College of Medicine and Health Sciences

School of Nursing
Department of Comprehensive Nursing

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 Coping and Stress Management

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 Learning objectives
On completion of this session, the learners will be able to:
 Define the term stress
 Define the term coping
 Distinguish between the sources of stress
 Distinguish between the types of stress
 Identify physiologic and psychosocial stressors
 Discuss the coping and stress management mechanisms
 Identify nursing actions that promote effective coping of
stress

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 Definitions
The word stress is derived from the Latin word
"stringi", which means, "to be drawn tight“

A bodily or mental tension resulting from factors that

tend to alter an existent equilibrium (Merriam-Webster’s
Collegiate Dictionary, 2011)

According to Randy and David “Stress is the

subjective feeling produced by events that are
uncontrollable or threatening."

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 Definitions Cont’d…

It is a universal experience, can be the catalyst for

positive change or it can be the source of discomfort and
pain

People experience stress as a sequence of daily life events

& experiences

Stress is helpful by stimulating thinking processes &

helping people stay alert to their environment

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 Definitions Cont’d…
A stressor: an internal or external event or situation that
creates the potential for physiologic, emotional,
cognitive, or behavioral changes in an individual
It can be:
ò Physical stressors: ones that pose a direct threat to our
physical well-being
E.g., cold, heat, infection, toxic substances etc.
ò Psychological stressors: events that challenge our safety,
not because they are physically dangerous, but because of our
thoughts, perceptions, and interpretations
E.g. failing a test, sound of footsteps on a dark street etc.

Stress response: people’s reactions to the stressors

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 Sources of Stress

Social pressures (e.g. interpersonal conflicts etc.)

Physiological (e.g. inadequate sleep, illness, poor

nutrition, lack of exercise etc…)

Your thoughts, etc

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 Physiological responses to stress

 Increased respiration rate

 Increased heart rate
 Higher blood pressure
 Increased metabolic rate
 Dilation of pupils
 Tensing of muscles
 Release of extra sugar from the liver etc.

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 Psychological responses to stress
Anxiety:
Anger and aggression:
 Animals behave aggressively in response to tress (overcrowding,
electric shock etc.). Children become angry and aggressive when
frustrated
Apathy and depression: Opposite responses to aggression
 When stressful conditions continue and the individual is unable to
cope with them. Apathy may become worse and turn into
depression
Cognitive impairment:
 May come from two sources:
1. High emotional arousal interferes with information processing
2. Distracting thoughts that go through our heads
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(e.g., excessive worrying during an exam) 11
 Responses to stress Cont’d…

Behavioral responses Spiritual responses

• Sweaty palms • Social isolation
• Rapid speech • Feeling of emptiness etc.
• Insomnia
• Withdrawal etc

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 Types of stress
Stress includes work stress, family stress, trauma, crisis
etc.

Stress also can be:

Distress -damaging stress
Eustress- is used to describe a type of stress that
results in positive outcomes

Eustress protects health by motivating energy such as

happiness, hopefulness, and purposeful movement

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 Coping with stress
How the individual deals with stressful situations is
known as ‘coping’

Refers to a person’s active efforts to resolve stress and

create new ways of handling new situations at each life
stage

Coping mechanism encompass psychological adaptive

behaviors

We habitually use certain coping responses to deal with

stress
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 Coping Behaviors
 There are two major targets of coping: changing
ourselves or changing our environment

 Frequently used coping strategies may include:

 Talking
 Crying
 Laughing
 Exercising etc.

 These strategies can result in successful adaptation

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 Defense Mechanisms
o Just as the body has physiological mechanisms (e.g., the
immune system, the inflammatory response) to defend
against infection and disease,

o The mind has psychological protective mechanisms

o Defense mechanisms are unconscious operations that

protect the mind from stressful state

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 Common defense mechanisms
Denial-Negation of reality of threatening situations
despite factual evidence
e.g. The client refuses to admit to anger, even though the
situation warrants it and the client’s voice indicates anger

Projection-Attribution of one’s own thoughts, feelings,

or impulses to others
e.g. A cheating spouse who suspects their partner is
being unfaithful

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 Common defense mechanisms Cont’d…

Displacement-Transfer of feelings or reactions evoked

by one topic or event to another that is less threatening
e.g. A husband who is angry at his wife yells at the
family dog rather than dealing directly with his anger

 Suppression-attempt to keep threatening material out of

consciousness
e.g. A student nurse decides not to think about a family
problem at the moment so he can study for an upcoming
examination

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 Common defense mechanisms Cont’d…

 Rationalization-Intellectual explaining away of threatening

circumstances
e.g. ‘‘The test had too many trick questions; I really knew all
the material, but our instructor was out to get me.’’

 Compensation-is making up for a deficiency in one aspect

of self image by strongly emphasizing a feature considered
an asset
e.g. a man or woman who is unattractive wear stylish
fashion clothes to get attention

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 Nursing interventions
 Nsg interventions that promote positive adaptation to stress
may include:

 Empowerment of clients to meet basic needs

 Minimization of environmental stimuli
 Encouragement of verbalization of feeling
 Inclusion of significant others into client care and
 Cognitive techniques: teach new, more adaptive ways of
thinking and acting
 The use of various relaxation techniques, such as progressive
muscle relaxation, deep breathing etc

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 Nursing interventions Cont’d…

Some specific ways to limit environmental stimuli are:

Close the door to the client’s room
Turn off the television
Lower the tone of the telephone ringer
Turn off the lights
Limit the number of visitors
Decrease environmental noise etc.

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 Thank You In Advance!

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