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• Stress in the changing world

  • Pressure at work
  • College stress
  • Stress and retired population
  • Too many obligations
  • Negative thoughts
  • Poor skills to deal with conflicts
  • Pessimism
  • Too many commitments
• Stress


  • A condition in which the human responds to change in normal balanced state
  • A process of adjusting to or dealing with circumstances that disrupt or threats to disrupt a person's physical or psychological functioning
• Types of stress


  • Acute stress
  • Chronic stress
  • Episodic stress
  • Eustress
  • Distress
• Stressors


  • Psychological or physical stimuli that are precipitating a change
  • Anything that is perceived as challenging, threatening or demanding
• Types of stressors


  • Stressors related to personality
  • Personal stressors
  • Environmental stressors
  • Stressors related to job
• Stressors related to personality

  • Irrational beliefs, values and attitudes
  • Type A personality
  • Perfectionistic attitude
  • Poor time sense
  • Poor decision making
  • Poor habits
• Personal stressors


  • Improper life style
  • Loneliness
  • Marital conflicts
  • Poor physical health
  • Financial problems
• Environmental stressors


  • Pollution
  • Noise
  • Overcrowding
  • Extreme heat or cold
• Stressors related to job

  • Poor knowledge of job
  • Unwanted job
  • Shift work
  • Low salary
  • Job insecurity
• Causes of stress


  • Internal causes
  • External causes
• Indicators of stress


  • Physiologic indicators
  • Psychological indicators
  • Cognitive indicators
• Physiologic indicators


  • Pupil dilates to increase visual perception
  • Sweat production increased to control the elevated body heat
  • The heart rate and cardiac output increase
  • The rate and depth of respirations increase
  • Urinary output decreases
  • Blood sugar increase because of release of glucocorticoids
  • Muscle tension increases
• Psychological indicators


  • Anxiety - state of mental uneasiness, apprehension or a feeling of helplessness related to an impending or anticipated threat
  • Fear - an emotion or feeling of apprehension aroused by impending or seeming danger, pain or other perceived threat
  • Depression - a common reaction to events that seem overwhelming or negative
• Cognitive indicators


  • Problem solving
  • Structuring
  • Self-control/self-discipline
  • Suppression
  • Fantasy
• Adaptation


  An on-going process as a person strives to maintain balance in his / her internal or external environments
• Stuart Stress Adaptation Model

  • Predisposing factors
  • Precipitating factors
  • Appraisal of stressor
  • Coping resources
  • Coping mechanism
• Coping mechanism


  • Repression
  • Denial
  • Compensation
  • Regression
  • Constructive
  • Destructive
• Continuum of psychological responses

  • Adaptive responses
  • Maladaptive responses
  • Alarm
  • Resistance
  • Exhaustion
• Transactional Model of Stress

  • Precipitating event
  • Predisposing factors
  • Cognitive appraisal
  • Adaptation
  • Maladaptation
• Signs and symptoms of stress

  • Physiological and Physical
  • Cognitive symptoms
  • Emotional symptoms
  • Behavioral symptoms
• Holmes and Rahe Stress Scale

  • Score of 300+: At risk of illness
  • Score of 150-299: Risk of illness is moderate (reduced by 30% from the above risk)
  • Score <150: Only have a slight risk of illness
• Depression Anxiety Stress Scales (DASS)

  • The Depression Anxiety Stress Scales is made up of 42 self-report items to be completed over five to ten minutes, each reflecting a negative emotional symptom
  • The main purpose of the DASS is to isolate and identify aspects of emotional disturbance

  
• Perceived Stress Scale


  • The most widely used psychological instrument for measuring the perception of stress
  • A measure of the degree to which situations in one's life are appraised as stressful
  • Scores ranging from 0-13 would be considered low stress
  • Scores ranging from 14-26 would be considered moderate stress
  • Scores ranging from 27-40 would be considered high perceived stress
• Kingston Caregiver Stress Scale (KCSS)


  A scale used to monitor change in a family caregiver's stress level over time
• Adaptive coping strategies


  • Awareness
  • Relaxation
  • Meditation
  • Interpersonal communication with caring others
  • Problem solving
  • Pets
  • Music
  • Breathing exercises
• Breathing exercises


  1. Find a comfortable position

  2. Relax your shoulders and chest; let your body relax

  3. Shift to relaxed, abdominal breathing

  4. Take a deep breathe through your mouth, expanding the abdomen, Hold it for 3 seconds and then exhale slowly through the nose; exhale completely and telling yourself to relax

  5. With every breath turn attention to muscular sensation that accompanies the expansion of belly

  6. As you concentrate on you breathing, you will start to feel focused
• Guided imagery


  1. Sit or lie down in a comfortable position

  2. Close your eyes

  3. Imaging that you and someone you love are walking along the seashore

  4. The sun is shining, the sky is blue, and a gentle breeze is blowing

  5. You lie on the sand and close your eyes

  6. You hear the sound of the wave as they splash against the shore

  7. The sun feels warm on your face and body

  8. The sand feels soft and warm against your back

  9. An occasional wave, splash you with a cool mist that dry rapidly in the warm sun

  10. You lay in this quiet place for what seems like a very long time, talking in the sounds of the wave, the warmth of the sun and the cooling sensation of the mist and ocean breeze

  11. It is very quiet and warm

  12. You feel relaxed contented. This is your special place whenever you want to relax
• Meditation


  1. Select a quiet place and a comfortable position

  2. Sitting in a chair with feet flat on the floor, arms resting comfortably in your lap

  3. Crossed leg on the floor or on a cushion

  4. In the lotus yoga position, sitting on the floor with your legs flexed at the knees

  5. Select an object word or thought on which to dwell

  6. Counting ones breath- all attention focussed on breathing in and out

  7. Mantra- A mantra is syllable, word or name that repeats much time as the mind is cleared of thought

  8. A thought that has special meaning to you- With eyes closed focus total attention on a specific thought or idea

  9. Practice directing attention you selected focus for 10-15 minutes a day for several weeks
• Relaxation exercises


  1. Each muscle group is tensed for 5-7 seconds and then relaxed for 20-30 seconds during which the individual concentrates on the difference in sensation between the two conditions

  2. Soft, slow back ground music may facilitate relaxation

  3. Tense the muscles of the thigh and buttocks, and hold for a count of 5

  4. Release the hold. Feel the tension drain away and be aware of the difference in sensation

  5. Tense the abdominal muscles. Hold for a count of 5

  6. Release the hold. Concentrate on the feeling of relaxation in the muscles. You may feel a warmth sensation

  7. Tense the muscles in the back and hold for a count of 5

  8. Tense the muscle of your hands, biceps and forearm and clench your hands into a tight fist. Hold for a count of 5

  9. Sit in a comfortable chair with your hands in your lap, your feet flat on the floor and your eyes closed

  10. Begin by talking three deep, slow breaths, inhaling through nose and releasing air slowly through the mouth

  11. Now starting with the feet, pulls the toes forward toward the knees, stiffen your calves, and hold for a count of 5

  12. Release the hold. Let go of the tension. Feel the sensation of relaxation and warmth as the tension flow out of the muscle

  13. Tense the muscle of the shoulders and neck. Shrug the shoulders tightly and hold for a count of 5

  14. Tense the muscle of the face. Wrinkle the forehead, frown, squint the eyes and purse the lips. Hold for a count of 5

  15. Now feel he relaxation on your whole body. As the tension leaves your entire being, you feel completely relaxed

  16. Open your eyes and enjoy renewed energy
• Stress management for nurses

  • Alter the situation
  • Avoid unnecessary stress
  • Adapt to the stressor
  • Accept the things you can't change
  • Set aside relaxation time
  • Exercise regularly
  • Eat a healthy diet
  • Get adequate sleep
  • Be organized
  • Breathe
  • Talk
  • Learn to identify the feeling
  • Evaluate and relies on spirituality
  • Acquire skills in needed areas