Abstract
In the essay, there were reviewed questions about how prevalent and widespread stress are in the American population, what consequences and complications stress can cause, and which methods and intervention can be implemented in nursing practice to help patients with high levels of stress to overcome and prevent adverse impacts of stress. As different researches` results showed, there are no clear answers to questions about who is more vulnerable to stress – young or older adults, women or men. Some evidence indicates that representatives of ethnic minorities are more susceptible to stress. Many pieces of evidence point out that prolonged stress can have the long-term adverse effect on individual`s well-being and health. Many nursing interventions are focused on helping patients and their family members to overcome situational stress, negative feelings, etc. However, to prevent stress-related health problems, it is necessary to make long-term lifestyle changes, including establishing the balance between work and rest, increasing the time for physical activity, etc.
Key words: stress, nursing interventions, stress-related diseases
Introduction
Stress, on the one hand, it is a problem that it is impossible to rule completely out the human life. There are eustress and distress. The first type of stress - it is a useful stress, which helps the individual to cope with the difficult situation. Eustress influences to mobilize hidden resources of the human body and helps it achieve its goals.
At the same time, distress adversely affects people's health. However, if an individual is constantly experiencing a state of heightened tension, it affects very negatively his/her psychological and physiological state. Although stress is not an independent disease, it can cause the development of many other diseases. A significant problem is the fact that not all people are aware of and understand to what the consequences continuous stress can lead. Also, studies show that many individuals who understand the possible negative consequences still does not make necessary changes in their lives.
Causes of stress may be different for different age groups. The risk of occurrence stress in older age is associated with that events older people often experience critical changes in their lives during their age period. Also, older adults are more than younger generation disposed to the emergence of many diseases. Stress can aggravate diseases and trigger their occurrence.
The prevalence of stress in our population
A Recent survey showed that general degree of stress among American population decreased from 2007 to 2011. However, most of the American people reported they experience moderate and high stress in their life. 44% of participants of the survey reported they evaluate their degree of stress as increased for five years (from 2007 to 2011). Representatives of the sample also stated that they have unhealthy habits due to their stress (American Psychological Association, 2012).
Researchers suggest that men are more vulnerable to stress and different health problems exacerbated by stress, because, as results of various surveys says, men tend to underestimate the influence of stress on the development of diseases (American Psychological Association, 2012, p. 23). On the other hand, women report the higher degree of stress in their lives. The reason for vulnerability to stress of women can be explained by that women, as a rule, have to link work and home activities.
The older generation reported lower levels of stress than younger generations. It may be due, that the elderly, who are at increased risk of various diseases, tend to maintain a healthier way of life. According to data from 2007 to 2011, the level of stress among the older generation has decreased from 6.5 to 4.9 (American Psychological Association, 2012).
However, the elderly are more vulnerable to stress for several reasons. First of all, older adults experience life changes such as a death of friends and spouses, health problems, financial worries, etc. Besides that, since aging process causes many changes in a body, so the elderly are not so strong to resist stress, as younger people can do it.
Dowd and colleagues conducted longitude study on ethnic/race differences in stress vulnerability. Results of their study showed that blacks have a higher degree of stress than whites, but the same level of perceiving stress as whites. It means that, however, black are more vulnerable to different stressors, they are not aware that their degree of experiencing stress are higher than in whites (Dowd, Palermo, Chyu, Adam& McDade, 2014, p. 54).
Possible complications that can occur if stress is not addressed and treated appropriately
Stress, especially if it is frequent and long-term, have an adverse impact not only on the psychological state but also on physical health. Stress is the main risk factors for the manifestation and exacerbation of many diseases. Among these diseases are diseases of the cardiovascular system (myocardial infarction, angina, and hypertension), of the gastrointestinal tract (gastritis, gastric and duodenal ulcer disease), decreased immunity.
Hormones, which are produced by stress, are necessary for moderate amounts for normal body function. However, same hormones in large amounts cause many undesirable reactions leading to illness and even death. Their adverse effect is compounded by the fact that modern man rarely resorts to muscle energy during stress. Therefore, biologically active agents circulate in the blood for a long time in high concentrations without giving any calm to the nervous system or internal organs.
High concentrations of glucocorticoids in muscles cause disintegration of nucleic acids and proteins that during prolonged stress lead to muscular dystrophy.
These hormones hinder the growth and division of fibroblasts in the skin that leads to thinning of the skin, its harmfulness, poor healing of wounds. In bone tissue, these hormones suppress the absorption of calcium. The result of the prolonged action of these hormones is a decrease of bone mass, an extremely common disease - osteoporosis.
Sheldon Cohen indicated that stress can cause not only psychological, mental problems as depression, anxiety but also become a reason of different physical diseases. Sheldon with his colleagues explains how exactly stress influence on human body. Prolonged stress decreases the ability of human body to regulate inflammation. Regulation of inflammation partly depends on cortisol and stress can destroy this hormone`s functioning. Sheldon conducted several studies. In one of these studies, participants were exposed to the virus after completing intensive stress interview. Results of this study showed that those participants who had prolonged stress were more likely to get cold. As inflammation influence also such diseases as cardiovascular, autoimmune disorders, asthma and others, so we can predict what conditions can arise in our life because of stressful situations (Carnegie Mellon University, 2012).
Some evidence points out that stress has a negative influence on both physical and psychological states of an individual. Distress can lead to adverse psychological outcomes as anxiety, depression, lack of feeling pleasure and well-being in a life of a person. Also, one who experience stress can have problems in relationships with other people.
Stress also can cause heart diseases. However, as results of researches show, heart problems caused by stressed are more typical for men than for women. Stress cardiomyopathy is a condition of caused by stress severe heart dysfunction. This condition can be a similar heart attack in several symptoms.
The link between stress and cancer is unverified. However, studies showed that stress influences a quality of life of patients with cancer. Also, one study indicated that patient, who were separated from their wives/husbands and, consequently, experienced a higher level of stress, had lower survival rates in comparison to those patients who were not separated with their spouses.
Stress can become the reason of eating disorders and weight gaining. Some people start to gain weight because experiencing stressful events they cannot control their desires associated with foods. Other people can become overweight only because of the stress reactions even if they have proper nutrition.
Stress-related food cravings are related to cortisol, the hormone which releasing when a person experience stress. Cortisol influences increasing of abdominal fat. There is the theory that eating “comfort food” help people to reduce an impact of stress on their organism. Tasty foods, for example, can produce serotonin.
Nursing interventions that can be used to address stress, including teaching patient for lifestyle changes
Reducing stress cannot cure diseases, but it can prevent negative consequences of stress, and it is an important part of medical treatment. First of all to manage stress means changing lifestyle. And nurses can direct patients to lifestyle changes and help them to achieve these changes. Besides that, nurses can help patients to reduce “situational” stress which can be connected with the fear of medical procedures, etc.
Different patients experience stress due to various reasons, so before using a certain strategy to reduce stress, nurses need to understand what a source of stress is for a particular individual. Nursing strategies may be designed to reduce patient anxiety. To achieve this goal, the nurse may ask the patient to breathe deeply at the time of the procedure. Also, the nurse can teach the patient different relaxation techniques, which the patient can use in everyday life (Papathanasiou, Konstantinos, Neroliatsiou & Aikaterini, 2015).
Sometimes the causes of stress in the life of a patient associated with a lack of time management skills. It is necessary for such patients to learn how to plan days and weeks, learn how to set priorities as to what should be done, and learn to refuse proposals that are uninteresting to them.
Patient`s stress also can be associated with anger. Angry patients can be a danger to the safety of healthcare professionals and others. To manage anger of a patient nurses must understand and accept one`s reaction. It is also useful to communicate with a patient and try to understand the real reason for his/her anger.
As rest and sleep can be very helpful in stress-management, nurses must provide to a necessary patient level of comfort, pain management, etc. Also, stress –management interventions are impossible without proper nutrition and physical activity. Patient`s diet should include food rich in vitamins and minerals (Papathanasiou, Konstantinos, Neroliatsiou & Aikaterini, 2015).
Physical activity is very useful in stress management because it can have direct influence (distraction from stressful events) and mediated effect (regulating blood pressure heart activity). Nurses can give recommendations about type and duration of exercise to patients to prevent possible harmful consequences of physical exercises. There are many kinds of physical activities including swimming, walking, yoga, etc. which can help decrease patients` stress (University of Maryland Medical System, 2013).
Kim et al. identified that the optimal amount of hours of physical activity per week is 26 hours or more. This amount of hours of physical exercises can prevent the adverse effects of the metabolic syndrome. Besides decreasing of stress, physical activity helps to decrease arterial pressure in patient with hypertension); to reduce weight and to control body fat distribution; to improve myocardial oxygen supply; to increase coronary circulation, etc. (2011).
Cognitive Behavioral Therapy is the method which can be very effective in reducing stress and increasing the experience of well-being. This method help not only to manage situational stress reactions but also to make an individual`s lifestyle healthier.
The first step of increasing stress, according to CBT, is recording of daily activities and finding activities or events that are stressful for a person. Making records in a diary an individual can see what triggers for stress are in his or her life.
The second step is to analyze sources of stress. An individual has to five answers to questions about if stressful activities are linked to personal goals or with desires and goals of other people if individual goals he/she set can reasonably achieve. Also, an individual must indicate those task which is not under one`s control.
The next step is to add new activities which can reduce stress in an individual`s life. Such activity can be linked with personal hobbies, recreation, vacations, etc. Also, it is critical for reducing stress to express and discuss own feelings. A person can discuss one`s emotions with close friends, spouse or other significant people. Also, he/she can express his/her feelings without direct communication through writing letters (without sending them), poems, diaries, etc. Nurses can explain to clients how important expressing of feeling is (University of Maryland Medical System, 2013).
Results of the study of Remmers, Holtgräwe & Pinkert (2010) demonstrated that women at the early phase of breast cancer experience psychological stress more than physical pain. That is why the primary need of female patients with breast cancer is the need for being emotionally supported. Nurses can help to decrease cancer patient`s stress during the early phase by active listening to them, accepting their feelings and informing them about details of treating.
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References
American Psychological Association (2012). Stress in America: our health at risk. Retrieved on February 20, 2016 from https://www.apa.org/news/press/releases/stress/2011/final-2011.pdf
Carnegie Mellon University (2012). How stress influences disease: Study reveals inflammation as the culprit. Science Daily. Retrieved on February 20, 2016 from www.sciencedaily.com/releases/2012/04/120402162546.htm
Dowd, J. B., Palermo, T., Chyu, L., Adam, E., & McDade, T. W. (2014). Race/ethnic and socioeconomic differences in stress and immune function in The National Longitudinal Study of Adolescent Health. Social Science & Medicine, 115, 49-55.
Kim, J., Tanabe, K., Yokoyama, N., Zempo, H., & Kuno, S. 2011. Association between physical activity and metabolic syndrome in middle-aged Japanese: a cross-sectional study. BMC Public Health, 11(1), 624
Papathanasiou, I., Konstantinos, T., Neroliatsiou, A., & Aikaterini, R. (2015). Stress: Concepts, theoretical models and nursing interventions. IN: American Journal of Nursing Science, published online, 4(2-1), 45-50.
Remmers, H., Holtgräwe, M., & Pinkert, C. (2010). Stress and nursing care needs of women with breast cancer during primary treatment: a qualitative study. European Journal of Oncology Nursing, 14(1), 11-16.
