In today’s modern society stress has become a huge issue with regard to both physiological and psychological health (Ricardo Blaug, Amy Kenyon, Rohit Lekhi, 2007). People these days can be stressed by a variety of factors such as money, family life and also in people’s occupations. For many people, stress is so commonplace that it has become a way of life (smith, M., segal, r. and segal, j. 2015). Stress is a normal physiological response to events that make you feel threatened or upset your balance in some way (Pacak, 2004). However stress isn’t always a bad thing (dna, 2013). In small doses, it can help you perform better under pressure and motivate you to achieve and do your very best. But when you’re constantly running in emergency mode, your mind and body pay the price. The stress response is the body’s way of protecting you (George P 1995). When working properly, it helps you stay focused, energetic, and alert. Stress responses of individuals are determined by a variety of different factors, which many of them are inherited according to quantitative genetics of human behaviours (Boyle, R. 2012). Reassurance is a large role that a nurse can play when a patient is stressed because of illness or otherwise, we must take into consideration the physiological, psychological and social aspects of a person’s behaviour and condition when caring for a patient (McNally, M. 2015) and this is what the ‘The Biopsychosocial Model of Health and Illness’ focus on in relation to stress, its implications and management (Engel, G,L. 1977). The biopsychosocial model is an interdisciplinary model that assumes that health and wellness are caused by a complex interaction of physiological, psychological, and social factors. It integrates biological factors, psychological factors and social factors into one model (Engle, 1977). The model includes the general systems theory, social cognitive behavioural theory, the information theory, the game theory and the theory of holistic biology. The application of this biopsychosocial model will help many nursing students and nursing and medical professionals integrate social, physiological and psychological nursing plans together so that they can have a holistic and humanistic approach to their patients.
Stress has a substantial effect on a person’s physiological clock (Walonick, D, S. Ph.D. 1993). Stress occurs when there is an imbalance between the way a person perceives the demand imposed and the ability to cope with the demand (Odgen 2004). Stress can alter a person’s emotional balance, which commonly reflects low energy levels, headaches, nausea, pains, tense muscles, chest pain and tachycardia and often insomnia (Boyle, R. 2012). These physiological processes of stress can determine whether or not the presenting problem, such as hypertension, is a symptom of stress or another health concern, once the patient has been reassured by the healthcare professional, this must be considered vital as part of the nursing assessment (McNally, M. (2015). When a person is stressed for a considerable amount of time their immune system does not work as well as it should, hence they are susceptible to frequent colds and infections than they would have been previously (Bierma, P. 2015). During a stress response the heart shoots into overdrive so it can pump much faster to ensure that the organs around the body can receive adequate amounts of blood and oxygen. Prokaryotic and eukaryotic cells of the heart exhibit specific responses to sudden changes in their environment because of stress. The ability of these cells to accelerate into a new environment is the integral driving force for adaptive modification of cells (Das, D. 1999). Much like stress is meant to be, these changes are short-lived and reversible, and if stress were to be a long term process it could lead to the permanent alteration in the pattern of gene expression of a person. This process has shown that condition of the heart by repeated ischemia and reperfusion of stress, can delay the onset of further injury like ventricular arrhythmias (Das, D. 1999). During the stress response, the person begins to breathe faster to meet oxygen demand and the digestive system and sensory organs slow down and diminish their blood supply to organs that need it more at the time, such as the brain (Boyle, R. 2012). It was found that an individual’s susceptibility to undue stress seems to reflect in early life experiences (Cicchetti, 2005) which, when a child’s brain is still developing, have an effect on the area of the brain that manages the stress response such as the amygdala, hippocampus, and prefrontal cortex (Bremner, J. 2006). This could possibly have a negative effect on the glucocorticoid receptors in the hippocampus which is responsible for long-term or declarative memory when the person is fully developed (Sapolsky, R., 1996). The glucocorticoid receptors prevent the production of CRH in the hypothalamus and thus dampen the stress response (Leutwyler, K. 1998). When a person is under stress for a length of time the glucocorticoids, Cortisol and Catecholamimes encourage glycogenolysis and lipid and amino acid catabolism in liver, which is why people lose weight when under stress (Thompson, V. 2014). Ketones are produced and released into blood circulation which promotes glucose release by liver into bloodstream, increasing the blood glucose level (Prevention, 2011), which must be considered when a patient is admitted into hospital so a false diagnosis is not made. The glucocorticoids provoke an increase in glycogen and protein breakdown in skeletal muscle and amino acid release. Many physiological stressors such as injury to the body and inflammation, illness, pain and hot cold temperatures and even the aging process could have this effect on people (McKay, L. and Cidlowski, J. 2003). Stressors are not necessarily life threating, however mild to chronic social stressors can lead to bursts of increased blood pressure which can cause structural thickening of the blood vessel wall and neuroendocrine changes, leading to further blood pressure increase which in turn could lead to heart disease (Chrousos, 1995). There have been studies carried out to test the effectiveness of interventions to try and dampen physiological symptoms of stress on clinically stressed patients, were examined and it proved to be a positive result that music, as a non-pharmacological intervention on the physiological stress response and the anxiety level, was effective (Han L, 2010). Stress management could be a possible treatment course, if this proved to be unsuccessful; the patient should really consider other treatment options like anxiety control (Mayo Clinic, 2014).
As previously stated, prolonged stress can have a significant impact on a person’s mental health (smith, M., segal, r. and segal, j. 2015). Although research has shown to have a link between psychological problems and stress, the evidence behind this connection has not been clarified, (Walonick, D, S. Ph.D. 1993) although recent research from the University of California, Berkeley, has discovered a new insight into why stress can have such an impact to a person’s psychological wellbeing (maldonado, 2014). There are typical psychological symptoms such as impatience, irritation, anger, aggressiveness, frustration, insecurity, distress, worry, tearful, lack of interest in appearance (Ogden, 2004), that a person goes through when they are affected by stress over a period of time. We as nurses must be vigilant as to these changes among patients so that we can provide biopsychosocial care to address the problem as quickly as possible before it could become a larger issue (McNally, M. 2015). They have found reasons to believe that people with stress disorders such as post-traumatic stress disorder (PTSD) have alterations in their brain activity in comparison to those without (Badaruddin, A. 2014), which is being looked into in a wide range of areas even when it comes to children and adolescents (Cicchetti, 2005). Topics such as violence, abuse, be it physical, sexual, emotional or neglect and also divorce or conflict amongst parents seem to be the most frequent occurrences causing stress ton children (Cicchetti 2005). Psychological effects of abuse include higher levels of general stress than others and also major psychological disorders including personality disturbances, provocative behaviours and the avoidance of intimacy within close relationships (Siegal, S., Ironson, g. and Schneiderman, n. 2008). Furthermore, there is evidence that stressful life events are common ground for the onset of depression (Monroe, S., Slavich, G. and Georiades, K. 2015). It has been found that a diagnosis of a major medical illness, such as diabetes for example, is often considered a severe life stressor and often is accompanied by high rates of depression (Blaug, B., Kenyon, A., Lekhi, R. 2007). The link between stress and depression is complex and confusing. People who are stressed often neglect healthy lifestyle practices like eating well, exercising, regular sleeping patterns and smoke or drink more than normal (Bruno, K. 2011). “Stress, or being stressed out, leads to behaviours and patterns that in turn can lead to a chronic stress burden and increase the risk of major depression,” (McEwen and Lasley, 2002). Cognitive behavioural therapy (CBT) is a non-pharmacologic means of therapy often employed to relieve depression. CBT is generally the go to treatment if first line treatments with antidepressant medications don’t work however it’s sometimes used as part of primary treatment along with antidepressants for stress induced depression (Duckworth, K. and Freedman, J. 2012). CBT helps people reframe events in a more positive fashion (Bruno, K. 2011). Negative attitudes and the tendency to worry and stress over situations can amplify depressions effect on people’s mental well-being, ‘It’s important that people suffering from depression not blame themselves–it’s partly your genetic makeup, partly your current environment, and partly your early environment that led to the depression, if you’re depressed, seek help. You can’t beat it on your own” (smith, segal and segal, 2015).
From examining the biopsychosocial model I have found that it was perfectly suited to the topic of stress as it comprises of physiological, psychological and social aspects when treating or dealing with patients. These three factors could not be considered on their own as part of an evaluation as it would be unrealistic and the idea of holistic care would be pointless. In conclusion, it is of my belief that stress has both advantages and disadvantages. If stress is handled effectively, it could prove to be very beneficial to people under the right circumstances, but if people do not handle stress well, it may lead to other physiological and psychological problems adding even more stress to a person. Stress is a common everyday problem that no one has an escape from; the only way to deal with it is to find a way to manage it.
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