Stress and coping

By: Ibne Amin/Zafar Iqbal

(INS ),Khyber Medical university
 Objectives

At the end of this unit learners will be able to:

1.Discuss the stress and coping
2. Identify different stressors and different types of
stress
3. List the different Symptoms of Stress.
4. Identify different techniques of stress management.
 Stress
Stress is a person response to stressor such as an
environmental condition or a stimulus.
OR
Mind and body response or reaction to a real or
imagined threat, event or change.
OR
Stress is condition in which the person experience
changes in the normal balance state.
 Stress
 Stressor-----as any event or stimulus that cause the
individual to experience stress.
 Coping strategies, coping response, coping
mechanism-----person response to stress
 Stress
Stress can result from both positive and negative
experiences........
Examples ;
• A bride preparing for her wedding
• A graduate preparing to start new job
• A husband concern about caring of his wife and family
• Diagnosis of cancer
• Lossing of special object ,person or any other things
all experiences stress reactions.
 Stress Coping

"The cognitive and behavioral efforts to manage

specific internal demands (infection ,feeling of depression) or
external demands (move to another city ,death in family ) that
are appraised as exceeding the resources of a
person". Folkman and Lazarus(1991)

OR
When a person faces stressors ,then the responses of
the person are reffered as coping strategies ,coping
responses or coping mechanisms.
 Indicators of stress
1. Physiological indicators
2. Psychological indicators
 Stress indicators
1. Physiological indicators
• The physiological sign & symptoms of stress
result from the activation of sympathetic and
neuroendocrine systems of the body
• Clinical manifestations lists physiological
indicators of stress
 Clinical Manifestation Of Stress
• Pupils dilates
• Sweat production
• Heart rate increase
• Cardiac output increase
• Skin is pailed (because of constriction of peripheral blood vessels)
• Sodium and water retention increase which
increase blood volume
 Clinical Manifestation Of
Stress/Physiological indicators
• Rate and depth of respiration increase
(because of dilation of bronchioles)
• Urinary output decrease
• Mouth may be dry
• Paristalsis of intestine decrease
• Muscles tension increase
 Psychological Indicators
• Anxiety
• Fear
• Anger
• Depression
• Uncounsious Ego Mechanism
 Psychological Indicators
1. Anxiety: Common reaction to stress
• A state of mental uneasiness ,apprehension, or a
feeling of helplessness related to an impending or
anticipated unidentified threat to self or significant
relationships.
Four levels of anxiety
– Mild Anxiety
– Moderate Anxiety
– Severe Anxiety
– Panic
 Psychological Indicators
2. FEAR
An emotion or feeling of apprehension aroused
by impending or seeming danger ,pain or
another perceived threat.
 Psychological Indicators
Anxiety and Fear differ in four ways
1. The source of anxiety may not be identified
2. Anxiety is related to mainly future, to an anticipated
event ,fear is related to past ,present and future
3. Anxiety is Vague, whereas fear is definite
4. Anxiety results from psychological or emotional
conflicts ,fear results from a specific physical or
psychological entity.
 Psychological Indicators
3.Anger
An emotional state consisting of a subjective
feeling of animosity or strong displeasure
 Psychological Indicators
4. Depression
• A common reaction to events that seem
overwhelming or negative
• An extreme feeling of
saidness ,dispair ,dejection ,lack of worth ,or
emptiness
 Psychological Indicators
5. Unconscious Ego Mechanisms
Unconscious psychological adaptive mechanism
or mental mechanisms that develop as the
personality attempts to defend itself ,establish
compromises among conflicting impulses and
calm inner tentions
 Coping Pattern
• The cognitive and behavioral efforts to
manage specific external or internal demands
that are appraised as exceeding the resources
of the person
OR
• A natural or learned way of responding to a
changing environment or specific problem or
situation
 Types of coping
1. Problem- focused coping
2. Emotion-Focused coping
3. Long term coping strategies
4. Short term coping strategies
5. Adoptive coping
6. Maladaptive coping
7. Care-giver burden
 Types of coping
1. Problem- focused coping
Refers to efforts to improve a situation by making
changes or talking actions (Lozarus 2006)

2. Emotion-focused coping
• Include thoughts and actions that relieve
emotional destress
• Doesn't improve the situation but the person
often feels better (Lozarus 2006)
 Types of coping
3. Long term coping strategies
• Can be constructive and practical
• In certain situations talking with others and trying to
find out more about the situation are long term
strategies
• Other long term Coping strategies include
• Lifestyle pattern
e.g. Eating a healthy diet
Exersicing regularly
Decision making
 Types of coping
4. Short term coping strategies
• Can reduce stress to a tolerable limit temporarily
but are ineffective ways to permennently deal
with reality.
• These may even have destructive or detrimental
effect on the person
• Examples;
• Using Alcohol
• Using drugs
 Types of coping
5. Adaptive coping
• Helps the person to deal effectively with stressful
events and minimizes distress associated with them
• Effective coping result in adaptations
6. Maladaptive coping
• Can cause unnessasary distress for the person and
others associated with the person or stressfull events
• Ineffective coping result In maladaptation
 Types of coping
7. care giver Burden
• Reaction to a long term stress is seen in family
members who undertake the Care of a person in the
home for long time period
• Produces responses such as chronic fatigue , sleeping
difficulties and high blood pressure
 Factors affecting copping pattern during
hospitalization
• Many factors can affect the copping pattern of
patient,family members and nurses in
hospital.
• Following are the main factors which affect
the copping pattern during hospitalization.
 Conti…
Anxiety:Anxiety is an emotion characterized by feelings of
tension, worried thoughts and physical changes like increased
blood pressure.
Anxiety in hospital: Depression and anxiety are common in
hospitalized patients especially those waiting for surgery and with
chronic or hard-to-treat conditions. Psychological disorders are
not only related to a poor adjustment to hospitalization
distress, but is associated with adverse events and unsatisfactory
outcomes.
• Hospitalization exacerbates patients' emotions, and increases
feelings of depression and anxiety.
• By this way copping is affected by admitted into hospital.
 Conti ..
• Fear: More prosaic issues might result in the fear of
hospitals, such as smells, sick roommates, and a
complete lack of privacy. Media reports surrounding
medical mishaps often result in fear among patients.
• The fear from doctor or nurse during the intervention
steps by applying nursing processs affect the copping
 Conti …
• Example of fear.The most common examples of fear a nurse
encounter are patient in the community, a patient may also
have fear during diagnostic testing in an outpatient setting, or
during hospitalization. The nurse’s role is to identify when
patients are experiencing fear and must find ways to help
them in a respectful way to face these feelings. The nurse
must also learn to distinguish when fear becomes persistent
and pervasive that it affects the individual’s ability to perform
his or her activities of daily living. Referral to a reliable
support system and programs increase the chances of
successfully managing, treating, and overcoming phobias and
other fears.
 Conti…
• Possibility of fear for nurse: the possibility of
harming a patient is their biggest fear. “We are the
gatekeepers of health.
• For family:Family member of the patient are also at
fear condition because there may be chance of
paralysis or even death may be cause of their patient .
 Conti…
Sleep: Unfortunately, the hospital environment is often
poorly conducive to sleep .
Pain, anxiety, medication effects, medical interventions,
environmental noise and light, and the acute illness
itself all contribute to decreased quality and quantity
of sleep in hospitalized patients.then the patient
cannot mannage such stress.
• Sleep loss in the hospital is associated with worse health
outcomes, including cardio-metabolic derangements and
increased risk of delirium
 Conti.
• Isolation from parents: to separate the child frome parents and
admitted them into hospital it will affected the copping of the
childs mostly .it this stages child are totally dependent to their
parents .
• Change in nutrition
• The following factors can also contribute to malnutrition:
• teeth that are in poor condition, or dentures that do not fit
properly, which can make eating difficult or painful.
• a physical disability or other impairment that makes it difficult to
move around, cook or shop for food.
• living alone and being
• These all are including in changing the copping of clints.
 Conti…
• Economic:the lower economy level and poverty can affect
copping of patient and their family . some time when patient
require surgery of heart and other serious surgery but they
cannot afford and sustain their cost that s way the copping
pattern is affected .
• Social culture :the Clint of various culture are admitted into
hospital .
• They affect decisions about a patient's treatment and who
makes the decisions. Cultural differences create problems in
communication, rapport, physical examination and treatment
compliance and follow through. The special meaning of
medicines and diet requires particular attention.
 Nursing Management of stress
Assessing
Nursing assessment of clients stress and coping
pattern includes;Nursing History & Physical
Examination. During Nursing History the nurse
have to poses questions ,,i.e Client perceived
stressors or stressful incidents
Manifestations of stress
Past coping strategies
Present coping strategies
 Nursing Management of stress
During physical examination the Nurse observe for;
• Verbal and cognitive manifestations
• Indicators of stress such as,Nail
biting,Nervousness,Weight changes
• Stress related health problems such as,
Hypertension
Hyperthyroidism
Dyspnea
 Nursing Management of stress
2.Nursing diagnosis
• Anxiety related to unconscious conflict's about
essential goals and values of life , threat to self
concept , positive or negative self talk ,or
physiological factors (E.g
hyperthyroidism ,dysrhythmias ,dyspnea )
 Conti..
Planning
• The overall clients goals for individual experiencing
stress related responses are;
• Decrease or resolve anxiety
• Increase abality to manage or cope with stressful
events or circumstances
• Improve role performance
 Nursing Management of stress
Implementation
• Although stress is a part of daily life ,it is also highly
individualize
• Some methods help to reduce stress will be
effective for one person
• Other methods are appropriate for a different
person
• A Nurse who is sensitive to clients needs and
reactions can choose those methods of interventions
that will be most effective for each individuals
 Nursing Management of stress
• Several health promotion strategies are often
appropriate as interventions for clients with stress
related Nursing daignosis
• Among these are;
• Physical exercise (relief mention,feeling of well being,
relaxation)
 Nursing Management of stress
Optimal Nutrition (balanced diet)
• Adequate rest and sleep (sleep restore bodies energy
levels and is essential aspect of stress management)
• Time management (people who manage their time
effectively usually experience less stress because
they feel more in control of their circumstances)
 Nursing Management of stress
Evaluation
• How does the cleint perceive the problems?
• Is there an underlying problem not identified?
• Have new stressors occur that interfare with
successful Coping?
• Were existing coping strategies sufficient to meet
intended outcomes?
 Nursing Management of stress
• How does the client perceive the effctiveness of new
coping strategies?
• Did the client implement new coping strategies
properly?
• Did the client access and use available resources?
• Have family members and significant others provided
effective support?
 Stress Management for Nurses
• Nurses like client's are susceptible to experiencing
anxiety and stress
• Nursing practice involves many stressors I.e;
• Increasing severity of client illness
• Adjusting to various work shifts
• Inadequate support from supervisors
• Caring for dying client etc
Although most Nurses cope effectively with physical and
emotional demands of nursing But some Nurses
become overwhelmed and develop Burnout
 Stress Management for Nurses
BURNOUT
• A complex syndrome of behavior
• The Nurses with Burnout manifests physical and
emotional depletion
• A negative attitude and self concept
• Feeling of helplessness and hopelessness
 Stress Management for Nurses
STEPS TO REDUCE STRESS FOR NURSES
Plan daily relaxation programs to reduce tention (I.e read novels ,listen to music
or other favorite activities)

Establish regular exercise program

Learn to accept failure's
• Seek counseling if indicated

• Support each others as a team

• Take time to relax

• Eat properly
• Lern something New
 References

• Kozier & Erb’s Fundamental of Nursing Book, 8th

edition.
• Potter and Perry (2005) “Fundamentals of nursing”
published by most by an imprint of Elsevier, 6th
edition. New Delhi. Page no 1068 – 1071 
• www.google.com
THANK YOU