302 CHAPTER 42 / Stress and Coping
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1
Differentiate the concepts of stress as a stimulus, as a response, and as a
transaction.
Concepts for Lecture
1. Three main models of stress are stimulus-based, response–based, and
2. In stimulus-based stress models, stress is defined as a stimulus, a life
event, or a set of circumstances that arouses physiological and/or
3. Stress may also be considered as a response. This definition was
4.
Transaction-based theories are based on the work of Lazarus (1966),
who stated that the stimulus and response theories do not consider indi-
vidual differences. The Lazarus transactional stress theory encompasses
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2
Describe the three stages of Selye’s general adaptation syndrome.
Concepts for Lecture
1. Selye’s stress response is characterized by a chain or pattern of phys-
iological events called the general adaptation syndrome (GAS). The
The initial reaction of the body is the alarm reaction, which
alerts the body’s defenses. This stage is divided into two parts: the
shock phase and the countershock phase. During the shock phase,
the stressor may be perceived consciously or unconsciously by the
C
HAPTER
42
STRESS AND COPING
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UGGESTIONS FOR
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LASSROOM
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CTIVITIES
• Have the students provide examples that illus-
trate stress as a stimulus, response, or transac-
tion.
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LINICAL
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CTIVITIES
whether these examples represent stress as a
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UGGESTIONS FOR
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LASSROOM
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CTIVITIES
• Provide the students with clinical examples
demonstrating one of Selye’s three stages and
have the students identify the appropriate stage.
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CHAPTER 42 / Stress and Coping 303
The second part of the alarm reaction is the countershock phase,
in which the changes produced in the body during the shock phase
are reversed. Thus, the person is best mobilized to react during the
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3
Identify physiological, psychological, and cognitive indicators of stress.
Concepts for Lecture
2. Physiological indicators of stress are listed in Box 42–1: Clinical
Manifestations: Stress. Pupils dilate, sweat production increases,
3. Psychological manifestations of stress include anxiety, fear, anger,
depression, and unconscious ego defense mechanisms.
4. Cognitive indicators of stress are thinking responses that include
problem solving (thinking through threatening situations using
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UGGESTIONS FOR
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• Discuss the difference between anxiety and fear.
•
Have the students review the charts of individu-
als who have had surgery and identify physiolog-
mechanisms observed in their clients or staff and
304 CHAPTER 42 / Stress and Coping
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4
Differentiate four levels of anxiety.
Concepts for Lecture
1. The four levels of anxiety are mild, moderate, severe, and panic.
2. Indicators of mild anxiety include increased questioning, mild rest-
3. Indicators of moderate anxiety include voice tremors and pitch
changes; tremors, facial twitches, and shakiness; increased muscle
4. Indicators of severe anxiety include communication that is difficult
to understand, increased motor activity, inability to relax, fearful
5.
Indicators of panic include communication that may not be understanda-
ble, increased motor activity, agitation, unpredictable responses, trem-
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5
Identify behaviors related to specific ego defense mechanisms.
Concepts for Lecture
1. Table 42–3 lists defense mechanisms, behavioral examples, and the
use or purpose of each.
Defense mechanisms listed include compensation, denial,
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6
Discuss types of coping and coping strategies.
Concepts for Lecture
1. Coping may be described as dealing with change, either successfully
2. Two types of coping strategies have been described: problem-
focused and emotion-focused coping. Problem–focused coping refers
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UGGESTIONS FOR
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LASSROOM
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CTIVITIES
• Have the students relate the indicators of anxiety
they have experienced in various situations: giving
a speech, performing a skill for the first time, or
taking a test. Ask the students to identify the level
of anxiety represented and whether the level of
•
Have the students identify indicators of anxiety
they have observed in their assigned clients. Dis-
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UGGESTIONS FOR
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LASSROOM
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CTIVITIES
• Invite one or more psychiatric nurses to discuss
defense mechanisms and how these are used by
individuals to manage stress.
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UGGESTIONS FOR
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LINICAL
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CTIVITIES
•
Have the students provide examples of defense
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UGGESTIONS FOR
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• Discuss the negative effects of using alcohol or
drugs as coping mechanisms.
and long-term or short-term strategies.
3. Coping strategies are also viewed as long term or short term. Long–
term coping strategies can be constructive and realistic. Examples
include talking with others, trying to find out more about the situa-
tion, changing lifestyle patterns, or using problem solving in
decision making instead of anger or other nonconstructive responses.
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7
Identify essential aspects of assessing a client’s stress and coping patterns.
Concepts for Lecture
1. Nursing assessment of a client’s stress and coping patterns includes
a nursing history and physical examination for indicators of stress or
2. Questions to elicit data about the client’s stress and coping patterns
are shown in the accompanying Assessment Interview: Ask the
3. During the physical examination, the nurse observes for verbal,
motor, cognitive, or other physical manifestations of stress. Howev-
er, the clinical signs and symptoms may not occur when cognitive
coping is effective.
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Identify nursing diagnoses related to stress.
Concepts for Lecture
1. NANDA diagnostic labels related to stress, adaptation, and coping
include Anxiety, Caregiver Role Strain, Compromised Family Cop-
ing, Decisional Conflict (Specify), Defensive Coping, Disabled Fam-
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UGGESTIONS FOR
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• Using the Assessment Interview in the text, have
each student perform the assessment on another
student. Have the students discuss insights
gained from this assessment.
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UGGESTIONS FOR
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• Have the students investigate the definition,
defining characteristics, and etiology for each of
the NANDA diagnostic labels related to stress,
adaptation, and coping.
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306 CHAPTER 42 / Stress and Coping
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9
Describe interventions to help clients minimize and manage stress.
Concepts for Lecture
1. Some methods to help reduce stress will be effective for one person;
2. Exercise promotes both physical and emotional health. Thirty
3. Optimal nutrition is essential for health and increases the body’s
4. Sleep restores the body’s energy level. To get adequate rest and
5. Time management must address both what is important to the client
6.
Other methods to minimize stress and anxiety include (see Box 42–1):
listen attentively; try to understand the client’s perspective; provide an
atmosphere of warmth and trust; convey a sense of caring and empathy;
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UGGESTIONS FOR
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• Invite a psychiatric nurse to discuss suicide
prevention and suicide precautions.
• Divide the students into groups and have each
group identify a technique to reduce stress and
anxiety. Have each group investigate this method
for short-term use to assist clients to sleep.