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major risk factors for illness (6)

1. age =older higher than young, different stress levels
2. genetics
3. physiological factors (obesity)
4. health habits (smoking, poor nutrition, sun exposure)
5. lifestyle habits (multiple sexual partners, stress)
6. environment (work & home)

personal wellness models: Dunn

1. model of high level wellness
• functioning to one's maximum potential, maintaining balance & a purposeful direction in the environment
• good health = passive state where the person is not ill
• wellness = active state where the person's potential is maximize regardless of the state of their health (ex. you may have diabetes but you are maximizing your health. know the effect, work with the disease & max
2. defined 3 processes that helps a person know who/what they are and their perception of their health

Dunn: good health

passive state where the person is not ill

Dunn: wellness

active state where the person's potential is maximize regardless of the state of their health (ex. you may have diabetes but you are maximizing your health. know the effect, work with the disease & maximize

personal wellness models: rosenstock

Rosenstock 1974 Health belief model
1. 3 components to what people believe or perceive to be true about themselves & their health
• perceived susceptibility to a disease, perceived seriousness of the disease, perceived benefits of action (ex. smokers denial - don't perceive the problems)
2. modifying factors = advice, media campaigns, demographics, peer pressure, personality, knowledge, etc

wellness trends (3)

1. teaching health promotion activities are ineffective unless the person believes they are necessary
2. trend toward health awareness:
• biggest loser, stress management techniques, nutritional awareness, exercise & fitness programs, antismoking, anti drugs, seat belts, gun control, hazardous waste disposal, school lunch programs
3. US Dept Health & Human Services = regular moderate physical activity can help prevent chronic diseases like: hypertension, type 2 diabetes, CVD, obesity, osteoporosis

Stress (4)

1. condition, imbalanced state or change in the environment
2. stressors are anything perceived as a threat, challenge, demanding or danger, perceptions are very individualized
3. can be positive or negative stressors
4. Pender 2006 = major source of stress is from interpersonal relationships & performance demands not actual physical threats

Homeostasis General adaptation syndrom (GAS)

1. Selye 1976 - biochemical model of stress (physical & psychological)
• alarm stage = (minutes to a few hours) perceive a stressor, activate psychological defense mechanisms, physical fight or flight syndromes
• Resistance = return to normal and psychological functioning or do not adapt
• exhaustion = physical & emotional if you do not adapt

Homeostasis General adaptation syndrom (GAS): alarm stage

(minutes to a few hours) perceive a stressor, activate psychological defense mechanisms, physical fight or flight syndromes

Homeostasis General adaptation syndrom (GAS): Resistance

return to normal and psychological functioning or do not adapt

Homeostasis General adaptation syndrom (GAS): exhaustion

physical & emotional if you do not adapt

mind body interaction

1. humans react to threats & perception of danger as if they were real physical threats
• body cannot tell the difference between real danger & perceived psychological danger/stress
• activates physical stress response regardless of real or perceived dangers

anxiety (5)

1. most common human response to stress. fear (known) is a cognitive response but anxiety (unknown) is an emotional response to a stressor. both fear & anxiety trigger physical responses
2. mild anxiety = normal & motivates humans
3. moderate anxiety - narrow perception field & only focus on the immediate concern
4. severe anxiety = impaired learning, relief behaviors, easily distracted
5. panic = lose control, terror

mild anxiety

normal & motivates humans
- increased alertness, increased ability to focus, improved concentration, expanded capacity for learning

moderate anxiety

-narrow perception field & only focus on the immediate concern
- concentration limited to one thing, increased body movement, rapid speech, subjective awareness of discomfort

severe anxiety

- impaired learning, relief behaviors, easily distracted
- scattered thoughts, difficulty with verbal communication, considerable discomfort, purposeless movements

panic

- lose control, terror
- complete disorganization, difficulty differentiating reality from unreality, constant random movements, unable to function without assistance

coping mechanisms for stress/anxiety (4)

1. learned
2. mild to moderate anxiety: unconscious automatic responses = (cry, laugh, sleep, curse, exercise, smoke, drink)
3. moderate to panic anxiety: become task oriented = solve the problem, attack behaviors, withdraw, compromise, develop guilt
4. defense mechanisms = unconscious reactions that decrease anxiety & protect self esteem (denial, projection, sublimation)

coping mechanisms for stress/anxiety: mild to moderate anxiety

unconscious automatic responses
• (cry, laugh, sleep, curse, exercise, smoke, drink)

coping mechanisms for stress/anxiety: moderate to panic anxiety

become task oriented
• solve the problem, attack behaviors, withdraw, compromise, develop guilt

coping mechanisms for stress/anxiety: defense mechanisms

unconscious reactions that decrease anxiety & protect self esteem (denial, projection, sublimation)

positive effects of stress on health & illness (5)

1. motivate us to promote health & prevent illness
2. facilitate normal growth & development
3. stimulate us for learning new constructive adaptation behaviors
4. encourage social relationships
5. stimulate our problem solving/critical thinking skills

negative effects of prolonged stress on health & illness

opposite of positive & can cause illness & delay recovery

caregiver stress (nurses & SO)

kingston-scale handout
repeated over time to see if there are increases & need to refer

stressors for nurses (6)

1. assuming responsibilities you are not prepared for
2. working with unqualified staff
3. non-supportive managerial staff
4. cardiac arrests & dying patients
5. peer conflicts & lateral violence (ex. turning you back on someone, verbal abuse, shift to shift, doctor to nurse, etc)
6. greatest stress is experiences by new nurse graduates, nurses working intensive care & ER (you need to get organized - can happen thru repetition)

student nurse stressors (7)

1. fear failing a course (clinical or theory)
2. fear of failing the program
3. fear of failing licensure exam after graduation
4. demands of the nursing program/cirriculum
5. fear of injuring patients
6. need to balance work and family
7. need to meet financial & family obligations

strategies for managing stress & avoiding burnout (8)

professional lifestyle:
1. set realistic goals
2. vary work routing
3. objectify negative interactions & situations
4. take time away (short breaks)
5. become an advocate
6. seek support from colleagues
7. grieve well
8. enhance communication skills

other strategies for stress mgt (7)

1. medications can lower anxiety
2. art, music, massage, therapeutic touch
3. stuart Laria 2005 rhythmic deep breathing = reduced muscle tension & altered the state of consciousness
4. meditation
5. anticipatory guidance (know what to expect)
6. guided imagery
7. biofeedback

crisis intervention (3)

1. individualize a plan of action to manage stress
2. overall concepts:
• identify the problem
• list alternative
• choose one "what would happen if.."
• do it
• did it work? if not choose another & do it
3. people in crisis need support & encouragement, accepting help from others can be difficult for some people

brain dominance (4)

1. take the brain dominance quiz & determine your dominance
2. how will this effect your nursing?
3. which learning style best describes you?
4. how could this effect your nursing?

conclusion

the perfect no stress environment is the grave. when we change our perception we gain control. the stress becomes a challenge, not a threat. when we commit to action, to actually doing something rather than feeling trapped by events, the stress in our life becomes manageable

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