You might be wondering how is learning about stress relevant to nursing? You think?

As a nurse yourself, you will feel the effects of stress in your daily work. As a patient, being sick can increase stress levels and being stress could make you more sick. Sometimes this stress rubs off to the healthcare workers helping them too. Then come the worried family members of your patients. Because they feel stressed over a loved one being sick you may find yourself on the receiving end of some unfair or negative treatment. Let's start off by looking at the definition of stress.

Stress is your body's reaction to the demands of the world. Stressors are events or conditions in your surroundings that may trigger stress. Your body responds to stressors differently depending on whether the stressor is new or short term — acute stress — or whether the stressor has been around for a longer time — chronic stress. A useful way to conceptualize stress is to view it as a process whereby an individual perceives and responds to events that he appraises as overwhelming or threatening to his well-being.

Stress appraisal refers to the process by which individuals evaluate and cope with a stressful event. Stress appraisal theory is concerned with individuals’ evaluation of the event, rather than with the event per se. People differ in how they construe what is happening to them and their options for coping.

Stress appraisal comes in two forms, primary and secondary appraisal, which should be considered as two stages of appraisal or evaluation. These two types of appraisal are not mutually exclusive; they work in concert with one another to complete the appraisal process.

Primary appraisal

The individual determines whether the stressor represents a threat.

Three things need to be evaluated:

1. Is the threat significant to that person

2. Is it a positive or negative encounter

3. Is it threatening/harmful/challenging.

Example:

There is a sudden heavy thunderstorm. Roads are flooded and you are supposed to attend an examination today.

1. Is the threat significant to that person

Yes it is significant because you have an examination to attend and it is important to you that you pass.

2. Is it a positive encounter?

Definitely negative. There would be a negative outcome if you are late or missed your exam.

3. Is it threatening/harmful/challenging.

Threatening to how well you do this semester.

People who experience the same symptoms of illness can react in quite different ways.

• One person may view the symptoms as unimportant

• Another may view them as important but manageable

• Yet another may view the same symptoms as catastrophic (End of their world)

Secondary appraisal

The secondary appraisal actually happens simultaneously with the primary appraisal.

Assessing what resources are available to us to help combat or cope with the stressor.

An individual may choose to use Problem-Based Coping or Emotional Based Coping strategies.

Problem-Based Coping - When we feel we have control over the situation and can manage the source of the problem.

i.e. coming up with a revision schedule before exams

Emotional-Based Coping - Used when an individual feels as they cannot manage the source of the problem

i.e. crying or binge-eating snacks to deal with school stress

For an individual to experience stress, he must first encounter a potential stressor. In general, stressors can be placed into one of two broad categories: chronic and acute.

• Chronic stressors include events that persist over an extended period of time, such as caring for a parent with dementia, long-term unemployment, or imprisonment.

• Acute stressors involve brief focal events that sometimes continue to be experienced as overwhelming well after the event has ended, such as falling on a sidewalk and breaking your leg.
  
  Whether chronic or acute, potential stressors come in many shapes and sizes. They can include major traumatic events, significant life changes, daily hassles, as well as other situations in which a person is regularly exposed to threat, challenge, or danger.

Traumatic events

Some stressors involve traumatic events or situations in which a person is exposed to actual or threatened death or serious injury. Stressors in this category include exposure to military combat, threatened or actual physical assaults (e.g., physical attacks, sexual assault, robbery, childhood abuse), terrorist attacks, natural disasters (e.g., earthquakes, floods, hurricanes), and automobile accidents.

Life events

Most stressors that we encounter are not nearly as intense as the ones described above. Many potential stressors we face involve events or situations that require us to make changes in our ongoing lives and require time as we adjust to those changes. Examples include death of a close family member, marriage, divorce, and moving.

How stressed are you?

Click here to find out!

In the 1960s, psychiatrists Thomas Holmes and Richard Rahe wanted to examine the link between life stressors and physical illness, based on the hypothesis that life events requiring significant changes in a person’s normal life routines are stressful, whether these events are desirable or undesirable. They developed the Social Readjustment Rating Scale (SRRS), consisting of 43 life events that require varying degrees of personal readjustment . Holmes and Rahe also proposed that life events can add up over time, and that experiencing a cluster of stressful events increases one’s risk of developing physical illnesses.

The Social Readjustment Rating Scale (SRRS) provides researchers a simple, easy-to-administer way of assessing the amount of stress in people’s lives, and it has been used in hundreds of studies. Below is an excerpt of the Scale.

Consider the following questions as you move on to the next section.

In what way is stress different for people across different age groups? Who are most vulnerable?

How does stress in our lives influence our perception of health and illness?

What can we do to help our patients and family members manage stress?