1、Stress ManagementAllan Sanders, MN, ARNPObjectivesExplore the biological, psychological, and social aspects of the human stress response.Describe the difference between adaptive and maladaptive coping strategies.Understand coping strategies that increase resilience to promote productive living and h

2、ealthy aging.Common Stress Associated DiseasesDiminished ImmunityHeadacheFatigueWeight gainDyslipidemiaHypertensionHeart DiseasePsoriasis/EczemaDigestive problemsAnxietyDepressionAlcoholismSubstance abuseInsomniaIrritable bowel syndromeFibromyalgiaDecreased sex driveOverview of TerminologyStress: A

3、state of disharmony or a threat to homeostasisPhysiological changes increase alertness, focus, and energyPerceived demands may exceed the perceived resourcesCoping: The ability to maintain control, think rationally, and problem solve Resilience: Resistant quality that permits a person to recovery qu

4、ickly and thrive in spite of adversity StressEustressManageable Stress can lead to growth and enhanced competenceDistressUncontrollable, prolonged, or overwhelming stress is destructive.Acute StressImmediate response to a threat or challengeChronic StressOngoing exposure to stress, may seem unrelent

5、ing Causes of StressExternal causesFamily, work, economics, work, school, major life changes, unforeseen events, etc.Internal causesWorry, uncertainty, fear, attitudes, unrealistic expectations, etc.Sources of Clinical StressFor patientsUncertaintyFearPainCost Lack of knowledgeRisk for harmUnknown r

6、esourcesFor nursesPoor patient outcomesRisk of making an errorUnfamiliar situationsExcessive workloadInadequate resourcesStages of the Stress ResponseGeneral Adaptation Syndrome of Hans Selye (1907-1982)Alarmwhen one feels threatenedActivation of the fight or flight reactionResistancemobilization of

7、 resources to solve the problemContinued stress causes adaptationExhaustionAdaptation fails and level of function decreasesALARM: Activation of Hypothalamic Pituitary Adrenal AxisCatecholaminesIncreases cardiac outputDilates airwaysDilates pupilsMobilizes glucoseCauses vasomotor changesDecreases dig

8、estionEnhances coagulationCortical SteroidsElevates glucoseIncreases amino acidsIncreases NA resorptionIncreases extracellular fluid volumeInhibits histamine and bradykininSuppresses the immune responseResistance Adaptation occursActivation of the hypothalamic pituitary adrenal axis continuesThe str

9、essor may be resolvedThe body returns to homeostasisMay progress to exhaustionStress continues as resources are depletedExhaustionOccurs when the demands of the stress exceeds the persons ability to adapt. Functioning declinesMay result in health problemsPhysical symptomsMental symptomsSigns & Sympt

10、oms of StressCognitiveDecreased concentration, comprehension, & memory BehavioralIrritability, withdrawal, violence EmotionalFear, anxiety, depression, fatiguePhysiologicalIncreased BP, HR, Respirations, etcSomatic symptomsDecreased immune responseGenetics & DevelopmentGeneticsGenes control the stre

11、ss responseIndividuals have different responses to stressThere is a genetic component to:fearful behavioranxiety disordersNeurobiological responseDevelopmentLife experiences can affect a persons stress responseSocial supportStrong support is protectiveEarly life stressIncreases stress reactivity as

12、an adultCoping & ResilienceCopingAbility to control emotionsAbility to perceive reality Ability to think rationallyAbility to problem solveCulturally definedResilienceThe ability to bounce backThe positive capacity to cope with stressProvides resistance to negative eventsHardiness, ResourcefulnessCo

13、pingAdaptive CopingContribute to resolution of the stress responseMaladaptive CopingStrategies that cause further problemsActive CopingActively seeking resolution to the stress Promote Adaptive CopingRealistic expectationsSet realistic goalsPlanningAnticipate problems, have a backup planReframingCha

14、nge the way you look at thingsRelaxationLearn relaxation techniques, take time-out for leisureDiscuss the problemUtilize existing social supports to problem solvePromote Adaptive CopingTrainingPrepares for stressful eventsNutritionEat healthy, avoid skipping mealsExerciseInclude regular exerciseSlee

15、pGet adequate sleepavoid fatigueAvoid Maladaptive CopingBlurring of boundariesAvoidance/withdrawalNegative attitudeAnger outburstsAlcohol/DrugsHopelessnessNegative self-talkResentmentViolencePromote Resilience FactorsPositive Role ModelsOptimismHumorMoral CompassAltruismReligion & SpiritualitySocial

16、 Support Positive Role ModelsTransmit:AttitudesValuesSkillsPatterns of thoughts and behaviorsOptimismPositive BeliefsAssociated with well beingCognitive reframingPositive thinkingRefute the negative thinkingBelieve in a meaningful causeIt is important to acknowledge relevant negative factorsHumorHig

17、hly effectiveMature coping mechanism“Another of the souls weapons for the fight for self-preservation, it is well known that humor, more then anything else in the human makeup, can provide an aloofness and the ability to rise above any situation, even for a few seconds.” Viktor FranklMoral CompassCo

18、nduct a moral inventory“Look not for any greater harm then this, destroying the trustworthy, self-respecting, well-behaved man within you.” Epicetus Maintain your integrity“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our gro

19、wth and our freedom.” Viktor FranklAltruismUnselfish regarding the welfare of othersBelieve in a meaningful causeMutual cooperationActivates of the brains reward center Religion & Spirituality Associated with psychological and physical well beingGuards against despairProvides social supportProvides

20、positive role modelsProvides a positive missionSocial SupportSocial support has a profound effect on life expectancyPatients have better outcomes with strong social supportIsolation and poor social support are associated with a poor stress responseFew hardy individuals “go it alone” Signature Streng

21、thsRecognize skills and talentsInventory strengthsUse your strengths and talentsDecide what worksActively copeApply concepts to enable active coping.ReviewStress is part of everyday lifeIt can promote growth and competencyIf unrelenting or overwhelming it can cause adverse effectsAdaptive coping enh

22、ances resilienceMaladaptive coping causes additional problemsEnhanced coping increases resilience while diminishing the adverse affects of stress, thus promoting health Review: Practical TipsSet realistic expectations Exercise regularlyEat healthy Get adequate sleepMaintain a work-leisure balancePos

23、itive Reframing & optimism Enhance social supportInternet ResourcesBuilding resilience: Diet, exercise, stress and the immune system: Exercise: Rev up your routine to reduce stress: Positive thinking: Reduce stress, enjoy life more: Stress management for patient and physician: Stress management: Und

24、erstand your sources of stress: Stress reduction techniques: A must for a healthy lifestyle: Learning ExerciseList your current sources of stress.Conduct an inventory of coping strategies that you use or have used in the past.Include maladaptive strategiesList your signature strengths and factors th

25、at may enhance your resilience.While considering the above, develop a personalized stress management plan to enhance your coping and resilience. ReferencesAhern, N., Ark, P., Byers, J. (2001). Resilience and coping strategies in adolescents. Paediatric Nursing. 28(10).Beckmann-Murray, R., Proctor-Ze

26、ntner, J., & Yakimo, R. (2009). Health promotion strategies through the life span. New Jersey: Prentice HallBhui, K., King, M., Dein, S., & OConor, (2008). Ethnicity and religious coping with mental distress. Journal of Mental Health. 12(2).Copstead, L. C. & Banasik, J. L. (2010). Pathophysiology: Biological and behaviora