Week 8--> Stress and Coping Flashcards
Stress
The condition of stress has two components: physical, involving direct material or bodily challenge, and psychological, involving how individuals perceive circumstances in their lives
Stress: The circumstance in which transactions lead a person to perceive a discrepancy between the physical or psychological demands of a situation and the resources of his or her biological, psychological, or social systems
Can we measure stress?
We can assess physiological arousal by measuring:
Blood pressure
Heart rate
Respiration
Galvanic skin response- defined as a change in the electrical properties of the skin
Biochemical analysis of blood urine or saliva- adrenaline and cortisol released
Inventories of stress response. E.g. mood and anxiety
Life events and hassles
Stress hormones
- Breathing rate increase
- Intestinal muscles relax
- Pupils dilate
- Blood pressure in arteries increases
- Heart rate increases
- Blood sugar levels increase
- Blood flow to skeletal muscles increases
Physiological consequences of excessive or prolonged stress include
- Cognitive changes- forgetfulness and obsessional thoughts
- Affective changes- anxiety and mood changes, anxiety, depression
- Changes to health behaviours, diet, sleep
- Increases risky behaviours- drug and alcohol abuse
- In the longer term, unrelieved stress can have a serious lifestyle consequences such as burnout and contribute to depression
Coping mechanisms
- Resilience
- Debriefing- peers, mentors, facilitators, staff, students in other years, family
- Self care- exercise, meditation, relaxation
- Reflection
- Mindfulness
- Exercise
- Time out
Pain (and pain assessment)
Pain assessment→ on a scale of 1-10 (pain scale→ rates pain)
Can look at body language, how they are guarding the body part in pain, they may be withdrawn or not communicating. Can look at facial expressions- elg. Grimacing or frowning. Can look at skin colour, e.g. pale. People may be sweating. May become agitated
Patient pain (PQRST)
Patient is the expert on pain- pain is what the patient says it is
P- provokes/precipitates (what were you doing when the pain started)
Q- quality (e.g. dull, sharp, throbbing pain)
R- radiates (does the pain move, is it in more than one spot)
S- severity (pain assessment, faces scale for children or non-english speakers)
T- time (how long have you had this pain)
Pain Management
Pre-emptive pain management
- Pain assessment- before, during and after (empower to speak up during procedure)
Magement
- Pharmacological
- Opioids (e.g. morphine)
- Multimodal- different medications and routes and action time to act and duration
- E.g. IV, patches, topical, inhaled, sub-cut
- E.g. morphine and paracetamol
- Sedation
- Antiemetics
Non- pharmacological (Physical interventions)
Distraction Therapy heat/cold Massage Acupuncture Positioning Breathing techniques Comfort measures Rest and mobilisation Transcutaneous electrical nerve stimulation (TENS)
Psychological interventions
Therapeutic relationships Info and education Relaxation Music and art therapy Involvement in care
Impact of Chronic Illness
Chronic illness is a problem across the lifespan and can affect anyone of any age
Chronic diseases are characterised by complex causality, multiple risk factors, long latency periods, a prolonged course of illness and functional impairment or disability
A chronic illness is defined as being permanent, incurable and irreversible.
Chronic illness often requires ongoing lifetime attention and impacts significantly on a person’s life
Chronic diseases are increasing in prevalence and are the leading cause of ill health and disease burden in Aus
Factors relevant to chronic illness
- Often referred to as Australia’s biggest health burden
- Internationally and in Australia, people are living longer
- Poor lifestyle choices: Poor eating and exercise habits, smoking and alcohol contribute significantly to chronic
- 10% of children are said to have 3 or more long term conditions
- Surviving previously fatal illnesses e.g. cancer, cystic fibrosis
Chronic illness is complex because
- It is linked to lifestyle factors that are hard to shift
- It is characterised by periods of exacerbation
- Treatment and deterioration impact over time
- Services and support vary geographically
- Socially disadvantaged people have higher rates
- High rates of comorbidity
Why study health behaviour?
- Strong association between lifestyle and disease
- Many lifestyle factors are under individual control m people can make choices
- Health behaviours seem to be important in predicting mortality and longevity of individuals
- Nurses can be influential in improving the health behaviour of others
- We need to understand and predict the factors relevant to health behaviours
- Most people find it extremely difficult to adopt and maintain health behaviours
- Helping people change is a complex activity
- Most of us will talk about wrong to change and know we should, but the evidence shows our intentions and desires are easily weakened and commitment abandoned
Locus of control
- Behaviour is influenced by expectations about reinforcements
- Internal LOC→ believe reinforcements are the consequences of their own behaviour , therefore there are more likely to engage in preventative health behaviours i.e. assume responsibility for their own health
- External LOC→ believe reinforcements are under the control of external agents, they feel less dependent on their own actions and see their health as under the control of external forces
Self- efficacy
- Construct of social cognitive theory
- It is a person’s beliefs that they can succeed at something they want to do
- Individuals with high self-efficacy believe their actions will affect outcomes- they have control,
- Characteristics: Gained through; experiencing success, vicarious learning, verbal persuasion,
The health belief model
- First attempts to view health within a social context
- Underlying principle→ individuals with better info make better health decisions
- Underlying variables→ the value placed on a particular goal by an individual. The individual’s estimate of the likelihood that a given action will achieve the goal
- HBM is predicted on beliefs and individuals must believe they are susceptible, the condition is serious, there is a successful intervention, barriers to using the intervention can be overcome
Motivational interviewing
- MI is a collaborative, goal-orientated style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion
Initial reactions to chronic illness
Shock→ stunned or bewildered, behaving in an automatic fashion, feeling a sense of detachment
Encounter reaction→ disorganised thinking: loss, grief, helplessness, despair, overwhelmed
Retreat→ avoidance strategies (denial)
Retreat wears away to adjustment. Maladaptive responses can be harmful to well being
Effects of chronic illness include
- Everyday life activities are disrupted
- Often permanent behavioral, social and emotional adjustments need to be made
- Self-image and self esteem may be effected
- Major and minor plans can be disrupted
- Often leave patients and their families with uncertainty
Quality of life and chronic illness
- Health related quality of life→ the degree in which one’s usual or expected level of physical, emotional and social well-being are affected by a medical condition or the treatment of the condition
- Places more focus on the aspects of the patient’s life affected by disease or the treatment of disease, instead of concentrating solely on clinical endpoints, such as length of stay, morbidity and mortality
- Shifted the focus from survival to the quality of survival in chronic illness
- Care is directed towards facilitating adequate pain management, maximising function and offering psychosocial support
Self management in chronic illness
- Self management is the active participation by people in their own health care (essential in chronic illness)
- All patients with chronic illness inevitably self-manage
- Nurses promoting self-management are focused on not only patient education but also coaching. This approach includes active listening, identifying patient beliefs and values, talking about eliciting change and recognising the patient’s readiness to change
General principles of self-management
- Understanding the disease, treatments and consequences. Having an accurate schema of the nature of one’s illness is very important
- Maintenance of physical and emotional health within the limits of illness
- Monitoring key signs and symptoms of the condition, interpreting changes in these symptoms, initiating treatments and determining when help is needed
- Taking medications and undertaking treatments to manage symptoms and consequences of the illness and assessing the relative benefits and costs of these treatments
- Problem solving as new issues arise and activating different resources or skills as needed
- Negotiating health systems and participating in decision making with health professionals
Successful self managements
- Engagement- people see themselves as their own main caregivers and health professionals support them
- Self management capacity→ self management suits 70%-80%
- Depends upon: severity of symptoms, co-morbidities, cognitive status, constructs such as learned helplessness and Social and cultural circumstances, health professional attitudes and community resources and virtual support
Learned helplessness
When a person feels and believes they are helpless and unable to avoid negative situations because previous experience has shown them that they don’t have control.
Learned helplessness diminishes motivation
People with poor self-management capacity need supportive care
