• The term "stress", as it is currently used was coined by Hans Selye in 1936, who defined

it as "the non-specific response of the body to any demand for change".

General Adaptation Syndrome (GAS) (Selye)

General Adaptation Syndrome (GAS) (Selye)

• 3 stages
– Alarm
– Resistance/Adaptation
– Exhaustion
 • Alarm stage: fight-or-flight response due to stressful stimulus
– Hypothalamic-pituitary-adrenal (HPA) axis
• Resistance or Adaptation: activity of the nervous and endocrine systems in returning the
body to homeostasis
– Allostatic state: activity of various systems attempting to restore homeostasis
• Exhaustion: point where body can no longer return to homeostasis
– Allostatic overload: “cost” of body’s organs and tissues for an excessive or
ineffectively regulated allostatic response; effect of “wear and tear” on the body

Effects of allostatic overload

Catecholamines
• Play an integral role in allostasis
• Sympathico-adrenal system response mediates the fight-or-flight response
• Examples
– Norepinephrine and epinephrine
Adrenocortical Steroids
• Critical to maintenance of homeostasis
• May synergize or antagonize effects of catecholamines
• Examples
– Cortisol and aldosterone
Norepinephrine
• Constricts blood vessels and raises blood pressure
• Reduces gastric secretions
• Increases night and far vision
Epinephrine
• Enhances myocardial contractility, increases heart rate, and increases cardiac output
• Causes bronchodilation
• Increases the release of glucose from the liver (glycogenolysis) and elevates blood
glucose levels

Adrenocortical Steroids
• Critical to maintenance of homeostasis
• May synergize or antagonize effects of catecholamines
• Examples
– Cortisol and aldosterone
Cortisol
• Primary glucocorticoid
• Affects protein metabolism
• Promotes appetite and food-seeking behaviors
• Has anti-inflammatory effects

Aldosterone
• Primary mineralocorticoid
• Promotes reabsorption of sodium and water
• Increases blood pressure

Endorphins and Enkephalins

• Endogenous opioids (body’s natural pain relievers)
– Raise pain threshold
– Produce sedation and euphoria
Immune Cytokines
• Secreted by macrophages during stress response
– Enhance immune system response
– Prolonged stress can suppress immune functioning
• Example
– Interleukin-1

Sex Hormones
• Affect stress responses, thus influencing allostasis
• May help explain gender responses during stress
• Examples
– Estrogen, testosterone, and dehydroepiandrosterone

Other Hormones
• Growth hormone
– Can increase during stress to enhance immune function
– Prolactin
– Similar to structure of growth hormone
– Role in immune response
• Oxytocin
– Produced during childbirth and lactation
– Associated with bonding and social attachment
– Thought to moderate stress response and produce a calming effect

Significant Effects of Stress

• Elevated BP & HR
• Bronchodilation and increase ventilation
• Increase blood glucose to respond to cell needs
• Arousal of CNS
• Vasoconstriction of skin and viscera
• Decreased inflammatory and immune response

Getting a Handle on Stress

• Stress is how people react to situations that feel taxing
• What motivates one person may burden another
• Stress is subjective. Your perception of stress/stressors may be very different from
another person
Effects of Prolonged Stress
• RENAL FAILURE
• PREVENT THIS = Promote good hydration
• STRESS ULCERS
• PREVENT THIS = eat healthy! Or meds to reduce acid secretions

• INFECTION
• Good hydration & proper sleep
• TISSUE HEALING
Workplace stress in nursing: A literature review

• (McVicar, 2003) Stress Hardiness: depends on a person’s

• Characteristics
• Experiences
• Coping mechanisms
• Circumstances facing them
• Stress continuum-
• Eustress….Distress

(French, 2000)
• Conflict with physicians
• Inadequate preparation- new grads
• Problems with peers
• Problems with supervisors- ? Lack of rewards?
• Discrimination
• *****Workload /time pressure/shift work
• Uncertainty regarding treatments
• Dealing with death and dying
• Parents/their families

And……….

• Perceptions vary greatly among nurses working in the same area!! (Demerouti et al.
2000)
• Too simplistic to say that one or two stressors are the primary cause of stress for nurses
(Foxall et al. 2000)

• Levels of companionship and social interaction at work increase coping (Celowitz 1989,
Morano 1993 ,Healy & Mckay 2000)
• Living with a partner and living with children reduced stress for nurses in their job
situation with clients (Tyler & Ellison ,1994)
• Problem solving skills are more effective than emotion-focused coping in preventing
burnout
• Identifying early nurses at risk and improving their stress management techniques can
help prevent severe distress (McVicar, 2003)