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Copyright © 2005 Mosby, Inc. All rights reserved. Slide 0 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 Copyright © 2005 Mosby, Inc. All rights reserved. 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 Copyright © 2005 Mosby, Inc. All rights reserved. Slide 3 Figure 4-2 Patterns of behavior. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 4 Figure 4-4 Biopsychosocial components of the Stuart Stress Adaptation Model of psychiatric nursing care. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 5 Figure 4-5 Comparison of nursing and medical models of care. Copyright © 2005 Mosby, Inc. All rights reserved. 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. Copyright © 2005 Mosby, Inc. All rights reserved. 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 Copyright © 2005 Mosby, Inc. All rights reserved. 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 Copyright © 2005 Mosby, Inc. All rights reserved. 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 Copyright © 2005 Mosby, Inc. All rights reserved. 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 Copyright © 2005 Mosby, Inc. All rights reserved. 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) Copyright © 2005 Mosby, Inc. All rights reserved. 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) Copyright © 2005 Mosby, Inc. All rights reserved. Slide 13