Learning Objectives
By the end of this section, you will be able to:
- Define stress and stressors
- Identify physical, physiological, and psychological stressors
- Differentiate between internal and external stressors
- Distinguish between acute and chronic stressors
Stress is a normal part of life. Nurses need to understand the types of stressors, how people define stress, and how to distinguish between internal, external, acute, and chronic stressors for their patients. They must apply concepts of stress management to help patients and their families, as well as to help themselves.
Dimension of Stress and Stressors
Recall that different people may experience the same stressor in different ways and that an individual’s experience of a stressor is influenced by a variety of physical, psychological, and emotional factors. Furthermore, people experience stress along a continuum, ranging from mildly stressful events to severely alarming or even life-threatening ones. A familiar mild stressor is an alarm clock in the morning: the sound disrupts our sleep, waking us up and forcing us out of bed. At the other extreme of the stress continuum, consider a car accident that leaves the driver pinned beneath a vehicle and a loved one looking on. The stress resulting from such an event can cause surprising physical changes. For example, the onlooker may experience a temporary surge of strength that allows them to lift the car off their loved one.
The stress continuum encompasses responses to many types of stressors, which may be categorized in different ways: internal or external, physical or psychosocial, acute or chronic (National Institute of Mental Health, 2023). An acute stress is short term, compared with chronic stress, which lasts longer than several months. Internal stress may be caused by a physical disorder within the body in contrast to an external stress outside the body. A physical stress can affect the body both internally and externally. A psychosocial stress is generally a disruption in the person’s mental health and well-being.
Internal and External Stressors
Recall that a stressor is an event or stimulus that activates an individual’s stress response. A stressor may come from within or outside of the body. Internal stressors generally come from a person’s mental interpretation of an event or stimulus, and they can vary largely among people depending on their age, sex, experience, values, cultural and religious beliefs, and even resources available to deal with the stressor. Consider how two nursing students might respond to an upcoming exam. One student might feel a lot of anxiety and have difficulty studying, whereas another student might approach the exam confidently as one step closer to graduating as a nurse. The stressor is the same, but the individual’s interpretation of it can create a negative experience for one student compared with an energizing experience for the other student.
External stressors are events and circumstances that come from outside sources rather than mental or emotional processes. A common example of an external stressor that nurses see in their patients is the physical stress of an infection or injury. Another example is a full bladder that the patient cannot empty on their own. Regardless of the stressor, nurses focus on eliminating and treating it through medication administration and nursing interventions. In the case of an illness, this might involve antibiotics or surgery; in the case of a full bladder, the nurse might place a urinary catheter in the patient.
Physical and Psychosocial Stressors
Physical stress involves measurable disruption to the body, and it is often the focus of many patients whom nurses see in medical clinics or hospitals. Physical stress may be due to factors such as infections, trauma, and external exposure to pathogens. A large percentage of the work nurses do is to care for the physical needs of patients as medical providers prescribe the plan of medical treatment for physical stressors.
It is important for the nurse to recognize physical manifestations of stress, which include activation of the sympathetic nervous system, which controls many automatic body functions, such as heart rate, blood pressure, and perspiration.
Physical stress includes any external or internal condition that disrupts normal cellular function, such as temperature change, poor nutrition, hemorrhage, or dehydration (Freedland et al., 2023). The disruption produces physical manifestations as the body attempts to restore homeostasis. An interesting example is a condition seen in patients with spinal cord injury patients: autonomic dysreflexia, in which the body tries to rid itself of a stressor that the brain cannot recognize (McCarty, 2016).
Link to Learning
Watch this video to learn more about causes and effects of autonomic dysreflexia as well as assessments and interventions.
The mental and emotional response to stress is referred to as psychosocial stress. For example, consider how two people may respond to the loss of a job. For some people, a layoff or getting fired is viewed as a personal failure. They may lose confidence in themselves and even develop symptoms of depression. Over time, these deep emotions can lead to physical distress. But for someone else, losing a job can be a “blessing in disguise” that gives them the opportunity to follow a different path, perhaps pursuing a dream career or going back to school. In both situations, the external stressor is the same—it’s the personal interpretation and experience of psychosocial stress that make the difference.
Factors that influence psychosocial stress include age, gender, culture, religion, family support, and access to economic resources. For example, an event that causes an adult great stress, such as a family reunion, may not bother a child, who does not realize the event’s significance. Stress that is devastating to someone with a certain cultural background may not affect someone with a different background. The sound of a shotgun may be distressful to a member of the military who has experienced warfare, because the sound may trigger symptoms of post-traumatic stress disorder (PTSD); however, members of the general public may mistake a gunshot for an unthreatening popping sound, like the backfire of a car exhaust, and scarcely notice.
Life-Stage Context
Effects of Age on Stress
An individual's response to a stressful event includes the important variables of gender, culture, and age. Children, for example, are at increased risk for stress because their coping skills may be underdeveloped. They may not have the vocabulary or understanding of their own feelings to be able to express and explain their stressors. Children may also not be able to regulate their emotions and may react impulsively because they have not developed coping skills. However, children are generally resilient and adaptable, especially with support from caregivers.
Older adults are at increased risk for stress due to cognitive changes that may lead to slower processing or memory issues. Although stress may make these cognitive challenges worse, their life experiences may help them deal with stressful situations. Health problems may increase an older adult's stress but may also affect their ability to remain independent, which can further increase stress and thereby exacerbate health problems. Declining mobility and physical health can make adapting to stress more difficult.
Although stress can affect children and older adults in different ways, the nurse can encourage patients of all ages to establish or rely on an existing support system to help improve their abilities to cope.
Acute and Chronic Stressors
In medicine, the terms acute and chronic are used to describe the time frame of symptoms or conditions. Stressors that generally appear suddenly and may cause severe distress, but whose symptoms may last only several minutes, hours, or days are acute stressors. For example, someone working outside in the heat may begin to become dehydrated, but they can relieve this stress by cooling off and drinking water. On the other hand, chronic stressors are long-term experiences; they produce symptoms that may last weeks, months, or even years. For example, a stroke may leave a person with hemiparesis (one-sided paralysis) that lingers for years.
Sometimes acute and chronic stressors can occur at the same time. For instance, someone who is struggling with a chronic condition of cancer may have an acute stress after breaking an arm or developing a viral sinus infection. A careful nursing assessment includes the ability to assess and treat both kinds of stress. If an acute stress is not treated effectively and in a timely manner, it may progress to become a chronic condition (e.g., an untreated foot infection may progress to gangrene).