Download Chapter 004 Stuart Stress Model

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Chapter 4
The Stuart Stress
Adaptation Model of
Psychiatric Nursing Care
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 1
The Stuart Stress Adaptation Model
• Views nature as ordered on a social hierarchy
• Assumes a holistic biopsychosocial approach to
psychiatric nursing practice
• Regards adaptation/maladaptation as distinct from
health/illness
• Incorporates elements of primary, secondary, and
tertiary levels of prevention
• Identifies four stages of psychiatric treatment and
related nursing activities
• Can be used across psychiatric settings throughout the
continuum of care
• Is based on standards of psychiatric nursing care and
professional performance
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Slide 2
The Criteria of Mental Health
• Possesses a positive attitude toward self, including
acceptance of self and self-awareness
• Seeks growth, development, and self-actualization
• Integrates or balances inner and outer conflicts and
regulates moods
• Strives for autonomy or self-determination, a balance
between dependence and independence, and
acceptance of the consequences of one’s actions
• Tests assumptions about the world by empirical
thought
• Demonstrates environmental mastery and feels
success in an approved role in society
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Slide 3
Figure 4-2 Patterns of behavior.
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Slide 4
Figure 4-4 Biopsychosocial components of the Stuart Stress Adaptation Model of psychiatric nursing care.
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Slide 5
Figure 4-5 Comparison of nursing and medical models of care.
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Slide 6
DSM-IV-TR
• Axes I and II constitute the entire classification of
mental disorders plus conditions that are not
attributable to a mental disorder that are a focus of
attention or treatment.
• Axis III allows the clinician to identify any physical
disorder potentially relevant to the understanding or
treatment of the individual.
• Axis IV is for reporting psychosocial and environmental
problems that may affect the diagnosis, treatment, and
prognosis of mental disorders.
• Axis V is for reporting the clinician’s judgment of the
individual’s overall level of functioning. This information
is useful in planning treatment, measuring its impact,
and predicting outcomes.
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Slide 7
Treatment Stages and Activities
CRISIS STAGE
• Nursing goal: Stabilization of the patient
• Nursing assessment: Focuses on the risk factors that
threaten the patient’s health and well-being
• Nursing intervention: Directed toward managing the
environment to provide safety
• Nursing expected outcome of care: No harm to the
patient or others
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Slide 8
Treatment Stages and Activities (cont.)
ACUTE STAGE
• Nursing goal: Remission of the patient’s illness
• Nursing assessment: Focuses on the patient’s
symptoms and maladaptive coping responses
• Nursing intervention: Directed toward treatment
planning with the patient and the modeling and
teaching of adaptive responses
• Nursing expected outcome of care: Symptom relief
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Slide 9
Treatment Stages and Activities (cont.)
MAINTENANCE STAGE
• Nursing goal: Complete recovery of the patient
• Nursing assessment: Focuses on the patient’s
functional status
• Nursing intervention: Directed toward reinforcement
of the patient’s adaptive coping responses and patient
advocacy
• Nursing expected outcome of care: Improved patient
functioning
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Slide 10
Treatment Stages and Activities (cont.)
HEALTH PROMOTION STAGE
• Nursing goal: Achievement of the patient’s optimal
level of wellness
• Nursing assessment: Focuses on the patient’s quality
of life and well-being
• Nursing intervention: Directed toward inspiring and
validating the patient
• Nursing expected outcome of care: Optimal quality
of life for the patient
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Slide 11
Summary of the Stuart
Stress Adaptation Model
• Predisposing factors—Risk factors that influence
both the type and amount of resources the person can
elicit to cope with stress (such as genetic background,
intelligence, self-concept, age, ethnicity, education,
gender, belief systems)
• Precipitating stressors—Stimuli that the person
perceives as challenging, threatening, or demanding
and that require excess energy for coping (such as life
events, injury, hassles, and strains)
• Appraisal of stressor—An evaluation of the
significance of a stressor for a person’s well-being,
considering the stressor’s meaning, intensity, and
importance (such as hardiness, perceived seriousness,
anxiety, and attribution)
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Slide 12
Summary of the Stuart
Stress Adaptation Model (cont.)
• Coping resources—An evaluation of a person’s
coping options and strategies (such as finances, social
support, and ego integrity)
• Coping mechanisms—Any effort directed at stress
management (such as problem solving, compliance,
and defense mechanisms)
• Continuum of coping responses—A range of
adaptive or maladaptive human responses (such as
social changes, physical symptoms, and emotional
well-being)
• Treatment stage activities—The range of nursing
functions related to the treatment goal, nursing
assessment, nursing intervention, and expected
outcome (such as environment management, patient
teaching, role modeling, and advocacy)
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Slide 13