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NURS 509A

Stress, Adaptation, Psychosocial Health

QuestionAnswer
The biopsychosocial model of health and illness is a venn diagram that intersects by way of these factors psychological---sociological---biological
Psychosocial health largely depends on self-concept . . . .what is a simple definition of self-concept how one thinks/feels about oneself----it is a complex, life-long & multifactorial process
Self-concept has 4 dimensions . . .they are identity---body image---self estem---role performance
Self concept: body image the sum of attitudes that a person has toward their body---depends only partly on the reality of the body
Self-concept: role performance the ways in which we perceive our ability to carry out significan roles such as care-taker, parent, friend, etc.
self-concept: identity the constructs by which we perceive ourselves---age/race/culture/sexuality/occupation/beliefs/personality/character------in short, what distinguishes self from non-self
self-concept: self-esteem overall judgement of one's own worth or value----expressed as a venn diagram intersecting between ideal self and real self
What are some factors that effect self-concept history of success/failure---family/peer relations----developmental level---locus of control
other factors that affect self-concept SES---illness---sexual dysfunction---abuse (past/present)
Nursing interventions to promote self-esteem/self-concept include encouraging pt to be as independent as possible---realistic pt goals---positive words---pt use positive self-talk---ackowledge pt positive health behaviors
Most commonaly accepted definition of stress-Dr. Richard S. Lazarus (paraphrased) feeling when a person perceives that demands exceed resources
Work stress is becoming more widely viewed as a major cause of poor health that must be addressed. What causes stress? It is different for each of us - it depends upon the individual
distress can threaten health (financial worries)
eustress good stress (winning a prize)
developmental stress associated with life stages (graduation)
situational stress associated with random, unpredictable events (hurricane)
physiological stress affects structure/function of body (motility problems, disease states)
psychological stress arise from life events (work pressure)
common responses to stress include body---mind---emotions---behavior. Give an example of each body (muscle tension)---mind (impaired judgement)---behavior (insomnia) ---emotions (anxiety)
coping strategies can either be adaptive or maladaptive. give an example of each adaptive (lifestyle choice)-----maladaptive (overeating)
psychological defense mechanisms include the following include the following definitions for psychological defense mechanisms
avoidance staying away from (I'm too tired to go)
compensation making up for perceived inadequacy (being a musician when you'd rather be a football player)
conversion emotional conflict changed to physical symptom (developing nausea causing you to miss exam)
denial unconsciously refusing to acknowledge reality (I can quit smoking any time I want to)
displacement transferring emotions from original object to perceived less powerful one (mad at the boss, kick your dog)
dissociation painful events separated from conscious mind (sexually abused child describes as though it happened to sibling)
identification taking on ideas of another (child who plays policeman)
intellectualizaiton cognitive reasoning used to block/avoid painful incident (husband dies, wife says it's better because he is in a better place now)
minimization making one's part less important (it doesn't matter how much I drink because I'm not driving)
projection blaming others (I can't do it right because you make me nervous)
rationalization logical sounding excuses---(it was God's will that this happened to me)
What happens when stress occurs it produces voluntary/involuntary coping responses to restore equilibrium
Name 3 general approaches for coping alter the stressor---avoid the stressor---adapt to the stressor
Hans Selye - the father of stress research - defined stress in 2 ways (1936 & 1950) 1936- non-specific response of the body to any demand for change-----1950 the rate of wear & tear on the body
Hans Selye- definition of a stressor stimulus perceived as a challenge/threat---it disturbs equalibrium---initiates physical/emotional response
slide 24 depicts Selye's schematic of stress, the point emphasized in lecture relating to this slide is that it is the HPA axis that gets activated (hypothalmus---pituitary---adrenal) with the resultant release of cortisol, which is also known as the 'stress hormone'
Selye's model for stress is called "General Adaptation Syndrome" = GAS, which has 3 stages Alarm Stage---Resistance or Adaptation---Exhaustion or Recovery
What happens in GAS-Stage 1: Alarm stage Fight or flight by endocrine system --> SNS (sympathetic NS) --> activates CV, Resp, metabolic, GU, Musculoskeletal (MS). Take home message = it is a SNS response
What happens in GAS-Stage 2: Compensatory mechanisms for coping/protection. PSNS (parasymathetic) balances out SNS and hormones return to normal if adapting.
GAS stage 2 adaptation is the desired outcome of stress---involves adusting to stress/stressor and allows for normal growth/devel----But the ability to adapt depends on these 3 factors intensity of the stressor---effectiveness of coping skilss---personal factors (realistic understanding of stressor, previous adaptations successful? overall health status)
What is a HUGE personal factor as relates to stress PERCEPTION - high, high degree of variability
Other factors that influence adaptation suport system (the stronger the better)---age, developmental level, life experiences
Slide 30 of ppt depicts the equalibrium of adaptation and homeostasis as being balanced by these factors available supports/coping abilities & experiences-----#, duration, strength of stressors + unrealistic perception of stressor
GAS: Stage 3 has two possible outcomes, which are exhaustion (if adaptive mechanisms ineffective)---recovery (if adaptive mechanisms effective)
Long term exhaustion can contribute to stress-related illnesses including CV disease, metabolic (CVD, DM, Syndrdome X)---Central sensitization syndroms (IBS, fibromyalgia, pelvic DOs)---cancer, pschiatric/mental health DOs
Stress management tools change perception of stressor---use support systems---spiritual support---crisis intervention---appropriate referrals (anger mgt, addiction counseling, etc)
What is the BEST health promoting activity for stress mgmt exercise
Can over-use of adaptive coping mechanisms become mal-adaptive? Yes, behaviors such as ETOH, caffeine, sweets, smoking, etc become maladaptive if used long term
Other important health promotion activities for stress management nutrition---7-8 hours of sleep---leisure activites---time/responsibility management
Stress management techniques relaxation, imagery, humor, mediation and a host of common-sense others on slide
Does the CDC have tips for self care? Yes - which essentially restates material covered in previous slides
Take home message from Seyle when he dedicated his book That he could not be CURED of his stress, merely taught to ENJOY it . . .in other words, acceptance and adapting are the ways out of hell :-)
Note included in this study stack: slides she tacked onto end of lecture and stated would not be on exam
Created by: MEPN 2013