Stress Family Psycho Sp 09

STRESS

State Of Being Out Of Balance

Types Of Stressors • Must be perceived as a threat – Distress vs. eustress – Developmental stress vs. situational stress – Physiological stress vs. psychological stress

Responses To Stressors • Alter , adapt or avoid stressors – Change the way the stressor is viewed – Be a positive thinker – Surround yourself with positive people – The straw that broke the camel’s back

Concepts of Stress • Stimulus-based models • Transaction-based models • Response-based models (Selye)

Stress Models Stimulus-based • Any set of circumstances positive or negative that arouses physiologic/psychologic reaction • may increase vulnerability to illness

Transaction-based (Lazarus ) • Set of cognitive, affective, and adaptive (coping) responses that arise out of person-environment transactions

Stress Models • Response-based (Selye’s) GAS • Stress may be considered a response • Selye (1956, 1976) defined as nonspecific response of body to any kind of demand made upon it

Body tries to adapt or return to homeostasis

No more energy. Body becomes ill or dies

Body is able to return to homeostasis

Fight Or Flight

Response-based (Selye’s) General Adaptation Syndrome Local - Reflex pain or Inflammatory responses

Disorders Caused by Stress

Physiologic Causes of Stress Increase • Sweat production increases • Heart rate • Cardiac output increase • Skin is pallid • Respiration rate and depth • Mental alertness • Blood sugar • Pupils dilation

Decrease • Urinary output • Salivation • Intestinal Peristalsis • Excretion of Sodium and water

Cognitive Indicators of Stress • • • • •

Problem solving Structuring Self-control or self-discipline Suppression Fantasy

Psychologic Indicators of Stress • Anxiety and Fear • Anger and Depression • Unconscious ego defense mechanisms

Defense Mechanisms • • • • • • • •

Avoidance Compensation Denial Displacement Identification Intellectualization Introjection Minimization

• • • • • • • •

Projection Rationalization Reaction formation Regression Repression Sublimation Substitution Undoing

Four Levels of Anxiety Mild Increased questioning Mild restlessness Sleeplessness Use learning to adapt Severe Increased motor activity Inability to relax Fearful facial expression Hyperventilation HA, Dizziness, Nausea

Moderate Voice tremors, pitch changes Shakiness, muscle tension Narrowed focus of attention Panic Increased motor activity Unpredictable responses Trembling Chest pain/pressure Feeling of impending doom

Coping • Dealing with change (either successfully or unsuccessfully) – natural or learned way of responding to changing environment or specific problem or situation – Internal vs. external – Problem focus vs. emotional focus

Assessing Stress and Coping Patterns • Nursing History – Client-perceived stressors or stressful incidents – Manifestations of stress – Past and present coping strategies – Developmental transitions

Assessing Stress and Coping Patterns • Assessment interview – Scale to rate specific stressors – Duration of stressful situation – Usual strategy for handling stressful situations – Effectiveness of these strategies

Nursing Diagnoses Related to Stress • Anxiety • Caregiver Role Strain • Compromised Family Coping • Decisional Conflict (Specify) • Defensive Coping • Disabled Family Coping

• • • • •

Fear Impaired Adjustment Ineffective Coping Ineffective Denial Post-Trauma Syndrome • Relocation Stress Syndrome

Interventions to Minimize and Manage Stress • • • •

Physical Exercise Optimal Nutrition Adequate Rest and Sleep Time Management

Interventions • Physical exercise – Promotes physical and emotional health – 30 minutes/day recommended

• Optimal nutrition – Essential for health – Increases resistance to stress – Avoid excesses of caffeine, salt, sugar, fat – Avoid vitamin deficiencies

Interventions • Sleep – Restores body’s energy level – May need to use relaxation techniques

• Time Management – Must address what is important and achievable – Reexamine “should do”, “ought to do”, “must do”

Reducing Client Stress • Other methods include: – Listen attentively – Provide atmosphere of warmth and trust – Convey sense of caring and empathy – Include client in plan of care – Promote feeling of safety and security – Minimize additional stressors – Help with recognition of stressors and coping mechanisms

Sensory Perception Making sense of the environment

The Sensory Experience •

Stimulus – any that wakes up a nerve receptor

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Sensory reception - Process of receiving stimuli or data

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Sensory perception - Conscious organization and translation of data into meaningful information

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Arousal mechanism – gives meaning to stimulus

Sensory Alterations • Sensory deprivation – not enough stimulation to keep the Reticular Activating System alert

• Sensory overloads – to much stimuli

Risk Factors for Sensory Overload • Pain or discomfort • Admission to an acute care facility • Monitoring in intensive care units • Invasive tubes • Decreased cognitive ability

Factors Influencing Sensory Function

• • • • •

Developmental stage Culture Level of stress Medications and illness Lifestyle

Orientation Strategies for Client with Acute Confusion/Delirium

Sensory Alterations • Sensory Deprivation – Impaired vision, hearing – sensory aids – Impaired taste – incr seasoning, not salt – Impaired smell – aroma therapy – Impaired tactile perception (neuro) – Impaired kinesthetic sense – dance walking

Promoting Structured Sensory Stimulation for Unconscious Client • Auditory – Introduce yourself to the client – Orient the client to time, month, year, location – Inform client beforehand the care to be provided – Read literature to client – Play a tape recording of familiar voice – Converse directly to client

Sensory Alterations • Sensory Overload – Decrease light , noise – Use calm voice tone – Control pain – Decrease TV and radio use – Do not communicate with others in the patient's room

Promoting Structured Sensory Stimulation for Unconscious Client • Visual – Sit client upright in a chair or bed

• Olfactory – Provide aromatic stimuli that may include client’s favorites

• Gustatory – Provide mouth care – Place different tastes on tongue

• Tactile – Incorporate during bath activities

• Kinesthetic – Perform range-of-motion exercises – Change client’s position

NANDA Nursing Diagnoses • Disturbed Sensory Perception (Specify: Visual, Auditory, Kinesthetic, Gustatory, Tactile, Olfactory) • Acute Confusion • Chronic Confusion • Impaired Memory

NANDA Nursing Diagnoses • Examples for which sensory-perceptual disturbances are the etiology: – Risk for Injury – Impaired Home Maintenance – Risk for Impaired Skin Integrity – Impaired Verbal Communication – Self-Care Deficit: Bathing/Hygiene – Social Isolation

Health And Illness

Health And Illness Defined • Subjective – Health is ideal stated of physical and mental well being – Illness is absence if physical and mental well being – Hardiness is a strong will to live

Health / Illness Continuum Health • Biological factors • Nutrition • Physical activity • Sleep and rest • Meaningful work • Lifestyle choices • Family relationships • Religion and spirituality • Environmental factors • Finances

Illness • Physical disease • Injury • Mental illness • Pain • Loss • Impending death • Competing demands • The unknown • Imbalance • isolation

Stages of Illness Behavior • • • •

Experiencing symptoms Sick role behavior Seeking professional care Dependence on others

• Settle in – Understand the situation • Attune – pay attention to cues from the patient • Acceptance – respecting the patient’s choice of coping • Enjoying – accept the patient for who they are

Self Concept

Product Of Social Interaction

Gender Developmental level Peer relationship

Family Relationships AFFECTS SELF CONCEPT

Internal influences

Socio economic status

Four Dimensions of Self-Concept • • • •

Self-knowledge Self-expectation Social self Social evaluation

Four Components of Self-Concept • Personal identity unique self • Body image – what you see • Role performance – things you do to reach where you are going • Self-esteem - how satisfied with self

STRESSORS AFFECTING SELF CONCEPT

BODY IMAGE

SELF ESTEEM

ROLE IDENTITY

Assessing Role Relationships • Assess satisfaction and dissatisfaction with role responsibilities and relationships • Tailor questions to individual, culture, age, and situation

NANDA Nursing Diagnoses • • • • • • • •

Disturbed Body Image Ineffective Role Performance Chronic Low Self-Esteem Disturbed Personal Identity Impaired Adjustment Anticipatory Grieving Hopelessness Parental Role Conflict

NANDA Nursing Diagnoses • • • • • • • • •

Social Isolation Disturbed Thought Processes Readiness for Enhanced Self-Concept Anxiety Ineffective Coping Dysfunctional Grieving Powerlessness Disturbed Sleep Pattern Spiritual Distress

Nursing Interventions for Clients with Altered Self-Concept

• Help client to identify areas of strength • Assist clients to evaluate themselves and make behavioral changes • Framework for identifying personality strengths

Specific Strategies to Reinforce Strengths • Stress positive thinking • Notice and verbally reinforce client strengths • Encourage the setting of attainable goals • Acknowledge goals that been attained • Provide honest, positive feedback

Enhance Client Self-Esteem • Encourage clients to appraise situations and express feelings • Encourage clients to ask questions • Provide accurate information • Become aware of distortions, inappropriate or unrealistic standards, and faulty labels in clients’ speech • Explore clients’ positive qualities and strengths

Enhance Client Self-Esteem • Encourage clients’ positive qualities and strengths • Encourage clients to express positive selfevaluation more than negative self-evaluation • Avoid criticism • Teach clients to substitute negative self-talk with positive self-talk

Family

Family Nursing • • • • • • •

Not just one but many Longer visiting hours Allowing more than one visitor at a time Chapel Allowing the family to assist in nursing Teaching the family Nurse must know the family structure of the patient

Family Nursing Family structure • Who is in charge? • Characteristics of the family • Single head – young children, teenager • Low income • Mature family • Young family

Family’s View Of Medical Treatments • • • • •

Acceptance of invasive treatments Receiving blood Nutritional choices Usage of medications Personal definition of health

Religion and Spirituality • Religion- the practicing of rituals and beliefs associated with particular denomination • Spirituality is a sum total of a person’s experiences that provides insight to life • Spiritual distress- the disruption of an individual’s “life principle”

Increased Time of Spiritual Need • • • • •

Acute Illness Chronic Illness Terminal Illness Individuation Near-Death experience – Nurse must incorporate spiritual need in the care of the patient

Assessment • • • • • • •

Faith/Beliefs Life and self responsibility Life satisfaction Culture Support systems Rituals or practices Client Expectations

Nursing Diagnosis • Spiritual distress related to…. • Ineffective coping related to ….. • Hopelessness related to……

Goals • The patient will achieve balance between life values, goals,belief systems, and their relationship within themselves and others • The patient will utilize support system

Implementation • Caring behaviors • Assessing need for clergy; knowing how to contact hospital chaplain • Prayer and rituals • Integration of care with family- provide meals, assist with care, and support

Evaluation • Review specific goals set for patients • Determine whether they were met? • Were clients expectations met?

Future of Nursing and Spirituality -Parish Nursing

Sexuality

Sexual Development: • From birth - External genitals are sensitive to touch. Males have penile erections, Females have vaginal lubrication • Toddler (1-3 Years) - Can identify own gender • Preschooler (4-5 Years) -Explores own and classmates’ body parts, Focuses love on parent of opposite sex

Sexual Development: • School Age (6-12 Years) - Strong identification with parent of same gender, Friends of same gender, Increasing awareness of self • Age 8 or 9 often have specific concerns about sexuality and Sexual Development: • Adolescence (12-18 Years) = Primary and secondary sexual characteristics develop • Masturbation common, May experiment with homosexuality

Sexual Development • Young Adulthood - Establishes own lifestyle and values, Homosexual identity established in mid20s • Middle Adulthood - Decreased hormone production, Menopause in women between 4055 years, Quality rather than number of occurrences becomes important

Varieties of Sexuality • Sexual Orientation • Gender Identity • Erotic Preferences

Influences on Sexuality • • • •

Family Culture Religion Personal expectations and ethics

Male and Female Sexual Response Cycle • Excitement/Plateau • Orgasmic • Resolution

Sexual Dysfunction • May be related to: – Past and current factors – Sexual desire disorder – Sexual arousal disorder – Orgasmic disorder – Sexual pain disorder – Problem with satisfaction

NANDA Nursing Diagnoses • Diagnoses relating specifically to sexuality: – Ineffective Sexuality Pattern – Sexual Dysfunction

NANDA Nursing Diagnoses • Sexual problems as etiology of other diagnoses: – Deficient Knowledge – Pain – Anxiety – Fear – Disturbed Body Image

Health Promotion Teaching • Sex Education • Teaching Self Examinations – Self-breast examination (BSE) – Testicular self-examination (TSE)

• Responsible Sexual Behavior – Prevention of sexually transmitted disease – Prevention of unwanted pregnancies – Avoidance of sexual harassment and abuse