Stress and its management for nursing students

1. Maheswari.S
M.Scnursing1 year

2. Definition
• A type of stimulus that occurs in sufficient
amount to cause stress
- Malott and Whaby (1983)
• The non specific response of the body to any
demand. The non-specific response always
not same, it is the degree of the respond
that changes
- Selye (1958)

3. • Stress is the body’s reaction to a change that
requires a physical, mental or emotional
adjustment or response

4. Nature of stress
• According to Selye , stress occurs as a
response to a range of circumstances.
Biologically, stress reactions evolved as an
emergency response intended to prepare an
individual for “ Fight or flight ”
• That is either to defend or try to run away
from a threat (the same is followed by all
mammals)

5. Nature of stress

6. Types

7. Stressors
A type of stimulus that occurs in significant
amount to cause stress
Stressors as we must know about them are
those stimuli that cause a serious damage to
our limit to normal

8. Types

9. • Internal stressors:
Internal stressors are stimulus which arouse
from the internal environment of one’s
individual
 Frustration
 Conflicts
 Pressures

10. External stressors
• Environmental stressors are those environmental
stimuli, that may be found to cause a heavy
stress on the individual.
 Environmental
 Health
 Financial problems
 Psychological
 Workplace stress
 Personal relationship

11. Other classification
Chart

12. Effect on stress
• When stress becomes overloading, at first, it
results to less severe damage resulting into
overall unhappiness, uncomfort and
unproductivity to the suffering individual to
the extend of the loss of life
• We can describe these immediate and long-
term effects of the stress on the body and
mind of the individual in the way given
below

13. Immediate and long-term
effects of stress
Behavioural changes
Physiological changes
Emotional changes
Cognitive changes

14. Behavioural changes
Short-term effect:
• Visible signs of nervousness,
helplessness, exhausion and
paralysed thinking
• Showing a state of panic
reaction, running here and
there, or unable to decide
and do anything
• Developing overeating
• Resorting to smoking and
alcoholism
• Exhibiting restlessness and
sleeping disorders
• Long-term effect:
• Serious behavioural disorders
• Alcoholism
• Drug addiction
• Obesity
• Forgetfullness

15. Physiological changes
• Short-term effect:
• Level of muscular tension is
increased
• There is an abnormal change in
the rate of heartbeat and blood
pressure
• There arises problems related to
digestion and elimination
• Long-term effect:
• In it evil effect, stress make one
or more susceptible to infectious
agent by temporarily
suppressing the immune system
• High blood pressure
• Migraine
• Hypertension
• Heart disease
• Ulcer
• Skin disorder
• Cancer

16. Emotional changes
• Short-term effect:
• There is sudden arrival of
negative emotions on the
scene in an abnormal and
excessive amount in one’s
emotional output that is
sudden output of anger,
fear, jealousy and hatred
• High state of anxiety,
restlessness and
depression
• Lack of interest in love-
making and social
intimacy
• Long-term effect:
• Chronic emotional disorders such
as,
• Anxiety
• Depression
• Fears
• Phobias
• Personality changes
• Mental illness

17. Cognitive changes
• Short-term effect:
• Marked distoration
in one’s ability to
attend or
concentrate on a
particular thing or
idea with an
unusual increase in
distractibility and
decrease in
concentration
• Long-term effect:
• Serious cognitive disorders
such as
• Memory problem
• Obsessive thoughts
• Sleep disorders

18. Theory
Adaptation theory (Dr. Hans Selye) 1948:

19. • All stresses tends to produce a hemostatic
change in the body. Through stress itself
cannot be perceived. It can be measured by
the structural and chemical changes that it
produces in the body. Theses manifest
themselves as the general adaptation
syndrome when only a limited part of the
body is exposed to stress. A syndrome is a
particular pattern or group of symptoms

20. General adaptation syndrome

21. The alarm reaction (Fight or
flight)
• It is the emergency response of the body.
Initial reaction to stressor
• Alarm reaction include,

22. Alarm reaction
• Heart rate and
strength of cardiac
muscle contraction
increases, this
circulates blood
quickly to areas
when it is needed to
fight the stress

23. • Blood vessels supplying
to skin, viscera, except
heart and lung
contrict
• Blood vessels supplying
skeletal muscles and
brain dilate
• Route more blood to
organs acute in stress
response, thus
decreasing blood
supply to organs
which do not have
immediate action role

24. • RBC production is
increased, leading to
an increase in the
ability of the blood
to clot. This helps
control bleeding

25. • Liver converts
glycogen into
glucose and release
it into blood stream.
This provides the
energy needed to
fight the stressor

26. • Rate of breathing increases, respiratory
passage widen to accommodate more air,
enables the body to acquire more oxygen

27. • Production of saliva
and digestive
enzymes reduces, as
digestive activity is
not essential for
counteracting stress

28. Stage of resistance
• Major feature is certain hormonal response,
especially in the adrenocorticotropic (ACTH)
axis an important line of defense in resisting
the effects of stresses.
• Prolonged activity of the adrecorticotropic
axis can impair the body’s ability to fight
infection and can have other harmful effects

29. Stage of exhausion
• The body’s ability to respond to stresses has
been seriously affected. At this stage or late
in the stage of resistance, various
psychosomatic disorders may occur

30. Stress management
• 1. Diaphragmatic Breathing
• Stress reduction doesn’t get any easier, or more
fundamental, than learning how to breathe
properly.
• When you’re under stress, your chest feels tight
and your breathing becomes shallow and rapid.
• This is a hardwired response to danger that is
supposed to be temporary.
• But most adults breathe this way all the time
which unfortunately keeps us in a “flight or
fight” mode.

31. • The most basic breathing exercise is to
consciously breathe from your diaphragm.
• As you slowly inhale and exhale, concentrate
on keeping your chest still while expanding
and contracting your stomach.
• A few minutes of diaphragmatic breathing
will lower levels of the stress hormone
cortisol and stimulate the parasympathetic
nervous system to evoke a state of calm.

33. 2. Meditation
• Meditation is undoubtedly one of the best stress
management techniques known.
• Meditation makes you more resilient and less
reactive to stress by decreasing the number of
neurons in your amygdala, the area of the brain
associated with fear, anxiety, and stress.
• It increases levels of the calming
neurotransmitter GABA (gamma-aminobutyric
acid).
• GABA puts the brakes on brain activity, letting
you relax.

34. • Meditation helps you quiet your mind and
master negative thought patterns which are
often the root cause of stress.
• Until you’re experienced at meditation, I
recommend listening to guided meditations
or audio files that incorporate binaural beats
or brainwave entrainment.

36. Mindfulness Meditation
• There are many kinds of meditation, and
one that stands out for stress relief is
mindfulness meditation.
• It’s the meditation of choice among those
facing unusual levels of on-the-job stress
such as Wall Street brokers, Silicon Valley
entrepreneurs, and military personnel.

37. • Mindfulness actually builds a bigger and
better brain.
• It increases the amount of gray matter, the
volume of the hippocampus, and
the thickness of the cortex while
it decreases the size of the amygdala, the
fear center of your brain.
• It also improves connectivity between various
regions of the brain

38. 4. Yoga
• One reason for the explosion in interest in
this 5,000-year-old practice is that people
are looking for a way to de-stress.
• Any kind of physical exercise will reduce
stress, but yoga excels at it.
• Yoga slows your breathing and heart rates,
lowers blood pressure, and increases heart
rate variability.
• Just a single one-hour session of yoga can
increase GABA by 27%.

39. • If you want to target feelings of stress or
anxiety, you’ll find yoga poses specifically for
stress at Yoga Journal.
• If you’re concerned you aren’t flexible
enough, give the ancient martial arts tai chi
or qi gong a try

41. 6. Self-Hypnosis
• Hypnosis is a trance-like state
characterized by extreme relaxation,
increased suggestibility, and heightened
imagination.
• Self-hypnosis occurs when you intentionally
put yourself in this state without the help of
a hypnotherapist.

42. • If you’ve ever found yourself entranced by a
crackling fire or ocean waves, you’ve
experienced self-hypnosis.
• A huge volume of research confirms
the benefits of hypnosis for anxiety and
other disorders with a stress-related
component.
• There are self-hypnosis scripts that you
can perform from memory or record and
follow along to your own voice.

43. 7. Autogenic Training
• Autogenic training is a little known but
highly effective type of self-hypnosis that
teaches you to regulate functions that are
normally under subconscious control, such as
heart rate, breathing, and blood pressure.
• It works by calming down your overactive
stress response.
• It puts you in a relaxed brain wave state
similar to meditation.

45. 8. Personal Biofeedback
• Biofeedback is a powerful
technique that teaches you how to
manage your breathing, heart rate and
blood flow to stop the stress response in its
tracks.
• It enables you to monitor what your body is
doing in real time by measuring functions
like heart rate, blood pressure, brain wave
state, skin temperature and muscle tension

46. • Besides stress relief, biofeedback can be used to
treat a wide variety of mental health and brain-
related disorders including anxiety, ADHD,
memory loss, and depression.
• Traditional biofeedback is expensive and time-
consuming, but now there are effective personal
biofeedback devices that work by measuring
various functions such as blood pressure
(RESPeRATE), heart rate variablity (HeartMath
emWave2), or galvanic skin response (Mindplace
ThoughtStream).

47. • Biofeedback devices that measure brain
waves are called neurofeedback devices
and require you to wear a headset (brand
names include Melon, Muse, NeuroSky,
Thync).
• With the assistance of a personal biofeedback
device allows, you can relax anytime,
anywhere

48. 9. Progressive Muscle
Relaxation
• When you get stressed, your muscles get tight.
• You may be feeling it in your back, neck,
or shoulders as you read this.
• And these tight muscles are not only caused by
stress, they contribute to stress.
• Progressive muscle relaxation is a simple
technique that involves tensing and relaxing
specific groups of muscles in a systematic
way to break the vicious cycle of stress and
muscle tension.

50. 10. Emotional Freedom
Technique (Tapping)
• Emotional Freedom Technique (EFT),
generally known as tapping, is a form of
acupressure that works by stimulating
meridian points with your fingertips.
• Tapping can be used for pretty much
anything that ails you — physically or
emotionally — including instant stress relief.
• One session of tapping can lower levels of the
stress hormone cortisol by up to 50%

52. 11. Aromatherapy
• Aromatherapy is a healing and relaxation
technique that makes use of the scent
of essential oils.
• According to the US National Library of
Medicine, more than 15,000 scientific
research studies have been done on essential
oils.
• Dozens of essential oils deliver stress relief,
but you can’t go wrong with lavender.

53. • Lavender is the most studied and possibly
the most versatile of all essential oils. (28)
• Put a few drops on your wrists, dab some
under your nose, or diffuse it into the air for
instant stress relief.
• Besides being generally relaxing, lavender
also has anti-anxiety, antidepressant, and
mood stabilizing properties

54. 2. Enjoyable Pastimes
• You almost certainly already have your own
favorite stress reduction strategy.
• I’m not talking plopping down in front of the TV
• What is it you love to do in your spare time that
gets you in the zone and makes time fade away?
• Creating art, listening to music, or getting
absorbed in your favorite hobby are all legitimate
stress management techniques.
• Hobbies as diverse as knitting, woodworking,
gardening, or home repair reduce stress and put
you in a relaxed state.

55. • Anti-stress coloring books — a recent trend
— can significantly reduce stress and
depression.
• Engaging in these activities before going
to bed can help you relax and fall asleep
faster than using your laptop or tablet which
emit sleep-disruptive blue light.

56. 13. Nature
• Go outside and spend some time in nature.
• It will lower your cortisol, blood pressure,
and pulse rate while increasing heart rate
variability.
• It doesn’t have to be a major outing —
simply spending a few minutes at a park on
your lunch break can help.
• And when you go, leave your Smartphone
behind or at least turned off.

57. • Research has confirmed what most of us
suspect anyway — that trying to do more
than one thing at once is stressful.
• Heart rate and cortisol levels go up when
you constantly check your email.
• And if you can’t get outdoors, take a few
minutes to look at pictures of nature.
• Even that can help reduce your stress levels,
anger, and fear and put you in a better
mood

59. 14. Gratitude
• Expressing gratitude creates a surge of feel-
good brain chemicals that will make you feel
happier and more relaxed.
• This benefits both you and the recipient.
• You can thank a friend by phone, text,
email, or (gasp!) put pen to paper and write
a genuine thank you note for words of
encouragement, act of kindness, or any
other “gift” you’ve received.

60. Green tea (Instead of coffee)
• caffeine can be part of a healthy lifestyle, it also
increases stress hormones and reduces calming brain
chemicals, while restricting blood flow to the brain
• Caffeine is even linked to four recognized psychiatric
disorders.
• So if you are feeling stressed, grabbing a caffeine-
laden cup of coffee, a soda or an energy drink is the
totally wrong thing to do!
• Instead, make your next drink a cup of green tea.
• Green tea contains a little caffeine — about 25 mg
per 8-ounce serving — which should be enough to
keep you from full-blown caffeine withdrawal.

61. • But green tea provides focus and energy while it
relaxes you, thanks to l-theanine and EGCG
(epigallocatechin gallate).
• L-theanine is an amino acid that increases your
resilience to stress.
• It causes an increase in alpha brainwave activity
that’s similar to that experienced during
meditation.
• EGCG is a polyphenol that normalizes activity of
the calming neurotransmitter GABA.
• Like theanine, EGCG also changes brain wave
patterns to put you in a “relaxed yet attentive
state.”

62. Green tea

63. Summary
• Stress is a necessary part of life, but too
much stress can make you sick and unhappy.
• Fortunately, there’s a wide variety of stress
management techniques that can bring relief
quickly and, if practiced regularly,
permanently.
• Almost all of them can be started right now,
be done anytime, and require little or no
investment.