Stress: Concept, Theories, And Strategies To Cope

Introduction

Is your heart racing, can’t concentrate, feeling irritable, or just plain not feeling well? Perhaps it is stress. This paper will take a look at the many facets of stress and explore the different theories and suggested coping strategies. We will analyze why we should investigate the concept of stress, explain the signs and symptoms and potential consequences of stress, and detail the criteria one must meet to be diagnosed with a stress induced mental disorder. Sorenson in ‘Fundamentals of Nursing,’ explains that “stress” is a word used to represent a process where an event (a. k. a. a stressor) that evokes a physical, emotional, or psychological demand is interpreted as threatening, producing tension or anxiety (p771). “Stress refers to the consequences of the stressor and the person’s appraisal of it” (Sorenson, 2017, p771).

Stress can have serious implications, and the majority of humans experience some form of stress in their everyday lives. Lubit (2017) explains in the “Acute Stress Disorder” article: “All people lose loved ones, 1 in 4 women experience rape or attempted rape during their lifetime, and 1 million children are abused or neglected each year. In 2000, one quarter of a million Americans were raped or sexually assaulted, three quarters of a million were robed, and half a million were assaulted. Millions of children are bullied in school, 7 % of men and 22 % of women are assaulted by an intimate partner, and 3 million people a year are involved in car accidents” (para. 1). “The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DMS-5), lists 5 specific diagnostic criteria for Acute Stress Disorder (ASD)” (Lubit, 2017, para. 5). To meet the first of these stringent criteria one must experience exposure to actual or threatened death, serious injury, or sexual violation (directly, witnessed, experienced by a close loved one, or experience repeated exposure to aspects of the traumatic event). The second criterion requires the person to meet at least 9 of 14 symptoms from 5 different categories; intrusion (recurrent, involuntary, distressing memories, dreams, or flashbacks of the traumatic event), negative mood (persistent inability to experience positive emotions), dissociation (altered sense of reality or amnesia not attributed to other factors), avoidance (efforts to avoid memories or reminders of the event), and arousal (sleep disturbances, irritability, hypervigilance, difficulty concentrating) (Lubit, 2017, para. 5-11).

The intrusion of the event must last 3 days to 1 month after the trauma in order to meet the third DSM-5 diagnostic criterion for ASD (Lubit, 2017, para. 12). The fourth criterion requires the disturbance cause clinically significant distress or impairment in important areas of functioning (Lubit, 2017, para. 13). The fifth and final criterion necessitates that the disturbance cannot be attributed to a substance or other medical condition (Lubit, 2017, para. 14). To explore how stress affects the real world, and specifically nursing, we are going to review, compare and relate various nursing articles written on different aspects of the same psychological, physiological and physical phenomenon-stress. We first take a look at the textbook summarizations of stress in the different generations of life. We will explore stress in nursing, how stress affects nursing care, discrimination caused stress, stress experienced by nursing students and stress our government perpetrated on the community with policies and procedures.

Discussion

Stress is the body’s reaction to a threat, challenge, physical or psychological obstacle. The three stages of stress include alarm, resistance, and exhaustion. Stress can be positive; making it possible to meet a deadline when it kicks in, or negatively; impairing one’s ability to do things they normally do. Symptoms of stress can be sleeplessness, exhaustion, and excessive worry, lack of focus, irritability, rapid heart rate, muscle tension and headache. Sarafis et al. (2016) study (mentioned later) revealed “findings to suggest that occupational stress is associated with mental health problems…[for example] anxiety, dysthymia, low self-esteem, depression and feelings of inadequacy. ” Anxiety has similar symptoms only it is a sustained mental disorder that can be triggered by stress. Anxiety hangs around for the long haul and can cause significant social and occupational impairment and other important areas of functioning.

Additionally, with anxiety, one has no control over the symptoms; for instance worrying, restlessness, easily fatigued, difficulty concentrating, and irritability, shortness of breath, excessive sweating, and chest pain. Anxiety is best treated with psychotherapy, medication and lifestyle changes. Depression has similar symptoms as stress; only depression is more serious, long-lasting and requires a different method of treatment. A depressed person may exhibit symptoms such as withdraw from people; feel sad, hopelessness, be unable to make decisions, restless/irritable, have difficulty concentrating and trouble with their memory. For the more severe depression sufferer, guilt, anger, rage, trouble functioning, and thoughts of suicide plague their soul. Stress, anxiety, and depression may all be experienced by a person with the more chronic, intrusive and debilitating post-traumatic stress disorder (PTSD). Only a small amount of traumatic event victims have appropriate symptoms satisfying the diagnostic criteria for acute stress disorder (ASD) or post-traumatic stress disorder (PTSD). About 50% of people who are diagnosed with PTSD presented initially as ASD (Lubit, 2017, para. 12). Though stress may be a contributor or even a bridge to these other disorders, there is hope that stress is more manageable. To explore stress as experienced in the profession of nursing, we will review several sources, discuss their relevant and relatable information, and explore personal opinions as related to nursing.

Biopsychosocial components of The Stuart Stress Adaptation

Model of psychiatric nursing care state that stressors may be biological, psychological, or sociocultural in nature (Stuart, 2013, p. 47). It has been believed but not proven that stressful life events contribute in some way to psychiatric illnesses (Stuart, 2013, p. 49).

However, repeated small daily strains may have a greater effect on mood and health than major misfortunes do (Stuart, 2013, p. 49). “Hassles are irritating, frustrating, or distressing incidents that occur in everyday life, …[for example] disagreements, disappointments, and unpleasant occurrences, such as losing a wallet, getting stuck in a traffic jam, or arguing with a family member” (Stuart, 2013, p. 49). Stuart (2013) explains that it is the evaluation of the stressor that determines the impact the situation will have on the individual (p49). “Resilient or stress-resistant people have a positive attitude toward life, an openness to change, a feeling of involvement in whatever they are doing, and a sense of control over events” (Stuart, 2013, p. 49). Stuart discusses a person’s different responses to stress, such as affective (feelings like fear, anger, and distrust), physiological (reflect the interaction of hormones in the body and neurotransmitters in the brain), behavioral (emotional, cognitive and physiological), and social responses (searching for meaning) (p. 50). To help a person process the stressful event, one might utilize coping resources like spiritual beliefs, cultural stability, problem-solving skills, a system of values and beliefs, or coping mechanisms; such as problem-focused (targets causes of stress in practical ways), emotional-focused (decreases the negative response) or cognitively-focused (challenge personal assumptions) (Stuart, 2013, p. 51).

In the ‘Nursing Center Blog,’ “Stress: The Elephant in Your Career,” Donnelly (2017) documents “the alarming percentage of nurses who are leaving their jobs or leaving the profession climbing to 17. 2 % in 2016 and costing hospitals an average of $5. 2M - $8. 1M annually. ” She explained that nurses reported leaving due to poor management and stressful work conditions as a result of inadequate staffing, verbal abuse, and issues with work-life balances (Connelly, 2017). In the blog’s story, the apathy of colleagues, rude behavior, insults, and the passivity of the nurse manager were the perceived “stressors” that caused the nurse to resign her position (Donnelly, 2017). It was then suggested that she could have attempted different coping mechanisms like change her perceptions, reactions, or behavior to the perceived threats and even solicited help. Donnelly (2017) discussed how “striving to develop a deep awareness of how you can plan, craft, and control your responses to difficult situations can be the first step to stress inoculation. ” She explored creative strategies to help a nurse alleviate stress. She explains that one must personalize their adaptation by selecting what and how to change based on their own preferences, style, and time.

Donnelly offers structured stress management modalities such as exercise, rehearsal of difficult conversations, laughter, reframing situations, fantasizing, and singing. She explains that a minimum of 20 minutes per day of exercising improves cardiovascular function, strengthens muscles and produces endorphins in the brain alleviating stress (Donnelly, 2017). Rehearsing difficult conversations in private helps a person analyze their own verbal responses during stressful situations and may help them develop more calm assertive responses (Donnelly, 2017). Humor has powerful healing capabilities and puts things in a new perspective. Whereas, changing the meaning, emotional tone or your point of view of a difficult situation can be liberating (Donnelly, 2017). Another modality of stress inoculation is using ones imagination to fantasize different scenarios (Donnelly, 2017). The final modality Donnelly (2017) mentions is the use of singing (in private) to uplift and inspire self-empowerment. Singing in itself has been known to have healing powers.