Stress, the body’s physiological reaction to any stimulus that evokes change, is a universal experience that can be a catalyst for positive change or a source of discomfort and pain. A stressor is any situation, event, or agent that threatens a person’s security. Stressors can be physical, physiological, or psychosocial. Coping is a complex of behavioral, cognitive, and physiologic responses that aim to prevent or minimize unpleasant or harmful experiences that challenge a person’s personal resources. Coping can be active (assertiveness, imagery, self-statements) and restive (progressive relaxation, meditation).

Anxiety is a vague, nonspecific, uncomfortable subjective response to a perceived or actual threat to one’s biologic, psychologic, or social integrity. Adaptation is an ongoing process by which individuals adjust to stressors in order to achieve homeostasis (steady state, equilibrium between physiological, psychological, sociocultural, intellectual, and spiritual needs). Wellness is an adaptative state in which a person copes effectively to maintain a high level of well-being.

Responses to stress are physiological or psychoneurologic. Physiological responses are those outlined as the general adaptation syndrome (GAS) by Hans Selye. There are three stages to the GAS: the alarm stage, when stressors are threatening or are perceived to be threatening and the body activates physiological changes; the resistance stage in which the fight-or-flight response occurs; and the exhaustion stage, when the body uses up its adaptive energy and can no longer cope. Arousal of the autonomic nervous system (ANS), particularly the sympathetic branch, leads to the fight-or-flight response by provoking an increased heart rate; increased blood pressure; rapid, shallow respirations; diaphoresis; increased production of blood glucose; excess gastric acid; slowed digestion, and increased metabolism.

Psychoneurologic responses connect immune-related diseases and stress. Individuals can respond to stress as an opportunity for personal growth (eustress) or as disorganization and distress (maladaptation). A crisis occurs when stressors exceed the person’s ability to cope. The balancing factors influencing a person’s resolution of a crisis are perceptions, coping mechanisms, and situational support. Mild anxiety can be positive, because it increases a person’s awareness of surroundings and can promote growth and creativity. Higher anxiety can result in muscle tension, lack of coordination, tremors, poor concentration, forgetfulness, errors in judgment and preoccupation, hyper-vigilance or confusion, loss of objectivity, anger, guilt, hostility, or depression.

The three types of coping mechanisms are problem-focused, cognitively-focused, and emotion-focused. Common defense mechanisms (mental processes the ego uses to control or cope with anxiety) are denial, repression, suppression, rationalization, introjection, displacement, reaction formation, sublmination, and symbolism.

The relationship between stress and illness is complex. The fight-or-flight response is used for immediate stressors. Extended stress prolongs the fight-or-flight response and results in a number of stress-related disorders, such as hypertension, migraine headaches, chronic pain, impotence, colitis, eczema, and psoriasis.

Change is a dynamic process in which an individual’s behavior is altered in response to a stressor. Change is inevitable, may be eustressful or distressful, can be self-initiated or externally imposed, can be abrupt or gradual, and always requires energy. Change can be developmental, reactive, covert, or overt. Lewin’s Theory of Change proposes that change occurs in three stages, unfreezing, moving, and refreezing. In unfreezing, the person sees a need for change and is motivated to move into a new direction. In moving, the person makes the needed change, In refreezing, new changes are incorporated into the person’s lifestyle. Lippitt’s Theory of Change proposes seven phases: diagnosis of the need for change, assessment of the change target’s motivation and capacity for change, assessment of the change agent’s motivation and capacity for change, establishment of the objectives for change, determination of the role of the change agent, maintenance of the change, and termination of the role of the change agent. Change results in the development of a new paradigm (pattern or model).

The nurse acts as a change agent for positive adaptation, beginning with an assessment of the patterns of a person’s stressors, typical responses to stress, relationships between stressors and behaviors, past history of coping, and personal strengths. Nursing diagnoses related to stress include Impaired Adjustment, Ineffective Role Performance, Disturbed Thought Processes, Defensive Coping, Fear, Post-Trauma Syndrome, Impaired Social Interaction, and Spiritual Distress. Common nursing interventions for stress are meeting basic needs, limiting environmental stimuli, allowing the client to verbalize anxieties, teaching relaxation techniques (such as progressive muscle relaxation, rapid relaxation response, guided imagery, cognitive reframing, and thought stopping), and crisis intervention. Nurses need to handle their own stress in order to most effectively help others.