Stress among Health Professionals - Coursework Example

Running Head: STRESS Stress [The Writer’s Name] [The Name of the Institution] Stress Stress is an element of everyone's life. It can be triggered by various factors. Recognizing stress and understanding how it can affect one mentally, physically, and behaviourally is very important. Strategies to manage or eliminate stress are readily available. The scope of treatments range from simple to complex. Stress is triggered by anything that causes a change in which you must adapt. Some stress is caused by imagined change. Imagining change is what we call worry. Anxiety can be produced by self-generated factors such as negative personal interpretations--low self esteem. Negative thinking increases stress because the negative thinker tends to interpret events in such a way as to produce anxiety. Positive thinking minimizes or eliminates stress because positive thinkers rarely perceive events as stressful. Some psychologists used the term biologic stress, in referring to what caused this syndrome, but there was too much criticism of the word stress in reference to bodily reactions, because in everyday English it generally implied nervous strain. The Three Stages of Stress There are three stages of stress among which the name alarm reaction for the initial response--that is, in the previously mentioned triad--because this syndrome probably represented the bodily expression of a generalized call to arms of the defensive forces in the organism. But this alarm reaction was evidently not the whole response. Upon continued exposure to any noxious agent capable of eliciting this alarm reaction unless it killed immediately, a stage of adaptation or resistance followed. In other words, no living organism can be maintained continuously in a state of alarm. If the body is confronted with an agent so damaging that continuous exposure to it is incompatible with life, then death ensues during the alarm reaction within the first hours or days. If survival is possible at all, this alarm reaction is essentially followed by the second stage, which is called the stage of resistance. The manifestation of this second stage was quite different from, and in many instances the exact opposite of, those which characterized the alarm reaction. For instance, during the alarm reaction, the cells of the adrenal cortex discharged their miscroscopically visible granules of secretion (which contain the hormone) into the blood stream. Consequently, the stores of the gland were depleted. Conversely, in the stage of resistance, the cortex accumulated an abundant reserve of secretory granules. In the alarm reaction, the blood became concentrated and there was a marked loss of bodyweight; but during the stage of resistance, the blood was diluted and the body-weight returned toward normal. Many similar examples could be cited, but these suffice to illustrate the way one can objectively follow resistance-changes in various organs. Curiously, after still more prolonged exposure to any of the noxious agents, this acquired adaptation was eventually lost. The animal entered into a third phase, the stage of exhaustion, the symptoms of which were, in many respects, strikingly similar to those of the initial alarm reaction. At the end of a life under stress, this was a kind of premature aging due to wear and tear, a sort of second childhood which, in some ways, resembled the first. The overall net effect of an initial stress on resistance to a subsequent stress is based on a number of factors including: the timing and intensity of the stresses; the similarity of the stresses; the adequacy of the mobilized adjustment process to the first stress to deal with the subsequent stress; and the total amount of exertion required relative to the total amount of energy available to the system. Desensitization to a given stress produces resistance, not by enhancement of adjustment processes, but by diminishing the amount of strain and distress produced by a stress through repeated exposure. This increases the amount of stress required to produce strain and disruption of homeostasis. Whereas the resistance capacity of a system or subsystem after exposure to stress with successful adjustment may be increased, there may be decreased resistance in a system or subsystem where there is ongoing adjustment to a chronic stress. These systems or subsystems may be said to be more vulnerable because of the increased risk of exhaustion of adjustment processes. In Selye's classic experiments of General Adaptation Syndrome (G-A-S) involving cold stress in rodents for example, it was demonstrated that animals who had adapted to a cold stress of a given temperature and were then challenged with a more extreme cold stress quickly went into an exhaustion stage which was often fatal. Other rodents exposed initially to the more extreme cold stress were better able to maintain an adjustment to it (Selye, 1950). Stress and anxiety are basically the same concept with a few small differences. The largest difference is that emotions are involved with anxiety, which in turn is a representative of stress. (Catherall, 2003, 76-92) The tone and events brought up in normal conversation or an argument affect the anxiety level of the people involved in the conversation. Emotions also affect the anxiety of a given person. When there are two people in the same situation, there is a good chance they will not react in the same way. (Barlow, 2001, 16-18) This goes for a reaction physically and emotionally. Negative emotions are most commonly viewed as a coping response to stress. Different expressive behaviours go along with the different emotions caused due to stress. These emotions help to communicate with others as well as have survival values. (Zautra, et. al 2002 309–318) Anxiety is not the only physical reaction to stress though, the ulcer, which is deadly, is also associated with stress. In the specific case of the peptic ulcer, it has been associated with the occupation of the victim. The peptic ulcer was considered to be prototypical for some time until a link was actually found. It was found that in high responsibility occupations, such as an air traffic controller, there is a high rate of peptic ulcer. Also, women who had more than a single basic responsibility were found to have fewer ulcers than women who had worked and family responsibilities. (Clore & Ortony 2000, 24-61) Since no one actually knows how ulcers form, or why they even form, this makes it impossible to tell what exactly they come from. It has been found though, victims of ulcers have been proven to have a higher stress level that those who do not have ulcers at all. The ulcer itself usually forms in the lining of the stomach and the small intestine. They are generally small sores that appear for no apparent reason. (Barlow, 2001, 16-18) There is no way around the fact that stress is a part of life and if not managed correctly will cause depression; headaches and migraines; as well as stomach pains, ulcers, and anxiety. Sometimes it is difficult to see the stress approaching, but the effects of too much stress will cause problems. With there being no way around stress, contact with it is made everyday at any given time. Anyone trying to run away from stress will never stop, for it will surround him or her forever and never once go away. Also, a distinction between where it is coming from and how it is affecting the stress a person has obtained must be distinguished before any advancements should be made to ease the stress. If stress is mistaken for simple uneasiness, the victim of stress or uneasiness rather, is confused. Stress comes from the workplace, home, school, and simply the people that are in contact with someone feeling stressed-out. It is true that some people are more prone to stress than others, but simply for the reason that they are not as capable in managing their stress as others. Adults also believe for some reason that they are the only ones who can be under stress, when in fact children and teenagers commonly have at least as much if not more than an adult. This is due to the fact that children and teenagers are still in the developmental stage and undergo more change in their lives. A simple cure for stress for one person also may not help another person under a great deal of the same type of stress. The Nature of Stress during Patient Care There can be few people in the western healthcare set up who have not heard of stress, or who have not occasionally described their day to a colleague or friend as ‘stressful’. Furthermore, stress cannot be dismissed as an irrelevant and minor side-effect of modern life, because, as we will learn in Part Four of this text, it has been linked to the onset of major disease and an overall increase in morbidity and mortality in vulnerable patients. Our first task, however, is to examine the basic nature of stress, so that we have a platform for discussion. Stress is often conceptualised as comprising two basic dimensions: a stressor, such as the onset of illness or the threat posed to self-esteem by redundancy or exam failure, and a stress response, such as the feelings of tension and anxiety that may be experienced and the often invisible strain that is placed on the body’s systems when the stress response is prolonged (Sarrafino 1994, 174-77). In addition, a third dimension emerges from the transactional view, which depicts stress as a process involving an interaction between the challenging event, the subsequent threat perception and the coping responses available to the individual (Lazarus and Folkman 1984, 209-12). Challenging events result in stress only when there is found a discrepancy between the demands of the situation and the resources available to the individual. This is an important point. Significant events, such as hospitalisation, may result in initial anxiety for most patients, but if the patient views the reasons for admission as serious and beyond his or her control, stress is highly likely to result. Causes of Stress among Healthcare Professionals Whilst life event scales are not a wholly reliable indicator of stress at the level of the individual, it is possible to identify a number of general, or non-situation specific, factors that are very likely to evoke stress in most people. Sometimes these factors interact. For example, conflict may arise when a patient has to make a forced choice between premature death and a disfiguring operation that threatens his or her body image. Additionally, the novel nature of the situation may cause the patient to question his or her ability to deal with the possible consequences of either course of action. (Losee, 1998, 3-5) According to Cohen and Wills (1985, 114-19), there are two basic ways in which social support may mediate the effects of stress. First, high levels of social support may prevent stress from occurring (the so-called direct effect model), because individuals with high levels of support are less likely to perceive challenging events as threatening. Second, social support may provide a cushion or buffer that protects the individuals from the most stressful aspects of challenging events (the so-called buffering hypothesis). So a well-supported individual that has been diagnosed as having, say, Parkinson’s disease, is likely to experience less stress than an individual who lacks such support. Emotional and self-esteem support may be offered by the nurse during periods when the patient feels particularly low. Those experiencing depression, for example, often feel a sense of worthlessness that can be counteracted by someone spending time listening and talking to them. Similarly, the nurse can offer tangible support in the form of practical advice and information that may help to relieve stress by providing the patient with a means to deal with it. (Siviter, 2004, p1) Whilst this type of support may normally be offered by friends and relatives, it is the quality of support rather than the size of the individual’s network that is the critical factor in helping vulnerable individuals to meet their own needs. The sense of vocation and commitment to community service has traditionally been associated with work in nursing and medicine. It is this sense which, in the context of burnout speculation, has been suggested as a significant source of the 'depersonalisation' experienced by healthcare staff responding defensively to the emotional exhaustion associated with loss of a sense of professional efficacy (Leiter, 1991, 547-55). For example, in an anonymous postal survey of 94 clinical psychologists in the UK, Caplan (1994: 1261-63) found that they faced considerable obstacles to admitting and responding to occupational stress. These obstacles included: (a) the 'debilitating nature of professional values' associated with the job, involving the threat of lost credibility, lost equality with non-support-receiving colleagues, and lost job security; and (b) the fear of becoming a client; having needs for emotional support is construed as being unfit to work in the profession. If such results associated with the perception of professional role are generalisable, it is easy to see how personal needs in response to stress at work can be denied, minimised or devalued and may thus lead, if unresolved, to serious personal difficulties. Walsh importantly identified the need to distinguish between receiving professional (case management) support, and receiving emotional (therapeutic) support in this population. References Barlow, D. H. (2001). Anxiety and its disorders, 2nd ed.: The nature and treatment of anxiety and panic. New York: Guilford Press. 16-18 Caplan, R.P. (1994). 'Stress, anxiety, and depression in hospital consultants, general practitioners, and senior health service managers'. British Medical Journal, 309, 1261-3 Catherall, D. R. (2003). How fear differs from anxiety. Traumatology, 9(2), 76-92. Clore, G. L., & Ortony, A. (2000). Cognition in emotion: Always, sometimes, or never? In R. D. Lane & L. Nadel (Eds.), Cognitive neuroscience of emotion (pp. 24–61) Oxford University Press. Cohen, F. and Wills, R.S. (1985). Coping and adaptation in health and illness. In Mechanic, D. (Ed). Handbook of Health Care and the Health Professions. New York: Free Press.114-19 Lazarus, R.S. and Folkman, S. (1984). Stress, Appraisal and Coping. New York: Springer. 209-12 Leiter, M.P. (1991). 'The dream denied: professional burnout and the constraints of human service organisations'. Canadian Psychology, 32(4), 547-55 Losee, R. (1998). Caught in the Crossfire: Stress in Healthcare Settings and Ways to Address It. Journal of Behavioural Medicine: 22 (7) 3-5 Sarrafino, E.P. (1994). Health Psychology: Biopsychosocial interactions. New York: John Wiley. 174-77 Siviter, B. (2004). Stressed out: learning to cope with stress is a useful skill for your nursing career and life ahead: Nursing Standard, 19(4), 1 Selye, H. The physiology and pathology of exposure to stress: A treatise based on the concepts of the general-adaptation-syndrome and the diseases of adaptation. Montreal: ACTA, Inc. Medical Publishers, 1950. Zautra, A. J., Berkhof, J., & Nicolson, N. A. (2002). Changes in affect interrelations as a function of stressful events. Cognition and Emotion, 16, 309–318. Read More

The manifestation of this second stage was quite different from, and in many instances the exact opposite of, those which characterized the alarm reaction. For instance, during the alarm reaction, the cells of the adrenal cortex discharged their miscroscopically visible granules of secretion (which contain the hormone) into the blood stream. Consequently, the stores of the gland were depleted. Conversely, in the stage of resistance, the cortex accumulated an abundant reserve of secretory granules.

In the alarm reaction, the blood became concentrated and there was a marked loss of bodyweight; but during the stage of resistance, the blood was diluted and the body-weight returned toward normal. Many similar examples could be cited, but these suffice to illustrate the way one can objectively follow resistance-changes in various organs. Curiously, after still more prolonged exposure to any of the noxious agents, this acquired adaptation was eventually lost. The animal entered into a third phase, the stage of exhaustion, the symptoms of which were, in many respects, strikingly similar to those of the initial alarm reaction.

At the end of a life under stress, this was a kind of premature aging due to wear and tear, a sort of second childhood which, in some ways, resembled the first. The overall net effect of an initial stress on resistance to a subsequent stress is based on a number of factors including: the timing and intensity of the stresses; the similarity of the stresses; the adequacy of the mobilized adjustment process to the first stress to deal with the subsequent stress; and the total amount of exertion required relative to the total amount of energy available to the system.

Desensitization to a given stress produces resistance, not by enhancement of adjustment processes, but by diminishing the amount of strain and distress produced by a stress through repeated exposure. This increases the amount of stress required to produce strain and disruption of homeostasis. Whereas the resistance capacity of a system or subsystem after exposure to stress with successful adjustment may be increased, there may be decreased resistance in a system or subsystem where there is ongoing adjustment to a chronic stress.

These systems or subsystems may be said to be more vulnerable because of the increased risk of exhaustion of adjustment processes. In Selye's classic experiments of General Adaptation Syndrome (G-A-S) involving cold stress in rodents for example, it was demonstrated that animals who had adapted to a cold stress of a given temperature and were then challenged with a more extreme cold stress quickly went into an exhaustion stage which was often fatal. Other rodents exposed initially to the more extreme cold stress were better able to maintain an adjustment to it (Selye, 1950).

Stress and anxiety are basically the same concept with a few small differences. The largest difference is that emotions are involved with anxiety, which in turn is a representative of stress. (Catherall, 2003, 76-92) The tone and events brought up in normal conversation or an argument affect the anxiety level of the people involved in the conversation. Emotions also affect the anxiety of a given person. When there are two people in the same situation, there is a good chance they will not react in the same way.

(Barlow, 2001, 16-18) This goes for a reaction physically and emotionally. Negative emotions are most commonly viewed as a coping response to stress. Different expressive behaviours go along with the different emotions caused due to stress. These emotions help to communicate with others as well as have survival values. (Zautra, et. al 2002 309–318) Anxiety is not the only physical reaction to stress though, the ulcer, which is deadly, is also associated with stress. In the specific case of the peptic ulcer, it has been associated with the occupation of the victim.

The peptic ulcer was considered to be prototypical for some time until a link was actually found.

Read More