Lewis: Medical-Surgical Nursing, 10th Edition

Chapter 6

Stress and Stress Management

KEY POINTS
DEFINITION OF STRESS
• Stress is the inability to cope with perceived (real or imagined) demands or threats to
one’s mental, emotional, and spiritual well-being.
• Stress occurs as a response to demands placed on one’s body and/or mind. Because
demands are perceived differently based on the person and/or situation, what is
considered stressful varies.
• Many different events or factors can be stressors. A stressor can be physical or emotional/
psychologic and positive or negative.
• The common aspect is that stressors require an individual to adapt. Adaptation is affected
by the duration of the stressor (acute or chronic) and its intensity (mild, moderate, or
severe).

FACTORS AFFECTING RESPONSE TO STRESS

• Great variability exists among the individual response to the same stressor.
• Key personal characteristics, such as resilience and attitude, buffer the impact of stress.
Attitude and optimism also influence the way stress affects the person.
• External factors, including positive support from one’s social support system, play a role
in one’s ability to cope with stress.

PHYSIOLOGIC RESPONSE TO STRESS

• The physiologic response of the person to stress is reflected in the interrelationship of the
nervous, endocrine, and immune systems.
• Stress activation of these systems affects other systems, such as the cardiovascular,
respiratory, gastrointestinal, renal, and reproductive systems.

MIND, BODY, AND SPIRIT CONNECTION

• A person is made of three parts: mind, body, and spirit. All three parts are important in
your life and determining who you are.
• What goes on in your mind influences every part of the body. Your body and your mind
are affected by how connected you feel to your spirit (soul). Your spirit is the life force
within you that gives life, energy, and power.
• You are not just a person with a body. You are a spiritual being with a mind that affects
every aspect of your body.
EFFECTS OF STRESS ON HEALTH
• Stress can have effects on cognitive function, including poor concentration, memory
problems, distressing dreams, sleep disturbances, and impaired decision making.
• Long-term stress may increase the risk of cardiovascular diseases, such as arteriosclerosis
and hypertension. Other conditions are either precipitated or aggravated by stress,
including migraine headaches, irritable bowel syndrome, and peptic ulcers.

COPING STRATEGIES
• Coping is a person’s efforts to manage stressors.
• External factors, including positive support from one’s social support system, play a role
in one’s ability to cope with stress.
• Coping can be either positive or negative. Positive coping includes activities such as
exercise and use of social support. Negative coping may include substance abuse and
denial.
• Coping strategies can be divided into two broad categories: emotion-focused coping and
problem-focused coping.
♣ Emotion-focused coping involves managing the emotions that an individual feels
when a stressful event occurs.
♣ Problem-focused coping attempts to find solutions to resolve the problems
causing the stress.

RELAXATION STRATEGIES
• Relaxation strategies can be used to cope with stressful circumstances and elicit the
relaxation response.
• The relaxation response is state of physiologic and psychologic rest. It is the opposite of
the stress response and is characterized by decreased sympathetic nervous system
activity, which leads to decreased heart and respiratory rate, decreased BP, decreased
muscle tension, decreased brain activity, and increased skin temperature.
• Regular elicitation of the relaxation response has been proven to be an effective treatment
for a wide range of stress-related disorders, including chronic pain, insomnia, and
hypertension. This can be achieved through relaxation breathing, meditation, imagery,
music, and massage.
♣ One of the simplest and most effective ways to stop the stress response is to
practice relaxation or abdominal breathing.
♣ Meditation is a practice of concentrated focus on a sound, object, visualization,
the breath, or movement. The purpose of meditation is to increase awareness,
reduce stress, promote relaxation, and enhance personal and spiritual growth.
♣ Imagery is the use of one’s mind to generate images that have a calming effect on
the body.

NURSING MANAGEMENT: STRESS

• As a nurse, you are in a key position to assess stress in patients and families, assist them
 to identify high-risk periods for stress, and implement stress management strategies that
can prevent the negative consequences of stress on their health.
• There are many stress management strategies within the scope of nursing practice,
including relaxation breathing, imagery, music, exercise, massage, meditation, art
therapy, and journaling.
• Before teaching stress management strategies to patients, you need to become personally
familiar with them.