses' involvement in addressing these issues at all levels
from public policy to practice is crucial. Health promotion and disease prevention strategies that
address the known causes of infertility must be given priority as effective and efficient means of
increasing fertility (Canadian Nurses Association, 2002).

SEXUAL AND REPRODUCTIVE TRACT INFECTIONS

Advise sexual abstinence (including oral sex) or condom use where an STI is suspected,
until treatment has been undertaken, for at least one week after treatment, and, ideally, until
treatment has been proved effective. Nurses need to find their own way of eliciting a patient
history without being judgmental or trying to force their own sexual morals onto the patient.
Motivational interviewing and counseling skills can be useful tools, particularly when a lot of
information and advice needs to be supplied within a short time.

CONCLUSION:
Sexual health is vital to human society because we are all mortal, and have to produce
healthy children if society is to survive. Sexuality is all this, including the way religion, morals,
friends, age, body concepts, life goals and self esteem shape your sexual self. Understanding
sexuality fosters and encourages the development of good relationships throughout our lives.
REFERENCES:
1. Brar K Navdeep and etal. Textbook of advanced nursing practice. 2015. Jaypee Brothers
Medical Publishers (P) Ltd New Delhi Pp: 846-64
2. Lewis L. Sharon and etal .Medical- surgical nursing. 2015. Elsevier India Private limited,
New Delhi Pp: 1283-94
3. Nettina M Sandra. Lippincott manual of nursing practice. 9th edn. 2010. Walters Kluwer
(P) Ltd New Delhi Pp: 1669-70