Stress is the body’s response to dangerous circumstances, whether they are actual or only perceived. When a person feels threatened, the body experiences a hormonal change that enables it to respond and prevent harm. This stress response, otherwise called the “fight-or-flight” response, happens when the body prepares to defend itself and reacts by increasing the heart rate, breathing rate, muscle tension, and blood pressure.
While some stress can be healthy and valuable, excessive stress can lead to physical and mental health challenges. Human bodies are built to handle stress in moderation. However, persistent, long-term stress will eventually cause adverse effects if not properly managed. Stress overload occurs when stress becomes chronic, leading to negative physical, emotional, and psychological consequences.
In this article:
- Nursing Process
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Nursing Process
Reduced stress levels and improved coping are the goals of stress management. Nurses, in addition to their patients, may employ stress reduction techniques to improve their overall well-being. It is imperative to work to reduce stress because doing so can help avoid sickness, enhance the quality of life, and improve overall health.
Stress-related symptoms can result in long term health issues if not addressed. Cardiovascular disease, chronic pain, anxiety, and depression are closely related to stress.
The management of stress relies heavily on patient education. Stress cannot be avoided entirely, but it can be controlled. The patient must be encouraged to actively participate in developing the treatment plan, selecting the appropriate therapies, and engaging in activities to reduce their stress. However, it may also be appropriate to refer the patient to a mental health specialist, therapist, or counselor to help the patient cope more effectively.
Causes (Related to)
The following are causative factors of stress overload:
- Being abused, injured, or subjected to violence
- Conflicts in families, relationships, or immense grief or loss
- Ongoing work-related stress, disputes with co-workers, or job discontentment
- Intensive schedules, insufficient downtime, and constant decision-making
- Financial strain, poverty, food insecurity or housing insecurity
- Health issues, chronic illness, acute illness, surgery or ongoing pain
Signs and Symptoms (As evidenced by)
The following are common signs and symptoms of stress overload. They are categorized based on patient reports and observations by the nurse.
Signs: (Nurse Observes)
- Impaired decision-making
- Impaired functioning
- Increasing strain
- Impatience
- Aggression
- Adverse effects of stress (such as sickness, physical complaints, and psychological suffering)
- Avoidance of others
Symptoms: (Patient reports)
Emotional symptoms include:
- Mood changes
- Feelings of overwhelm
- Difficulty relaxing and calming the mind
- Poor self-esteem
Physical symptoms include:
- Fatigue
- Headaches
- Gastrointestinal (GI) upset, nausea, diarrhea, or constipation
- Muscle pain
- Tension
- Chest pain and tachycardia
- Insomnia
- Compromised immune system and increased infections
- Loss of sexual desire
- Nervousness and shaking, ringing in the ears (tinnitus), and cold or sweaty hands and feet
- Xerostomia (dry mouth)
- Clenched jaw and bruxism (teeth grinding)
Cognitive symptoms include:
- Anxiety
- Flustered thinking
- Forgetfulness
- Disorganisation
- Difficulty concentrating
- Faulty judgment
- Pessimistic or negative-thinking
Behavioral symptoms include:
- Changes in appetite
- Avoiding obligations and procrastination
- Increased consumption of alcohol, drugs, or tobacco
- Anxious habits, including fidgeting, nail-biting, and pacing
With stress overload, the medical team should also rule out any illnesses that could be causing the symptoms which may include a personal and family health history, blood and urine tests, and other evaluations. There are also validated stress scales that the nurse can use to assess the stress such as the Perceived Stress Scale (PSS-10).
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for stress overload:
- Patient will demonstrate strategies to reduce stress.
- Patient will be able to meet psychological needs to reduce stress as demonstrated by adequate emotional expression and resource utilization.
- Patient will be able to verbalize or manifest a diminished stress response.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to stress overload.
1. Identify the causative factors.
Stress overload can result from demands that are too severe, prolonged, or handled without support or respite. The nurse may also assess for life changes or transitions, which can also add to the stress load.
2. Determine repetitive events.
Inquire about stressful events in the present or past (violence, poverty, grief, etc.) to help determine the quantity, length, severity, and perception of overwhelmingly stressful occurrences.
3. Assess the physical, mental, and emotional effects.
Analyze the patient’s reports of any physical, mental, or emotional issues that may be the body’s response to stress.
4. Consider the patient’s gender, age, and developmental stage.
There may be unique stressors that are linked to the patient’s life stage and experience. Understanding the patient’s unique characteristics may help the nurse identify stressors and create a tailored plan to reduce stress.
5. Recognize the patient’s cultural norms, religious beliefs, and expectations.
These may impact the patient’s ability to seek assistance from others and their expectations for themselves in handling situations.
6. Determine the patient’s locus of control.
Recognizing the patient’s locus of control and whether they believe they are responsible or not for their health and what happens to them will aid in developing a realistic care plan.
7. Identify the patient’s self-talk and feelings of stress.
Stress overload can be worsened by negative self-talk, all-or-nothing or pessimistic thinking, exaggeration, or unrealistically high expectations.
8. Assess the patient’s relationships.
Divorce, the death of a family member, and family conflict can disrupt the type of support that a patient is used to receiving and make it more difficult for them to manage their stress.
9. Assess the patient’s stress level.
Use tools or questionnaires to evaluate stress levels. The patient can also be asked on a 1-10 scale how stressed they feel.
10. Review the patient’s medication.
Some medications can exacerbate stress and anxiety through side effects. These medications include stimulants, decongestants, steroids, thyroid medications, and weight loss medications.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with stress overload.
1. Actively listen to the patient.
Actively listen to worries and be empathetic, employing both words and silence as necessary. Listening can be a simple intervention that allows the patient time to express themselves and unload their stress.
2. Assist the patient in adapting to change.
Assist the patient in deciding whether they can alter the stressor or their response. Enable the patient to identify factors over which they have control (internal locus of control) and decide on actions that can be changed.
3. Manage immediate threats.
If stress is related to abuse or violence, this requires intervention through appropriate channels such as law enforcement involvement.
4. Ask for help.
We can’t be expected to do everything ourselves. The need to “feel in control” only creates an environment for failure. Encourage the patient to rely on family, spouses, friends, and co-workers and delegate tasks to others when they’re feeling overwhelmed.
5. Allow the patient to reflect on their coping mechanisms.
Discuss safe and effective coping mechanisms. Then, let the patient evaluate whether their coping mechanisms are positive or negative (avoidance, substance abuse, smoking).
6. Make time for fun and relaxation:
- Exercise
- Reading
- Journaling
- Time outside
- Games
- Massage
- Crafting
- Music
- Sleep
- Time with friends/family
7. Inform the patient about available resources.
Identify and inform the patient about available community resources. Resources include career counseling, educational opportunities, child and elder care, Women, Infants, or Children (WIC) or food assistance, and in-home or respite care that reduce the burden of caretaking.
8. Educate that stress affects the entire body.
The stress hormone cortisol can have detrimental effects on the body and cause weight gain, high glucose levels, and reduce the immune system’s ability to fight infections.
9. Block out time alone.
“Me time” and time to do things we enjoy is a requirement for happiness. Advise the patient that time each day to focus on themselves is not selfish and will allow them to handle daily stressors better.
10. Promote deep breathing exercises and meditation.
Deep breathing and meditation can reduce tension and stress by getting more oxygen and slowing down the heart rate.
11. Refer to a mental health specialist.
Talk therapy and mental health services can work with patients on overcoming and managing stress.
12. Refer to stress management group therapy.
Integrating mindfulness with group therapy reduces stress and boosts positivity and resilience.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for stress overload.
Care Plan #1
Diagnostic statement:
Stress overload related to coping with terminal illness as evidenced by anger and overwhelm.
Expected outcomes:
- Patient will demonstrate effective stress management behaviors.
- Patient will exhibit appropriate expressions of feelings towards terminal illness.
Assessment:
1. Evaluate stress levels using validated tools such as the PHQ-9 (Patient Health Questionnaire-9) for depression or the Generalized Anxiety Disorder 7-item (GAD-7) for anxiety.
These tools help identify the most distressful areas in the patient’s life. They may also let the nurse know if higher level interventions are needed.
2. Evaluate the patient’s understanding of illness.
The perception of the patient towards illness will help the nurse plan stress stress reduction strategies. It is also important for the nurse to assess if the patient accurately understands their diagnosis and prognosis.
3. Note the cultural values, religious beliefs, and expectations of the family to the patient.
Values and expectations may affect the patient’s expectation for self in dealing with the situation and the ability to ask for help from others.
4. Identify the patient’s internal and external locus of control.
Knowing the patient’s locus of control will help develop a care plan reflecting their ability to cope and manage stress better.
Interventions:
1. Discuss the situation or condition in a simple, concise manner.
Devoting time to listening may help the patient express emotions, grasp the situation, and feel more in control. It is also important to explain medical concepts without jargon to reduce the likelihood of misunderstanding.
2. Teach the patient to engage in proven stress reduction techniques such as guided imagery, meditation, art therapy or spending time in nature.
Stress is inevitable and can happen unpredictably at times. The nurse can teach the patient techniques to deal with stress both in the moment as well as strategies to reduce chronic stress.
3. Help the client to focus on strengths, set limits on acting out behaviors, and learn ways to express emotions acceptably.
This promotes internal locus of control, enabling the client to maintain self-concept and feel more positive about self.
4. Provide information as needed to reduce stress responses to acute and chronic illnesses.
Adequate knowledge about the illness allows the patient to make informed choices, feel in control over the situation, and decrease stress and anxiety.
5. Collaborate in treating underlying conditions as well as symptom control (e.g., traumatic injury, chronic or terminal illness, hormone imbalance, depression, and other psychiatric disorders).
Treating the underlying condition in addition to symptoms that cause stress may create a more positive outlook and increase the patient’s quality of life.
Care Plan #2
Diagnostic statement:
Stress overload related to coping with assault as evidenced by changes in appetite and feelings of edginess.
Expected outcomes:
- Patient will report improvement in appetite.
- Patient will meet psychological needs as evidenced by appropriate expression of feelings and use of social resources.
Assessment:
1. Assess emotional responses and coping mechanisms being used.
The nurse can use or modify the previously worked coping mechanisms in addition to the new interventions to be introduced.
2. Complete a patient history of the event if necessary.
Depending on the nature of the visit, it may be important for a nurse to understand the circumstances of the event. However, it is important to only collect this history if necessary for care. Understanding the history of adverse situations the patient faced will aid in determining the most suitable interventions (e.g., psychosocial therapy, individualized health education, community resources referrals) for the patient.
3. Evaluate the client’s report of physical or emotional problems.
This could include fatigue, aches and pains, irritable bowel, skin rashes, frequent colds, sleeplessness, crying spells, anger, feeling overwhelmed or numb, as well as compulsive behaviors. Clinical manifestations can represent the body’s response to stress. It is important to address the underlying emotions and treat the current symptoms.
Interventions:
1. Actively listen to the concerns of the patient and provide empathy, using talk and silence as needed.
A patient who experienced assault may find it hard to trust others. The nurse can use therapeutic communication to slowly build trust.
2. Teach relaxation techniques.
Relaxation techniques help divert negative thoughts.
3. Advise to list one or two changes they would like to make in the next week to engage in self-care (e.g., for diet, the patient may start to eat one vegetable a day; for exercise, the patient may aim to walk one to two blocks a day).
In a patient who is already overwhelmed, small lifestyle changes may have a higher chance for success and will increase self-confidence.
4. Refer for therapy as indicated (e.g., medical treatment, psychological counselling, hypnosis, massage, biofeedback).
Therapy can help the patient improve their self-awareness, develop practical coping skills, and create healthier relationships with others.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- American Heart Association. (2021). 3 tips to manage stress. www.heart.org. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/3-tips-to-manage-stress
- Amirkhan, J. H. (2011). Stress overload: A new approach to the assessment of stress. American Journal of Community Psychology, 49(1-2), 55-71. https://doi.org/10.1007/s10464-011-9438-x
- Bhandari, S. (2021). Stress symptoms: Effects of stress on the body. WebMD. https://www.webmd.com/balance/stress-management/stress-symptoms-effects_of-stress-on-the-body
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, interventions, and rationales (15th ed.). F A Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Lunney, M. (2006). Stress overload: A new diagnosis. International Journal of Nursing Terminologies and Classifications, 17(4), 165-175. https://doi.org/10.1111/j.1744-618x.2006.00035.x
- Mayo Clinic. (2022). Stress management stress basics. https://www.mayoclinic.org/healthy-lifestyle/stress-management/basics/stress-basics/hlv-20049495
- Silvestri, L. A., & Silvestri, A. E. (2022). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier Inc.
