198 unit 3 | Professional Issues
Consider the Statistics
Fifty years ago, the term personal anxietywas never
used to describe stress. In the decades since, stress
has become the most common psychological com-
plaint and a widespread health problem. In the last
decade alone, approximately 28,000 studies have
been published on the subject of stress and over
1000 studies on the subject of burnout (Pines,
2004, p. 66).
In the workplace, stress is usually defined from a
“demand-perception-response” perspective—that
stress is related to the perception of the demands
being made on the individual as well as that individ-
ual’s perception of the ability to meet those demands.
When there is a mismatch between the two, the
stress response is triggered. The stress threshold, or
hardiness, depends on the individual’s characteristics,
experiences, coping mechanisms, and the circum-
stances of the event (McVicar, 2003).
The phrase “this is so stressful” is frequently
used to describe negative work and personal situa-
tions. However, in reality, some stress responses are
positive (eustress). The stress response is not a sin-
gle event but a continuum, ranging from feeling of
eustress to mild/moderate distress to severe dis-
tress. It is the severe and prolonged distress that
causes people to “burn out” emotionally and expe-
rience serious physiological and psychological dis-
turbances. Table 13-1 describes the continuum of
the stress response.
Stress
Effects of Stress
Hans Selye first explored the concept of stress in
the 1930s. Selye (1956) defined stressas the non-
specific response of the body to any demands made
on it. His description of the general adaptation
syndrome (GAS) has had an enormous influence
on our present-day notions about stress and its
effect on people. The GAS consists of three stages:
1.Alarm.The body awakens to the stressor, and
there is a slight change below the normal level
of resistance.
2.Resistance.The body adjusts to the stressor
and tries to restore balance.
- Exhaustion.As the stressor continues, the
body energy falls below the normal level of
resistance, and illness may occur.
Most people think of stress as work pressure, rush-
hour traffic, or sick children. These are triggers to
the stress response, the actual body reaction to the
daily factors mentioned. As identified by Selye,stress
is the fight-or-flight response in the body, caused by
adrenaline and other stress hormones, causing phys-
iological changes such as increased heart rate and
blood pressure, faster breathing, dilated pupils,
increased blood sugar, and dry mouth.
Currently, stress is assessed on four levels: envi-
ronmental, social, physiological, and psychological.
Environmental stressorsinclude weather, pollens,
noise, traffic, and pollution.Social stressorsinclude
deadlines, finances, work responsibilities and
interactions, and multiple demands on time and
attention. Physiological stressors include illness,
aging, injuries, lack of exercise, poor nutrition, and
inadequate sleep. Psychological stressors are
thoughts: how the brain interprets changes in the
environment and the body and determines when
the body turns on the fight-or-flight response
(Davis, Eshelman, & McCay, 2000).
Epidemiological research has shown that long-
term stress contributes to cardiovascular disease,
hypertension, ulcers, substance abuse, immune system
disorders, emotional disturbances, and job-related
injuries (Crawford, 1993; Lusk, 1993).Responses to Stress
“Whether the stress you experience is the result of
major life changes or the cumulative effect of minor
everyday hassles, it is how you respond to these expe-
riences that determines the impact stress will have
on your life” (Davis, Eshelman, & McCay, 2000).
Some people manage potentially stressful events
more effectively than others (Crawford, 1993;
Teague, 1992). Perceptions of events and the sub-
sequent stress responses vary considerably from
one person to another. A patient crisis that one
nurse considers stressful, for example, may not
seem stressful to a coworker. The following is an
example:
A new graduate was employed on a busy teleme-
try floor. Often, when patients were admitted,
they were in acute distress, with shortness of
breath, diaphoresis, and chest pain. Family mem-
bers were distraught and anxious. Each time the
new graduate had to admit a patient, she experi-
enced a “sick-to-the-stomach” feeling, tightness in
the chest and throat, and diff iculty concentrating.