Stress on a patient
... will make the patient more anxious, which in turn will make the patient more stressed. This cyclic relationship will lead to physiological reactions as reported by both authors such as hypertension, increased heart rate and increased metabolism. The immune system becomes suppressed which can lead to more frequent illness. Left unchecked, pathological conditions such as heart disease, stroke and, more commonly, ulcers will occur. At the very least recovery time in hospital will be extended which can in turn become a stress factor itself. Some early research, Csikszentmihalyi (1975:50) observed, “When a person is bombarded with demands which he or she feels unable to meet, a state of anxiety ensues. When the demands for action are fewer … the state of experience is one of worry” What is interesting is that it was also noted that “If, however, skills are greater than opportunities … boredom will follow” and that “A person with great skills and few opportunities will pass from the state of boredom again into that of anxiety”. By using the flow model defined by Csikszentmihalyi (1975) and applying it to today’s patient it can be said that a person, upon entering hospital can experience 5 distinct stages; 1. Anxious Patient is anxious possibly due to nervousness of entering a strange and unfamiliar place. They do not know what is happening. Fear of the unknown makes them frightened, apprehensive and twitchy. They may also be worried about their particular medical complaint. They may also have religious and social beliefs, attitudes and values that may conflict with their hospital stay. 2. Worried The patient settles down into hospital life and becomes familiar with their surroundings and begins to understand what is happening. Their level of anxiety is reduced. They may have compromised their beliefs a little to allow them to be cared for but are still be a little nervous about the situation. So the levels of stress are reduced but not completely eliminated. 3. Comfortable This is where the coping mechanism of the patient is sufficient for them not to be worried or anxious about their current situation. With the complex number of issues that the patient has it would be rare for them to be in this position for any length of time, if at all. 4. Bored If the surroundings become too familiar then the patient starts to dwell again on any perceived threat such as forthcoming operation or procedure. They may even start to reflect and regret upon any compromises that they have made with their beliefs or lifestyles. 5. Anxious This final stage is the patient no longer being able to cope with being hospitalised and, as a result, becomes frustrated, angry and aggravated about things. Issues that would normally be of little or no consequence would become a serious problem and the patient becomes uncooperative and disruptive. They have, by this time, had enough and have an urgent and overwhelming desire to have whatever treatment they are having stopped or they wish to discharge themselves before treatment or care is complete. The transition between these stages is fluid and reversible. The number of issues can be great and each issue may also be at a different stage. Time spent in each stage will depend upon the success of the coping mechanisms employed by the patient and nursing staff. The nurse needs to identify and separate each issue and each stage of each issue so that the right coping mechanisms can be applied. So how can the nurse help? The nurse must be observant and apply a little detective work. There are language barriers to break, cultural and religious difference to understand and possibly physical and mental disabilities to overcome. However, the nurses themselves need to overcome their own limitations, attitudes and stresses towards the patients or their medical condition. A Health and Safety Executive report (2002) showed that within the hospital work place the most common causes of stress for nurses in on a day-to-day basis where factors such as; inability to take regular breaks, clarity of written communications and misunderstanding of job roles as well as not having enough time to complete tasks. The reports goes on to state that the emotional effects of this were reactions such as feeling “worn-out”, tired, mixed up, tearful, nervous and anxious. Nurses frequently stop the patient from telling them their problems by using blocking tactics. Examples such as changing the subject or making excuses to withdraw are classic problem-focused coping mechanisms. By the same token, by applying the adapted flow model to the staff, there will be some nurses that will have the ability to cope and excel under pressure to the point where they become bored. This boredom can also become a blocking mechanism especially if staff no longer have the motivation to address the patient’s concerns. Another difficulty for the nurse is to identify what the stress factors are that are really affecting the patient and also how the patient really feels. This can be overcome by using the elementary skills of effective communication (The Royal Marsden Hospital Manual of Clinical Nursing Procedures, 2000). These are clarification, reflection, silence, probing and summarising. The manual states that open questions can be one of the simplest and yet most effective means of communications. Once the stressors have been identified (and they may be many) the nurse can then try to help the patient by applying various coping methods. Smith et al. (2003) defines coping as the process by which a person attempts to manage stressful demands. They further define two methods of coping as problem-focused coping and emotion-focused coping. The first is where the patient focuses on a specific problem or situation and then tries to avoid or change it. The second is where the patient alleviates the emotions associated with the stressful situation, even if the situation itself cannot be changed. For example, a patient with a fear of injections may be given their medication orally. Where as a patient requiring surgery may not be in a pos...