Online Companion: Fundamentals of Nursing Standards and Practice 2E

Chapter Summary

In Chapter 20, the student studies the major concepts related to stress and anxiety and learns strategies that can be used to cope with stress. Stress is the body's physiological and psychological reaction to any stimulus that evokes a change. The individual's perception of the stressor greatly determines whether the outcome is positive or negative. A process of maladaptation occurs when the individual does not cope effectively with stress. Illness can result from prolonged maladaptive response. When stressors, by their number or intensity, exceed a person's ability to cope, a crisis develops. A concept closely related to stress is anxiety, the subjective response that occurs when when an individual experiences a threat to well-being. Anxiety can be both a response to stress and cause of stress. The individual attempts to deal with stress by using coping behaviors and defense mechanisms. The most commonly-used defense mechanisms are described in Chapter 20. Stress and anxiety are increased during illness and recovery. Hospitalization and admission to a nursing home evoke the stress response. The nurse's role is to assess the level of the client's anxiety and determine the effectiveness of the coping mechanisms being used. The nurse is prepared to intervene to assist the client to manage anxiety and learn new coping strategies.

The topic of stress and change is presented in the chapter. Some characteristics of change include: it is inevitable, it can be eustressful or distressful, it can be self-initiated or externally imposed. The classic theory of change was developed by Lewen who proposed three stages of change: unfreezing, moving, refreezing. Many people tend to resist change because of the energy required to adapt. Some people associate change with fear of failure, or feel a threat to security or survival in change. Coping with change of any type calls for flexibility, adaptability, and resilience. The nurse has a role as an agent for change. There is a need for changes in the health care delivery system. The nurse advocates for change when working with clients who need to adapt to illness or disability. Client education is one of the most powerful tools for initiating change.

The nursing process is used when caring for an anxious client. The four common nursing diagnoses that are used for the anxious client are described in Chapter 20. The suggested strategies for this client include: meeting basic needs, decreasing environmental stimuli and personalizing the environment, encouraging expression of feelings, and using stress management techniques. These techniques and how to implement them with clients are detailed in the chapter. The chapter concludes with a case study of a client with anxiety.

Personal stress management for nurses is the final topic in Chapter 20. Burnout can develop in a nurse from job-related stress, workload, and interpersonal conflict in the workplace. Nurses are advised to cultivate the hardiness factor to protect themselves from the negative effects of stress.