for in-service education

1. INSERVICE
EDUCATION OF
STRESS
MANAGEMENT
Prepared By
PBNS 2nd Year

2. CONTENT
 Definition
 Types of stress
 Stressor
 Classification of Stressor
 Causes and effect of stress
 Stress Response
 Body response to stress
 Stress Management

3. Stress
Management

7. What is Stress?
Stress can be defined as
our mental, physical,
emotional, and behavioral
reactions to any perceived
demands or threats.
According to old concept
–“ To be alive is to be
under stress.”

8. Stress
 Stress is the way human beings
react both physically and mentally
to changes, events, and situations
in their lives. People experience
stress in different ways and for
different reasons.
 Right from the time of birth till the
last breath, we all face different
challenges and obstacles and
sometimes the pressure is hard to
handle .

9. Definition
According to Hans Selye, “stress is nonspecific response of
the body to any demand made upon it, whether it is
caused by the results of pleasant and unpleasant situation
(one which effects all or most parts of a system without
selectively, for eg exposure to extreme cold is specific
problem to which the body must respond and adjust heat
by perspiring).

10. RESEARCH
EVIDENCE
A quantitative research conducted
among 100 teachers from nursing
and paramedical colleges in Punjab
concluded that 94% of faculty
members had moderate level
occupational stress and had more
stress related to workload.
Qualification, designation and
experience were found significant
p< 0.05 level (Kaur & Sharma,
2022).

11. CONT...
•A non- experimental correlation study
was done among 130 teaching.
•Faculties from Tribhuvan University
affiliated colleges. The correlation
between workload, working situation,
role and responsibility, peer
relationship and recognition had a
significant positive relationship on
occupational stress (Adikari & Tiwari,
2023).

12. IsAll Stress Bad?
Moderate levels of stress may actually improve
peormance and efficiency
No, not all stress is bad. It depends on the situation and
how it is handled.
Too much stress may cause an unproductive anxiety level

13. Eustress
Eustress is "good" stress. It is stress that arises from the
demand of pleasant or fun activities.
E.g : vacation, weddings, promotions, running, etc.

14. POSITIVE STRESS RESULTS
Enables Concentration
Increases performance
Generates Motivation

15. Distress
Distress is “bad” stress. It is
stress we experience in
regard to “negative”
demands to which we must
adapt. It is when we
experience stress for too
much of the time. Example:
cramming for finals, too
heavy of a workload,
troubled relationships, etc.

16. Negative Stress Results
Loss of motivation
Reduce effectiveness
Physical,Mental and
Behavioral Problems

17. Negative Effects of Stress
• Weight gain/loss
• Unexpected hair loss
• Heart palpitations
• High blood pressure
1. Physical

18. 2. Emotional
• Mood swings
• Anxiety
• Can lead to depression
• Can also lead to
unhealthy coping
strategies (i.e. alcohol,
drugs, etc)

20. STRESSOR
• Stressors are any events or stimulus that causes an
individual to experience stress.
• It may be physical, psychological or social in nature or
a combination of these.
• Stressors might be heat, cold, radiation, infectious
agent,

21. Classifications
of stressor
A. On the basis of origin
(internal and external
stressor)
B. On the basis of source
(Physical,
Psychological,
Financial, Spiritual,
cultural)

22. A. On the Basis of origin
1. Internal stressors
•It originates within a person, such
as different diseases, fever , cancer
etc.
2. External stressors
•It originates outside a person such
as peer rejection, peer pressure,
death with in family, migration,
disaster etc.

23. Continue..
3. Developmental- It occurs at
predictable times throughout an
individual’s life. E.g. entry to the
school, puberty, pregnancy,
menarche, birth giving, rearing
child.
4. Situational- unpredictable
and may occur at any time during
life. It may be positive or
negative. E.g. accidents,
interview, getting job, illness etc.

24. B. On the basis of source
Stressors may also be categorized as physical,
psychological, financial, spiritual and social
1. Physical stressor - such as heat, cold excessive
noise etc.
2.Psychological stressor- arise from time pressures or
the unrealistic expectations we place on ourselves or
allow to be placed on us by others such as” you must
be perfect”,fear of increasing responsibility, death of
parent, harm and discomfort

25. 3. Financial stressors-
No job, loan, medical cost, school,
increasing cost of daily groceries are
some examples of financial stressor.
4. Spiritual stressor-
Arise when basic spiritual values or
beliefs are reformulated, called into
questions, ignored or, when time
constraints obstruct on spiritual
needs contributes to higher level of
stress and impairment.

26. 5. Social stress-
The loss of contact with friends and family
contributes to feeling of loneliness. Social stressors
are abundant and can arise in any context where
interpersonal relationship exist, like school, work,
church and community.

27. Source of stress
• Attack of bacteria, virus
and parasites.
• Trauma (injury burn
electric shock etc)

28. • Inadequate food, warm,
cold, protection
• Disruptive social and
family relations.
• Imagined treats of injury.
• Unfulfilled basic needs.

29. Changes in maternal, physiology e.g. puberty,
menstruation, pregnancy, and menopause.
-Long period of separation from family.
-Natural disaster
-Hard competitive sports, examination

31. Causes and Effects of
stress in Humans
Everyone has different stress triggers.
Work stress tops the list, Causes of
work stress include:
 Being unhappy in job

32. Conti….
 Having a heavy workload or too
much responsibility
 Working long hours
 Having poor management, unclear
expectations of work

33.  Working under dangerous conditions
 Being insecure about chance for advancement or risk
of termination
 Having to give speeches in front of colleagues
 Facing discrimination or harassment at work,
especially if company isn't supportive

34. The Stress Response
•The stress response starts with a signal from
the part of your brain called the hypothalamus.
Perched above the brainstem, the
hypothalamus is a network of nerves wired to
the rest of your body through the autonomic
nervous system.

35. The autonomic nervous system rules such involuntary
body functions as breathing, blood pressure, heartbeat,
and the dilation or constriction of key blood vessels
and small airways in the lungs called bronchioles.
This stimulates cells in the pituitary to send their own
chemical messenger, adrenocorticotropic hormone
(ACTH), to the adrenal glands, which spill cortisol
into the bloodstream.

36. Surges of epinephrine and
norepinephrine are also released by the
adrenal glands on instructions from the
brain and simultaneously understanding
the stress response.
Stress hormones race through your
bloodstream to different parts of your
body, preparing you to fight or flee.

37. BODY
RESPONSE TO
STRESS
There are two kinds of
stress responses:
• Physiological response
• Psychological response

38. 1. Physiological response
• Physiological response to stressor
is fight or flight. When an
individual faces stress, his/her body
adjusts automatically to maintain
equilibrium.
• In this process include system
which controls the body’s
involuntary response such as
secretion of hormone, metabolism,
and fluid regulation through
sympathetic and parasympathetic
activities.

39. • Sympathetic is
responsible for restoring
the body to its normal
resting state. Sign and
symptoms of
physiological response to
stress.

40. CONTD….
The “Fight or Flight” Response
• When situations seem threatening to
us, our bodies react quickly to supply
protection by preparing to take action.
• This physiological reaction is
known as the "fight or flight"
response.

41. CONTD….
• The physiological response to a
stressor is known as reactivity.
• Physiological responses can
accumulate and result in long-term
wear on the body.

42. CONTD
…
• The body’s autonomic nervous
system controls your heartrate,
breathing, vision changes and more.
Its built-in stress response, the “fight-
or-flight response,” helps the body
face stressful situations.

43. CONTD…
• When a person has long-term
(chronic) stress, continued
activation of the stress response
causes wear and tear on the body.

44. CONTD…
Physical, emotional and
behavioral symptoms develop.
Dilate pupil, diaphoresis, dry
mouth, increased heart rate, pulse
rate, increased BP, frequency of
urination, constipation and flatus,
nausea.

45. • Dilate pupil
• Diaphoresis
• Dry mouth
• Increased heart rate, pulse rate

46. • Increased BP
• Frequency of urination
• Constipation and flatus
• Nausea

47. Sign and symptoms of
psychological response
of body to stress
1. Anxiety
2. Fear
3. Anger –violence
 Hostility
 Aggression

48. 4. Depression
5. Cognitive manifestations
• Problem solving
• Structuring
• Self control
• Suppression
• fantasy or day dreaming

49. 6.Verbal and motor
• Crying
• verbal abuse
• Laughing
• heating or kicking
• holding and touch

50. 7. Self pity (a feeling
of sympathy)
• Sad
• increased negative
feeling
• helplessness

51. CONTD….
• Frustrated
• feel inadequate
• Difficult decision
making
• social withdrawal

54. Stress Management

55. Recognizing the Signs of Stress
Stress is both a psychological and physiological response
to change.
It does not manifest itself the same way in everyone.
Some people do not eat enough when they are stressed,
while others binge-eat.

56. CONTD….
Some develop insomnia during times of
stress, while others sleep excessively.
When your “ordinary” behaviors and
responses change significantly as a
result of life circumstances, chances are
that you are experiencing stress.

57. Learning to Manage Stress
Effective stress management involves the following:
Learning to recognize the signs that you are
experiencing stress.
Recognizing the circumstances that trigger
stress reactions in you.
Applying stress management techniques to
help you cope.

58. Importance of Stress
Management
•Those who don’t learn and use
appropriate stress management
techniques can experience a
variety of negative effects,
including physical illness,
psychological illness, damaged
personal relationships, poor
productivity and more.

59. Managing Stress
Stress Relief Strategies
1.Body relaxation exercises
-breathing techniques
-guided imagery

60. CONTD….
2.Physical exercise
-yoga
-workout routine
3.Meditation
4.Counseling

61. 1. Relaxation Technique
a. Meditation
b. Prayer
c. Guided Imaginary
d. Deep Breathing
10 Stress Management Technique

62. 1.Relaxation Technique
•Relaxation is the state of
generalized decreased
cognitive Physiological and
or behavioural arousal. It
helps individual to develop
cognitive skills reducing the
negative ways in which they
respond to situation within
their environment. Some of
relaxation techniques are as
below:

63. 1.Progressive
Relaxation:
Relaxation techniques
have been used extensively
to reduce high levels of
stress and chronic pain.
Using relaxation
techniques enables to client
to exert control over the
body’s responses to tension
and anxiety.

64. CONTD….

65. STEPS:
First find a comfortable place to relax
where there are no distractions. During the
day darken the room, at night go to sleep
after the exercise.
Sit comfortably in a chair, with your feet
flat on the ground.
During the tension part of the cycle, the
patient taught first to tense and then to
relax groups of voluntary muscles in the
systemic manner. First the feet, then the
lower legs, the thigh and so on up to the
trunk and arms to the face.

66. CONTD..
During the relaxation part, relax the
muscles completely and quickly, let
your mind relax and see how relaxed
the muscles are feeing.
Tense and relax each muscle group
twice after you have completed the
entire sequence, go back and tense
and relax specific muscles which you
still feel tense.
Note: This process helps the person
learn to control tension in the muscles,
thus leading to reduction in heart rate
and blood pressure and creating mental
and emotional calmness.

67. a)Meditation:
• It is general term for a wide
range of practices that involve
relaxing the body and stilling the
mind. It is a technique used to
quiet the mind and focus in the
present and to release fears,
worries; anxiety and doubts
concerning the past and the
future and that reduce daily
stress.

68. CONTD….
It produces a state of deep peace
and rest combined with mental
alertness. Originally, meditation
was viewd as a religious practice
and is still practiced by many as
form of prayer.

69. CONTD….
•Meditation exercises can give
clients relief from chronic pain,
insomnia, anxiety, and
depression and can help in
coping with the side effects of
uncomfortable therapy, twice a
day for 10 to 20 minutes.

70. CONTD..
•Sit quietly in a comfortable
position with their eyes closed and
repeat a sound; phrase or sacred
word in rhythm with breathing,
gently disregarding intrusive
thoughts as they do so experience
decreased metabolism and heart
rate, easier breathing and slower
brain waves.

72. CONTD…
b) Prayer:
•It is similar to meditation but is
intended to be communication with
God; a saint or some other being who
answers the prayer.
•The act of prayer gives an individual the
opportunity to renew personal faith and
belief in a higher being in a specific
focused way that may be highly
ritualized and formal or quiet
spontaneous and informal.

74. •It is the internal experience
of memories, dreams,
fantasies and visions that
serves as bridge connecting
body, mind and spirit.
• A visualization technique
uses the conscious mind to
create mental image to
stimulate physical changes
in the body, improve
perceivced wellbeing and or
enhance self-awareness.
c) Guided Imaginary:

75. CONTD….
•Imaginary enables people to open their minds to mental
ideas of positive creative images that foster self-healing
and bring about desired achievements, imaginary can be
self- directed or guided.

76. CONTD….
•Guidelines:
Begin the session with the
person lying in bed or seated in
ac chair.
Ask the person to assume a
position as a comfortable as
possible, one in which the
person might even fall asleep.
Sit near the person and speak
slowly and soothing as you
provide guidance in the person’s
through processes.
Try to eliect images that are
pleasant, relaxing and associated
with positive physical sensations

77. d) Deep Breathing:
• A relaxation technique in which a person focuses on taking
slow, deep breaths. Deep breathing involves breathing in
slowly through the nose and then out through the mouth
using the diaphragm (the thin muscle that separates the
chest from the abdomen) and abdominal muscles.
• This helps boost the amount of oxygen in the blood, lowers
blood pressure and heart rate, and reduces muscle tension.
Deep breathing may be used to help relieve stress, pain, and
anxiety. Also called abdominal breathing and diaphragmatic
breathing.

78. CONTD…
This calming breathing technique for
stress, anxiety and panic takes just a
few minutes and can be done
anywhere.
1. You will get the most benefit if you
do it regularly, as part of your daily
routine.
2. You can do it standing up, sitting in
a chair that supports your back, or
lying on a bed or yoga mat on the
floor.
3. Make yourself as comfortable as you
can. If you can, loosen any clothes
that restrict your breathing.

79. CONTD..
4. If you're lying down, place your
arms a little bit away from your
sides, with the palms up. Let your
legs be straight or bend your knees
so your feet are flat on the floor.
5. If you're sitting, place your arms
on the chair arms.
6. If you're sitting or standing,
place both feet flat on the ground.
Whatever position you're in, place
your feet roughly hip-width apart.

82. 10 Stress ManagementT
echniques
2. Exercise
• Aerobic activities

84. • Running

85. • Swimming

86. • Zumba

87. • Anaerobic activities

88. • Walking

89. • Stretching

90. • Yoga

91. Cont…..
3. Nutrition
Eat a balanced diet.
Stay hydrated with plenty of water.
Avoid processed foods.
 Reduce caffeine consumption. Avoid
alcohol.
Take appropriate nutritional supplements.

92. CONTD….
4. Sufficient Rest
• Get plenty of sleep.
• Take a few short breaks
throughout the day.
• Allow your mind to rest
periodically.

93. 5. Goal Setting
Break major projects/tasks down into
achievable goals.
Set milestones for goal achievement.
Track progress toward goal
accomplishment.
Reward yourself for progress.

94. CONTD….
10 Stress ManagementT
echniques
6. Journaling
• Keeping a journal is a good way to keep stressors
from building up inside yourself.
• Journaling also provides a way to make it easier to
recognize circumstances and patterns that lead to
stress reactions.
• Writing down stressors can be a great step toward
learning how to manage them effectively.

95. CONTD….
7. Proactive
Communica
tion
Express your feelings to those who
are involved in the stressful
circumstances in your life.
Discuss the circumstances you are
facing with trusted friends and
confidantes.

96. CONTD….
8. Seek Counseling or Therapy
• Seeking professional assistance when
needed is a sign of strength.
• Working with a qualified therapist,
counselor or other qualified mental
health professional can be one of the
best ways to learn how to deal with
stress.

97. CONTD….
9. Deal with Circumstances
• Engaging in avoidance behavior is not an effective
technique for stress management.
• Ignoring problems or pretending that things are fine
when they are
not only leads to greater stress in the long run.
• Managing stress effectively requires actually dealing
with it and working through it.

98. CONTD….
10. Apply Effective Time Management
Skills
• Take the time to get organized. Prioritize your to-do
list.
• Learn to delegate.
• Leave time for yourself in your schedule.
• Learn how to say “no” to stress-inducing requests
that are not essential.

99. Stress ManagementThat Works forY
ou
• Finding the stress management techniques that work
effectively for you in the stressful situations that
arise throughout your life can be a powerful resource
for health promotion.
• Be mindful of when you experience stress, how it
affects you and what
actions best allow you to cope with its effects.

100. Other Helpful tips
Changing perceptions and expectations
Break jobs/tasks into manageable parts
Set reasonable/realistic goals
Avoid procrastination
Set boundaries
Don’t compromise your values/beliefs
Schedule “me” time
Avoid caffeine

101. FreeApps
You have at your fingertip multiple resources
through your electronic device to help you deal with
stress:
•Complete Relaxation: Guided Meditation for a Happy,
Stress free Life
•The Mindfulness App
•Calm – Meditate, Sleep, Relax
•OmVana – Meditation for Everyone

102. Benefits of Stress Management
Physical health gets better
More energy and stamina
Emotions stabilized positive attitude
Hopeful/happier
Ability to focus improved
Able to learn and achieve

103. The Key Word Is….
Balance

104. References
Sumitra Pathak, R. D., 2021. A textbook of foundation of
nursing. Bhotahity,kathmandu: Vidyarthi Pustak Bhandar.
Muna sharma, 2023(2080 B.S),.NURSING CONCEPTS &
PRINCIPLES, kathmandu: Samiksha Publication
American Psychological Association.
(2020). https://dictionary.apa.org/.

105. Patterson, E. (2020, November 6). Stress Facts, Statistics
and Trends: TheRecovery Village. The Recovery Village
Drug and Alcohol
Rehab. https://www.therecoveryvillage.com/mental-
health/stress/related/stressstatistics/#:~:text=According%2
0to%20The%20American%2
0Institute,that%20impacts%20their%20mental%20health.

106. Smith, M., Segal, J., & Robinson, L. (2020,
October). Burnout Prevention and Treatment.
HelpGuide.org. https://www.helpguide.org/articles/stress/bu
rnout-prevention-and-recovery.htm.

107. WebMD. (n.d.). Stress Symptoms: Physical Effects of Stress
on the Body.
WebMD. https://www.webmd.com/balance/stress-
management/stress-symptoms-effects_of-stress-on-the-
body#:~:text=Becoming%20easily%20agitated%2C%20frustr
ated%2C%20and,%2C%20lonely%2C%20worthless%
• 2C%20and%20depressed.