Page 211 - Essentials of Nursing Leadership and Management, 5th Edition

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Consider the Statistics Most people think of stress as work pressure, rush-
hour traffic, or sick children. These are triggers to
Fifty years ago, the term personal anxiety was never the stress response, the actual body reaction to the
used to describe stress. In the decades since, stress daily factors mentioned.As identified by Selye,stress
has become the most common psychological com- is the fight-or-flight response in the body, caused by
plaint and a widespread health problem. In the last adrenaline and other stress hormones,causing phys-
decade alone, approximately 28,000 studies have iological changes such as increased heart rate and
been published on the subject of stress and over blood pressure, faster breathing, dilated pupils,
1000 studies on the subject of burnout (Pines, increased blood sugar, and dry mouth.
2004, p. 66). Currently, stress is assessed on four levels: envi-
In the workplace, stress is usually defined from a ronmental, social, physiological, and psychological.
“demand-perception-response” perspective—that Environmental stressors include weather, pollens,
stress is related to the perception of the demands noise, traffic, and pollution. Social stressors include
being made on the individual as well as that individ- deadlines, finances, work responsibilities and
ual’s perception of the ability to meet those demands. interactions, and multiple demands on time and
When there is a mismatch between the two, the attention. Physiological stressors include illness,
stress response is triggered. The stress threshold, or aging, injuries, lack of exercise, poor nutrition, and
hardiness, depends on the individual’s characteristics, inadequate sleep. Psychological stressors are
experiences, coping mechanisms, and the circum- thoughts: how the brain interprets changes in the
stances of the event (McVicar, 2003). environment and the body and determines when
The phrase “this is so stressful” is frequently the body turns on the fight-or-flight response
used to describe negative work and personal situa- (Davis, Eshelman, & McCay, 2000).
tions. However, in reality, some stress responses are Epidemiological research has shown that long-
positive (eustress). The stress response is not a sin- term stress contributes to cardiovascular disease,
gle event but a continuum, ranging from feeling of hypertension,ulcers,substance abuse,immune system
eustress to mild/moderate distress to severe dis- disorders, emotional disturbances, and job-related
tress. It is the severe and prolonged distress that injuries (Crawford, 1993; Lusk, 1993).
causes people to “burn out” emotionally and expe-
rience serious physiological and psychological dis- Responses to Stress
turbances. Table 13-1 describes the continuum of “Whether the stress you experience is the result of
the stress response. major life changes or the cumulative effect of minor
everyday hassles, it is how you respond to these expe-
riences that determines the impact stress will have
Stress
on your life” (Davis, Eshelman, & McCay, 2000).
Effects of Stress Some people manage potentially stressful events
Hans Selye first explored the concept of stress in more effectively than others (Crawford, 1993;
the 1930s. Selye (1956) defined stress as the non- Teague, 1992). Perceptions of events and the sub-
specific response of the body to any demands made sequent stress responses vary considerably from
on it. His description of the general adaptation one person to another. A patient crisis that one
syndrome (GAS) has had an enormous influence nurse considers stressful, for example, may not
on our present-day notions about stress and its seem stressful to a coworker. The following is an
effect on people.The GAS consists of three stages: example:

1. Alarm. The body awakens to the stressor, and A new graduate was employed on a busy teleme-
there is a slight change below the normal level try floor. Often, when patients were admitted,
of resistance. they were in acute distress, with shortness of
2. Resistance. The body adjusts to the stressor breath, diaphoresis, and chest pain. Family mem-
and tries to restore balance. bers were distraught and anxious. Each time the
3. Exhaustion. As the stressor continues, the new graduate had to admit a patient, she experi-
body energy falls below the normal level of enced a “sick-to-the-stomach” feeling, tightness in
resistance, and illness may occur. the chest and throat, and difficulty concentrating.