34.5: Summary

34.1 Stress and Adaptation

Stress involves a perceived threat and responses associated with the release of chemicals that stimulate the SNS. Resulting effects are those commonly recognized as the fight-or-flight response, which readies the body for action against challenges and dangers. In many circumstances, stress is necessary and life sustaining, or even lifesaving. Stress is integral in some aspects of growth and development, especially through adaptation. Adaptive, or coping, responses support the body’s resistance to stress and ideally its resolution and return to a condition of homeostasis.

Resistance to stress involves adaptive responses, which when effective assist the body in its return to equilibrium, when the SNS effects diminish and homeostasis is restored. Unfortunately, coping does not always involve positive techniques, and maladaptive results may also occur, preventing or slowing the return to homeostasis. Sustained arousal responses, as seen by continued SNS stimulation, lead to chronic stress-induced illnesses and contribute to functional deterioration over time.

Stress and adaptation influence human development, health, and wellness throughout the life span. Responses to stress may be conscious or subconscious, as some reactions are strictly activated by neurobiological actions, and others may be controlled by the affected individual. Individuals who demonstrate higher levels of resilience and optimism typically experience fewer negative impacts from stress, with positive coping returning them to a level of homeostasis more promptly. Negative adaptive responses are more likely for those who lack resilience or have experienced adverse or traumatic events, as they have been hindered in developing effective coping skills and resilience.

Physiological and psychological aspects of homeostasis are maintained by various means. The stress response results in generalized, systemic effects, as well as localized effects, depending on the specific type of stressor. Classic examples of the LAS include reflex and inflammatory responses, while the GAS is exemplified by the fight-or-flight response associated with SNS stimulation affecting the entire body. Psychosocial homeostasis is affected by the close interaction of mind and body and by the development of effective coping mechanisms and adaptive abilities.

34.2 Effects of Stress on Health and Wellness

The effects of stress on health and wellness have been the topic of the previous sections. Using Maslow’s hierarchy of needs as a guide, physiological, safety and security, love and belonging, self-esteem, and self-actualization needs have been described. The impact of stress on achievement and satisfaction of these basic and advanced needs has been analyzed and exemplified.

Because there are negative consequences of long-term stress, effects on the body in general, and the immune system specifically, have been explored. Unfortunately, many of the stress-related disorders are all too common, with nursing students beginning to become familiar with them during clinical experiences. Throughout professional practice, nurses are apt to encounter some of these diagnoses repeatedly. Additionally, poor health habits have been characterized, and some of the negative impacts such decisions and behaviors have on families have been shown.

When adaptive responses are ineffective, results can be critical. When such maladaptive coping is unable to keep up with the stress responses, crises are possible. In crisis situations, the patient loses psychological homeostasis and the ability to cope and adapt. Major, typically adventitious, events may manifest initially at the crisis level; maturational and situational events tend to begin at lower stress levels. If coping is insufficient, day-to-day stresses or unexpected incidents can cause an individual to spiral out of control and into a stage where they are not able to regulate the disequilibrium and restore homeostasis.

34.3 Factors Affecting Stress and Adaptation

Stress can be found in most any area of human life. Assuming normal growth and development, there are actual and potential stressors from prenatal development through old age and ultimately death. During any of these life span phases, developmental and situational stressors impact neurocognitive changes as neural pathways and responses are created and promoted.

Whether adaptations have positive or negative results depends on a variety of individual factors. How stress is received and perceived affects a person’s ability to adapt. Additionally, state of health (essentially a continuum from wellness to illness, and ultimately critical illness and death) influences psychophysiological stress reactions. Outcomes tend to be better, demonstrating effective coping strategies and adaptive responses, when an individual is supported through stressful circumstances. A nurturing environment, support from family, friends, and the larger communities of employment, leisure, spiritual support, and perhaps formal mental health providers, tend to foster eustress and resilience.

Considerations within the topic of socioeconomic status may come to mind as simply financial, but there is more to it than money. While economic status is important, other issues, like healthcare access and availability of neighborhood and community systems, are also important under the socioeconomic umbrella. Again, these influences and systems reflect layers of support and the potential for stress. Such factors contribute, once again, to positive or negative stress responses and resultant impacts on health and wellness.

34.4 Adaptation Theories and Models

This final section of the chapter offers a high-level view of stress and adaptation through an exploration of theories and models. The stress-response theory and GAS are similar, with focus on the physiological response to a stressor or threat and resultant changes affecting psychobiological function. More recently, the concept of allostasis has been introduced, along with theories surrounding allostasis and allostatic load. This offers further information about physiological limits to chronic stress and how homeostasis is restored and maintained.

Two models of stress and adaptation, the RAM and the PSM, have been introduced. Roy’s model is a detailed framework for nursing education and practice, applicable as a guide for curriculum and potentially as a textbook. Its comprehensive nature addresses stress and its physiological reactions and different applications for the holistic aspects of nursing. There is some correlation with Selye’s stress and adaptation concepts but with expansion specific to nurses and patient care.

As the model’s name indicates, the PSM’s focus is on the connections between the psychological and physiological implications of stress and adaptation. There is an undeniable relationship between responses that are initiated by one system and have impacts on the other. As the PSM suggests, for example, anxiety can play a role as a stressor and lead to physiological responses, or it can be the result of a physiological threat, essentially a side effect of the stimulated SNS. Adaptations result, effectively or not, from either system as the original stimulus, and considering both aspects is important.

Coping strategies or adaptation techniques are the resistance mechanisms for restoring and fostering homeostasis. The process, from identification of risk factors, the stressor, and its impacts on the individual, through establishing priorities, producing solutions, implementing actions, and finally evaluation, has been studied.