SECTION 2 Problems Related to Comfort and Coping
7
Stress Management
Margaret R. Rateau
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Risk for Disease Stress and Coping
LEARNING OUTCOMES
1. Distinguish between the terms stressor and stress. 5. Explain the role of coping in managing stress.
2. Describe the role of the nervous and endocrine systems in 6. Select coping and relaxation strategies that you, a patient, or
the stress process. a caregiver experiencing stress can use.
3. Describe the effects of stress on the immune system. 7. Describe the assessment and management of a patient
4. Discuss the effects of stress on health. experiencing stress.
KEY TERMS
biofeedback mind-body-spirit connection
coping problem-focused coping
emotion-focused coping psychoneuroimmunology (PNI)
imagery relaxation breathing
massage stress
meditation stressors
All people have stress. Stress has a powerful effect on the mind More women seek help for stress-related symptoms. Men are
and a significant effect on one’s health and well-being. The con- more likely to die from stress-related illnesses.2
cept of stress directly relates to multiple other concepts. Chronic Many different events or factors can be stressors. They can
stress is a major factor in causing and worsening chronic health be physiologic (e.g., acute pain) or emotional/psychologic (e.g.,
conditions. This in turn is a major driver of soaring health care death of a child, loss of a home through fire, fear) (Fig. 7.1).
costs. Emotional/psychologic stressors can be positive or negative. For
High levels of stress are common among patients and care- example, the birth of a baby is usually a positive stressor. Marital
givers. How they deal with their stress is critical to their well- discord is a negative stressor.
being. As a nurse, you play a key role in helping them recognize Perception of the potential stressor influences the way a person
stress and manage stressful events. This chapter focuses on how responds to that stressor. Responses to the same stressor vary greatly.
stress can affect the mind, body, and spirit and how a person can What one person perceives as stressful may not be perceived as
effectively cope with stress. stressful to someone else. This is shown in the following examples:
• B.J., a 43-year-old woman, becomes depressed after a lapa-
roscopic hysterectomy for fibroids. She is unwilling to take
WHAT IS STRESS? part in normal self-care activities. You are surprised by her
Stress is the inability to cope with perceived (real or imagined) response. You think she had a simple surgery and should
demands or threats to one’s mental, emotional, or spiritual get on with life. After further assessment, you discover that
well-being.1 Stress is more prevalent in women and reported removing her uterus is a great psychologic stressor because
through physical symptoms such as anxiety and depression. she perceives it as a loss of her womanhood and femininity.
93
, 94 SECTION 2 Problems Related to Comfort and Coping
Stressors TABLE 7.1 Factors Affecting Response to
Stress
Physiologic
• Pain Internal
• Excessive noise • Age
• Starvation • Attitude
• Infection Stress
• Genetic background
Emotional/Psychologic • Hardiness
• Diagnosis of cancer • Health status
• Death of spouse Perception
• Nutrition status
• Caring for disabled child
• Marital problems • Optimistic outlook
• Personality characteristics
Fig. 7.1 Stressors can be physiologic or emotional/psychologic. Events • Previous experience with stressors
or circumstances become stressful when you perceive them to be. • Resilience
• Sleep status
• K
.R., a 52-year-old woman, has just been told by her health External
care provider (HCP) of her new diagnosis of type 2 diabetes. • Cultural and ethnic influences
After the HCP’s visit with her, you are prepared to provide • Number of stressors present
emotional support. However, you are puzzled when she is • Religious or spiritual influences
smiling and feeling relieved. You think that this diagnosis • Socioeconomic status
should be stressful. However, K.R. tells you that she is so • Social support
relieved because for weeks she was worried that her symp- • Timing of stressors
toms were caused by cancer.
Is Stress Bad or Good?
We tend to think of stress as bad or a threat. Actually, any event
or situation that is out of the ordinary can be a stressor. This
includes events that we normally consider happy or enjoy, such
as getting married or going on a vacation. Stress can be helpful.
A little stress can motivate you. Stress can actually inspire you to
achieve a goal, become more confident, or stronger physically.
The body cannot tell between bad and good stress or real or
imaginary stress. It responds to the stressor with the same stress
response. This stress response is the way our bodies react both
physically and emotionally to any change, be it good, bad, real,
or imagined.
For you as a nursing student, a test can be a stressful situa-
tion. A little bit of stress related to an upcoming test makes you Fig. 7.2 During stressful situations, demands may exceed resources.
study and become better prepared. If you feel mildly stressed (© SDI Productions/iStock.com.)
during the test, it may help your test performance. A little stress
heightens your awareness and increases your mental acuity. Internal and external factors play a vital role in one’s ability to
However, if you are overly stressed, it causes mental blocks, lack cope with stress (Table 7.1). Being surrounded by a strong social
of concentration, and inability to remember things. support system and receiving positive support from friends and
Stress is a key for survival, but too much stress can be detri- family have a large impact on a person’s ability to cope with
mental. That is why it is important for you and your patients to stressors (Fig. 7.2).
learn to cope more effectively with the stressors in life. Key personal characteristics that buffer the effects of stress are
attitude, hardiness, being optimistic, and resilience. Resilience is
Factors Affecting Response to Stress being resourceful and flexible and having good problem-solving
Why do people respond so differently to stress? Why do some skills. People who have a high degree of resilience are not as
people cope better with stress than others? Interestingly, some likely to perceive an event as stressful.
people experience significant adverse life events but do not Hardiness is a combination of 3 characteristics: commitment,
succumb to the effects of stress. It is important to use a holis- control, and openness to change. Together they give the cour-
tic approach when assessing the impact of stress on a person age and motivation needed to turn stressful circumstances from
because of the number of factors that influence a person’s potential calamities into opportunities for personal growth.
response to stress. Important variables include the type of Attitude can influence the effect of stress on a person. People
stressor, duration (acute or chronic), and intensity (mild, mod- with positive attitudes view situations differently from those
erate, or severe). with negative attitudes. A person’s attitude also influences how
7
Stress Management
Margaret R. Rateau
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Risk for Disease Stress and Coping
LEARNING OUTCOMES
1. Distinguish between the terms stressor and stress. 5. Explain the role of coping in managing stress.
2. Describe the role of the nervous and endocrine systems in 6. Select coping and relaxation strategies that you, a patient, or
the stress process. a caregiver experiencing stress can use.
3. Describe the effects of stress on the immune system. 7. Describe the assessment and management of a patient
4. Discuss the effects of stress on health. experiencing stress.
KEY TERMS
biofeedback mind-body-spirit connection
coping problem-focused coping
emotion-focused coping psychoneuroimmunology (PNI)
imagery relaxation breathing
massage stress
meditation stressors
All people have stress. Stress has a powerful effect on the mind More women seek help for stress-related symptoms. Men are
and a significant effect on one’s health and well-being. The con- more likely to die from stress-related illnesses.2
cept of stress directly relates to multiple other concepts. Chronic Many different events or factors can be stressors. They can
stress is a major factor in causing and worsening chronic health be physiologic (e.g., acute pain) or emotional/psychologic (e.g.,
conditions. This in turn is a major driver of soaring health care death of a child, loss of a home through fire, fear) (Fig. 7.1).
costs. Emotional/psychologic stressors can be positive or negative. For
High levels of stress are common among patients and care- example, the birth of a baby is usually a positive stressor. Marital
givers. How they deal with their stress is critical to their well- discord is a negative stressor.
being. As a nurse, you play a key role in helping them recognize Perception of the potential stressor influences the way a person
stress and manage stressful events. This chapter focuses on how responds to that stressor. Responses to the same stressor vary greatly.
stress can affect the mind, body, and spirit and how a person can What one person perceives as stressful may not be perceived as
effectively cope with stress. stressful to someone else. This is shown in the following examples:
• B.J., a 43-year-old woman, becomes depressed after a lapa-
roscopic hysterectomy for fibroids. She is unwilling to take
WHAT IS STRESS? part in normal self-care activities. You are surprised by her
Stress is the inability to cope with perceived (real or imagined) response. You think she had a simple surgery and should
demands or threats to one’s mental, emotional, or spiritual get on with life. After further assessment, you discover that
well-being.1 Stress is more prevalent in women and reported removing her uterus is a great psychologic stressor because
through physical symptoms such as anxiety and depression. she perceives it as a loss of her womanhood and femininity.
93
, 94 SECTION 2 Problems Related to Comfort and Coping
Stressors TABLE 7.1 Factors Affecting Response to
Stress
Physiologic
• Pain Internal
• Excessive noise • Age
• Starvation • Attitude
• Infection Stress
• Genetic background
Emotional/Psychologic • Hardiness
• Diagnosis of cancer • Health status
• Death of spouse Perception
• Nutrition status
• Caring for disabled child
• Marital problems • Optimistic outlook
• Personality characteristics
Fig. 7.1 Stressors can be physiologic or emotional/psychologic. Events • Previous experience with stressors
or circumstances become stressful when you perceive them to be. • Resilience
• Sleep status
• K
.R., a 52-year-old woman, has just been told by her health External
care provider (HCP) of her new diagnosis of type 2 diabetes. • Cultural and ethnic influences
After the HCP’s visit with her, you are prepared to provide • Number of stressors present
emotional support. However, you are puzzled when she is • Religious or spiritual influences
smiling and feeling relieved. You think that this diagnosis • Socioeconomic status
should be stressful. However, K.R. tells you that she is so • Social support
relieved because for weeks she was worried that her symp- • Timing of stressors
toms were caused by cancer.
Is Stress Bad or Good?
We tend to think of stress as bad or a threat. Actually, any event
or situation that is out of the ordinary can be a stressor. This
includes events that we normally consider happy or enjoy, such
as getting married or going on a vacation. Stress can be helpful.
A little stress can motivate you. Stress can actually inspire you to
achieve a goal, become more confident, or stronger physically.
The body cannot tell between bad and good stress or real or
imaginary stress. It responds to the stressor with the same stress
response. This stress response is the way our bodies react both
physically and emotionally to any change, be it good, bad, real,
or imagined.
For you as a nursing student, a test can be a stressful situa-
tion. A little bit of stress related to an upcoming test makes you Fig. 7.2 During stressful situations, demands may exceed resources.
study and become better prepared. If you feel mildly stressed (© SDI Productions/iStock.com.)
during the test, it may help your test performance. A little stress
heightens your awareness and increases your mental acuity. Internal and external factors play a vital role in one’s ability to
However, if you are overly stressed, it causes mental blocks, lack cope with stress (Table 7.1). Being surrounded by a strong social
of concentration, and inability to remember things. support system and receiving positive support from friends and
Stress is a key for survival, but too much stress can be detri- family have a large impact on a person’s ability to cope with
mental. That is why it is important for you and your patients to stressors (Fig. 7.2).
learn to cope more effectively with the stressors in life. Key personal characteristics that buffer the effects of stress are
attitude, hardiness, being optimistic, and resilience. Resilience is
Factors Affecting Response to Stress being resourceful and flexible and having good problem-solving
Why do people respond so differently to stress? Why do some skills. People who have a high degree of resilience are not as
people cope better with stress than others? Interestingly, some likely to perceive an event as stressful.
people experience significant adverse life events but do not Hardiness is a combination of 3 characteristics: commitment,
succumb to the effects of stress. It is important to use a holis- control, and openness to change. Together they give the cour-
tic approach when assessing the impact of stress on a person age and motivation needed to turn stressful circumstances from
because of the number of factors that influence a person’s potential calamities into opportunities for personal growth.
response to stress. Important variables include the type of Attitude can influence the effect of stress on a person. People
stressor, duration (acute or chronic), and intensity (mild, mod- with positive attitudes view situations differently from those
erate, or severe). with negative attitudes. A person’s attitude also influences how
