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The Stuart Stress Adaptation Model

of Psychiatric Nursing Care

Models provide a structure for thinking,
observing, and interpreting what is seen.
Conceptual nursing models are frames of
reference within which patients, their
environment and health states, and nursing
activities are described.
This textbook is based on the Stuart Stress
Adaptation Model of psychiatric nursing
care, which integrates biological,
psychological, sociocultural, environmental,
and legal-ethical aspects of patient care into
a unified framework for practice.
Theoretical Assumptions:
The first assumption of the Stuart Stress
Adaptation Model is that nature is ordered as a
social hierarchy from the simplest unit to the
most complex. Each level also is a part of the
next higher level, so nothing exists in isolation.
Thus the individual is a part of family, group,
community, society, and the larger biosphere.
The second assumption of the model is that
nursing care is provided within a biological,
psychological, sociocultural, environmental, and
legal-ethical context.
The nurse must understand each of them in order to
provide competent, holistic psychiatric nursing care.
The theoretical basis for psychiatric nursing practice is
derived from nursing science as well as from the
behavioral, social, and biological sciences.

This means that a person with a medically
diagnosed illness may be adapting well to it. An
example of this is the adaptive coping responses
used by some people who have chronic physical
or psychiatric illnesses. In contrast, a person
without a medically diagnosed illness may have
many maladaptive coping responses. These two
continuums thus reflect the complementary
nature of the nursing and medical models of
The fourth assumption is that the model
includes the primary, secondary, and tertiary
levels of prevention by describing four
discrete stages of psychiatric treatment:
crisis, acute, maintenance, and health
promotion. For each stage of treatment the
model suggest a treatment goal, a focus of the
nursing assessment, the nature of nursing
interventions, and the expected outcome of
nursing care.
The fifth assumption of the Stuart Stress
Adaptation Model is that it is based on the use
of the nursing process and the standards of
care and professional performance for
psychiatric nurses. Psychiatric nursing care is
provided through assessment, diagnosis,
outcome identification, planning,
implementation, and evaluation.
The fifth assumption of the Stuart Stress
Adaptation Model is that it is based on the use
of the nursing process and the standards of
care and professional performance for
psychiatric nurses. Psychiatric nursing care is
provided through assessment, diagnosis,
outcome identification, planning,
implementation, and evaluation.
Describing Mental Health and Illness:
Defining Mental Health:
Mental Health is often said to be a state of well-
being associated with happiness, contentment,
satisfaction, achievement, optimism, or hope.
These terms are difficult to define, and their
meanings change as they relate to a particular
person and life situation.
Criteria of Mental Health. The following six
criteria are indicators of mental health:
Positive attitudes toward self
Growth, development, and self-actualization
Reality perception
Environmental mastery
Positive attitudes toward self include and acceptance
of self and self-awareness.
Growth, development, and self-actualization mean
that the individual seeks new experiences to more
fully explore aspects of oneself.
Integration is a balance between what is expressed and
what is repressed, between outer and inner conflicts.
Anatomy involves self-determination, a balance
between dependence and independence, and acceptance
of the consequences of one's actions.
Each person should be seen in both a group and an
individual context
Dimensions of Mental Health:
The Global Burden of Disease Study thus showed the
true magnitude of the long underestimated impact of
mental health problems. Further, by the year 2020,
mental disorders are projected to increase, and major
depression is predicted to become the second leading
cause in disease burden worldwide. The Global Burden
of Disease Study has thus been eye opening in regard to
public health in terms of mainstreaming mental health
and high-lighting the public significance of mental
Biopsychosocial Components:
The Stuart Stress Adaptation Model of
psychiatric nursing care views human behavior
from a holistic perspective that integrates
biological, psychological, and sociocultural
aspects of care.
The holistic nature of psychiatric nursing
practice examines all aspects of the individual
and the environment.
Predisposing Factors:
Predisposing factors are risk factors that
influence both the type and amount of resources
the person can use to handle stress and are
biological, psychological, and sociocultural in
Biological predisposing factors include genetic background,
nutritional status, biological sensitive, general health, and
exposure to toxins.
Psychological predisposing factors include intelligence, verbal
skills; morale; personality; past experiences; self-concept,
motivation; psychological defenses; and locus of control, or a
sense of control over one's own fate.
Sociocultural predisposing factors include age, gender,
education, income, occupation, social position, cultural
background, religious upbringing and beliefs, political affiliation,
socialization experiences, and level of social integration or
Precipitation Stressors:
Precipitating stressors are stimuli that are challenging,
threatening or demanding to the individual. They
require excess energy, and produce a state of tension
and stress. They may be biological , psychological, or
sociocultural in nature, and they may originate either in
the person's internal or external environment.
Besides describing the nature and origin of a stressor, it
is important to assess the timing of the stressor. A final
factor to be considered is the number of stressors an
individual experiences.
Appraisal of Stressor
Appraisal of a stressor involves determining the
meaning of and understanding the impact of the
stressful situation for the individual. It includes
cognitive, affective, physiological, behavioral, and social
responses. Appraisal is an evaluation of the
significance of an event in relation to a person's
well-being. The stressor assumes its meaning,
intensity, and importance as a consequence of the
unique interpretation and significance given to it by the
person at risk.

Coping Resources:
Coping resources are options or strategies that help
determine what can be done as well as what is at stake.
Coping resources include economic assets, abilities and
skills, defensive techniques, social supports, and
motivation. Other coping resources include health and
energy, spiritual supports , positive beliefs, problem-
solving and social skills, social and material resources,
and physical well-being.
Coping Mechanisms:
Coping mechanisms are any efforts directed at stress management. The three
main types of coping mechanisms are as follows:
Problem-focused coping mechanisms, which involve tasks and direct
efforts to cope with the treat itself. Examples include negotiation,
confrontation, and seeking advice.
Cognitively focused coping mechanisms, by which the person attempts to
control the meaning of the problem and thus neutralize it. Examples include
positive comparison, selective ignorance, substitution of rewards, and the
devaluation of desired objects.
Emotion-focused coping mechanisms by which the patient is oriented to
moderating emotional distress. Examples include the use of ego defense
mechanisms, such as denial, suppression, or projection. A detailed discussion
of coping and defense mechanisms.
Coping mechanisms can be constructive or destructive.
Patterns of Response:
According to the Stuart Stress Adaptation Model
an individual's response to stress is based on
specific predisposing factors, the nature of the
stressor, the perception of the situation, and an
analysis of coping resources and mechanisms.
Coping responses of the patient are then
evaluated on a continuum of adaptation/
Responses that support functioning are seen
adaptive. They lead to growth, learning, and
goal achievement.
Responses that block integrated functioning
are seen as maladaptive. They prevent growth,
decrease autonomy, and interfere with mastery
of the environment.
Treatment Stages and Activities:
The final aspect of the Stuart Stress Adaptation Model
is the integration of the theoretical basis,
biopsychosocial components, patterns of response, and
nursing activities based on the patient's treatment stage.
Once patterns of coping responses have been
identified, the nurse determines which treatment stage
the patient is in and implements the most appropriate
nursing activities.
The model identifies four possible treatment stages: (1)
crisis, (2) acute, (3) maintenance, an (4) health