2. SEMINAR ON STRESS AND
ITS MANAGEMENT
Presented by,
Premnath R
I year MSc Nursing
Govt. CON Kottayam

3. History
• ‘Stringere’ means ‘to draw tight’
• Walter Cannon refer it as external
factors that disrupted homeostasis.
• The term stress coined by Hans Selye.

4. Stress - Definition
• The non-specific response of the body to any
demand placed upon it.
(Hans Selye)
Stress should be restricted to conditions where
an environmental demand exceeds the natural
regulatory capacity of an organism.
(Bruce McEwen and Jaap Koolhas)

5. Relationship between the person and the
environment that is appraised by the person as
taxing or exceeding his or her resources and
endangering his or her well-being.
(Lazarus and Folkman , 1984)

6. EUSTRESS
Eustress or positive stress occurs when your
level of stress is high enough to motivate you to
move into action to get things accomplished.

7. DISTRESS
Distress or negative stress occurs when your
level of stress is either too high or too low and
your body and/or mind begin to respond
negatively to the stressors.

8. CONCEPTS OF STRESS
• Stress as a biological response.
• Stress as an environmental event.
• Stress as a transaction between the
individual and the environment.

9. Stress as a biological response
• In 1956, Selye described the syndrome of
symptoms as the “fight or flight syndrome”.
He described the reaction in 3 different stages.
1. Alarm reaction stage- during this stage, the
physiological response of the “fight or flight”
syndrome are initiated.

10. 2. Stage of resistance- the individual uses the
physiological response of the first stage as a
defence in the attempt to adapt to the
stressor.
3. Stage of exhaustion- this stage occurs when
there is a prolonged exposure to the stressor
to which the body has adjusted. The adaptive
energy is depleted and the individual can no
longer draw from the resources for
adaptation. Diseases of adaptation (eg.,
headache, mental disorders, coronary artery
diseases, ulcers) may occur.

11. General Adaptation Syndrome

12. Alarm reaction stage

13. Stress responses in alarm reaction
• Heart rate and strength of cardiac muscle
contraction increases
• Blood vessels supplying to the skin and viscera
constrict; at the same time blood vessels
supplying to skeletal muscles and brain dilate;
thus decreasing blood supply to organs which
do not assume an immediate active role.
• RBC production is increased leading to an
increase in the ability of the blood to clot. This
helps to control bleeding.

14. • Liver converts glycogen into glucose and
releases it into he blood stream; this provides
energy needed to fight the stressor.
• The rate of breathing increases and respiratory
passages widen to accommodate more air.
• Production of saliva and digestive enzymes
reduces.

15. The General Adaptation Syndrome:
Alarm Phase
Figure 3.2

16. STRESS - BODY RESPONSE

17. Resistance Reaction
• It is initiated by regulating hormones
secreted by hypothalamus.
• It is a long-term reaction.
• Regulating hormones are
• Corticotropin Releasing Hormone (CRH)
• Growth Hormone Releasing Hormone (GHRH)
• Thyrotrophic Releasing Hormone(TRH)

18. • CRH stimulates the anterior pituitary to
increase its secretion of adrenocorticotrophic
hormone(ACTH). The action of these
hormones helps to control bleeding, maintain
blood pressure etc.
• GHRH stimulates anterior pituitary to secrete
human growth hormone(HGH).
• TRH causes the anterior pituitary to secrete
thyroid stimulating hormone (TSH). The
combined action of HGH and TSH help to
supply additional energy to the body.

19. Exhaustion stage
• At this stage, cells start to die, and the
organs weaken.
• A long – term resistance reaction put
heavy demand on the body, particularly on
the heart, blood vessels, and adrenal
cortex, which may suddenly fail under
strain.

20. • Immune system is exhausted and function is
impaired resulting in decompensation.
• The result can manifest itself in obvious illnesses
such as ulcers, depression, diabetes, trouble with
the digestive system or even cardiovascular
problems, along with other mental illnesses.

21. Stress as an environmental event
• Stress as the “thing” or “event” that triggers the
adaptive physiological and psychological response
in the individual.
• The event is one that create change in the life
pattern of the individual, requires significant
adjustment in the life style, and taxes available
personal resource.
• The change can be either positive, such as
accomplishing an outstanding personal
achievement, or negative, such as being fired from
a job.

22. • Holmes and Rahe(1967) devised the social
readjustment rating scale. Numerical values
were assigned to various events, or changes, that
are common in people’s lives.
• Holmes and Rahe concluded that the higher
the score on the social readjustment rating
scale, the greater the susceptibility of the
individual to physical or psychological illness.

24. Stress as a transaction between the
individual and the environment
• Personal characteristics as well as the
nature of the environmental event are
considered.
(Lazarus& Folkman,1984)

25. Precipitating event
 A precipitating event is a stimulus arising from the
internal or external environment and is perceived
by the individual in a specific manner.
 Determination that a particular
person/environment relationship is stressful
depends upon the cognitive appraisal of the
situation by the individual.

26. • Cogni t i ve apprai sal i s t he
i ndi vi dual ’s eval uat i on of t he
per sonal si gni f i cance of t he event or
occur r ence. The event pr eci pi t at es a
r esponse on t he par t of i ndi vi dual ,
and t he r esponse i s i mpact ed by t he
i ndi vi dual ’s per cept i on of t he event .

27. Predisposing factors
Types of precipitating factors include
genetic influences, past experiences and
existing conditions.
• Genetic influences are those circumstances of an
individual’s life that are acquired by heredity.
Examples include family history of physical and
psychological conditions and the individual’s
temperament.

28. • Past experiences are occurances that result in
learned patterns that can influence an individual’s
adaptation response.
• They include previous exposure to the stressor,
learned coping responses, and degree of
adaptation to previous experiences.

29. • Existing conditions incorporate vulnerabilities that
influence the adequacy of the individual’s physical ,
psychological and social resources for dealing with
adaptive demands.
• Examples include current health status, motivation,
developmental maturity, severity and duration of the
stressor, financial and educational resources, age,
existing coping strategies, and a support system of
caring others.

30. STRESS ADAPTATION MODELS
1. Stuarts Stress Adaptation Model
2. Transactional model of stress and
coping
3. Psychosomatic model

31. Stuarts Stress Adaptation
Model

32. TRANSACTIONAL MODEL OF STRESS AND
COPING
PRECIPITATING EVENT
PREDISPOSING EVENT
COGNITIVE APPRAISAL
IRRELEVANT BENIGN POSITIVE STRESS
APPRAISAL
NO RESPONSE PLEASURABLE RESPONSE

33. STRESS APPRAISAL
HARM THREAT CHALLENGE
SECONDARY RESPONSE
AVAILABILITY OF COPING STRATEGIES
PERCEIVED EFFECTIVENESS OF COPING STRATEGIES,
PERCEIVED AVAILABILITY TO USE COPING STRATEGIES
EFFECTIVELY
QUALITY OF RESPONSE
ADAPTIVE MALADAPTIVE

34. PSYCHOSOMATIC MODEL
• Psychic phase: It is marked by mild, but
persistent psychological and behavioral symptoms
of stress like irritability, disturbed sleep, anorexia
etc.
• Psychosomatic phase: If stress condition
continues, these symptoms become more
pronounced along with beginning of generalized
physiological symptoms like occasional
hypertension, tremors etc.

35. • Somatic phase: It is marked by increased
function of organ. At this stage, one begins to
identify beginning of a disease stage.
• Organic phase: It is marked by full
involvement of a so called disease state with
physiological changes like ulcerated stomach
or chronic hypertension.
PSYCHOSOMATIC MODEL

36. CAUSES OF STRESS
• 1.Catastrophs
• 2.Major life changes
• 3.Daily hassles

37. Catastrophe
A catastrophe is a sudden, often life-
threatening calamity or disaster that pushes
people to the outer limits of their coping
capability.
Catastrophes include natural disasters—such as
earthquakes, tornadoes, fires, floods, and
hurricanes—as well as wars, torture, automobile
accidents, violent physical attacks, and sexual
assaults.
Catastrophes often continue to affect their victims’
mental health long after the event has ended.

38. Major life changes
The most stressful events involve major life
changes, such as death of a spouse or family
member, divorce, imprisonment, losing one’s
job, and major personal disability or illness.

39. Daily hassles
• living in a noisy neighborhood
• commuting to work in heavy traffic
• disliking one’s fellow workers
• worrying about owing money
• waiting in a long line
• misplacing
• losing things.
When taken individually, these hassles may
feel like only minor irritants, but cumulatively,
over time, they can cause significant stress.

40. Symptoms of stress
• Feelings
• Behavior
• Physiology

41. Feelings
• The individual becomes anxious and is scared.
• The person feels that he has got something to
loose or something wrong will take place.
• The person becomes irritable and moody.
• Individual develops a negative frame of mind and
suffers from low self-esteem.
• The person loose faith in his capabilities and is
afraid of the failures.
• Not able to concentrate and is involved in his
own plans and thoughts.

42. PHYSIOLOGICAL AND
BEHAVIORAL CHANGES
• Speech problems.
• Impulsive Behavior
• Crying for no apparent reason.
• Laughing in a high pitch and nervous tone of
voice.
• Grinding of teeth
• Increasing smoking and use of drugs and alcohol.
• Being accident-prone
• Perspiration /sweaty hands
• Increased heart beat
• Trembling
• Nervous ticks

43. PHYSIOLOGICAL AND
BEHAVIORAL CHANGES
• Dryness of throat and mouth.
• Tiring easily
• Urinating frequently
• Sleeping problems
• Diarrhea / indigestion / vomiting/ nausea
• Butterflies in stomach
• Headaches
• Premenstrual tension
• Pain in the neck and or lower back
• Susceptibility to illness
• Loss of appetite or over eating

44. EFFECTS OF STRESS
• Stress response
• Disease
• Decreased immune response
• Mental illness

46. STRESS MANAGEMENT
• Become aware of stressors and emotional
and physical reactions.
• Relaxation
• Meditation
• Interpersonal relation with caring other
• Problem solving
• Pets

47. STRESS MANAGEMENT
• Music
• Recognize what we can change
• Reduce the intensity of emotional reactions to
stress
• Learn to moderate physical reactions to stress
• Build physical reserves.
• Maintain emotional reserves

48. STRESS MANAGEMENT
TECHNIQUES
1. Stress Diary - Finding Optimum Stress Levels
2. Psyching Up' - Raising Stress Levels to Improve
Performance
3. Anticipating Stress - Managing Stress by Preparing
For It
4. Get a hobby or two, relax and have fun: Talk with
friends or someone you can trust about
worries/problems.

49. STRESS MANAGEMENT
TECHNIQUES
5.Other Techniques:
• Meditation can also be a good effort to
bring down the stress levels.
• Taking exercise
• Effective time Management
• Good Food and nutrition.

50. THE NURSING PROCESS FOR
THE MANAGEMENT OF STRESS
ASSESSMENT:
 Nursing History
 Physical assessment
 Assessment of the person
 Assessment of the family
 Assessment of the environment

51. NURSING DIAGNOSIS

52. OUTCOME IDENTIFICATION
AND PLANNING
• Decrease in the level of anxiety
• Develop effective coping skills
• Describe a reduction in anxiety and
an increase in comfort.

53. IMPLEMENTATION
• Non-Pharmacological methods

54. A TO Z OF STRESS MANAGEMENT
• Always take time for yourself, at least 30
minutes per day.
• Be aware of your own stress meter: Know when
to step back and cool down.
• Concentrate on controlling your own situation,
without controlling everybody else.
• Daily exercise will burn off the stress chemicals.

55. A TO Z OF STRESS MANAGEMENT
• Eat lots of fresh fruit, veggies, bread and water;
give your body the best for it to perform at its
best.
• Forgive others, don't hold grudges and be
tolerant -- not everyone is as capable as you.
• Gain perspective on things, how important is
the issue?
• Hugs, kisses and laughter: Have fun and don't
be afraid to share your feelings with others.

56. A TO Z OF STRESS MANAGEMENT
• Identify stressors and plan to deal with them
better next time.
• Judge your own performance realistically; don't
set goals out of your own reach.
• Keep a positive attitude, your outlook will
influence outcomes and the way others treat
you.
• Limit alcohol, drugs and other stimulants, they
affect your perception and behavior.

57. A TO Z OF STRESS MANAGEMENT
• Manage money well, seek advice and save at least 10
per cent of what you earn.
• No is a word you need to learn to use without
feeling guilty.
• Outdoor activities by you, or with friends and
family, can be a great way to relax.
• Play your favorite music rather than watching
television.

58. A TO Z OF STRESS MANAGEMENT
• Quit smoking.
• Relationships.
• Sleep well.
• Treat yourself once a week with a massage,
dinner out, the movies.
• Understand things from the other person's point
of view.
• Verify information from the source before
exploding.

59. A TO Z OF STRESS MANAGEMENT
• Worry less.
• Xpress.
• Yearly goal setting.
• Zest for life.

60. Stress Management
Strategies
Remove the
Stressor
Withdraw from
the Stressor
Change Stress
Perceptions
Receive Social
Support
Control Stress
Consequences
Stress Management Strategies

61. Inverted-U Hypothesis:
Stress and Performance:

62. Who Wants to Get Rid of All the
Stress in Your Life?
Only One Group of
People Have No
Stress

63. The Key Word Is….
Balance

64. DISCUSSION QUESTION

65. Self management
of stress

66. Stress management
strategies for you

67. • Take a Deep Breath
• Manage Time
• Connect with Others

68. • Talk it Out
• Take a “Minute” Vacation
• Monitor Your Physical comfort

69. • Get Physical
• Take Care of Your Body
• Laugh

70. • Know your limits
• Think Positively
• Develop a Sense of Life Meaning

71. •Compromise
•Have a Good Cry
•Avoid Self Medication
•Look for the “Pieces of Gold”
Around you