Chemical Definition of stressor:
A substance that forces change, usually damage, on living organisms or ecosystems, or reduces their ability to cope with environmental changes. This occurs when the substance is released unplanned and unwanted into an environment.
Stress is a dynamic process, a review of the literature revealed a variety of disciplines that utilize the term stress. The majority of the literature was found in the disciplines of psychology and medicine.
Identify Key Characters
1- Coping mechanism.
2- Adaptive response.
3- Problem solving.
4- Physical and mental equilibrium.
5- Self-esteem.
6- Interpersonal relationships.
7- Response to challenge.
8- Self-efficacy.
Identify Antecedents and Consequences
Stress is a multiplicative function of perceived consequences and the degree of disparity between perceived demand and perceived ability to face it.
Antecedents:
The significant antecedent of stress is individual’s perception of a situation.
1- Deficient development of psychological coping mechanism to confront stressful situations.
2- Unable to acquire the maximum effective adaptive response to deal with complex and unexpected circumstances.
3- Inability to improve the capacity to solve difficult situations stablishing strategies.
4- Impediment to keep an adequate mental and physical balance for health adjustment.
5- Decrease of self-perception, self-image, confidence and abilities to react
6- Inconsistent and negative relationships as support system.
7- Incapacity to face challenges properly.
8- Personal incompetence, negativism, demotivation and pessimism to deal with demanding issues.
Consequences:
The significant outcomes or consequences of stress are effective coping, mastery, and positive adaptation.
1- Ineffective coping mechanism.
2- Insufficient adaptive response.
3- Unsuccessful problem solving.
4- Disturbances of physical and mental equilibrium.
5- Self-esteem problems.
6- Inability to stablish interpersonal relationships as support system.
7- Inadequate response to challenge.
8- Incompetent Self-efficacy.
Concept Analysis Model Conclusion
Fall Risk is a recurrent problem in the Home Health setting, physical, psychological, and cost related connotations are the most significant. This problem see under Betty Neuman’s System Model (NSM) can be prevented. NSM uses primary, secondary, as well as tertiary prevention mechanisms for maintenance, attainment, and retention for optimal patient system wellness. The Model incorporated both the individual and the environment in determining client safety. Neuman’s Model is holistic, universal, comprehensive, and flexible system. Its primary objective is concentrate on the client response system, as a core, towards the potential or actual environment stressors. When the client core structure is broken by stressors the normal defense line, which represent client wellness or adaptation state, is invade compromising the client equilibrium.
Study Case:
Mr. S. is a male client, 70 years/old, admitted to the facility 3 days ago from the Hospital. His PMH: HTN, BPH, Glaucoma, and Vascular Dementia. Client is in normal weight range, no history of alcohol, drug abuse or smoking. Client was considered high risk for falling after assessment, and measures were instituted for falling precaution. Mr. S. complains of urinary urgency due to BPH besides his regular treatment, besides of Glaucoma his vision is poor and he is despair, yelling, irritable, and anxious to find the call light when need to call for assistance, as a consequence he was seen going to the bathroom without supervision and assistance.
Based on NSM, stressors found to promote fall:
1- Intra-personal stressors: urinary urgency, anxiety, and poor vision.
2- Inter-personal stressor: Feel irritable and anxious when need to call for assistance and is unable to see the call light. Lack of social, and family usual support.
3- Extra-personal stressor: Change to a new place, and lack of the confidence family support for his necessities.
Mr. S. was invaded in too short time for multiples stressors (describe above) which penetrates his lines of defenses, the system integrity was not maintained, and a variance for wellness occurred with the risk for falling, and injury.
Prevention:
1- Primary: Education provide to a client to call for assistance when feel urinary urgency and bathroom necessities leaving the call light within client reach. Providing staffing rounds and supervision frequently to check client status. Request specialties consultation to reevaluate client symptoms.
2- Secondary: Administering medications ordered for BPH and Glaucoma, to decrease uncomfortable symptoms. Exploring anxiety and irritability triggers and decreasing episode frequencies. Allowing that client to verbalize feelings: fears, anger, and desires to provide adequate symptoms treatment and support. Allowing family to visit resident to provide support. Providing adequate support system when assisting client necessities.
3- Tertiary: Reeducation, maintain the highest client wellness, achieiving goals in order to maintain the client stability and avoid fall.
Reconstitution started after identification of stressors breaking client lines of defense, appropriate Nursing interventions focus on retaining or maintaining system stability with the application of primary, secondary and tertiary interventions in attempt to restore or maintain the stability of the client system.
Through the Nursing Application of NSM is possible to achieve goals:
1- Nursing Diagnosis – Based on this assessment of stressors and physiological and psychological findings, the nursing diagnosis of actual or perceived threat to variance in wellness was disturbance due to decrease in vision, urinary urgency, anxiousness. The nurse and patient reviewed the diagnosis and negotiated goals.
2- Nursing Goals – The expected outcome is that the patient will verbalize acceptance of the idea of his vision loss, and decrease autonomy.
3- Nursing Outcomes – Primary and secondary planned interventions are done with a nurse to explore the patient’s feelings about diagnosis, symptoms and meaning the disease has and modifications of expectations and activities. The nurse evaluated the goals after applying the interventions. The patient developed a therapeutic relationship with nurses. The patient openly shared and displayed feelings with nurses, expressed fears, anxiety. The nurses will work with patient to establish long term goals that relate to the adjustment of having a serious illness with an uncertain impact in his wellness.
NSM is an efficient tool used to evaluate systems interactions, and prevent client injuries. Health staffing can identify fall risk factors, same as, the stressors interactions breaking the defense lines of the body. The Model application can be useful not only in the primary prevention when the fall problem did not take place, and it is possible to reinforce the flexible line of defense, but even in secondary prevention to assist in the system restoration, and in the tertiary to maintain stability in order to avoid more damage in the progression to body equilibrium. I can conclude, with this study case example, that we can successfully apply the NSM in order to provide fall precaution and prevention.
References
Koolhaas JM et al. (2011). Stress revisited: a critical evaluation of the stress concept. Neuroscience & Biobehavioral Reviews, 35 (5): 1291–1301
Lazarus R S and Folkman S (1984) Stress, Appraisal and Coping. New York, Springer
Schneiderman N, Ironson G & Siegel SD (2005). Stress and Health: Psychological, Behavioral, and Biological Determinants. Annual Review of Clinical Psychology, Vol. 1: 607-628
Thoits, P. A. (1994). Stressors and problem-solving: The individual as psychological activist. Journal of Health and Social Behavior, 35(2) 143-160
University of Kansas Medical Center: Concept Analysis Tutorial “Journal of Advanced Nursing”; Rethinking Concept Analysis; M. Risjord; 2009
Ume-Nwagbo, P. N., DeWan, S. A., & Lowry, Lois W. (2006). Using the Neuman Systems Model for Best Practices. Nursing Science Quarterly, 19 (1), 31-35
