06.07 Stress and Crisis

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Overview

  1. Stress & Crisis
    1. Stress
    2. Crisis
    3. Coping
    4. Nursing support

Nursing Points

General

  1. Stress
    1. An experience or stimulus which forces a change in homeostasis
      1. Perceived or anticipated change
    2. Varying degrees of stress
      1. School project- minor
      2. Loss of job – major
    3. Good vs bad stress
      1. Good – stimulates a positive response to growth
        1. Ex: exercise
      2. Bad – stimulates a negative response
        1. Contributes to disease
        2. Worsens mental health
        3. Ex: Loss of job
    4. Stimulates a physiologic response
  2. Crisis
    1. Severe stress that forces a major change
    2. Can exacerbate mental illness if negative stress
      1. Anxiety or depression
    3. Crisis and stress are subjective
      1. What is stressful to one person may not be to another
  3. Coping
    1. Ability to respond to stress
    2. Maturation based
      1. Cognitive development influences ability to cope with stress
    3. Coping tools
      1. People can sometimes adapt to stress and crisis better than others
    4. Life experience
      1. Life experiences can contribute to coping skills
    5. Family support
      1. Presence of family can reduce stress and allow for resources for coping

Assessment

  1. Nursing Assessment
    1. Assess patient for stress
      1. Conduct interview
      2. Determine baseline stress
      3. Evaluate for new stressors
    2. Assess for knowledge
      1. Misinformation or knowledge deficits contribute to stress

Therapeutic Management

  1. Symptom management
    1. Manage symptoms of illness
    2. Manage physiologic manifestations of stress, if not the primary cause
    3. Promote health
      1. Exercise
      2. Health promotion assessment
    4. Offer resources for patient
      1. Other healthcare providers
      2. Mental health services
      3. Other resources pertinent to the patient’s cause of stress
        1. Socioeconomic
        2. Chaplain

Nursing Concepts

  1. Coping
  2. Interpersonal relationships

Patient Education

  1. Educate patient on ways to cope
  2. Educate patient on accuracy of misinformation which may be contributing to stress

Reference Links

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Video Transcript

In this lesson, we’re going to look at stress and crisis.

We all get stressed. School, work, family…it’s all a part of stress.

What I’m gonna try to do today is share some knowledge with you about what stress really is, and how it affects our patients and other people.

Stress is the experience or a stimulus that forces a change. Our bodies like to be in homeostasis or balanced. And any outside force that changes that balance is what we call “stress.”

There are varying degrees of stress. Some stress is minor, and some stress is major. A school project would be a minor comparison to something like losing your job. And that’s the other thing. Stress is extremely subjective. That school project that’s coming up next week that you haven’t worked on may seem daunting to you, but may pale in comparison to someone else who has the same project that just lost their job. It’s just something to keep in mind when dealing with your patient, and that’s that you need to treat everyone’s stress as subjective.

The other thing about stress is that it stimulates a physiologic response. Sometimes it triggers the fight-or-flight response and sometimes it totally jacks with hormone production and dysregulation and other times different types of stress promote muscle growth, like in exercise.

Stress is usually classified as good or bad stress. Good stresses are positive stimuli that usually contribute to growth. An example here is exercise. Strength training encourages muscle growth because you stress the muscles to the point of creating microtears in the muscle, and which encourages the muscles to grow back stronger.

Then you have things like bad stress, or negative stress. Negative stress can make illnesses worse, including different types of mental illness.

This is why we want to encourage good or positive stress and really try to minimize bad stress.

When we talk about stress, we really think of it being on this scale of severity, subjective to everyone. A loss of a parent who is the breadwinner of the family might be considered a crisis, whereas losing a parent suffering from cancer that is expected may not be considered a crisis.

The important thing to remember here is that crisis is severe stress that forces a change in the patient, or forces the patient to change.

Now that we’ve covered stress and crisis, let’s look at the healthy way to respond – and that’s coping.

Coping is the ability to respond to stress, and it looks different for everyone. You’ll continue to hear things like “coping mechanisms,” which is basically a fancy way of saying “how well a patient responds to stress.”

There are lots of things that influence how people cope. Maturity is a big one. Some people are more cognitively developed, and have the ability to physically process stressors differently. In addition some people have been given different coping tools, especially through life experience. It’s not uncommon to see maturity, coping tools and life experience all born from similar things a patient may have gone through. Another major factor leading to a patient’s ability to cope is family support – they’ll be able to process things easier with the support of family. They feel less isolated and alone, and family members can be there to reinforce positivity for the patient.

So how do we deal with patient stress as nurses?

Take a look at your patient and figure out how stressed they are. Use that health promotion assessment to find out what their baseline stress level is. Hospitalization can often in itself be stressful. So find out what their stress level was before they came in. Also, be sure to manage the illness or disease. The last thing you need is a patient’s illness contributing to their stress level. Manage those stress-induced symptoms. If you’ve got a patient with hypertensive crisis, meaning their blood pressure is jacked up and they’re concerned that they’re missing work, and now their blood pressure is 220/120, well you’d better be working on that blood pressure.

Always promote health and wellness, like exercise and mobility. Use your resources when you need to, like other health care providers. For patients suffering with mental illness who need the help of a mental health professional, be sure to find a resource for them, or if they’re suffering a hardship, see what resources your facility offers for them. Be their advocate, and use your therapeutic relationship skills.
Today, our nursing concepts really help to drive home building interpersonal relationships with our patients through coping with stress.
So let’s recap for today.

There are both good and bad types of stress. They can positively or negatively affect your patient.

Everyone perceives stress differently, so trust your patient when they tell you they’re stressed.

Extreme stress is crisis, and that usually mean a patient needs a change or the patient will change.

Coping is how the patient deals with stress. Some people cope better than others.

One big takeaway is just to recognize stress in the patient. Sometimes that stress can contribute to illness and sometimes it can be the main symptoms. Manage your patient first

That’s it for our lesson today. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

Read more

  • Question 1 of 9

A client with a history of severe depression and anxiety is in the hospital after attempting suicide. Which evidence would most likely be seen that indicates a crisis in a person with a mental illness? Select all that apply.

  • Question 2 of 9

A public health nurse is reviewing elements of crisis intervention that she has used in the community. Which of the following is an example of a community-level crisis event? Select all that apply.

  • Question 3 of 9

A nurse is caring for a 20-year-old client who is experiencing a dispositional crisis. Which of the following situations is an example of a dispositional crisis?

  • Question 4 of 9

Which is an example of a situation that would be considered a situational crisis?

  • Question 5 of 9

A nurse is caring for a client in crisis who has endured a physical assault. The nurse would expect to see which behavior associated with the integration phase of crisis? Select all that apply.

  • Question 6 of 9

A client is experiencing stress after delivering twins 3 weeks ago. The nurse is helping to manage her stress levels and cope with her situation. Which best describes the role of the nurse in crisis intervention?

  • Question 7 of 9

A client receives a referral to a crisis recovery center. Based on the nurse’s knowledge of this environment, the nurse understands that this type of center does which of the following?

  • Question 8 of 9

A nurse who works in a healthcare clinic is utilizing primary crisis prevention with her clients. Which actions demonstrate this level of crisis intervention? Select all that apply.

  • Question 9 of 9

A 63-year-old client is admitted for care with chest pain, diaphoresis, and falling blood pressure. The client’s family is very upset and anxious and the client’s wife refuses to talk to the nurse, saying, “I do not want to talk right now! My husband is probably dying!” Which action from the nurse best demonstrates the most appropriate method of managing the family’s crisis in this situation?

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