Nurses are under stress always .... get rid of it .

1. Understanding Stress
How can we GET RID of it ?
By: Ms. Shanta Peter
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4. STRESS
Stress is a process of adjusting to or
dealing with circumstances that disrupt
or threaten to disrupt a person’s
physical or psychological functioning
(Selyle -1976)
Stress is strain, tension or
Pressure from a situation that
requires us to use , adapt or
develop new coping skills 4

5. Emotions & Feelings
• Emotions are the raw energy that we sense
in our body when we encounter stressors.
• Mediated by the limbic system of brain
(mammals )
• Feelings, on the other hand, are
how we interpret our emotions
• Energy for stress /worries = 8 hrs
of physical job 5

6. Stressor
Is the stimuli proceeding or precipitating
a change. It may be
• Internal( fear, guilt) or
• External(trauma , peer pressure )
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8. Common external causes of stress
• Major life changes
• Work or school
• Relationship difficulties
• Financial problems
• Being too busy
• Children and family
Common internal causes of stress
• Chronic worry
• Pessimism
• Negative self-talk
• Unrealistic expectations/Perfectionism
• Rigid thinking, lack of flexibility
• All-or-nothing attitude
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9. Stress is caused by two things.
1. Primarily it is down to whether you think
situations around you are worthy of
anxiety.
2. How your body reacts to your thought
processes.
This instinctive stress response to unexpected
events is known as 'fight or flight'.
At times of danger, the body's innate intelligence
automatically takes charge by triggering a set of
changes that bypass our rational thoughts.
Priority is given to all physical functions which
provide more power to face an enemy or to flee.
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10. Stress Sources
Physiological stressors –
• Physical-illness, injuries, hormonal, inadequate sleep
• Chemical agents
• Infectious agent
• Nutrition imbalances
• Genetic /immune disorders
Psychological stressors
• Accidents – victim and who did accident
• Stress events for families- friends
• Fear – murder, rape, terrorist and attacks
• Events we see – TV –war natural calamities
• Rapid change in world – economical- political- technological
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11. Types of STRESS
POSITIVE STRESS (EUSTRESS)
• A positive form of stress that
helps us to perform
• Going through happy events like graduation,
wedding, birth of a child, a competitive event or
a vacation , praise from incharge
NEGATIVE stress (DISTRESS)
The mind and body undergoes stress when the
normal routine is constantly adjusted and altered
( acute & chronic stress )
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12. HYPOSTRESS
Is lack of stress experienced by people who are
constantly bore
HYPERSTRESS
Is the type of negative stress that comes when a
person forced to undertake or undergo more than
he/she can take ( job)
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13. Causes of Stress in Nursing
Sources of stress Description
Job design and workload Dealing with death, dying, ambiguity
Interpersonal relationship at work Conflict with other staff
Relationship with patients and
their families
Inadequate preparation for dealing with
emotional needs of family
Work organization and
management of work
Lack of staff support and Resources
Personal /technologies Concern about technical knowledge and skills
Language barrier Inadequate /no interaction
Age Age 35 – 40 reporting high work stress – the
highest among age groups
Hours worked Health care providers who work 44-48 hrs/wk
Shift Shift duty likely to report high work stress
Bullying Between Peers and other H/care team 13

14. ACUTE /Short term STRESS
Fight /Flight
SAM ( Sympathetic Adrenal Medulla)
Release Adrenaline
• Increased O2 & glucose to the brain and muscles
• ↓ non-emergency bodily process (Eg Digestion
Panic over  Para Sympathetic Nerve System
return the body to default position
(Walter cannon in 1932)
STRESSOR
CNS Prepare for action
Increase
HR, BP, Pupil size
Metabolic changes
Mobilize fat &
glycogen
(Nor-adrenaline
related)
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Acute Stress ……..

16. CHRONIC STRESS (long term on-going stress)
(Require higher brain function
Hypothalamus releases CRF ( Corticotropin Releasing Factor)
Pituitary Gland release ACTH stimulate Adrenal cortex
Release CORTISOL
Cortisol Has good and bad effects –
• Quick burst of energy
• Higher pain threshold
• High BP
• Impaired thinking
• Lowered immune system
Hypothalamus – Pituitary --- Adrenal glands ---called
HPA axis Hypothalamo- Pituitary- Adrenal axis
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17. Long-term Effects of Stress
• Raised levels of cortisol for prolonged periods 
decrease your immune system &
• Decrease the number of brain cells  impairing
your memory.
• Cortisol damage and kill cells in the hippocampus
(the brain area responsible for your memory)
premature brain aging)
• It can also affect your blood pressure
atherosclerosis heart attack or stroke.
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18. • Does stress kill brain cells?
YES
Stress excites brain cells to death
BUT
Cortisol is important  short term –
To make the brain to
cope with dangerous
situations
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19. Symptoms of stress
• Disbelief and shock
• Tension and irritability
• Fear and anxiety about the future
• Difficulty making decisions
• Being numb to one’s feelings
• Loss of interest in normal activities
• Loss of appetite
• Nightmares and recurring thoughts about the event
• Anger
• Increased use of alcohol and drugs
• Sadness and other symptoms of depression
• Feeling powerless
• Crying
• Sleep problems
• Headaches, back pains, and stomach problems
• Trouble concentrating 19

20. Effects of stress in the body
Ground Zero
Headache
Depression
Pounding Heart
Heart Attack
In the Blood
Stomach Ache
Not in the Mood
Erectile Dysfunction
Immune System Response
Fight or Flight
Can’t Sleep
Rapid Breathing
High Blood Pressure
In the Liver
Heartburn
My Aching Back
Irregular Menstrual Cycle
Infertility
Susceptibility
http://www.healthline.com/health/stress/effects-on-body 20

21. Common Reactions to Stress
• Sleep Disturbances
• Appetite Changes
• Muscle Tension
• Headaches
• Neck and Back Problems
• Fatigue
• Anxiety 21

22. 8 Ways Stress Is More Dangerous Than
You Think
1. Stress Makes It Difficult to
Control Your Emotions
2. Stress Can Bring Out Disease
3. Stress Can Affect Your Love Life
4. Stress Can Ruin Your Teeth
5. Stress Can Ruin Your Heart
6. Stress Can Make You Fat
7. Stress Can Make You Look Older
8. Stress Weakens Your
Immune System
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23. If no stress
life is boring
Stress is like a cone ice cream
you have to learn to lick it!
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24. “The crisis of today is the joke
of tomorrow.”
~ H.G. Wells
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25. • Insecurity comes with your uselessness
There are 3 kinds of people in the world
1. Making something happen
2. Watch things happen
3. Sit and wonder what will happen
When we deal with people – we want
them to behave according to the way you
want them to behave but--
When deal with animals -----
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26. BODY RESPONSE to STRESS
Part . I COPING
Stress imbalance  When demands exceeds
resources --- “Too much to do”
“I did not know how to make
things better”
“I don’t have energy to cope”
Stress as an appraisal
• Does this situation matter to me?
• Demands-- what is happening,
• Resource – what can I do ? what are my options?
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27. 2 Major Categories of Coping
1.Emotion focused coping
(Regulates stress emotions)
• Distancing----- (distracting yourself – putting
problem out of your mind)
• Humour—seeking emotional support, looking on
the bright side, escape avoidance(day dreaming,
eating, using alcohol/drugs)
2.Problem focused coping
( Manages problem causing distress)
• Instrumental coping
• Problem solving
• Information gathering
People use both of this
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28. 4 General Principles of Effective
Coping with Stress
1.Focus on specific situation rather than total
stressful context…. it is a good way to begin—this
matters to my worry/fear/anxiety
2. Ask what made it stressful---.identify --
3. Distinguish changeable and unchangeable
aspects of situations (identify which aspects of
situation you can do something /you cannot do
something) .
what can be done – what has to be accepted –
begin to make plans / get resources 28

29. Principles …..
4. Fit the coping to the situation
controllable aspects – problem focused coping
• Gather information
• Select a strategy
• Aspects that have to be accepted – emotion
focused coping-
• Stress reduction exercises (* breathing,
meditation)
• Distraction
• Seek emotional support
Sorting process helps a lot
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30. Part II. Positive Emotion &
Stress Process
• Stress process is filled with emotion----
Anger, worry, guilt , sadness
• When we think about stress--- we think
about distress and its harmful effect
“ Are you kidding “
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31. Distress
Affect----
• Family function
• Work function
• Health behaviour
Affect—endocrine system, immune system,
CV System, Digestive system
So how does positive emotion get into the picture?
• Do positive emotions matter?
• So A third coping category---
focused coping evolve

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32.  Focused coping
• Specific emotions-
• Values- ( mattering-how its matter to)
• Goals (*Purpose)
• Expectations( Hope about self and about
world)
• Spiritual and religious beliefs
4 coping strategies that
create positive emotion mood32

33. Strategy-1- Goal Revision
• Relinquish untenable goals
• Substitute new goals – both realistic and
meaningful- no critical element
–It helps sustain sense of control
–Create renewed sense of purpose
–Allow hope and optimism with respect to new
goals
• Eg. Pt with end stage Cancer
( I can’t do what ever I was doing! But what now?
What to do now with the time I have left? – in my
action, spiritual life, pray more ,service to human etc33

34. When goal revision does not
occur –
(Man with advanced AIDS )
Q:How did you spend your day?
• Ans: (moping depressed)--- “Trying to get as
close to the life I had, before I got sick”
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35. Strategy-2: Creating Positive Moments
• Infuse ordinary events with positive meaning---
Eg. Beautiful flower, sunset, be with coworkers,
eating delicious food--- appreciate
• You must ask +ve things ------- not always –Ve
• Eg..tell me the what did you do today ?
( Mother of terminally ill kid – says she brought all
what he wanted ---she is happy to say what she did
for him)
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36. Strategy -3 Benefit Finding
• Reflect on growth in personal strength
and resources
• Reinforces +ve beliefs about self and the world.
Eg. Wife getting stronger when husband sick
• Each one of us out of stress came out with greater
strength
• We develop resources and got stronger
( benefit finding)
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37. Strategy.4 Focus on What Matters
• It motivate coping, energy for coping goes up
• When child/husband is sick—rearranged the
priority
• Whole night wife is awake changing her husband--
- she feel in the morning good and said” I’m proud
and pleased that I can comfort him” – shows love
and care
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38. When we cope at last there is certain
joy and contentment out of
sadness
Other strategies
AGE
• Amplify positive events – tell someone close to
you what happened and why it made you feel
good
• Gratitude Journal-wonderful---- can refer on and
off
• Engage in act of kindness – Teaching/instructing/to
make people feel good
• Just talking positively to people . 38

39. How can you relieve stress?
• The best ways to relieve stress are different for
each person
• Exercise – Regular exercise is one of the best
ways to manage stress. Relaxing exercises like yoga
are great for stress relief.
• Let your feelings out – Talk, laugh, cry, and
express anger when you need to with someone
you trust.
• Do something you enjoy – A hobby can help
you relax. Eg. Volunteer work or helping others

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40. …relieve stress ….
• Relax your body & mind –-breathing exercises,
muscle relaxation exercises, massage
aromatherapy ---relief solution and promoting
overall relaxation of body and soul.
• Focus on the present – Meditation, imagery
exercises, self-hypnosis or listening to relaxing
music can be helpful.
• Try to look for the humor in life. Laughter really
can be the best medicine.
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41. Improvise, Adapt &
Overcome.
U.S. Marine Corps
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42. How can you avoid stress?
You may not be able to get rid of stress—but
ways to lower it.
• Learn better ways to manage your time . Prioritize the
work
• Find better ways to cope. Look at how you have been
dealing with stress.
• Be honest about what works and what does not. find
other options too.
• Take good care of yourself. Get plenty of rest. Eat well.
Don’t smoke./alcohol
• Try out new ways of thinking. When you find yourself
starting to worry, try to stop the thoughts. . Learn to
say “no.” 42

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44. Nursing Interventions for patients
Experience Stress
• Anxiety reduction
• Anger management
• Rest and sleep
• Nutrition/proper diet
• Physical exercise
• Relaxation techniques
• Management of Time
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46. What can you do about stress?
• The good news is that you can learn ways to
manage stress. To get stress under control:
• Find out what is causing stress in your life.
• Look for ways to reduce the amount of stress
in your life.
• Learn healthy ways to relieve stress or reduce
its harmful effects.
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47. How can you avoid stress?
• Stress is a fact of life for most people. You may not be able to get
rid of stress, but you can look for ways to lower it.
You might try some of these ideas:
• Learn better ways to manage your time. Think about which things
are most important, and do those first.
• Find better ways to cope. Look at how you have been dealing with
stress. Be honest about what works and what does not . find
other options too.
• Take good care of yourself. Get plenty of rest. Eat well. Don’t
smoke./alcohol
• Try out new ways of thinking. When you find yourself starting to
worry, try to stop the thoughts. . Learn to say “no.”
• Speak up. Assertive communication can help you express how
you feel in a thoughtful, tactful way.
• Ask for help. People who have a strong network of family and
friends manage stress better.
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