Coping and stress tolerance

Coping and stress tolerance : 

Coping and stress tolerance

I. INTRODUCTION : 

I. INTRODUCTION Stress- regarded as a normal part of life and can have both positive and negative effect on a person’s functional capacity. Eustress- positive stress that can be associated with adaptation and is necessary for growth and development. Distress- negative stress that is potentially harmful and may exhaust adaptive capacities. It may be excessive or cumulative.

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Stressor- alarming stimuli that arouse the body from the resting state into a state of readiness to combat or deal with the stressor. Types: Physiologic stressors- physical stimuli that initiate the stress response. It may be detected during the physical examination as well as during the interview. examples: disease process, fatigue, aging, sleep deprivation. Psychological stressors- stimuli originating from the person’s thought process in relation to personal safety and security, personal control over events, and social integration. Environmental stressors- a person’s unfamiliar surrounding or setting. examples: unfamiliar smells, changes in daily routine, lack of privacy, sensory deprivation or overload. Sociocultural stressors- encompasses stressful events related to family relations, career, financial concerns and religion.

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Stress Response- an adaptive mechanism that restores a person’s balance and equilibrium.   Coping- “what one does about a problem in order to bring about relief, reward, and equilibrium…what one does or does not do about that problem, constitutes how one copes.” Weisman, 1979

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Coping Strategies- specific techniques used to deal with a stressor and its consequences. (Lazarus & Launier, 1978) Direct action- includes the common coping strategy, fight or flight. The role of the sympathetic nervous system is paramount in preparing the body for this type of action. - the bronchioles of the lungs dilate, the heart beats more forcefully, glucose level rise. Information seeking- cognitive coping strategy applied to dealing with potential stressors as well as existing stressors. This may help eliminate frightening misconceptions about the stressor and may be useful when information about the potential stressor’s sensations are provided in advance.

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Intrapsychic mode- involves directing one’s attention to other considerations. This helps reduce the tension and anxiety associated with a stressor and involves distractions. - it may be viewed as: Coping mechanism- may relieve distress against a known threat. Defense mechanism- may involve the reaction to only an unknown threat. Action inhibition- a person will refrain from activities that are impulsive, dangerous, or embarrassing.

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Effective coping- manifested by high levels of adaptation to stress or the development of stress tolerance. It may have the following results (Visotsky & associates, 1961): Distress is maintained within manageable limits. Hope and encouragement are generated. A sense of personal worth is maintained. Relationships with significant others are maintained or destroyed. Prospects for physical recovery are enhanced. Prospects for favorable situations are enhanced.

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Influences of effective coping(Cohen, 1981; Kobasa, 1979; Selye, 1976): Number of stressors confronting a person. In the presence of multiple stressors, stress may be perceived as an insurmountable obstacle, and crisis may result. Access to social or financial support resources. People with such resources usually perceive themselves as more able to cope. Stressor duration. Chronic exposure to stressors predisposes a person to chronic stress or tension.

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Stressor intensity. An intense stressor may be perceived as insurmountable and may precipitate crisis. Past experiences with stressors. If a person has coped successfully in the past, the stressor may be perceived as less threatening. Personality. Certain people are more stress resistant- especially those who view change as a challenge and believe they can influence events.

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Crisis- occurs when the person feels overwhelmed by stressors and unable to resolve the problem. (Aquilera & Messick, 1980) it is an acute, self-limiting state that is usually resolved within a period of 4 to 6 weeks.

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Crisis stages (Flink, 1967): Shock(stress)- stressors are perceived as overwhelming. The person may experience powerlessness, anxiety, and altered thought process. Defensive retreat- attempts are made to maintain usual structures, often by employing coping strategies to reduce tension and to reorganize one’s thoughts. Being challenged at this stage may result in anger because it interferes with coping attempts.

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Acknowledgments- the person can no longer be distracted from the overwhelming stress. Feelings of hopelessness and powerlessness may be strong, and suicide may be considered. Thought processes are altered as perceptions must become more reality oriented. Adaptation and change- new and pre-crisis structures are established, and a person gains a feeling of control and increasing self-worth. Thought processes return to normal.

II. HEALTH HISTORY : 

II. HEALTH HISTORY Based on observation and interpretation of the person’s statement. It is interpreted in relation to the stage of the person’s stress reaction. Recognition helps the nurse plan interventions, primarily by gauging the person’s readiness for developing effective coping skills.

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The alarm reaction to stress is characterized by a sense of panic and stimulation of the sympathetic nervous system. The person is in a state of hypervigilence with the following responses: Feelings of being “nervous” or “jittery” Hyperactivity Preoccupation with frightening images Ineffective problem-solving or decision making Stereotypes thinking

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Whether or not the person responds to direct questioning during the interview may depend on what coping mechanism is being used to handle stress. Not every person will be ready to discuss stressors and coping at the moment the subject is raised in the interview. Injecting one’s bias into the situation may interfere with the objective evaluation of the person’s statements and should be avoided.

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Focus of interview: A. Nature of Stressors. Recognizing problems and talking about them is usually necessary before the person can learn to develop effective coping strategies. This enables the nurse and the patient to plan appropriate interventions. - Formal assessment tools help identify and rank everyday stressful events: Social Readjustment Rating Scale (SRRS)- presents a list of major stressful life events and assigns numerical stress quotient to each event. Everyday Hassles Scale (EHS)- contains item that can cause stress and identifies behaviors and feelings that promote well-being.

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B. Stress perception. May be influenced by several factors, such as other concurrent events, the level of existing coping abilities, and the degree of distress experienced. Coping may be ineffective if the person perceives the stressor to be intense, is dealing with multiple stressors, or questions their ability to deal with the situation. Determining the number of stressors confronting a person at once is important, because more effort to adapt is needed when multiple stressors are present. A person may be asked to rate the stressor, then the nurse and client can then establish priorities for developing coping strategies.

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Coping Strategies. One method to determine is to ask directly how the person normally deals with stressful events. Some people are reluctant to share this information, however, or are unable to describe their behavior accurately. Defense mechanisms. It may be the first indication that the person is experiencing a threat from a stressor because stress signs may be masked. The defensive response, however, avoids the problem; it does not solve it.

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Formal assessment tools may provide means of identifying coping strategies and determining the client’s readiness for interventions: COPE interview guide- identify key stressors and select specific statements as appropriate responses. Jaloweic Coping Scale- list 40 strategies that a person can rate on a scale of 1 to 5( 1= never, 5= almost always). May be classified as problem-oriented strategy, which involves resolving problems and dealing with a stressful situation directly, or an affective-oriented strategy, which involves relieving the tension or distressing emotions evoked by the stressor.

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D. Stress Resolution. Effective coping will help resolve stress and result in positive outcomes. Ineffective coping mechanisms merely conceal stress and do not help in developing stress tolerance. Thus, the nurse needs to assess the reasons why the person has chosen particular coping strategies.

III. NURSING ASSESSMENT RELATED TO COPING AND STRESS TOLERANCE : 

III. NURSING ASSESSMENT RELATED TO COPING AND STRESS TOLERANCE A. Physiological Responses- stressors activate the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, resulting in physiological alterations that may be observed during physical assessment.

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Cardiovascular System. When the SNS is activated during stress, norepinephrine is released, producing the following: Increased heart rate Increased force of myocardial contractions Vasoconstriction in the skin, viscera and kidneys Increased myocardial oxygen consumption Increased systolic blood pressure Cardiac dysrhythmias, PVC ECG changes Chest pain sensations and palpitations Headache (migraine) Ischemic pain

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Respiratory system. Norepinephrine secretion during stress can lead to bronchiolar dilation. A more discernable response to anxiety is increase in respiration. This may occur as a subjective feeling of “air-hunger”. Gastrointestinal System. SNS stimulation inhibits GIT motility. Nevertheless, stress is often associated with nausea, vomiting, increased peristaltic activity, and excessive secretion of hydrochloric acid.

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Musculoskeletal System. Muscle tone may increase in response to stress. The person may appear tense and hold the extremities in a taut, nonrelaxed position. Low back pain and tremors if the hands may occur. Integumentary System. The skin may become diaphoretic in response to stress, a reaction that represents vasoactive changes in the subcuataneous vessels. Moist skin may be limited to the palms and face, or may be generalized. Skin lesions may recur during periods of stress.

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B. Behavioral Responses. Unresolved stress may be manifested by changes such as impaired thinking process, and inability to master task and meet basic needs. This is demonstrated by failure to complete everyday task, difficulty learning new skills and inability to interact with friends. C. Cognitive Responses. Impairment includes inability to concentrate, make decisions, and remember new information. D. Affective Responses. This includes anxiety, sadness, depression, fear and frustration. Feelings may progress to hopelessness, helpfulness, powerlessness and ambivalence and conflict.

Assessment of Suicide Potential : 

Assessment of Suicide Potential Techniques: Interviewing- the quickest and most direct assessment method. Questions should be done in a direct but caring manner. Ask if they have a plan or method in mind. Ask if the means in the plan are available.

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Listening- thoughts of suicide may be expressed verbally. “I don’t deserve to live anymore” “they’ll be sorry when I’m gone” “I found the solution to my problem Observing- it may be difficult, but it may be the only clue. Look especially for behaviors that are out of character for the person.

IV. NURSING DIAGNOSES : 

IV. NURSING DIAGNOSES A. Ineffective Individual Coping- is a state of inadequate response to stressors because of lack of physical, psychological, and behavioral resources necessary to promote effective coping strategies. Dysfunctional coping is identified if a person fails to adapt to a stressor within 3-6months period.

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Manifestations: Persistence of distressing symptoms Impaired social functioning Inadequate performance Self-destructive behaviors Overuse of defense mechanisms Verbalize inability to cope

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B. Dysfunctional or Anticipatory Grieving. Normally, grieving is a process of coping in response to a loss. It may also be anticipatory, in response to a future loss.

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Stages of Grieving: Shock and disbelief- the person may feel numb to all unpleasant emotion or deny that the loss has occurred. Awareness- the person becomes increasingly and painfully aware of the reality of the loss and may express anger towards others. Restitution- the person begins to mourn the loss. Resolution- the person resolves the loss by using intrapsychic methods and perhaps, becoming less preoccupied with the loss.

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C. Posttrauma Response- the trauma victim has usually been exposed to multiple stressors directly associated with traumatic events, not to mention threats to life and safety, and increasing feelings of vulnerability. Assessing a person includes evaluating the coping mechanism as well as the need for crisis intervention or other forms of emotional support.

V. NURSING DIAGNOSIS : 

V. NURSING DIAGNOSIS Coping, family: Potential for growth Coping, ineffective family; Compromised Coping, ineffective family; Disabling Coping, ineffective individual Decisional conflict Grieving, anticipatory Grieving, dysfunctional

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Other related nursing diagnosis: Adjustment, impaired Fear Hopelessness Post-trauma response Powerlessness Rape-trauma syndrome Self-concept, altered Spiritual distress Violence, potential for: self-directed or directed at others

VALUES AND BELIEFS : 

VALUES AND BELIEFS

I. INTRODUCTION : 

I. INTRODUCTION Values- is an affective disposition towards a person, object or idea. It can influence health-related decisions, health practices and priorities, and behavior in life threatening situations. Belief- a special class of attitudes in which the cognitive component is based more on faith than fact. They represent a personal confidence in the validity of some idea, person, or object.

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A value and belief system is the basis of person’s philosophy of life, whether conscious or unconscious. The pattern of a person’s values and beliefs is closely related to his or her self-concept, coping abilities, stress tolerance, and role-relationship behaviors. Values and beliefs must be considered in the assessment process in order to provide a basis for holistic care, and an understanding of the reasons for certain health-related decisions.

II. INTERVIEW PARAMETERS : 

II. INTERVIEW PARAMETERS A person’s values and beliefs are revealed throughout the health assessment interview and become apparent through language, behavior, and appearance. If a person does not indicate any difficulties with spirituality, only a screening assessment may be necessary. However, if a person does report a problem or is at risk, then a more thorough assessment is indicated.

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Interview parameters on: A. Culture Ethnic background- the impact will depend on the degree to which the person adheres to the values and beliefs of the ethnic group. Health beliefs- a cultural group may have their differences in remedies of different diseases and may stick to what has been established in their tradition, unless when the folk remedy fails. Rituals and folk treatments should be accepted, as long as it is within limits that will not in turn harm a person in need.

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Time orientation- assess how the client views past, present and future and how the client regards other human beings and their relationship to nature, health and illness. B. Spirituality Philosophy of Life- these are culturally influenced and are related to time orientation, beliefs about the relationship of humans to nature, interpersonal relationships and life purposes. It is to determine whether the client is satisfied with life, has plans for the future, and sees a purpose for life.

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Beliefs and values- although many spiritual assessment tools exist, most explore only a person’s relationship with God or a spiritual being. Some practices affect health related decisions: - Jehovah’s witness forbid blood transfusions. - Christian scientist avoid medicines - Jews and Seventh day Adventist cannot take gelatin capsules because of dietary laws. Spiritual support- exploring other philosophical areas can help identify means of providing psychological support. Inquire about family values, stage of faith development, spiritual support from others and of self.

III. NURSING ASSESSMENT : 

III. NURSING ASSESSMENT Focus: Person’s values, beliefs and spiritual dimensions, especially in relation to health and illness. Relationship of values, beliefs and spirituality to health care regimens Identification of spiritual problems that require nursing interventions or referrals. Assess dress, accent, language use and presence of religious or spiritual articles Observation of consistency between stated cultural membership and behavior.

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Considerations: Your own spirituality, culture, and values may influence the care provided to others. Some spiritual problems are best treated by others, thus, make appropriate referrals. Understanding the accepted norms and cultural groups enhances the ability to identify cultural or spiritual conflicts. Avoid generalizing and stereotyping and respect the values and beliefs of all clients.

IV. NURSING DIAGNOSIS : 

IV. NURSING DIAGNOSIS Decisional conflict Spiritual distress Other related nursing diagnosis: Anxiety Coping, ineffective family Coping, ineffective individual Family processes, altered Grieving, anticipatory Hopelessness Knowledge deficit Self-concept, altered

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