NAME: Cyrus Josher DC.

Mayoyo DATE SUBMITTED: April 15, 2020

SECTION: BSN 1-B SCORE: ______

WORKSHEET#4-PSYCHOSOCIAL HEALTH-STRESS AND COPING

Answer the guide questions below:

1.) Explain the concepts of stress as a stimulus, as a response, and as a

transaction.
CONCEPT OF STRESS
Stimulus-Based Models
In stimulus-based stress models, stress is defined as a stimulus, a life event,
or a set of circumstances that arouses physiological and/or psychological reactions
that may increase the individual’s vulnerability to illness.
Response-Based Models
As described by Selye, it is “the nonspecific response of the body to any kind
of demand made upon it”. Selye’s stress response is characterized by a chain or
pattern of physiological events called the general adaptation syndrome (GAS) or
stress syndrome.
Transaction-Based Models
Transactional theories of stress are based on the work of Lazarus (1966), who
stated that the stimulus theory and the response theory do not consider individual
differences. Neither theory explains which factors lead some people and not others
to respond effectively nor interprets why some people are able to adapt for longer
periods than are others.
2.) Explain the three stages of Selye’s general adaptation syndrome.
Three stages of Selye’s general adaptation syndrome
Alarm Reaction
Alarm reaction is the initial reaction of the body, which alerts the body’s
defenses. It is divided into two parts such as the shock phase and counter phase.
During the shock phase, the stressor maybe perceived consciously or
unconsciously by the person. Stressors stimulate the sympathetic nervous system,
which in turn stimulates the hypothalamus. The hypothalamus releases
corticotropin-releasing hormone, which stimulates the anterior pituitary gland to
release adrenocorticotropic hormone. During times of stress, the adrenal medulla
secretes epinephrine and norepinephrine in response to sympathetic stimulation.
The second part of the alarm reaction is called the countershock phase.
During this time, the changes produced in the body during the shock phase are
reversed. Thus, a person is best mobilized to react during the shock phase of the
alarm reaction.
Stage of Resistance
The second stage in the GAS and LAS syndromes, the stage of resistance, is
when the body’s adaptation takes place. In other words, the body attempts to cope
with the stressor and to limit the stressor to the smallest area of the body that can
deal with it.
Stage of Exhaustion
During the third stage, the stage of exhaustion, the adaptation that the body
made during the second stage cannot be maintained. This means that the ways
used to cope with the stressor have been exhausted. If adaptation has not
overcome the stressor, the stress effects may spread to the entire body. At the end
of this stage, the body may either rest and return to normal, or death may be the
ultimate consequence. The end of this stage depends largely on the adaptive
energy resources of the individual, the severity of the stressor, and the external
adaptive resources that are provided, such as oxygen.
 3.) Discuss types of coping and coping strategies.
TYPES OF COPING
Adaptive Coping
Helps the person to deal effectively with stressful event and minimizes
distress associated with them.
Maladaptive Coping
Can cause unnecessary distress for the person and others associated with the
person or stressful events.
In nursing literature, effective and ineffective coping are often
differentiated.
Effective Coping
Results in adaptation.
Ineffective Coping
Results in maladaptation.

COPING STRATEGIES
Problem-Focused Coping
It refers to efforts to improve a situation by making changes or taking some
action.
Emotion-Focused Coping

It includes thoughts and actions that relieve emotional distress. Emotion-

focused coping does not improve the situation, but the person often feels better.
Long-Term Coping Strategies
It can be constructive and practical. Other long-term strategies include a
change in lifestyle patterns such as eating a healthy diet, exercising regularly,
balancing leisure time with working, or using problem solving in decision making
instead of anger or other non-constructive responses.
Short-Term Coping Strategies
It can reduce stress to a tolerable limit temporarily but are ineffective ways to
permanently deal with reality. They may even have a destructive or detrimental
effect on the person.
4.) Identify essential aspects of assessing a client’s stress and coping patterns.
Nursing assessment of a client’s stress and coping patterns includes (a)
nursing history and (b) physical examination of the client for indicators of stress
(e.g., nail biting, nervousness, weight changes) or stress-related health problems
(e.g., hypertension, dyspnea). When obtaining the nursing history, the nurse poses
questions about client-perceived stressors or stressful incidents, manifestations of
stress, and past and present coping strategies. During the physical examination, the
nurse observed for verbal, motor, cognitive, or other physical manifestations of
stress. Remember, however, that clinical signs and symptoms may not occur when
cognitive coping is effective. In addition, the nurse should be aware of expected
developmental transitions. Persons go through different developmental stages from
infancy to old age when certain tasks are expected to be completed or resolved.
When these tasks are carried over and not resolved, stress increases as they
become older. For example, if an infant does not learn to trust those around him
during infancy, this mistrust may accompany him through life, influencing his
relationships and possibly being the root of dysfunction, stress, and ineffective
coping. This knowledge helps the nurse identify additional stressors and the client’s
response to them. Questions to elicit data about the client’s stress and coping
patterns are shown in the accompanying Assessment Interview.
ASSESSMENT INTERVIEW
 STRESS AND COPING PATTERNS
 On a scale of 1 to 10, where 1 is “very minor” and 10 is “extreme,”
how would you rate the stress you are experiencing in the following
areas?
a. Home
b. Work or school
c. Finance
d. Recent illness or loss of loved one
e. Your health
f. Family responsibilities
g. Relationships with friends
h. Relationship with parents or children
i. Relationship with partner
j. Recent hospitalization
k. Other (specify)
 How long have you been dealing with these stressors?
 How do you usually handle stressful situations? If the client does not
adequately describe, prompt with the following:
a. Cry
b. Get angry
c. Talk to someone (Who?)
d. Withdraw from the situation
e. Control others or situation
f. Go for a walk or perform physical exercise
g. Try to arrive at a solution
h. Pray
i. Laugh, joke, or use some other expression of humor
j. Meditate or use some other relaxation technique such
as yoga or guided imagery
 How well does your usual coping strategy work?

Application:

Mark is a 48-year-old dress designer who is hospitalized with AIDS related

complication.  He is scheduled for MRI because of chronic cough. Mark was
relatively healthy until he had chronic diarrhea a year ago. He is extremely anxious
about the MRI. Mark confides to the admitting nurse that “I can’t stand the idea of
having to inform my family about my condition; I don’t know how I’m going to tell
them.” Mark’s partner informs the nurse that he has been abusing alcohol since his
diagnosis and neglecting his responsibilities at home. He is tearful and doesn’t see
how he will be able to continue his work as a dress designer.
 

 Does Mark’s ’situation reflect more of a stimulus-based model or a response-

based model? Why?
In Mark’s situation it compliments with the stimulus-based model since the
stressors or the stimuli of his diagnosis and his laboratory procedure affects his
physiological or psychological reaction of having a condition related to the AIDS that
makes him very anxious because in our society, it is not that easy to be understand
by the others. In addition to his condition, he is experiencing chronic cough and a
chronic diarrhea a year ago. Thus, MRI results makes him anxious because if it
confirms that he has an AIDS, there’s a thought that his parent might not accept it
and what others can respond about it.
Since there is a response to the stressful situation he experienced, he is
being affected negatively by the situation by abusing himself on drinking too much
alcohol, becoming unproductive by refusing doing responsibilities at home and a
thought of not continuing his job as a dress designer. Hence, response-based model
compliment with his situation as well.

 While working with Mark, he becomes very angry and says to you, “You don’t
understand. You’ve never had to go through this.” How would you respond?

In this case, I will agree to his statement that I can’t really know exactly what
he is experiencing because I’ve never experienced yet that kind of situation. In this
scenario, I will focus in emotion-focused coping, it does not improve the situation
but it he may feel better somehow about it. Hence, I will listen to his feeling and
side first, then I will response to the content of his message especially to the
emotional part of his message such as to his anger, fear and lack of control. As a
religious person, if I find out that he is religious at some point or has a personal
connection with God at first but becomes unsteady, I will try to share a word of God
to him. This action of mine depends upon the situation. Also, for other intervention I
will try to connect with other people like my friends or other patient with the same
circumstances with his. In addition, I should be mindful in becoming sensitive
because this is one of the sensitive situations that a nurse may experience with a
client.

 Do you believe that Mark is in crisis?  What factors led to your decision?

The fact that he might diagnose with this kind of condition that is hard to
accept by the society or even his family, I’m absolutely sure that he is in crisis.
Other factors that led to my decision that he is in crisis, are the responses he made
towards his situation such as abusing alcohol, becoming unproductive by not doing
responsibilities at home and even having thought of not continuing his job which is
dress designer which may lead to even critical psychological condition aside to his
current condition. In this case, I should be sensitive in handling him and providing
him care and making decision. I could refer him also for psychological therapy or
counselling.

 Give one example of how Mark might use the defense mechanisms described
on the book. Explain whether this is adaptive or maladaptive.
For me, one of the defense mechanisms that Mark do to himself is
“displacement”. According to the book of Kozier & Erb’s Fundamentals of nursing, it
is the discharging pent-up feelings on people less dangerous than those who initially
aroused the emotion. In this case, while I’m working with Mark, he becomes very
angry. Moreover, because of the possibility that he may diagnose with having an
AIDs and being anxious to tell it to his family, he suddenly become angry and blows
up with me.
In his action, it shows that it falls under the maladaptive coping which causes
unnecessary distress for the person and the people around him. In relation to this,
his partner is being affected too because his partner saw the negative response of
Mark towards the situation he is facing like abusing alcohol, avoid doing
responsibilities at home and thoughts to stop continuing his job.