NURSING MANAGEMENT OF STRESS – Nursing Interventions in Stress Management (MENTAL HEALTH NURSING)
The client faces an array of potential stressors, or demands that can have health consequences. The nurse needs to be aware of the situations that are likely to result in stress and also must assess the client’s appraisal of the situations. The major areas that provide the nurse with useful guide in the assessment process include demands, human response to stressors and coping. It is always better to observe the following indices of stress, in which some are psychologic some are physiologic, some behavioral and some reflect social behavior and thought process
Some of these reactions may be coping behaviors
- General irritability, hyperexcitation or depression
- Dryness of the throat and mouth
- Overpowering urge to cry or run and hide
- Easily fatigued, loss of interest
- Floating anxiety – do not know what or why
- Easily started
- Stuttering or other speech difficulties
- Hypermobility, pacing, moving about, cannot look still
- GI symptoms – butterflies in the stomach, diarrhea, vomiting
- Change in menstrual cycle
- Loss or excessive appetite
- Increased use of legally prescribed drugs, e.g. tranquilizers
- Accident proneness
- Disturbed behavior
- Pounding of the heart
- Impulsive behavior, emotional instability
- Inability to concentrate
- Feelings of unreality, weakness or dizziness
- Tension, alertness
- Nervous laughter
- Grinding of teeth
- Insomnia
- Perspiring
- Increased frequency of urination
- Muscle tension and migraine, headache
- Pain in the neck, and lower back
- Increased smoking
- Alcohol and drug addiction
- Nightmares
The probable nursing diagnosis in coping-tolerance pattern will be as follows:
- Impaired adjustment
- Caregiver role strain
- Ineffective individual coping; defensive coping/ineffective denial
- Ineffective family coping; compromised
- Ineffective family coping; disabled
- Family coping; potential for growth
- Post-trauma response
- Relocation stress syndrome
- Risk for self-harm
- Risk for violence
NURSING INTERVENTIONS IN STRESS MANAGEMENT
The first step in managing stress is to become aware of its presence. This includes identifying and expressing stressful feelings (as stated above). The role of the nurse is to facilitate and enhance the coping and adaptation. Nursing interventions depend on the severity of the stress experience and demand. The nurse’s efforts are directed to life-supporting interventions and to the occlusion of approaches aimed at the reduction of additional stressors to the client
The importance of cognitive appraisal in the stress experience should prompt the nurse to assess if changes in the way the client perceives and label particular events or situations (cognitive reappraisal) are possible. So the nurse should also consider the positive effects that result from successfully meeting and stressful demands. Greater emphasis should also be placed on the part of cultural values and beliefs enhancing or constraining various coping options
An individual personal resource that aids in coping includes health and energy. A health-promoting lifestyle provides these resources and buffers or cushions the impact of stressors. Lifestyle or habits that contributed to the risk of developing illness can be reduced or eliminated. Health risk appraisal is an assessment method designed to promote health by examining the individual personal habits and recommending change where health risk is identified. For example, smoking causes lung cancer and can be prevented by reducing or leaving the habit of smoking
Coping enhancement: coping enhancement is a nursing intervention and defined as “assisting a patient to adapt to perceived stressors, changes, or threats which interfere with meeting life demands and roles”. After completing a health risk approach, the nurse could use “coping enhancement to assist the patient in an analysis of the appraisal and to explore methods to improve the person’s coping abilities including appraisal of his or her own personal resources
The activities of coping enhancement are as follows:
- Appraise the patient’s adjustment to change in body image as indicated
- Appraise the impact of the patient’s life situations on roles and relationships
- Encourage the patient to identify a realistic description of change in role
- Approve the patient’s understanding of the disease process
- Approve and discuss alternative responses to situation
- Use a calm reassuring approach
- Provide an atmosphere of acceptance
- Assist patient in developing an objective appraisal of an event
- Help the client to identify the information he/she made interested in obtaining
- Provide factual information concerning diagnosis, treatment and prognosis
- Provide the patient with realistic choices about certain aspects of care
- Encourage an attitude to realistic hope as a way of dealings with feelings of helplessness
- Evaluate patient’s decision-making ability
- Seek to understand the patient’s perspective of a stressful situation
- Discourage decision-making when patient is under severe stress
- Encourage gradual mastery of the situation
- Encourage patience in developing relationships
- Encourage relationships with persons who have common interests and goals
- Encourage social and community activities
- Encourage the acceptance of limitation of others
- Acknowledge the patient’s spiritual/cultural background
- Encourage the use of spiritual resources if desired
- Explore the patient’s previous achievement of success
- Explore patient’s reason for self-criticism
- Confront patient’s ambivalent (anger or depression) feelings
- Foster constructive outlets of anger and hostility
- Arrange situations that encourage patient’s autonomy
- Assist patient in identifying positive responses from others
- Encourage the identification of specific life values
- Explore with the patient previous methods of dealing with life problems
- Introduce the patient to persons (or group) who have successfully undergone the same experience
- Support the use of appropriate defense mechanisms
- Encourage verbalization of feelings, perceptions and fears
- Discuss consequences not dealing with guilt and shame
- Encourage the patient to identify own strength and abilities
- Assist patient in identifying appropriate short and long-term goals
- Assist the patient in breaking down complex goals into manageable steps
- Assist the patient in examining available resources to meet the goal
- Reduce stimuli in the environment that could be misinterpreted as threatening
- Appraise patient’s needs/desires for social support
- Assist the patient to identify available support systems
- Determine the risk of the patient’s inflicting self-harm
- Encourage family involvement as appropriate as possible
- Encourage the family verbalize feelings about ill family member
- Provide appropriate social skills training
- Assist the patient to solve problem in a constructive manner
- Instruct the patient about the use of relaxation techniques as needed
- Assist the patient to grieve, and work through the losses of chronic illness and/or disability if appropriate
- Assist the patient to clarify misconceptions
- Encourage the patient to evaluate his/her own behavior
