The patient, a female aged 27, has normal vital signs and WNL lab values. However, the term “normal” is subjective and can have various interpretations among individuals. In the nursing field, normalcy is often defined in relation to homeostasis.
Homeostasis, originally proposed by 20th century physiologist Claude Bernard, was further expanded upon by physician Walter Canon. Canon used feedback mechanisms to explain the regulation of Bernard’s concept. Both Bernard and Canon recognized that the body’s physiological processes can adapt to changes in the environment. Later, Hans Selye, a Doctor of Medicine and Chemistry who studied in Prague and later at Johns Hopkins, contributed to this understanding.
Researching stress began in 1926 at McGill University in Canada. The concept was inspired by an endocrinological experiment where various organ extracts were injected into mice. This led to the development of general adaptation syndrome (GAS), a theory of stress. Originally, it was thought to be a new hormone discovery, but further experimentation proved this to be incorrect. Each injection of an irritating substance resulted in the same symptoms – swelling of the adrenal cortex, atrophy of the thymus, gastric and duodenal ulcers.
The text describes how Selye’s observation of people with different diseases exhibiting similar symptoms led to his initial description of the effects of “noxious agents.” While caring for sick individuals, Selye noticed recurring clinical manifestations such as loss of appetite, weight loss, feeling and looking ill, and generalized muscle aching and pain. He later introduced the term “stress,” which has become a part of multiple languages. We selected Stress Theory because it applies to various situations. Both us and our patients experience stress in our lives.
By understanding the expected physiological reaction to stress, we are able to focus on providing nursing care to identify when patients are experiencing “noxious stimuli” and prevent the occurrence of complications. Dr. Hans Selye’s work demonstrates that nursing theory can be applied in our daily practice and can endure over time. Description and Analysis of the Theory and Components: Dr. Hans Selye (1930’s-1970’s) defined stress, whether positive or negative stress, as “wear and tear on the body” and developed the General Adaptation Syndrome (GAS) to explain the physiological response to stress.
Stress and stressful events can come from within or outside of a person and can last for either a short period of time or a long period of time. They can originate from small annoyances in daily life or major incidents, with their significance varying for each individual (McEwen & Wills, 2007). Stress has the ability to cause general or specific disorders that affect both the body and mind. It directly or indirectly impacts physical functioning by increasing levels of adrenaline and corticosterone, which leads to an increase in heart rate, respiration, and blood pressure. This puts additional stress on bodily organs.
Experiencing stress for a prolonged period can lead to heart disease, high blood pressure, stroke, and other illnesses. When individuals encounter a stressor, they enter the alarm phase. In this phase, they initially feel shocked and experience ongoing sympathetic arousal due to adrenaline/epinephrine and nor epinephrine. These effects include elevated heart rate and increased blood flow to the heart, brain, and skeletal muscles. Conversely, there is decreased blood flow to organs and an enlargement of the adrenal glands that release hormones. Collectively, these physiological responses are known as counter shock.
During the resistance phase, the individual moves to this stage if there are extra stressors or if the original stressor persists. The main objective of the endocrine system in this phase is to regain balance within the body. In order to achieve this, hormones are released by the adrenal glands that increase blood sugar levels and provide energy for dealing with stressors. This energy is referred to as adaptation energy. If adaptation energy effectively counteracts the effects of stressors, balance is restored. However, if coping mechanisms fail to restore balance, exhaustion occurs.
According to McEwen (2005), when the homeostatic control systems fail, the signs of the alarm stage reappear, resulting in stress-related illness. In order to restore homeostasis, intervention is needed. At this point, medical intervention becomes necessary to diagnose and treat the stressor associated with the illness. It is important to note that adaptation energy is limited, as continuous distress leads to depletion, exhaustion, and potentially death.
The application of theory in nursing involves understanding the impact of stress on individuals and their response to it. Stress theories provide a framework for this understanding, as stress is inevitable in everyone’s life and requires coping and adaptation. If an individual successfully adapts to stress, they reach a state of equilibrium, but if not, they may experience physiologic or psychological disorders. Using Stress Theory, nurses can assess an individual’s stressors, resources, and support for coping with these stressors. They can then provide assistance with problem-solving or cognitive restructuring to improve coping and adaptation.
(McEwen & Wills, 2007)
A patient may have unexplained physical complaints, but a nurse can identify their stressors and coping mechanisms through assessment. The nurse can provide appropriate resources or referrals when needed. Long-term stress can contribute to various health conditions such as cancer, hypertension, heart disease, stroke, peripheral vascular disease, asthma, tuberculosis, emphysema, irritable bowel syndrome, sexual dysfunction, obesity, anorexia, bulimia, connective tissue disease ulcerative colitis Crohn’s disease infections allergic or hypersensitivity diseases.
According to Clancy and McVicar (1993), Seyle’s definition of freedom from stress is death. Numerous other theories and studies have been derived from Seyle’s work, specifically those focusing on psychological changes. Given the broad range of diseases that can be influenced by stress, all categories and spectrums of nursing can connect to this theory. Stress Theory elucidates various physical and psychological ailments across different age groups.
This theory is directly applicable to a situation that occurred in an outpatient therapy setting involving an adult female patient who had high levels of anxiety, Tourette’s syndrome, and Crohn’s disease. Throughout the course of her treatment, which included group therapy, education, meetings with a psychiatrist, and medication, the patient’s anxiety levels decreased and her physical symptoms improved. This highlights the strong connection between the mind and body in relation to stress. An example of how Stress Theory has been utilized in research is the assigned reading (Hays, All, Mannahan, Cuaderes, and Wallace) that examined stressors and coping mechanisms utilized by nurses working in intensive care units.
In the study, it was discovered that the shortage of staff was the most commonly reported high to maximum stressor. This was followed by issues related to patients’ families. The two most frequently reported methods of coping were escape-avoidance and confrontive approaches. The analysis revealed a weak statistical correlation between the identified stressors and coping strategies. Furthermore, there was no statistical significance found when comparing the identified stressors and chosen coping methods among different demographic variables such as gender, length of employment in the ICU, age, marital status, and highest level of education.
Kenney & Bhattacharjee (2000) conducted a study on women’s stressors, personality traits, and health problems, utilizing Seyle’s theory and other theories. The study explored how stress reactions, according to the psychoneuroimmunology (PNI) model, can impact the immune system and potentially weaken resistance against various illnesses. In another study examining stress theories and incorporating Seyle’s work, Olofsson, Bengtsson, and Brink (2003) focused on nurses’ experience of stress in the workplace.
The text explores how the autonomic nervous system, consisting of both sympathetic and parasympathetic systems, reacts to a perceived or actual threat. This involves converting stored energy into usable energy. In essence, there is an identifiable physiological response to stress in the body. Selye classified this response into three stages known as Alarm, Resistance, and Exhaustion within his General Adaptation Syndrome.
The application and testing of this theory in nursing research, including its relation to the psychoneuroimmunology (PNI) model, supports the belief that the body will show symptoms. Based on this application, it is recommended to include GAS in undergraduate nursing education to introduce nursing theory early in a career, as previously discussed in this course. Selye’s work serves as a great example of how theory can easily connect to the fundamentals of our care.
Undergraduate education starts by establishing a solid foundation in physiology. During this stage, it is an ideal moment to introduce theories like Selye’s. In terms of our guidance, it is important to incorporate the General Adaptation Syndrome (GAS). By acknowledging the significant influence of stress on the body, nurses can educate patients about its effects. Concrete information and examples are often the most effective teaching methods. Therefore, using Selye’s theory to enlighten individuals about the repercussions of failing to decrease stressors in their lives is an application of nursing theory.
By utilizing the stages outlined, we can also track our patients (particularly those in outpatient or long-term care) and strive to minimize unnecessary stress caused by healthcare interventions. As aspiring advanced practice nurses, it is our duty to build upon the previous contributions in order to better serve our patients and profession. While Selye’s General Adaptation Syndrome may be rudimentary, it remains highly applicable and a valuable resource for advancing our individualized care and our field.
The questions below are related to the unit content and will be discussed in the Unit Discussion, open for reading and posting from November 3, 2009. Please post your entries to the corresponding questions during that week.
- Identify the three stages of Stress Theory, The General Adaptation Syndrome, and apply the theory to a clinical situation. Explain what is occurring during the three phases as they apply to your situation and state how you can provide nursing intervention.
- After reading the research article regarding stressors and ways of coping utilized by ICU nurses, provide examples of stressors in your area of employment and the coping methods you use to resist those stressors. Have you ever attended an educational or work related program that taught you coping and stress reduction methods?
