September 21st, 2006
ATE TINE :)
There are numbers of definitions of stress as well as number of events that can lead one to experience stress. People say they are stressed when they take experimentation, when having to deal with frustrating work situations, or from the point of view of a student nurse being exposed to the medical ward where one would encounter varied medical diseases which require varied intervention is a source of stress in itself already. For a novice, a practicing student nurse, stressful situations can be viewed as harmful, as threatening, or for some even challenging.
With so many factors that can contribute to stress, it can be difficult to define the concept of “stress”. Defining stress is indeed stressing! However, according to Hans Selye, stress is the wear and tear that life causes on the body. It occurs when the person has difficulty dealing with life situations, problems and goals. Each person handles stress differently; one person can thrive in a situation which can create great distress for another (Videbeck, 2004).
Accordingly, Selye came up with his concept of General Adaptation Syndrome (GAS) or also known as the “Stress Syndrome”. He furthered that there are 3 stages concerning an organism’s response to stress namely the first stage known as Alarm Reaction, wherein the body prepares itself for “fight or flight”. The second stage is known as “Adaptation Stage” wherein an individual’s resistance is built. Finally, the third stage is known as the “Exhaustion Stage” wherein the duration of the stress is sufficiently long such to cause the body’s energy reserves to breakdown as a result of “wear and tear”. Furthermore, it is noted that many of the diseases caused by stress occurs in the resistance stage and it is referred to as the “Disease of Adaptation”. This disease of adaptation includes headache, insomnia, high blood pressure and further more.
Taking into context our status as Student Nurses, duty stress can be defined generally as the harmful physical and emotional responses that occurs when the requirements of the duty do not match the capabilities, resources, or needs of the individual.
Another nursing theory on stress is the Lazarus Theory of Stress and Coping. Stress is described as phenomenological; that is, the person is understood to constitute and be constituted by meanings; wherein, stress is the disruption of meanings and coping is what the person does about the distraction. (Tomey and Alligood, 2002). It is evident that in every concept, a stressor is present. Stressors are tension-producing stimuli occurring within the boundaries of the client system. They may be; 1. Interpersonal forces occurring within the individual, such as conditioned responses. 2. Intrapersonal forces occurring between one or more individuals, such as role expectations. 3. Extra personal forces occurring outside the individual, such as financial circumstances (A.M. Tomey and M.R. Alligood, 2002).
In the Philippines, related study on stress conducted by Benjamin Salvosa IV and Pinky de Leon defined stress as an event when there is an individual who attempts to meet the demands from the environment yet is unable to. It has also been defined as discrepancy between the demands on the person – external and internal – and the person potential responses to those demands. The demands from the environment on the person are also known as stressors – stimulus that causes stress (Salvosa and de Leon).
In the City of Baguio, a study made by a student of Baguio Colleges Foundation, emphasized that stress occurs when the demands, may it be external or internal, causes a person’s potential response to be disrupted (Villasi, 2004).
Stress is defined as “an adaptive response, moderated by individual differences, that is a consequence of any action, situation, or event, that places special demands on a person” (Ivancevich and Matteson, 1996). Perhaps the most important word in the definition is “special” since significant or unusual situations rather than day-to-day minor adjustments of life, usually produce stress (DeFrank and Ivancevich, 1999). It is important to note that there is substantial disagreement over the definition of stress. Scholars often have different definitions and abide by those explanations most suitable to the pursuit of their particular interests.
Stressors are external events or conditions that affect the organism (Breznitz and Goldberger,1993) and are considered an antecedent conditions to the demand or opportunity that will require an adaptive response on the part of a worker (Boehr, Walsh, and Tabor, 1976). A variety of dissimilar situations – emotional arousal, effort, fatigue, pain, fear, concentration, humiliation, and even great and unexpected success – are capable of producing stress; hence, no single factor can, in itself, be pinpointed as the cause of the reaction as such (Selye, 1993). Job stressors are defined as job demands, constraints (or opportunities), and job-related events or situations that may affect an individual’s role fulfillment (Parasuraman and Alutto, 1984) and evemtually their level of performance. Level of performance is motivational in nature – and some theorist claim that stress is a primary motivating factor. Some may perform well under stress though some may not!
The reaction to a stressful situation is called an outcome, and a negative outcome is called a strain. Typically, strains have been aggregated into three categories (Jex and Boehr, 1991; Lapidus, Roberts, and Chonko, 1997) – psychological and emotional strains including depression, burnout, frustration and anxiety; physical strains including headaches, stomach aches, and cardiovascular disease; and behavioral strains including absenteeism, turnover, smoking, drinking, etc. It is generally believed that stress impairs performance, but evidence provided by field studies has been both sparse and mixed (Parasuraman and Alutto, 1984). The experience of stress does not invariably lead to deterioration. It may facilitate growth by tempering arrogance and by enhancing our tenderness toward ourselves and others (Haan, 1993).
One reason to stress is the potential relationship between stress and Level of Performance. For this verification, it is necessary to measure the impact of stress on level of performance. Some stress impacts occur instantly and are thus easily observed. Others occur later, which can even affect performance in subsequent projects. Moreover, level of performance can, of course, be determined by factors other than stress.
The theories of how stress influences performance are not yet very predictive. Wickens et al. note that the amount of stress is difficult to predict for a given situation, as differences can arise due to how the task is performed (allowing more or less time to appraise the situation), how the task is appraised (e.g., threatening versus challenging) due to level of expertise, and whether one perceives that they are in control of the situation. The authors do, however, go on to provide some theoretical statements that can be used to implement theories of stress as overlays.
CHAPTER II
REVIEW OF RELATED LITERATURE
STRESS
Stress is a state of dynamic tension created when you respond to perceived demands and pressure build up while you to mobilize resources against them. It is a state of physical and emotional arousal caused by demands, pressure, and the wear and care of life (Saguipped, 1999).
Stress is a response to a stressor, or environmental demand that disrupts smooth functioning in a person’s life, resulting in challenge, harm or loss. It is something that makes you worry, anything that causes “change in your daily routine”, anything that causes change in your body health. There are several types of stress-ones that are so commonplace that you might not even realize that they are stressful. Emotional stress when arguments, disagreements and conflicts cause changes in your personal life. Environmental factors- very hot or very cold climates can be stressful. Very high altitude may me a stress. Toxins or poisons are a stress. Each of these factors threatens to cause changes in your body’s internal environment. Pushing your body too hard; the body’s fight to stay healthy in the face of the increased energy that you are expending is major stress.
When we talk about stress, the first thing that comes to mind is its negative implications. This should not be the case. According to Hans Selye, stress is the “wear and tear” our bodies experience as we adjust to our continually environment; it has physical and emotional effects on us and can create positive or negative feelings. As a positive influence, stress can help compel us to action; it can result in a new awareness and an exciting new perspective. As a negative influence, it can result in feelings of distrust, refection, anger and depression which in turn can lead to health problems such as headaches, upset stomach, insomnia, hypertension, heart disease and stroke. As we have seen, positive stress adds anticipation and excitement to life, and we all thrive under a certain amount of stress. Deadlines, competitions, confrontations, and even our frustrations and sorrows add depths and enrichment to our lives. Our goal is not to eliminate stress but to learn how to manage it and how to use it to help us. Insufficient stress acts as a depressant and may leave us feeling bored or dejected; on the other hand, excessive stress may leave us feeling “tied up in knots” (Videbeck, 2004).
So what we need to do is to find the optimal level of stress which will individually motivate but not overwhelm each of us.
There is no single level of stress that is optimal for all people. We are individual creatures with unique requirements. As such, what is distressing to one may be a joy to another. And even when we agree that a particular event is distressing, we are likely to differ in our physiological and psychological responses to it.
It has been found that most illness is related to unrelieved stress. If you are experiencing stress symptoms, you have gone beyond your optimal stress level, you need to reduce the stress in your life and/or improve your ability to manage it.
The same holds true with the way a person responds to stress. Stress for one person may just be another exciting challenge to the other person. This confirmed by ATWATER (1993), when he said that these are times when stress depends upon the relationships of a particular person and a given demand.
Due to such difference, it has become necessary to differentiate the two kinds of stress that a person refers to. Negative stress or distress refers to the harmful effects such as excessive or unpleasant demands that drain our energy and make us more vulnerable to illness. Eustress or positive stress refers to the stimulating beneficial effects of stress.
There are three different kinds of stress, they are as follows;
ACUTE STRESS according to Miller and Smith, it is the most common from the stress. It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future. Acute Stress is thrilling and exciting in small doses, but too much is exhausting. A fast run down a challenging ski slope, for example, is exhilarating early in the day. That same ski run late in the day is taxing and wearing. Skiing beyond your limits leads to falls and to broken bones. By the same token, overdoing on short-term stress can lead to psychological distress, tension headaches, upset stomach, and other symptoms.
Because it is short term, acute stress doesn’t have enough time to do the extensive damage associated with long-term stress. The most common symptoms are:
- emotional distress—some combination of anger or irritability, anxiety, and depression, the three stress emotions:
- muscular problems including tension headache, back pain, jaw pain, and the muscular tensions that lead to pulled muscles and tendon and ligament problems;
- stomach, gut and bowel problems such as heartburn, acid stomach, flatulence, diarrhea, constipation, and irritable bowel syndrome;
- Transient over arousal leads to elevation in blood pressure, rapid heartbeat, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breathe, and chest pain.
Acute stress can crop up in anyone’s life, and it is highly treatable and manageable.
EPISODIC ACUTE STRESS is those, however, who suffer frequently, whose lives are so disordered that they are studies in chaos and crisis. They’re always in a rush, but always late. If something goes wrong, it does. They take on too much, have too many irons in the fire, and can’t organize the slew of self inflicted demands and pressures clamoring for their attention. They seem perpetually in the clutches of acute stress.
It is common for people with acute stress reactions to be over aroused, short-tempered, irritable, anxious, and tense. Often, they describe themselves as having “a lot of nervous energy.” Always in a hurry, they tend to be abrupt, and sometimes their irritability comes across as hostility. Interpersonal relationships deteriorate rapidly when others respond with real hostility. The work becomes a very stressful place for them.
Another form of episodic acute stress comes from ceaseless worry. “Worry warts” see disaster around every corner and pessimistically forecast catastrophe in every situation. The world is dangerous, unrewarding, punitive place where something awful is always about to happen. These “awfulizers” also tend to be over aroused and tense, but are more anxious and depressed than angry and hostile.
The symptoms of episodic acute stress are the symptoms of extended over arousal: persistent tension headaches, migraines, hypertension, chest pain, and heart disease. Treating episodic acute stress requires intervention on a number of levels, generally requiring professional help, which may take many months.
Often, lifestyle and personality issues are so ingrained and habitual with these individuals that they see nothing wrong with the way they conduct their lives. They blame their woes on other people and external events. Frequently, they see their lifestyle, their patterns of interacting with others, and their ways of perceiving the world as part and parcel of who and what they are.
Sufferers can be fiercely resistant to change. Only the promise of relief from pain and discomfort of their symptoms can keep them in treatment and on track in their recovery program.
CHRONIC STRESS this is the grinding stress that wears people away day after day, year after year. Chronic stress destroys bodies, minds and lives. It wreaks havoc through long-term attrition. It’s the stress of poverty, of dysfunctional families, of being trapped in an unhappy marriage or in a despised job or career. It’s the stress that the never-ending “troubles.”
Chronic stress comes when a person never sees a way out of a miserable situation. It’s the stress of unrelenting demands and pressures for seemingly interminable periods of time. With no hope, the individual gives up searching for solutions.
Some chronic stresses stem traumatic, early childhood experiences that become internalized and remain forever painful and present. Some experiences profoundly affect personality. A view of the world, or a belief system, is created that causes unending stress for the individual (e.g., the world is threatening place, people will find out you are a pretender, you must be perfect at all times). When personality or deep-seated convictions and beliefs must be reformulated, recovery requires active self-examination, often with professional help.
The worst aspect of chronic stress is that people get used to it. They forget it’s there. People are immediately aware of acute stress because it is new; they ignore chronic stress because it is old, familiar, and sometimes, almost comfortable.
Chronic stress kills through suicide, violence, heart attack, stroke, and, perhaps, even cancer. People wear down to a final, fatal breakdown. Because physical and mental resources are depleted through long-term attrition, the symptoms of chronic stress are difficult to treat and may require extended medical as well as behavioral treatment and stress management (www.ilo.org/public/english/protection/condtrav/pdf/we-cge-96.pdf.).
The authors made the following theoretical assumptions about the evolution of gender-specific stress response patterns: Traditionally and throughout evolution, males have been selected that mount a successful behavioral response to a threat, which maximizes the survival of self by either defeating the enemy or overcoming the threat. The fight and flight response should result in the selection of males that maximizes biological mechanisms to assure superior fight or flight responses, such as cardiovascular performance, motor planning, and necessary neuroendocrine responses, such as activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis—systems essential to self-preservation. Different considerations apply to females: Compared to males, females make a greater investment initially in pregnancy and nursing, and typically play the primary role in bringing offspring to maturity. Therefore, behavioral responses to threats that were successfully passed on would have been those that protected offspring as well as self. This maternal investment should result in selection of female stress responses. In females, there is a greater activation of vagal mechanisms (associated with parasympathetic nervous system "relax and restore" responses and increased gastrointestinal activation), and greater release of oxytocin (a calming hormone amplified by estrogen) and endorphins within the brain will inhibit the underlying fight and flight response, and promotes study habits and diligence. (http://www.aboutibs.org/Publications/stress.html)Taylor has coined the phrase "tend-and-befriend" to describe a very different pattern that her research group has found in women who are stressed. It seems that most of the earlier research on the fight-or-flight response was done using males. Taylor has found that females - even female animals from different species - respond differently to stress than males. Females under stress nurture themselves and their young ('tending') and form alliances with others ('befriending'). The fight-or-flight response seems to be present in women under acute stress. The tend-and-befriend response then seems to kick-in, and the women respond differently then men. Female animals may need to protect their young in a stressful situation. Fleeing too soon would be a problem. Taylor's research suggests that hormones may play a role in these differences. Males under stress produce androgens such as testosterone in addition to stress hormones such as cortisol. (http://mentalhealth.about.com/cs/womensmentalhealth/a/tendbefriend.htm)
STRESSORS
Some view stress as environmental pressure such as task overload, maintaining student discipline, and role conflict on the individual. Others define stress in terms of physiological reactions to environmental stimuli (Folkman 1994). The interactionalist who views the beginning of stress pointed out that both the environmental stimulus and the reacting individual are vital elements and the relationships between the two is crucial (Grasha 1997). The reaction depends on how the person interprets or appraises the significance of a harmful, threatening of challenging events.
On the other hand, Gimero defined stress as the apprehension cued off by threat to some uncues and needs that an individual holds essential to his existence as personality. Altman and Jeffe further mentioned that ach individual has several important needs to which have to be met, example survival, competence, self actualization, safety, esteem and intimacy. To meet these needs, individuals must cope with various life cycle context and stressors. Stress is the human’s ability or difficulty to cope with the demands in life. What follows are some of the common environmental demands that leads to psychological stress and tension, and thus are potential sources of counter productive response and adaptation crisis.
Stress is not simply out there in environment, though it may originate there. Stress depends not only on the external conditions, but also on the vulnerability of individual and the adequacy of is system of defense. Many environmental situations are not stressful for everyone, the reaction depends on the kind of person he is.
The experience of stress represents a psychological state. It can result from exposure, or threat of exposure, both to the more tangible workplace hazards and to the psychosocial hazards of work. The experience of stress is one important outcome of exposure to the hazards of work and to hazardous situations. Those hazards of work which are associated with the experience of stress are often termed stressors.
According to the study of Salvosa lll and de Leon stress occurs when there is an individual who attempts to meet the demands from the environment yet it unable to (Manstead and Hewetone 1996). It has also been defined as a discrepancy between the demands on the person-external and internal and the person’s potential responses to those demands (Hendricks 1998). The demands from the environment on the person are also known as stressors-stimulus that causes stress (Webster 1983).
There are basically two types of stressors which have been extensively researched: ambient and life events. Ambient stressors are termed as the day-to-day hassles of life in a community. It is an accumulation of stressors from the household, social and leisure pursuits, and in the work environment. Life events are more discrete stressors such as the loss of a job, the death of a close associate and the break up of an intimate relationship (Falloon 1993). Other samples of life events having serious illnesses, residence changes, fulfillment or non fulfillment of goals and change in roles (Murphy and Kupshik 1992).
STRESS LEVEL
The experience of exposure to a stressor leads to a variety of behavioral changes depending on the severity of the stress experienced, the individual’s characteristics, and the environmental possibilities.
MILD STRESS when the stress experienced is tolerable and doesn’t affect your performance in the area as much.
MODERATE STRESS when the stress experienced is on the verge of being intolerable and begins to affect your performance in the area.
SEVERE STRESS when the stress experienced is of no benefit to you feel impending panic and you cannot handle or tolerate it anymore (www.nso.com/newsletters/advisor/200/nurse/rarara.phf).
Taking into context our stress as student nurses, duty stress can be defined generally as the harmful physical and emotional responses that occurs when the requirements of the duty do not match the capabilities, resources or needs.
According to Selye on his concept of General Adaptation Syndrome (GAS) or also known as the “Stress Syndrome”. He furthered that there are three stages concerning the organisms response to stress namely; alarm reaction, wherein the body prepares itself for fight or flight. The second stage is known as Adaptation Stage. In this stage, the individual’s resistance is built, and finally, the third stage is known as Exhaustion Stage, the duration of the stress is sufficiently long such that the body’s energy reserves breakdown as a result of “wear and tear”. Furthermore it is noted that many of the disease caused by stress occurs in the resistance stage and it is referred to as “Disease of Adaptation”. This disease of adaptation includes headache, insomnia, and high blood pressure among others.
Other nursing theory on stress is that of Lazarus “Theory of Stress and Coping”. Stress is described as phenomenological; that is the person is understood to constitute and be constituted by meanings; wherein stress is what the person does about the disruption (A.M. Tomey and M.R. Alligood, 2002). It is evident that in every concept, a stressor is present. Stressors are tension-producing stimuli occurring within the boundaries of the client system. They may be, INTERPERSONAL forces occurring within the individual, such as conditioned responses. Interpersonal forces occurring between one or more individuals, such as role expectations. Extrapersonal forces occurring outside the individual, such as financial circumstances.
According to the American Academy of family, stress is simply a sign of times. Everywhere people are trying to reduce the effects of excessive tensions of the daily life. They emphasized that no one really knows whether people now a days experience more stress than their ancestors did, but it seems its true. Hobfol stated that the word stress was loosely borrowed from physics. Humans, as they say are in some ways similar to physical objects such as metals which resist moderate outside forces but lose their resiliency under great pressure but unlike metals, human beings can think and reason and they experience a myriad of social and environmental circumstances that make defining stress more complex in psychology than in physics. Thus in psychological terms, stress is the response of individuals and stressors, the circumstances and events that threaten them and tax their coping abilities (Santrock 2001).
Forshaw stated that stress is typically been used to refer both to the adjustive demands placed on an organism and to such responses to such demands. In order to avoid confusions, he cited that adjustive demands as stressors, to the effects they create within an organization as stress, and to deal with, it is coping strategies (Passer and Smith 2001).
Carson proposed that adjustive demands stress from source that fall into three basic categories. They are as follows:
- Frustrations – it is when a person’s striving are thwarted either by obstacles that progress toward a desired goal, frustrations occur. A wide range of obstacles, both external and internal can lead to frustration. Prejudice and discrimination, unfulfillment in a job and the death of a loved one are common frustrations stemming from the environment, physical handicaps, limited ability to perform certain tasks, loneliness, guilt and inadequate self control are so8urces of frustrations based on persons limitations.
- Conflicts – This occurs when one most decide between two or more incompatible stimuli. These conflicts are often classified into: approach-avoidance approach/conflicts are those involve choosing between two or more desirable goals and though the experience may cause more eustress that distress, the stress is still real and the choices are difficult; double-avoidance conflicts are those in which the choices are between undesirable alternatives. It is neither choice will bring satisfaction sot the task is to decide which cause of action will be less stressful
- Pressures – It is the stressor where the person is pressed to achieve goals or to behave in particular ways.
Stress when applied to nursing, contemporary theories of stress suggest that a situation which is typically experienced as stressful is perceived to involve (1) work demands which are threatening or which are not well matched to the knowledge, skills and ability to cope of the student nurses involved, or (2) work which does not fulfill their needs, especially where those nurses (3) have little control over work and (4) receive little support at work or outside of work.
Work-Related Stress in Nursing
1. Work in which the demands imposed are threatening and not well matched to the knowledge, skills and ability to cope of the student nurses involved.
2. Work which does not meet the needs of student nurses involved.
3. Situations in which student nurses have little control over work.
4. Situations in which student nurses receive little support at or outside on work.
I saw the drops of blood, got out of my room and walked to my mom’s. She was in her comfort room at that moment as I was rummaging through her drawers. ‘What are you looking for?’ She asked me. I replied to her like nothing happened still searching about, ‘I’m looking for a napkin. I have my period.’ Her face lit, hugged me and she actually shrieked with total excitement that her baby got older. She then gave me a napkin for now, “back up” napkins and little bag to put them in. Well, well, well. If only at every stage of our life the transition would run smoothly like that. Before I got my period my mom had conversations about it with me in preparation. When that fateful day arrived, when for the first time I blood stained my underwear, I just got up and looked through drawers. If only now as I am entering adulthood I could just enter my mom’s comfort room and get a napkin (metaphorically speaking of course.) If only transition between life’s stages was that easy. Though we all need to remember that life isn’t served on a silver platter. If everything was easy, where would be the fun in that? If knowledge was just slid into our brains like one would insert a CD in drive E, where would we get the joy of receiving a pat on the back for a job well done? Directing this towards the transition into adulthood, if it were real easy to become one how could you say that you have matured? You need to make mistakes, struggle through hardships and even heartache and that whole rut. Then you have to step up and get over it all and, guess what, mature. We could only say we have matured when we do the “teenage thing”, move forward and accept the next stage of life and all what comes with it. As most people would say, “Age gracefully” and with that said we must follow it with our hearts and minds.