Stress , adaptation and coping strategies
Introduction
• Stress is a universal phenomenon .
• All people experience it .
• Every people experience stress according
to the adaptation .
• Stress can be the result of positive and
negative experiences.
Concept of stress
• Stress is a condition in which the person
experience changes in the normal balanced
state.
• According to Brunner and Suddarth stressor
is defined as an internal or external event or
situation that creates the potential for
physiologic, environmental , emotional,
cognitive, or behavioral changes in an
individual.
• When a person faces the stressors ,
responses are referred to as coping strategies,
coping resources or coping mechanism
Adaptation:
• According to Brunner and Suddarth
adaptation, or adjustment to the change so that
the person is equilibrium and has the ability to
meet new demands.
• Adaptation is generally considered a
person’s capacity to survive and to flourish.
Definition
• According to Brunner and Suddarth, “ stress
is a state produced by a change in the
environment that is perceived as challenging,
threatening or damaging to the person’s
dynamic balance or equilibrium.”
• According to Hans Selye’s ,“Stress is a non-
specific responses to any kind of demand
made upon it.”
TYPES OF STRESS
• According to Hans Selye it is of two
types:
• Eustress(positive )
Stress that helps us function better. In fact, a
bit of stress can be energizing and motivating,
that is why many of us work best under
pressure.
• Distress( negative)
Stress that cause mental agony. Stress can be
mild moderate or severe
SOURCES OF STRESS:
• Internal stressor: It originates within a
person, for example, feelings of depression.
• External stressor: It originates outside the
individual, for example, a move to another city,
a death in the family or pressure from peers.
• Developmental stressor: It occurs at
predictable times throughout an individual’s
life.
TYPES OF STRESSOR:
Day to Day frustration or hassles:
• the day to day stressors, includes such
common occurrence as getting caught in traffic
jam, experiences computer downtime, and
having an argument.
Major complex occurrences involving large
groups, even entire nations:
• The second group of
stressors influences larger groups of people,
possibly even entire nations. Eg.terrorism and
war,
Stressors that occur less frequently and
involve fewer people:
• concerns relatively infrequent situation that
directly affect the individual. This category
includes the influence of life events such as
death, birth, marriage, divorce and retirement..
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• An acute time limited stressor, such as
studying for final examination
INDICATORS OF STRESS:
• Physiologic Indicators:
Responses to stress vary depending
on the individual’s perception of events.
• The physiologic signs and symptoms of
stress result from activation of stress result
from activation of the sympathetic and neuro
endocrine systems of the body.
Psychologic Indicators:
1. Anxiety :
A common reaction to stress is
anxiety, a state of mental uneasiness,
apprehensive, death, or a feeling of
helplessness related to an impending or
anticipated unidentified threat to self or
significant relationships.
Anxiety may be manifested on four levels:
• Mild anxiety
• Moderate anxiety
• Severe anxiety
• Panic
2.Fear:
Fear is the emotion or feeling of apprehension
aroused by impending or seeming danger,
pain, or another perceived threat.
• The fear may be in response to something
that has already occurred, in response to an
immediate or current threat.
3.Angry:
Anger is an emotional state consisting of a
subjective feeling of animosity or strong
displeasure.
4. Depression:
Depression is a common reaction to events
that seem overwhelming or negative.
Depression, an extreme feeling of sadness,
despair, dejection, lack or worth, or emptiness
Responses to the stress
• Physiological responses:
• Responses to stress vary depending on the
individual’s perception of events.
• Physiological signs and symptoms of stress
results from the activation of sympathetic and
neuroendocrine systems of body.
Symptoms:
• Pupils dilate - increase visual perception
when serious threats to body arise .
• Sweat production increases – to control the
elevated heat .
• Heart rate and cardiac output increases-
circulates blood quickly to area where it is
needed.
• RBC production increases
• Skin is pallid- construction of peripheral
blood vessels , an effect of epinephrine
• Sodium and water retention increases –
due to release of mineral corticoids , which
increases the blood volume.
• Rate and depth of respiration increases-
because of dilation of bronchioles , promoting
hyperventilation .
• Urinary output decreases.
• Mouth may be dry .
• Peristalsis of intestines decreases –
resulting in possible constriction and flatus.
• Muscle tension increases- rapid motor
activity
• Liver converts glycogen into glucose and
releases energy .
• blood sugar increases – because of release
of glucocorticoids and gluconeogenesis.
Psychological, behavioral responses
. Anxiety :
A common reaction to stress is anxiety, a
state of mental uneasiness, apprehensive,
death, or a feeling of helplessness related to
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an impending or anticipated unidentified threat
to self or significant relationships.
Anxiety may be manifested on four levels:
• Mild anxiety-
• Moderate anxiety
• Severe anxiety
• Panic anxiety
Mild anxiety
• It is the commonest reaction to the stress
which enhances perception, learning and
productive abilities.
• Most health person experience mild anxiety
• Responses: mild restlessness
Moderate anxiety
• The responses are seen based upon the
expression of tension , nervousness or
concern.
• Perceptual abilities are narrowed.
• Attention is focused on particular aspect of
situation than on peripheral activities.
Severe anxiety
• In this most person requires the intervention
.
• Perception is further decreased.
• Unable to focus
• Focuses on specific situation generating
anxiety
Panic anxiety
• The most severe form of anxiety .
• Frightening level of anxiety
• Looses the control
• Perceptual interpretation is markedly
disturbed.
FEAR
• Fear is the emotion or feeling of
apprehension aroused by impending or
seeming danger, pain, or another perceived
threat.
• The fear may be in response to something
that has already occurred, in response to an
immediate or current threat.
• The object of fear may or may not be
based upon the reality .
• E.g. first experience of nursing students in
hospital setting
• Anger
• Anger is an emotional state consisting of a
subjective feeling of animosity or strong
displeasure.
• People may feel guilty when they feel angry
because they have been taught that to feel
angry is wrong .
Depression
• Depression is a common reaction to events
that seem overwhelming or negative.
Depression, an extreme feeling of sadness,
despair, dejection, lack or worth, or emptiness
EFFECTS OF STRESS:
• Stress can have physical, emotional,
intellectual, social and spiritual consequences.
• Usually the effects are mixed, because
stress effects the whole person.
Physical effect
• Physically, stress can threaten a person
physiologic homeostasis.
• Example : increase in BP, raise in
temperature, excessive sweating , headache
Emotional effect
• Emotionally stress can produce negative or
non constructive feelings about the self.
• Example: helplessness, worthlessness. Not
good enough to live
Intellectual effect
• Intellectually stress can influence a person’s
perceptual and problem-solving abilities.
• Example: fear of exam, forgetfullness
Social effect
• Socially, stress can alter a person’s
relationships with others.
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• Example: lives alone, ignores the group, • It can reduce the stress temporarily but can
doesnot talk with anyone not deal with the reality permanently .
• They may even have a destructive or
Spiritual effect detrimental effect on the person
• Spiritually stress can challenge one’s • E.g. alcoholism , drugs, day dreaming ,
beliefs and values. fantasizing
• Example: does not believe in god, does not III types of coping
pray. • Adaptive
• maladaptive
Factors affecting client’s and family’s
responses to stress Coping strategies Adaptive coping
• Coping may be defined as the way of dealing • It helps the person to deal with the stressful
with the change – successfully or events/situations effectively and helps to
unsuccessfully . minimize the stress.
• A coping strategies is a natural or learned Maladaptive coping
way of responding to a changing environment • It helps to increase the mental agony and
or specific problems. unnecessary distress related to the events .
folkman and lazarus Defense mechanism
• Coping is the cognitive and behavioral effort • A defense mechanism is a coping
to manage specific, internal or external technique that reduces anxiety arising from
demand that is appraised. unacceptable or potentially harmful stimuli.
Types of coping • Defense mechanisms are unconscious
• Problem focused coping and are not to be confused with conscious
• Emotion focused coping coping strategies.
Problem focused coping • Defense mechanisms may result in healthy
• It refers to efforts to improve a situation by or unhealthy consequences depending on the
making changes or taking some actions. circumstances and frequency with which the
Emotion- focused coping mechanism is used
• It includes the thought and actions that • Sigmund Freud was one of the first
relieves the emotional distress. proponents of this construct.
• It does not improve the situation but the Type of defense mechanism
person often feels better. • Compensation
II types of coping Projection
• Short term coping • Denial
• Long term coping Minimization
Long term coping • Displacement
• It can be realistic and constructive. Rationalization
• E.g. talking with others and trying to find out • Identification Reaction formation
more about the situations . • Intellectualization
• E.g changing the lifestyle patterns such as Regression
eating healthy diet, exercising etc • Introjection
Short term coping Repression
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• Sublimation
Substitution
• Undoing
Compensation
• Covering up weakness by emphasizing a
more desirable trait or by overachievement in a
more comfortable way .
e.g. a high school student is too small to play
football but becomes the star long- distance
runner for the track team .
Denial
• An attempt to ignore or screen
unacceptable realities by refusing to
acknowledge it .
• . I wasn’t so drunk I could not drive.
• Eg. A women is told that her father has
cancer and she plans a reunion 18 months in
advance.
Displacement
• The transferring or discharge of emotional
reactions from one object to other object or
person
• • Justification of certain behaviors by faulty
• Eg. When a husband and wife are fighting
he becomes so angry that he hits the door.
Identification
• An attempt to manage the anxiety by
imitating the behavior of someone feared or
respected.
• Eg. A student nurse imitates the nurturing
behavior that she observes from one of her
instructor
Intellectualization
• A mechanism by which an emotional
responses that normally would accompany an
uncomfortable or painful incident is evaded by
the use of rational explanations that removes
from the incident.
• eg. The pain over the patient’s sudden
death is reduced by saying he would not have
wanted to live with disability .
Introjection
• A form of identification that allows for the
acceptance of other’s norms and values into
oneself , even contrary to one’s own previous
assumption
• E.g. A brother tells his sister “do not to talk
to the strangers” because this value is
introjected by the parents and elders
Minimization
• Not acknowledging the significance of one’s
behavior.
• E.g. don’t believe everything my wife’s says
Projection
• A process in which blame is attached to
others or environment for unacceptable
thoughts, desires, shortcomings
• E.g. If a child fails , mother blames it is
because teacher did not teach properly.
Rationalization
logics that are socially acceptable but did not in
fact inspire the behavior.
• Eg. A mother spanks the toddler too hard
and says it was alright because he could not
feel the pain as he has wore the diapers.
Reaction formation
• A mechanism that causes the people to act
exactly opposite to the way they feel .
• . E.g. if a wife is infatuated with a man who
is not her husband, reaction formation may
cause her to – rather than cheat – become
obsessed with showing her husband signs of
love and affection
Regression
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• Restoring to an earlier more comfortable Measures to reduce stress
level of functioning that is less demanding and • A,B,C- awareness, belief , commitment.
responsible • Diet
• E.g. the child may starts bed wetting or • Stress diary .
thumb sucking • Job analysis.
• Child may ask bottle when new baby • Performance planning
brother is being fed. • Mental imagery.
Repression • Relaxation technique.
• It is an unconscious mechanism employed • Anger management.
by the ego to keep disturbing or threatening • Music therapy
thoughts from becoming conscious • Yoga.
• The repressed material is denied of • Acupuncture.
entering to the consciousness. • Reiki therapy
• E.g. forgetting sexual abuse from childhood • Pet therapy
due to trauma and anxiety . • Thought stopping technique
Sublimation • Behavior technique/ therapy : catharsis ,
• Displacement of energy associated with ventilation , positive reinforcement , modeling
more primitive sexual or aggressive drives into • Assessing for : Client :
socially acceptable activities. • History of patient
• Punching a bag to channel angry impulses. • Assessment of knowledge .
• Physical examination : indicators of stress
Undoing like biting nails, weight changes .
• It is an attempt to take back an unconscious • Assessment of the stressors.
behavior or thought that is unacceptable or • Assessment of self care abilities
hurtful . • Assessment of coping strategies used in
• E.g. after realizing that you have insulted the past and present .
someone intentionally or unintentionally , you • Assessment of level of stress
might praise about her beauty for 2 hours. • Assessment of level of stress based on the
Substitution development transitions.
• It is the mechanism by which tension or • Assessment of family’s support
anxiety is reduced by replacing unachievable • Assessment of role expectation
goal with achievable goals. • Assessment of self harm and violence
• A woman who failed nursing for times ,
works as a nursing aide just to be in hospital . Nursing diagnosis
Suppression • Anxiety
• Consciously putting a thought or feeling out • Care giver role strain
of mind. • Compromised family coping
• Eg. I wont deal with that today I will deal it • Impaired verbal communication
tomorrow. • Social isolation
Fantasy or day dreaming • Ineffective coping mechanism
• Unfulfilled wishes and desires are imagined
or fulfilled. Planning
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• Nurses develops the plan of action in • Finding out the outcome:Evaluating the
collaboration with patient and other health care symptoms present and the symptoms which is
team member. improved .
Implementation
• 1. Encouraging health promotion
strategies:
 Many health promotion strategies like
exercise, optimal nutrition , rest and sleep ,
time management can be taught to the
patient .
Exercise
• It promotes both the physical and mental
health
• Deep breathing exercise
• Yoga
• Meditation Benefits:
Improvement of muscle tension Increased
cardio pulmonary function Weight control
Relief of tension

Nutrition
• Optimal nutrition is essential for health
• Avoidance of caffeine, salt, sugar ,fat and
deficiencies in vitamins and minerals.
Sleep
• Every individual needs sleep of maximum 8
hrs and minimum 6 hrs.
• Adequate sleep may need comfort, relief
from discomfort and pain
Time management
• People who manages their time effectively
are considered to be having less stress and
tension
• Client who feels overwhelmed needs to
prioritize their task .
Evaluation
• Evaluating weither the outcome is met or
not .
• Finding out the level of stress
• Assessing the level of stress and coping by
various tools available in ward Eg. Lazarus and
Folkman inventory scale
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