CONCEPT OF STRESS

AND COPING
By: Farzana Kausar Khattak
Lecturer
KMU-INS
OBJECTIVES
At the end of this session, students will be able to:
.

1. Define coping stress tolerance pattern.

2. Differentiate the concepts of stress as a Stimulus, Response,
and Transaction.
3. Identify Physiological and Psychological manifestations of
stress.
4. Discuss factors affecting coping pattern during hospitalization.
5. Describe various types of coping pattern.
6. Discuss the nursing process related to coping stress pattern.
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INTRODUCTION
 Stress is a universal experience, can be the catalyst for
positive change or it can be the source of discomfort and
pain.
 Successful stress management is necessary for wellness of
both patient and nurses.
 The individual’s perception of the stressor greatly
determines whether the outcome is positive or negative.
 Any event can be stressful, depending on the person’s
interpretation of that event .
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CONCEPT OF STRESS
 Stress is a condition in which the person experiences
changes in the normal balance state.
 A stressor is any event or stimulus that causes an individual
to experience stress.
 When a person faces stressors, responses are referred to as
coping strategies, coping responses, or coping mechanisms.

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 STRESS AND ANXIETY
 Stress is a reaction to difficult or challenging situations in
your life.
 Anxiety is a feeling of unease, often without a clear
reason, and it can be a general sense of worry or fear that
persists.
Stress is the person’s physiological response to a stimulus,
whereas Anxiety is the psychological response to a threat.

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STRESS AS A STIMULUS
 This theory sees stress as an external event or stimulus that
causes a person to experience stress.
 It suggests that certain situations, such as a demanding job
or a challenging life event, are inherently stressful and will
produce stress reactions in most people.
 Stress is viewed as a response to these external stressors,
and it's assumed that all individuals will experience the
same level of stress when exposed to the same stressor.
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STRESS AS A TRANSACTION
 Richard lazarus developed the Transactional Theory of stress
and coping.
 The theory describes stress as a product of interactions between
a person and their environment.
 It emphasizes that not all individuals will experience the same
level of stress in response to the same stressor.
 The way we interpret or react to an event can often have a more
powerful impact on our stress level than the event itself.
 For example, one person might regard spilling coffee as a minor
inconvenience, and just mop up and carry on. Another might get
upset and let it ruin her whole day.
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In simpler terms, Stress as a Stimulus Theory says stress
is something external causing stress for everyone
while Stress as a Transaction Theory says stress is the
product of how you interpret and deal with those events.
It highlights that our thoughts, feelings, and actions play
a crucial role in how we experience stress.

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STRESS AS A RESPONSE
General Adaptive Response (GAS)
An adaptive response in General Adaptation Syndrome where
our body moves from homeostasis to crises:
• Alarm Phase: Fight or flight response
• Resistance Phase: Homeostasis
• Exhaustion Phase: Malfunction of body part
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GENERAL ADAPTATION SYNDROME:
 Hans Selye (1976) , a Canadian Endocrinologist, introduced
the concept of the General Adaptation Syndrome (GAS).

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STAGE-I: ALARM REACTION
 It is immediate reaction to a stressor.
 Humans exhibit a “Flight or Fight” 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.

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STAGE-II: 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 stressor.
 For example, if the stressor is starvation (possibly due to
Anorexia), the person might experienced a reduced desire
for physical activity to conserve energy, and absorption of
nutrients from food might be maximized.

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STAGE-III: EXHAUSTION
 At this stage, the stress has continued for some time. The body’s
resistance to the stress may gradually be reduced, or may
collapse quickly. Generally, this means the Immune System, and
the body ability to resist disease, may be almost totally
eliminated.
 Patient who experience long-term stress may give way to Heart
Attacks or severe infection due to reduced immunity.
 For example, a person with a stressful job may experience long
term stress that might lead to high blood pressure and an
eventual Heart Attack.
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PHYSIOLOGICAL AND PSYCHOLOGICAL
MANIFESTATION OF STRESS

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PHYSIOLOGICAL SYMPTOMS
OF STRESS
 Headache
 Heart Burn
 Rapid Breathing
 Risk of Heart Attack
 Tense Muscles
 High Blood Sugar
 High Blood Pressure
 Stomach Ache
 Weakened Immune System
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PSYCHOLOGICAL SYMPTOMS
OF STRESS
 Eating More or Less
 Sleeping More or Less
 Mood less, Sadness, Feeling Upset
 Outburst of Anger
 Lack of Concentration
 Uncontrolled Crying Spell
 Forgetfulness

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FACTORS AFFECTING COPING PATTERN
DURING HOSPITALIZATION
 One of the factors influencing the amount of stress imposed by
hospitalization is the amount of control that patient perceive
themselves.
 Lack of control increases the perception of threat and can affect
patients coping skills .
 Hospitalized patients often experience separation anxiety as they are
away from home environment and being around strangers.
 Fear of pain and bodily injury .
 Sensory overload is another factor which affects coping skills .
 Hospitalization also affects sleeping patterns.

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The important factor seems to be how well a person COPES
with stress, rather than how much stress they face.

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19
TYPES OF COPING STRATEGIES

1. Appraisal-focused:
 Appraisal focused strategies are directed towards challenging your
own assumptions and modifying the way you think.
 This may include distancing yourself from the problem or
challenge, altering goals and values, or identifying the humor in
the situation to bring a positive spin.

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TYPES OF COPING STRATEGIES
2. Problem-focused:
 It tackles stressors by actively addressing and resolving the root
causes of the problem, aiming to alleviate stress through practical
solutions and actions.

 The three problem-focused coping strategies identified by

Folkman and Lazarus are taking control, information seeking,
and evaluating the pros and cons.

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TYPES OF COPING STRATEGIES
3. Emotion-focused:
 It is a psychological strategy aimed at managing and
regulating one's emotional response to stressors, rather
than directly addressing the underlying problem.
 This approach involves techniques such as emotional
expression, relaxation, meditation or seeking emotional
support to reduce emotional distress.

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5 EMOTION FOCUSED COPING
STRATEGIES
 Disclaiming
 Escape-avoidance
 Accepting Responsibility or Blame
 Exercising Self-control
 Positive Reappraisal

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NURSING PROCESS RELATED TO
STRESS PATTERN
 Assessment
• Subjective Data
• Objective Data
 Diagnosis
 Planning
 Implementation
 Evaluation
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ASSESSMENT:
Subjective Data:
• Patient states “he is unsure he will be able to handle work and family
duties”
• Feel like crying
• Abdominal pain
• Nauseous
• Sleep disturbance
• Fatigue

Objective Data:
• B.P: Varies Person To Person
• HR:104
• T:98.6F
• RR:20
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NURSING DIAGNOSIS
 Impaired Adjustment
 Impairment of Adaptive Behavior
 Ineffective Role Performance
 Post-Trauma Syndrome
 Impaired Social Interaction
 Spiritual Distress

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PLANNING
 Identifies situations that increase stress and
anxiety levels.
 Differentiate between positive and negative
stressors in his/her life.
 Patient will review the amounts and types of
stressors in daily life.
 Observe for barriers to Social Interaction.

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IMPLEMENTATION
 Provide positive reinforcement.
 Provide a safe environment for client.
 Interact with patient in peaceful manner.
 Provide massage and back rubs for patient to reduce stress.
 Allow the patient to talk about his feelings and examine stressful
situations.
 Assist the patient in developing new stress-reducing skills.
 Verbalize a plan for stress management(guided imagery, muscle
relaxation),including necessary lifestyle modifications.
 Instruct patient the appropriate use of anti-stress medications.
 Educate patient and family about stress, symptoms and coping methods.

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EVALUATION
 Patient was able to identify stress in his life and
admitted that current symptoms may have been
exacerbated by stress in his life.
 He stated that he begin to journal his thoughts and
feelings and stated this helped him in identifying stress
in his life.
 After nursing intervention, patients looks more calm and
attentive to nurse’s questions.
 With in 24hrs,patient’s vital signs will be in normal
limits.
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REFERENCES
 Kozier & Erb’s Fundamental of Nursing Book, 10th
edition.
 www.google.com

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 o u
nk Y
T h a
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