Client K.M is an an18-year-old Hispanic teen in the 12th grade with a history of domestic violence exposure. She lives with her family – a bio-mother, stepfather, and four siblings – in a family house in Los Angeles. The presenting concern entails symptoms of heavy breathing and incoherent speech triggered by an exercise in theater class.
Biopsychosocial Assessment
Biological
Client K.M has no history of medical problems and no biological predisposition to chronic illnesses or allergies. She has no sensory/motor impairment but wears glasses. She has no reported medical issues except weight or appetite change. Client K.M has no developmental issues. However, she has a history of social withdrawal in latency and anxiety attacks in adolescence. She reports no unusual reproductive or physical health issues.
Psychological Health/Symptoms
K.M’s psychological health was affected by a traumatic event – sexual abuse by a maternal uncle at the age of six. She also witnessed chronic domestic violence between her parents as a child. Client K.M suffers severe anxiety that is affecting her sleeping and eating patterns. She has maladaptive coping skills (cutting) and persistent avoidance associated with trauma (dissociative amnesia). The client could not remember parts of the events. She is easily distracted, is unable to communicate her feelings, and reports poor social skills and isolation. The trigger factor appears to be the exposure to theater class exercises. Her depressive symptoms are sleep disturbances, distraction, sadness, and altered eating patterns.
Social Components
Client K.M is an 18-year-old Hispanic female with a normal developmental history. The client stays with her mother, a stepfather, and four younger siblings – two brothers and two sisters. The client was temporarily placed in foster care after a case of sexual abuse at age 6. Her bio-father was deported when she was 11. Client K.M isolates from family members and friends. She seems to be attached to the bio – mother, but a lack of communication between them makes the client anxious as well. The client claims to be Christian but does not consider church a support system.
The client’s coping mechanisms seemed sufficient until the recent repetitive symptoms of anxiety, sadness, distraction, and poor social skills, which appear to indicate delayed expression of traumatic stress. Family dynamics and social withdrawal do not seem to have affected the client’s academic history; her grades are good and she has no history of behavioral problems.
Mental Status Exam
Appearance: Age-appropriate, well-groomed
Affect: Constricted
Mood: Depressed/Anxious
Thought Content: Fears for her future
Thought Process: Easily distracted
Speech: Normal
Motor: Limited activity
Intellect: Average
Insight: Cooperative and motivated
Judgment: Limited
Impulse Control: Uncontrollable hand rubbing
Memory: Intact
Concentration: Normal
Attention: Normal
Behavior: Cooperative
Thought Disorder: None identified
DSM-V Diagnosis
This 18-year-old female displays depressive episodes and anxiety as seen in her symptoms of sleep disturbance, sadness, difficulty concentrating, and socialization difficulties. The chosen DSM-V diagnosis, in this case, is F43.10 – posttraumatic stress disorder (PTSD) with delayed expression. The reasons for arriving at this diagnosis relate to histories of trauma exposure and evidence of intrusion symptoms.
Trauma exposures in childhood could explain the client’s symptoms at this stage in her life. As specified in Criteria A1 and A2 of the F43.10 diagnosis, traumatic stress could result from either directly experiencing trauma or witnessing violence as a child. A maternal uncle sexually assaulted client K.M at the age of six. She also witnessed repetitive domestic violence in her childhood.
Criteria B, C, D, and E also match with the symptoms identified through the biopsychosocial assessment. Client K.M presents with intense physiological distress or reactions – heavy breathing and speech difficulty – to a traumatic event, consistent with Criteria B4 and B5. In this case, the trigger factor or external cue symbolic of the trauma is the theater class exercise.
Trauma survivors demonstrate avoidance of reminders of the traumatic event. Based on Criterion C2, such stimuli may include people, locations, or situations that remind the victim of the event. Client K.M’s poor social/family relationships could be seen as an attempt to avoid reminders (kin perpetrators) of her history of sexual abuse. The client also displays trauma-related negative cognitions (Criteria D6 and D7) as demonstrated by two symptoms of detachment from friends and family (except the mother) and feelings of sadness. Her introverted nature and episodes of heavy breathing and incoherence indicate a benign inability to feel positive emotions due to her traumatic experiences.
Client K.M shows significant alterations in arousal specified in criterion E. Her sleeping patterns are not consistent, she lacks focus, and she is easily distracted. The criterion identifies problems with concentration and sleeps disturbance as evidence of alterations in arousal. Further, the client’s recent episodes in the theater class and socializing difficulty will have a significant impact on her social and academic functioning (Criterion G). Her symptoms are not attributable to substance use (Criterion H).
Possible Differential Diagnosis
A possible differential diagnosis for client K.M is an anxiety disorder or obsessive-compulsive disorder (OCD). In general, people diagnosed with OCD display intrusive obsessive or compulsive actions. Unlike PTSD, OCD is linked with other psychiatric co-occurring illnesses. Although both disorders involve persistent intrusive thoughts, OCD involves a more heightened obsessive symptom severity than PTSD. OCD is characterized by repetitive actions or mental acts, which constitute stress responses to obsessions, as opposed to a traumatic event. The obsessions and compulsions that are the prominent symptoms of OCD diagnosis are lacking in client K.M. She had intrusive symptoms – marked physiological reactions to a trigger – but not recurrent obsessive or compulsive episodes; hence, the PTSD diagnosis.
Generalized anxiety disorders are also ruled out because they involve no relation to traumatic experiences. A panic disorder diagnosis is made when the individual shows dissociative responses (flashbacks) and alterations in reactivity or hyper-arousal. Although client K.M displays symptoms of arousal (lack of concentration and sleep disturbance), she lacks marked dissociative symptoms that could support a panic disorder diagnosis. The diagnosis of a generalized anxiety disorder is also not feasible. Client M.K shows symptoms of sadness and anxiety, but not irritability. Since she lives with her mother and siblings, the separation anxiety disorder is ruled out. Therefore, it is not possible to make an OCD or anxiety disorder diagnosis for client M.K since their etiology does not involve recurrent exposure to a traumatic event.
Cultural and/or Social Justice Issues
Hispanic Americans, being a minority group in the US, are prone to stress-related disorders, which could be attributed to economic marginalization and racism. Further, Hispanic cultural characteristics seem to affect health-seeking behavior, symptom severity, and coping practices. Hispanics are not open to mental health services. In most cases, they do not seek help or report abuse, especially if the perpetrator is a family member. The cultural attributes may promote avoidance and self-harm coping behavior. The underreporting of abuse cases can be attributed to the Hispanic culture’s emphasis on family relationships. Family is an important part of the Hispanic culture. Client M.K may show discomfort discussing her history of sexual abuse or domestic violence with the therapist since it involves family members. An approach that builds therapeutic trust can promote self-disclosure. Family (mother) involvement can also lead to better therapeutic outcomes since client M.K identifies her as a support system.
Another cultural aspect that pertains to client M.K is the inclination to normalize stress. This behavior may be due to the cultural belief that people who seek mental health services are emotionally weak. The client only sought help after experiencing repetitive distress symptoms/episodes for weeks. Thus, Hispanics will only look for aid in emergency/crisis situations due to cultural attitudes and socio-economic hardships. Hispanics express their spirituality in the context of cultural beliefs. Although client M.K professes to be a Catholic, she does not identify the church as a support system. This shows that personal ideologies are critical in developing individualized therapy for Hispanic patients.
The risk of PTSD exposure in Hispanics could be higher owing to the economic difficulties often faced by minorities in the US. Client M.K belongs to the second generation of Hispanic immigrants. She admits that her family needs financial support. These factors could limit her ability to access to affordable mental health services and remain in treatment for long. Stress-related cultural concepts, such as ‘Ataque de nervios’, in the Hispanic culture can affect PTSD expression. In this case, a panic attack is a predominant symptom; hence, an accurate diagnosis based on the DSM-V criteria may be a challenge.
We all know that African Americans participated in every war in which the United States of America was involved. Their sufferings are not limited to their war struggle as they tend to suffer even when they return home. While African Americans make up for approximately 14% of the US population, they account for 17% of the overall number of US soldiers. The African American soldiers and veterans are exposed to numerous stressors that can be characterized by a rather high level of multi-layeredness and interconnection (Rosen et al. 355). Like numerous other American soldiers, African Americans may feel left and unsupported when they come back home from the battlefield. However, the issue is rather complex for Black veterans and soldiers because they experience stresses based on critical changes occurring in mental health and associated with institutional racism.
All these factors lead to the advent of a struggle regarding the inability to obtain necessary resources and gain support that is vital throughout the process of overcoming the pains of war (Kaczkurkin et al. 93). This is why clinicians have to understand that they have to deal with specific cultural experiences when treating African American veterans. This leads us to the hypothesis that the healthcare specialist has to be culturally competent to provide high-quality treatment to African American veterans. Within the framework of this submission, the author is going to discuss several components that may critically impact the complexity of psychological traumas received by African American soldiers and provide a conceptualized policy that will be expected to contribute to the changes in healthcare practices. This population necessitates essential clinical treatment, and specific assessment techniques have to be used (Mustillo and Kysar-Moon 330).
Moreover, the researcher realizes that there are quite a few ethnicity-specific reactions that may transpire during the veterans’ exposure to combat-related PTSD. This kind of ordeals may include the African American Psychic Trauma, for example. A thorough analysis of this topic will help the researcher to investigate the nature of African American vulnerabilities and come up with a brand new treatment plan that will also include a novel type of care delivery. Such evidence was presented by Tiet et al. who examined the status of minority veterans and then associated it with expectancies regarding the treatment of PTSD (317). This study was based on the information presented by the Department of Veteran Affairs (VA) and included several additional aspects such as components of the therapeutic alliance. The researchers asked veterans to complete surveys regarding the efficiency of PTSD residential treatment that they received (37% – minority respondents, 63% – white respondents) (Tiet et al. 319).
It was hypothesized by the researchers that minority status adversely impacted their therapeutic bond with the outpatient provider. At the same time, the authors of this research article stated that the expectancies for residential treatment also relied on the association with the former provider. Tiet et al. found out that higher expectancies could be positively associated with the concept of task agreement (instead of the previously mentioned therapeutic bond (319). The problem with their findings consisted in the fact that effect sizes were relatively small. To conclude, the researchers were not able to identify any critical differences in terms of VA PTSD residential treatment that would consider the ethnic minority status. According to the information obtained throughout the surveys, the investigators were able to point out the idea that other treatment settings should be involved in future research to investigate the issue of veterans with PTSD more comprehensively.
Another study on the topic of PTSD among African American veterans was conducted by Spoont et al. (419). They based their research project on the idea that PTSD can be associated with several physical and social deficiencies that are exclusively PTSD-related. Even though the VA does a lot to cover the expansion of mental health issues among African American veterans, they cannot provide sufficient care to the majority of those in need. Therefore, the clinical benefit cannot be achieved, and African American veterans keep on struggling (Spoont et al. 419). In addition to this inclusive hypothesis, the researchers decided to take into account the question of race differences when it came to premature mental health treatment. The investigators went even further and addressed the issue of differential access to healthcare services. To obtain the most accurate results, they took a sample of African American veterans who were recently diagnosed with PTSD (Spoont et al. 420).
The researchers waited for six months to complete a follow-up survey. The results of their investigation showed that minority veterans (Latino and African American) did not receive sufficient treatment throughout those six months (Spoont et al. 422). Nonetheless, African American veterans were also found to meet the effects of pharmacotherapy retention negatively. Race disparities related to treatment retention did not show any significant variation between White and African American veterans. Spoont et al. concluded by claiming that even in the VA, there are occasional disparities in terms of PTSD treatment. They advocated for a much more direct approach towards the patients’ treatment beliefs. Therefore, we have to conduct further research in the area to address the issue of treatment disparity properly and provide African American veterans with decent and fair PTSD treatment.
The issue with PTSD consists in the fact that more and more veterans are annually affected by this disorder. In perspective, treatment may be costing more than several billions of dollars because the country does not pay proper attention to the problem. Therefore, there is a need to advocate for critical changes in the current policy to help the VA get rid of race-associated disparities. Counseling Services of the organization also have to be improved – the VA does not even try to outsource these services yet, and the burden of derisory treatment resources remains undefeated. It is safe to say that without an applicable intervention, veterans with PTSD will be subject to abusing alcohol and other substances.
The evidence shows that they numb their pain using displaying hazardous or felonious behaviors (Koo et al. 12). Currently, fixing the short-term issues may lead to the advent of several complex long-term issues that will affect the whole ecology, not a single individual. African American veterans are mostly affected by PTSD because they showcase their non-adaptive coping mechanisms. Consequently, we have to find a solution that would let African American veterans have access to the necessary services and resources. Lee and Gabriele also mention that African American veterans are much more inclined to being exposed to traumas, obesity, and sleep problems (3). The VA did not pay enough attention to the question of posttraumatic stress, but there is a robust body of evidence that shows that the current policy has to be revised to provide better treatment plans for the minority veterans.
Policy Solution
This policy solution will be divided into several important points. First of all, there is a need to take into account the cultural eco-map and ethnically relevant readings. This policy stresses the importance of facilitating the development of simpler eco-maps and military-adjusted narratives. In this case, the policy relies on the idea that African American veterans may identify themselves more with their armed services family. The proposed action plan revolves around the idea that many African American veterans may have unresolved conflicts that transpired from the death of their military partners. The evidence discussed in the literature review section hints at the fact that there is a strict necessity to build new narratives to approach African American veterans culturally.
This policy change is justified by the fact that the new processes of cognitive synthesis may help African American veterans to integrate their traumatic past into the current existence. At the same time, this approach will help healthcare practitioners to decrease the strength of PTSD symptoms (this will be discussed in the next subsection of this proposal). The rationale for reworking the framework of passing down information consists is the difference between the traditional African American methods (storytelling and narratives) and those that are currently used by practitioners. The evidence shows that such clinical treatment plans may have a positive impact on African American veterans. Therefore, the idea that is covered in this policy relates to the concept that collaborative partnership increases the chances to come up with an appropriate treatment plan for African American veterans with PTSD.
The second part of this proposal is intended to disclose several recommendations for the practitioners. First of all, there is a stringent necessity to help PTSD practitioners to gain more insight into the question of the cultural identity of African American veterans. The problem here consists of the fact that they may be still exposed to the adverse influence of racism and the history enslavement. According to this policy proposal, practitioners should not disregard the fact that African American individuals are oppressed and battle against inequalities even in the modern world. Second, it is recommended to identify the strengths present in African American veterans to help them to build positive relationships with their families. Here, practitioners will have to emphasize the importance of finding the solution collaboratively. The third recommendation hints at the fact that African American veterans should be perceived as partners on several levels.
It may be reasonable to learn more about the everyday life of regular African American individuals to find more points of contact. Expanding on this topic, the new policy also suggests that practitioners should interact with veterans throughout each of the treatment stages. These stages include diagnosis, medication intake, and the overall treatment process. Clinical interaction with African American veterans can be subject to transference issues, so it has to be guided carefully. Overcoming this barrier is vital, and the policy suggests that African American veterans have to work on their PTSD in collaboration with the practitioners to achieve positive results. We should also consider the fact that the psychological traumas of African American veterans may be reflected in other family members. This may happen because typical African American families are in a state of interdependence. The policy intends to address PTSD as a disorder that causes a lack of affection and makes African American veterans too preoccupied with their traumas. Therefore, the possibility of internal family disintegration also has to be addressed by the renewed policy.
The third part of the proposal relates to the implementation of specific family therapies as they can also be helpful. This idea also has to be supported by an additional initiative – psychoeducation for the members of African American families with veterans. Nonetheless, this should not be the only improvement. It is also proposed to provide counseling services using the Army Community Services Program (ACS). The rationale behind this decision is an extensive number of services that can be adjusted to the needs of African American veterans with PTSD and their families. Also, this program can be implemented because it is available in several places and local communities fully support these initiatives. In perspective, the policy is willing to connect with the ACS because it provides relocation, deployment, and budgeting services for African American veterans.
Also, at this particular point, we may address the primary cultural issue associated with the African American population and soldiers/veterans in particular. There is a problem with the inability of the majority of clinicians to embrace a different archetype that outlines the African American community. The rationale for this particular decision consists of the idea that there are ways to conceptualize African American worldviews and develop an African-centered treatment framework that will be based on the strengths of this community. Within the framework of this policy, it is proposed to pay attention to the significance of family and collectivism, religion and spirituality, empathy, empowerment, and healing rituals. As it has been mentioned before, we have to focus on the African American culture and history to be able to develop a multi-dimensional treatment framework. To conclude, the author of this proposal believes that African American veterans with PTSD should be exposed to holistic treatment because of numerous spiritual aspects that are typical of this community.
The author of this proposal understands that religiosity and spirituality of African American veterans is one of the cornerstones of reforming the existing policy. Therefore, minority veterans with PTSD must be influenced by practitioners properly as there is no other method to cope with traumatic events. Without an in-depth understanding of the African-centered culture, there is no point in revising the current policy. All the PTSD practitioners dealing with African American veterans will have to possess knowledge in military culture. The author of this policy proposal is certain of the fact that clinicians have much better chances of building positive relationships with African American veterans if they are well-versed in the discipline of the armed services. This policy is compiled to promote the significance of military values that are highly appreciated by African American veterans. It may be safe to say that effective PTSD treatment can only take place into a culturally appropriate environment that respects the peculiarities of African American worldviews. To conclude, the development of a renewed policy can also be supported by the fact that African American veterans are less expected to approve PTSD treatment than their White counterparts. There is no way we can elaborate and implement a new policy without addressing the question of mental health stigma. This may be particularly beneficial when treating African American veterans with PTSD.
Policy Impact
It is expected that the epidemiological data reports will show a robust decline in the number of African American veterans with PTSD after the policy is implemented. Also, the researcher assumes that even the rates of PTSD prevalence will go even lower than expected. Nonetheless, there may still be some issues with providing appropriate treatment for veterans with severe functional impairment. One of the problems that may interfere with the successful implementation of the policy and spoil the positive impact of the latter is the willingness of quite a few veterans to exaggerate their symptoms for the sake of disability compensation. Regardless, the policy will deal with the cases where the reports on combat exposure change repeatedly and do not reflect the severity of PTSD correctly. The proposed policy will allow clinicians to perform a much more accurate clinical evaluation and provide services to the majority of African American veterans in need.
In perspective, this policy will exterminate the need to be watchful and validate veterans’ sincerity using additional check-ups and unnecessary interviews. One of the outcomes that are perceived as central is the ability to preserve effective and compassionate healthcare and maintain positive relationships with African American veterans. Statistically, African American veterans with PTSD do not commonly benefit from treatment if compared to other patients with this disorder. The researcher expects that the employment of the proposed policy will increase the overall number of African American veterans that are willing to complete psychotherapy and engage in posttreatment activities. It is also expected that the implementation of this policy within the VA framework will provide us with more evidence regarding clinical improvements in African American veterans with PTSD. This policy can be positively associated with a cognizant attempt to encourage African American veterans to participate in vocational rehabilitation.
The significance of this policy can be highlighted by the fact that currently, vocational rehabilitation is not available to the majority of African American VA associates with PTSD. This will help the researcher to replace the existing policy and implement only those evidence-based practices that are aligned with the rehabilitation principles mentioned in the previous subsection of the proposal. Most probably, African American veterans will be able to find a job after being exposed to the countertherapeutic practices of the past. The impact of the proposed policy will be perceived on working, social, and physical levels. More to say, the policy will strengthen the existing knowledge base regarding the African American community and the minority veterans with PTSD. The researcher expects to minimize the occurrence of cases where veterans with PTSD are merely seeking compensation and are not interested in being a part of clinical research or an evidence-based treatment plan. This recommendation was not taken into consideration before, but the author of this proposal believes that it makes no sense to ignore this population.
On a bigger scale, the implementation of the proposed policy will give clinicians the possibility to recruit applicants that are involved in the treatment process and not motivated solely by compensation. This will allow us to develop the existing PTSD interventions for African American veterans and help them overcome their combat trauma. It is also expected that they will closely collaborate with clinicians to investigate the under-researched aspects of PTSD. US veterans deserve to be treated appropriately, and this policy will change their status in the healthcare community. Moreover, appropriate rehabilitation services that are in line with the cultural specifics of African American veterans will positively impact their civilian life. The social expectations associated with this policy are rather high. In perspective, the proposed policy will eradicate the counterproductive practices from the radar of PTSD practitioners and provide the latter with more possibilities to save African American veterans from becoming psychiatrically disabled. Using this policy, the researcher expects to develop flexibility in the minority veterans, but they have to bear in mind that psychiatric problems may impact the process of recovery regardless of the chosen strategy. This is why resilience is pivotal, and the author of this policy proposal believes that the number of chronically ill African American veterans with PTSD will decrease significantly.
Therefore, the policy outlined within the framework of this submission will pave the way for a fundamental reform of healthcare that will flexibly address the issue of African American veterans with PTSD and increase the overall level of responsiveness of all actors involved in the circumstances. Using this extensive policy, the researcher is willing to increase the level of healthcare services and review the number of resources that are dedicated to helping African American veterans with PTSD. The prevalence of invalidism will not be nurtured, and the available resources will not be wasted. Despite quite a few changes that the author of the policy proposes to implement, the ultimate goal of this incentive is to integrate the existing principles into the proposed framework and adjust them so that they would be in line with the needs of African American veterans. Some of these crucial aspects include emphatic treatment and vocational rehabilitation. Using the proposed policy, we will be able to make sure that the interventions are recovery-focused and there are no principles that undermine or underestimate the value of the African American community and the minority veterans with PTSD.
This policy is expected to have a major impact on the development of rehabilitation strategies and facilitation of the treatment process. This will allow the current healthcare system to take care of the most relentlessly ill African American patients. The impact of this policy on healthcare can also be characterized by the fundamental changes that will occur in medicine and labor conditions. The existing technology allows us to conduct all-inclusive research projects and implement the most farfetched treatment practices. One of the most important concepts that will be addressed using this policy is the concern about symptom overstatement. All the defective check-up procedures will be replaced with culturally appropriate interventions that will be approved by African American veterans as well. The benefits of the proposed policy are also expected to include the reduction of impediments in terms of participation in different PTSD treatment practices. African American veterans deserve to come back from the battlefield and become productive members of society one more time. This is why the author of this proposal reconsidered the existing PTSD policy and realized that the implementation of certain practices would lead to improved patient outcomes.
The most important outcome of the implementation of this policy is the complete funding of the needs of African American veterans with PTSD. The researcher believes that this step will critically improve retention rates of healthcare personnel and improve the overall quality of services provided to the African American community. In perspective, the implementation of this policy will validate the existence of licensed mental health providers that practice PTSD specifically. The majority of faux disability claims will disappear due to an updated methodology of treating African American patients. Veterans will be treated appropriately, and the conditions of participating in a disability claim program will be revised. The author of this proposal expects that several programs that support African American veterans with PTSD will be deployed to provide the necessary assistance to this vulnerable population. The policy also suggests that the appointment scheduling procedures will also be impacted.
Additionally, the author of the proposal expects that the healthcare information system will also be revised and African American veterans with PTSD will receive continuous care. In terms of the military impact of the policy, it is expected to reduce mental health stigma and increase the involvement of military personnel in the process of elaborating veteran-related policies. Also, the policy presupposes that mental health awareness programs will become an essential part of military training and minimize the incidence of PTSD among African American soldiers in the future. The VA is expected to provide specific medications to its associates to ensure that more cognitive care practices are incorporated. Importantly, this policy is expected to trigger the advent of finance-based research on stigma and other types of military traumas. Therefore, the implementation of this policy will have an incredible impact on US healthcare and veteran policies in particular.
Conclusion
This policy proposal extensively dwelled on the existence of several issues that are commonly associated with African American veterans with PTSD. Taking into consideration numerous implications of this disorder and quite a few specific concepts that relate to the nature of African American soldiers and veterans, it is safe to say that any policy on PTSD has to be extensive enough to ensure that all the aspects of care are covered. The researcher accurately outlined the issue of racial disparities in PTSD treatment of veterans and then focused on the policy that would eliminate all those discrepancies. It was found out that the implementation of the policy will not be associated with major resource expenditures and the most important concept that has to be taken into account is the cultural exclusiveness of African American veterans.
In other words, this vulnerable population has to be treated differently, and the researcher conducted a serious literature review to identify the gaps and close them using the current proposal. It can be concluded that numerous issues have to be addressed. Nonetheless, the researcher believes that a decent relationship between the VA and policy-making institutions may ultimately lead to the creation of a practically flawless healthcare system where all veterans will be treated equally. The current state of affairs hints at the fact that a lot of hard work is necessary to revive the reimbursement system and get rid of unfairness inherent in the current treatment processes. While we cannot predict the future, we can make sure that the particular nature of the African American community is addressed properly. This will facilitate the process of providing care to any veteran, not only the minority representatives because practitioners will become way more knowledgeable and versatile.
PTSD is a serious disorder, and we cannot mitigate all of the discrepancies associated with African American veterans overnight. Nonetheless, the current policy proposal provides a rational framework for the upcoming incentives and makes the best effort to include all focal points into the healthcare equation. The impact of the proposed policy cannot be estimated yet, but it is going to affect the system of veteran care provision in the United States of America. Several essential resources have to be allocated properly and the author of this proposal critically addressed this issue. African American veterans with PTSD can be rightfully considered to be a vulnerable population that does not receive the recognition it deserves. This policy was elaborated to equalize the current state of affairs in healthcare and ensure that all the parties attain accurately calculated reimbursements that do not rely on veterans’ race and do not perceive the latter as one of the decisive factors when it comes to providing PTSD treatment. Most probably, even the attitude of African American veterans towards healthcare will be affected, and the researcher sees this as a positive outcome that cannot be replaced by any other benefits. A collaborative care environment will reduce the tension between veterans and care providers and the key idea behind the current policy proposal is that positive relationships between the parties may help them both. It may be concluded that this all-encompassing policy may be able to promote equality in healthcare and improve the majority of aspects that relate to the African American community and their veteran representatives who have PTSD.
Works Cited
Kaczkurkin, Antonia N., et al. “Ethnic and Racial Differences in Clinically Relevant Symptoms in Active Duty Military Personnel with Posttraumatic Stress Disorder.” Journal of Anxiety Disorders, vol. 43, 2016, pp. 90–98., Web.
Koo, Kelly H., et al. “PTSD Detection and Symptom Presentation: Racial/Ethnic Differences by Gender among Veterans with PTSD Returning from Iraq and Afghanistan.” Journal of Affective Disorders, vol. 189, 2016, pp. 10–16., Web.
Lee, Aaron A., and Jeanne M. Gabriele. “Racial Differences in the Associations of Posttraumatic Stress and Insomnia with Body Mass Index among Trauma-Exposed Veterans.” Behavioral Medicine, vol. 1, no. 1, 2017, pp. 1–8., Web.
Mustillo, Sarah A., and Ashleigh Kysar-Moon. “Race, Gender, and Post-Traumatic Stress Disorder in the U.S. Military.” Armed Forces & Society, vol. 43, no. 2, 2016, pp. 322–345., Web.
Rosen, Marc I., et al. “Racial Differences in Veterans’ Satisfaction with Examination of Disability from Posttraumatic Stress Disorder.” Psychiatric Services, vol. 64, no. 4, 2013, pp. 354–359., Web.
Spoont, Michele R., et al. “Are There Racial/Ethnic Disparities in VA PTSD Treatment Retention?” Depression and Anxiety, vol. 32, no. 6, 2014, pp. 415–425., Web.
Tiet, Quyen, et al. “Relationships between Racial/Ethnic Minority Status, Therapeutic Alliance, and Treatment Expectancies among Veterans with PTSD.” Psychological Services, vol. 13, no. 3, 2016, pp. 317–321., Web.
The title of the article being evaluated is “Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses.” The title of this primary source accurately depicts the key variable, which is the level of nurses’ stress and mentions the possible solution to this issue – the introduction of a special computer program. The abstract is well structured and has concisely summarized the main features of the study. Besides, it involves a brief overview of the addressed problem.
Research Problem
The problem of this study is very clearly stated and is easily identified. It is concluded in the abstract that “nursing is a notoriously high-stress occupation” (Hersch et al., 2016, p.18). Chronic exposure to stress and can have a negative influence on nurses’ health, their decision-making processes and potentially threaten patient and organizational outcomes (Van Bogaert et al., 2014). The study demonstrates that a web-based program may be an efficient way to reduce the level of stress among nurses.
Research Purpose
This study was conducted to examine the effectiveness of a web-based BREATHE: Stress Management for Nurses program. This software “was designed to provide nurses with the information and tools they need to manage the myriad of stressors that can impact their work life” (Hersch et al., 2016, p.19). The program processes feedback from nurses in focus groups and identifies stressors and the level of depression and anxiety. Thus, a pilot study was carried out to test this web-based stress management program to determine if it could help reduce the alleged stress associated with nursing.
Literature Review
In “Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses”, the authors of the study use a large amount of literature, mainly on the topic of nursing. More than that, most of the articles and books address the problems, including psychological ones, which this medical staff constantly have to face. It can be concluded that the choice of literature fully meets the objectives of this study, and allows studying the risen issue from different perspectives.
Framework and hypothesis
Key concepts are accurately identified and describe the importance of addressing nurses’ stress management and necessary measures. Frameworks include behavioral and psychological studies and theories, which they are based on. The concepts developed in the research assist in shaping a scientific understanding of stress control with the help of the special web-based program. It was hypothesized that participants of an experimental group who used this program “would experience greater reductions in nursing related stress when compared to participants in the wait-list control condition” (Hersch et al., 2016,p.19). Another hypothesis was that nurses of the pilot group would consume alcohol or use different substances to relieve stress less than the control group participants do.
Design and Variables
The BREATHE: Stress Management for Nurses program was tested on nurses in five suburban hospitals in Virginia and one in New York City. The study was a randomized controlled experiment in which participants were randomly divided into two groups. This design is appropriate as it allowed to receive reliable results. It is worth mentioning that all the participants got access to the program when the trial ended. As for variables, various indicators were used to identify the correlations between them and stress (Galdikiene, Asikainen, Balciunas, &Suominen, 2014). The authors of the study chose gender, race, age, marital status, the highest level of nursing education, number of years in nursing, and at the current hospital, and work setting.
Procedures
Interested nurses were asked to complete the pre-test questionnaire, after which two groups were formed. The experimental group got a link to the BREATHE program, access to which participants had at any time during the three-month test period. The control group was told that they would use the program later. Three months after randomization, participants were sent the second questionnaire, and, after its completion, all of them received access to the software.
Validity, Efficacy and Ethical Issues
The results of this study can be considered credible, as they are based on an objective experiment. Moreover, the experts analyzed not only the data that nurses contributed to the program but also indicators such as the frequency and duration of use of it. In addition, the research confirmed its effectiveness, as changes in stress levels were observed due to the use of this software. As for the ethics of the study, all participants took part in it voluntarily, and they could refuse to answer some questions of questionnaires if they felt that it could harm them.
Cultural Aspects
Cultural aspects cannot be accurately identified in “Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses.”
Sample
Nurses from five suburban hospitals in Virginia and one in New York City participated in the experimental group.
Results
Results of the provide evidence of the benefits of using a web-based program as “nurses who received access to the BREATHE program showed significant improvement in perceived nursing related stress” (Hersch et al., 2016, p.23). Moreover, researchers observed the decrease in the number of conflicts with other nurses and medical staff, and changes in the perception of inadequate preparation and workload. Thus, addressing the communication needs of nurses has been associated with the promotion of individual growth and work satisfaction (Wakim, 2014). That is why it is critical to encourage open communication and co-worker support in medical institutions.
Conclusion
Study findings indicate that the BREATHE Stress Management for Nurses can be effective in reducing nurses’ stress. Consequently, such web-based programs are an important intervention to help nurses in their daily work. The widespread introduction of such programs will improve the quality of medical services. Furthermore, they can be used in students’ nursing practice to help them understand how to cope with stress more effectively.
References
Galdikiene, N., Asikainen, P., Balciunas, S., & Suominen, T. (2014). Do nurses feel stressed? A perspective from primary health care. Nursing and Health Sciences, 16, 327-334.
Hersch, R. K., Cook, R. F., Deitz, D. K., Kaplan, S., Hughes, D., Friesen, M. A., & Vezins, M. (2016). Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses. Applied Nursing Research, 32, 18-25.
Van Bogaert, P., Adriaenssens, J., Dilles, T., Martens, D., Van Rompaey, B., & Timmermans, O. (2014). Impact of role-, job- and organizational characteristics on nursing unit managers’ work related stress and well-being. Journal of Advanced Nursing, 2622-2633.
Wakim, N. (2014). Occupational stressors, stress perception levels, and coping styles of medical surgical RNs: A generational perspective. Journal of Nursing Administration, 44(12), 632-639.
Nowadays, multiple individuals in the United States develop mental disorders, such as post-traumatic stress disorder, in response to traumatic events, including participation in military conflicts, accidents, or sexual and physical violence. According to the National Comorbidity Survey Replication, which is a general population survey, around 5.7% of adult Americans face increased risks of developing PTSD after exposure to traumatic events (Kessler, 2018).
Such risks are specifically high for the survivors of kidnapping, rape, and intimate partner violence (Kessler, 2018). Eye movement desensitization and reprocessing therapy (EMDR) belongs to the number of relatively recent approaches to treatment that reduce the distressing symptoms of PTSD in patients. The approach has been found rather effective in general PTSD populations in the previously conducted randomized controlled trials, which is a common and reliable study design (Jowett et al., 2016; Jacobsen, 2016). However, capitalizing on the wave of success, diverse institutions may apply EMDR to treat any patient with PTSD without giving proper consideration to limitations and research gaps surrounding its use in intellectually disabled adults.
Limitations
The main limitation of the present study is that it is based on information from methodologically diverse sources. Not all of the research articles testing EMDR in PTSD patients with disabilities document the features of EMDR sessions in a consistent manner (Jowett et al., 2016). Moreover, high-quality studies on EMDR in populations with PTSD and IDs are still scarce (Karatzias et al., 2019). The existing experimental studies greatly vary in terms of sample size. Because of that, the provided recommendations mainly point to the remaining research gaps.
Use and Application of Findings
The use and application of findings that shed light on current research gaps related to the effectiveness of EMDR in PTSD patients with IDs may contribute to improvements in this population’s quality of life and treatment outcomes. They can do so by attracting the attention of the scientific community to the sources of potential adverse effects of EMDR that disproportionately affect PTSD patients with generalized neurodevelopmental disorders. To start with, it is supposed that the presence of IDs may contribute to the risks of developing PTSD and symptoms’ severity in those exposed to traumatic events (Jowett et al., 2016).
In general, eight-phase EMDR sessions using standard protocols for adults show relatively good results in intellectually disabled patients with PTSD by causing a 20% increase in the number of diagnosis-free participants twelve weeks after treatment (Karatzias et al., 2019). In spite of potential extra challenges resulting from the overlapping of the two conditions, treatment guidelines for PTSD patients developed with reference to intellectually disabled people’s unique struggles and psycho-emotional characteristics are still lacking, which is a huge problem (Jowett et al., 2016). The recommendations below refer to specific goals to pursue in order to address the problem.
Recommendation 1
To start with, it will be impossible to maximize the benefits of EMDR for intellectually disabled patients without addressing research gaps surrounding differences between people with and without ID in terms of PTSD symptoms. Patients with disabilities are harmfully affected by diagnostic overshadowing, but this phenomenon is not well-researched in the context of PTSD therapy. Limited knowledge concerning disability-related differences in PTSD manifestations may lead to inaccurate assessments of disease severity before and after EMDR treatment.
Considering this, to some extent, the aforementioned research gap brings the said effectiveness of EMDR in PTSD patients with IDs into question. Consequently, studies addressing the unique symptoms of PTSD in ID patients would speed up the development of PTSD treatment guidelines adapted to such patients’ needs.
Recommendation 2
The second recommendation for the scientific community is to support research that would draw comparisons between different adaptations of the standard EMDR protocol in terms of their effectiveness in intellectually disabled patients diagnosed with PTSD. In 2007, Tomasulo and Razza presented evidence that suggested resemblances between the manifestations of PTSD in typically developing children and adults with ID (Jowett et al., 2016). After that, a few research groups attempted to integrate the elements of the child-adjusted EMDR protocol into protocols to be used with adults having IDs, with quite positive results (Jowett et al., 2016).
However, as of now, there are no projects to compare different approaches to protocol adaptation and address the issue of methodological diversity. Therefore, studies comparing the outcomes of three promising approaches to EMDR sessions (the standard protocol, the child-adjusted protocol, and the standard protocol with the storytelling method) in the discussed population would be of benefit.
Recommendation 3
Finally, future researchers and mental health specialists working with the population in question are recommended to avoid over-relying on EMDR. Bae, Kim, and Park (2016) report that high dissociation (depersonalization and derealisation) scores are negatively related to response to EMDR therapy. At the same time, dissociation is quite common in PTSD patients with disabilities. Taking this into account, the potential benefits of EMDR for such patients should not be overestimated despite the reported positive results. Probably, future studies will shed light on the role of IDs as a barrier to PTSD treatment using EMDR.
Conclusion
To sum up, it is widely accepted that a person’s ability to deal with stress and maintain social functioning despite distressing events of different types is a prerequisite to proper mental health and living a full-fledged life. PTSD profoundly affects an individual’s psychological well-being and daily life by resulting in frequent flashbacks. It also causes poorly controlled thoughts about distressing events of the past, the impaired ability to engage in everyday affairs, nightmares and sleep disorders, severe anxiety and phobias, and similar unwanted symptoms (Kessler, 2018).
Despite suggestions that people with IDs are more susceptible to PTSD, there are still no universally approved treatment recommendations developed for this specific subgroup of patients (Jowett et al., 2016). In particular, there is solid evidence to support the effectiveness of standard EMDR protocols in general populations, but its use in people with ID is only regarded as potentially beneficial (Jowett et al., 2016; Karatzias et al., 2019).
The review of the existing literature suggests that the scientific community should work towards filling a range of research gaps to unleash the true potential of EMDR in PTSD patients with IDs. To start with, there are some factors to suggest that people with IDs may experience more severe PTSD (specific characteristics of memory processing, communication challenges, less social support, etc.). Nevertheless, there is still no solid research on differences between people with and without IDs in terms of PTSD manifestations (Jowett et al., 2016; Karatzias et al., 2019). New research is specifically important given that response to EMDR is weaker in patients with high dissociation scores, and disabilities are likely to be a risk factor for developing depersonalization/derealization (Bae et al., 2016).
Next, there is no consensus on the best EMDR protocol to treat PTSD patients with IDs despite attempts to create new protocols by combining EMDR-related recommendations for children and adults (Bae et al., 2016). Taking these gaps into account, it is too early to say that PTSD patients with IDs enjoy the benefits of EMDR just like other populations.
References
Bae, H., Kim, D., & Park, Y. C. (2016). Dissociation predicts treatment response in eye-movement desensitization and reprocessing for posttraumatic stress disorder. Journal of Trauma & Dissociation, 17(1), 112-130.
Jacobsen, K. H. (2016). Introduction to health research methods (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Jowett, S., Karatzias, T., Brown, M., Grieve, A., Paterson, D., & Walley, R. (2016). Eye movement desensitization and reprocessing (EMDR) for DSM–5 posttraumatic stress disorder (PTSD) in adults with intellectual disabilities: A case study review. Psychological Trauma: Theory, Research, Practice, and Policy, 8(6), 709–719.
Kessler, R. C. (2018). Trauma and PTSD in the United States. In C. B. Nemeroff & C. R. Marmar (Eds.), Post-traumatic stress disorder (pp.109-131). New York, NY: Oxford University Press.
Karatzias, T., Brown, M., Taggart, L., Truesdale, M., Sirisena, C., Walley, R.,… Paterson, D. (2019). A mixed-methods, randomized controlled feasibility trial of eye movement desensitization and reprocessing (EMDR) plus standard care (SC) versus SC alone for DSM-5 posttraumatic stress disorder (PTSD) in adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 32(4), 806-818.
The Neuman Systems Model will be applied as the theoretical framework. Betty Neuman described her work as a unique perspective to approach a variety of concerns in a healthcare setting (Gonzalo, 2019). There is a properly developed client system, with stressors and the environment being investigated. An individual has to be viewed holistically, considering physiological, psychological, sociocultural, developmental, and spiritual variables (Gonzalo, 2019). Stressors penetrate the life of a human and can be of different types, including intrapersonal, interpersonal, and extrapersonal (Gonzalo, 2019). The prevention of stressors is one of the best interventions to stabilize human well-being, and lifestyle change is one of the primary recommendations. Regarding the nature of the Neuman Systems Model, the application of Lewin’s theory of change is a reasonable alternative.
The purpose of this paper is to understand how the use of a mindfulness meditation program helps nurses who work with high morbidity/mortality patients reduce work stress during a pandemic. The chosen model is based on the evaluation of individual factors about the environmental stressors and nurses’ reactions. This type of relationship plays a crucial role in understanding human behaviors under specific conditions (Gonzalo, 2019). This model explains how the pandemic and a group of patients contribute to increased stress among nurses (extrapersonal and interpersonal stressors). Its application shows the attitudes of nurses toward their responsibilities and their well-being (intrapersonal stressors). The Neuman Systems Model proves the importance of the environment and personal judgments to improve the quality of care and the effectiveness of services.
Change Model
To support the Neuman Systems Model, Lewin’s change theory is used. Change is a common process in any organization, regardless of its size or industry (Deborah, 2018). Attention to Lewin’s model, as one of the core organizational management approaches, helps people understand the importance of change and initial steps. If there is no plan for implementing intervention and promoting change, people face challenges because of chaos (Deborah, 2018). Lewin offered a three-step guide to support stability and avoid misunderstandings. A mindfulness meditation program is an organizational change when two-hour training for nurses is implemented three times per week. The outcomes include the reduction of stress, the improvement of care services, and well-being among the nursing staff.
Step 1:Unfreeze. It is not always easy to change the already accepted rules and standards. The goal of the first stage is to prepare nurses for new activities and enhance their driving powers (Deborah, 2018). It is planned to start with a one-hour lecture during which the instructor explains the importance of mindfulness meditation and its potential impact on work stress reduction. Nurses have to recognize their weaknesses when they cooperate with a specific group of patients. Their health-related challenges influence their work, well-being, and further attitudes toward their duties.
Step 2: Change. As soon as the priorities are established, and the characteristics of changes are understood, the next stage occurs. It includes the period when people start believing in the offered changes and resolve their ambiguity (Deborah, 2018). Instead of talking about their problems and thinking about new job opportunities, a two-hour meditation program is developed to make them less dependent on the work and organize their thoughts. Nurses can combine communication, physical activities, and lifestyle changes without leaving their work.
Step 3: Refreeze. The last stage of this change process is focused on the evaluation of the intrapersonal stressors and the possibility to manage them. It is necessary to ensure that the change can be sustained (Deborah, 2018). Mindfulness stress-based reduction is the goal that determines the effectiveness of the whole intervention. Nurses face new feelings and emotions and learn how to deal with them. At this last phase, all the unclear points are clarified, and nurses become confident if mindfulness meditation has to be promoted further.
Organizational Setting
The setting of this project is a postoperative unit in a local hospital where care is offered to chronic patients (diabetes, Alzheimer’s, or hypertension) or disabled people who cannot perform their basic functions. In this facility, the nursing staff helps patients receive medical treatment and occupational therapy and use custodial care like eating or bathing for some period. Usually, the diagnoses of patients in such a facility are mental health disorders, somatic problems, cardiovascular diseases, and musculoskeletal system changes. At this moment, there are 20 residents, but the number of patients is determined by their conditions. Usually, more than 500 patients are seen annually: some of them live several months here, some patients die in a week or a month, and some people go home.
Population Description
The population for this study is nurses who work with high mortality patients in a postoperative unit of a local hospital. It is planned to invite 20 nurses who meet the inclusion criteria. As soon as a hospital administrator approves the study, a face-to-face meeting occurs with potential participants where general rules, statistics, and goals are explained. Informed consent is signed after personal communication with each nurse. Their primary characteristics are compassion, communicativeness, and desire to change their working conditions.
Inclusion criteria:
a one-year nursing experience;
work with high mortality patients during a pandemic;
English-speaking.
Excluding criteria:
vacation/sick leaves;
chronic disorders or acute diseases (except stress).
The only variable that could influence the project outcomes is the nature of the pandemic. If unknown and rapid changes are caused by the situation, nurses and researchers are not able to control the development of the events. Therefore, the conditions of nurses and patients have to be regularly checked to prevent the development of serious illnesses. If urgent measures are required, there could be no time for mindfulness mediation in a setting.
Post-traumatic stress disorder (PTSD) is a serious mental abnormality, which results from exposure to highly traumatic experiences. Suddenly surging bright memories, colored with painful emotions, can completely capture a person’s attention. It seems that he or she is experiencing a traumatic event again and sees it as real. The state of a person during such a flashback can sometimes be mistaken for sleepwalking, and, in children, it can manifest itself as a repetitive, stereotyped play. In cases of pronounced episodes of returning to the past, a person behaves as if he or she is reliving the transferred situation again, without being fully aware of his or her actions.
Main text
The overall process of evaluation and analysis of the film was done correctly and adhered to the standard principles of counseling. The identified trauma disorders are common among war veterans and combatants but can also occur in civilians who have survived various disasters. PTSD takes place more often in women than in men. It can be caused by birth trauma, family scandals, child abuse, the loss of parents, and the scourge of war. In some cases, PTSD symptoms fade away over time and may disappear altogether. In others, they persist for many years, and then the signs of other mental disorders, such as depression, alcoholism, and drug addiction, may join them.
I fully agree with the diagnosis, and the possibility was pointed out as a major depressive disorder. The goals of treatment were determined appropriately because they fit the case description. However, I would order a more detailed assessment, which revolves around Chris’s childhood. Although the movie depicts his military service being the main source of his PTSD, exploring the client’s youth might also be effective. There could be some underlying factors, which were facilitated and expanded by the combat traumas.
The suggested level of care and location of treatment was appropriate. However, the team did not specifically mention the core principle of any PTSD intervention, which needs to be directive and active. One should understand that a therapist plays a key role in ensuring that any given session is time-limited, skill-based, and goal-oriented. In other words, PTSD clients are not proactive on their own, and, thus, it is critical to lead them through the counseling process by setting clear objectives.
The team listed all essential medications and intervention strategies, which are plausible for Chris. I would also include anxiety management therapy (AMT) because it is evident that there is a need to address the client’s anxious behavior. The team has done an outstanding job by including all necessary adjunct services. In addition, I fully agree with the suggested prognosis because it reflects the possible outcomes.
Conclusion
In conclusion, people with PTSD often undergo conditions when they vividly and deeply experience an event that traumatized them, and it is most likely to be embedded in their daily life. When a person does not have a chance to discharge internal tension, the body and mental abnormality find a way to apply it to this tension. It is important to understand the fact that this is the mechanism of post-traumatic stress. Symptoms that collectively look like a mental disorder are, in fact, nothing more than deeply ingrained behaviors associated with extreme events in the past. Therefore, Chris’s childhood needs to be analyzed, and he should undergo AMT to manage his anxiety.
Due to recent changes in the health sector, nursing professionals find themselves in stressful situations that often lead to burnout. One of the root causes of stress is increased workload (Collie, 2005). Others get stressed because they lack the necessary skills to work well and especially when assisting the aged. Though I have not experienced stress or violence in the workplace, there is so much stress among home healthcare givers. The few nurses available always have to work for more than one agency and attend to many patients. Besides having to deal with rising gas costs as they are made to move from place to place, nurses suffer from tiredness and waste so much time in between. Apart from causing a huge decline in the quality of services, this has also led to work dissatisfaction. This paper discusses the difficulty faced by the state, healthcare providers, and nursing practitioners when dealing with the aged. Baby boomers, as they are commonly known, are a generation of those born between 1946 and 1964. This aging population requires highly specialized attention that subjects nurses to a lot of pressure. Jansen, Kerkstra, Abu-Saab, and Van Der Zee (1996) also observed that high dependency amongst elderly patients adds to the problem of increased workload and hence more pressure. Some nurses have opted out of the profession making things even worse.
The relevance of the key points in this paper has to do with the increased stress experienced by nurses working for more than one agency and serving many clients. Usually, these nurses are unable to cover other patients when needed. This becomes trickier when helping boomers since they require much more support to cope with their complex health conditions. Research shows that this will drastically transform the future of medical and healthcare services (Dunnan, 2007).
Through healthy lifestyles, boomers have been able to live for a longer period. With time, however, they develop severe medical problems that require expert medical attention. This situation puts healthcare service providers in a tight spot given that in the next twenty years, most of those hospitalized will be boomers (Dunnan, 2007). With shocking reports and statistics being released about healthcare for baby boomers, stakeholders now wonder how prepared the U.S. healthcare system is to address future health challenges.
Collins, Davis, Schoen, Doty, and Kriss (2006) noticed that players in different sectors are not in any way ready to cooperate with state officials to provide a way out. Insurance companies for example are out to sell very costly products oblivious of the fact that people are living in a world where they have to make tough economic decisions. The rising cost of healthcare has also compelled some employers to pass this burden to employees by increasing premium contributions. Other employers have gone to the extent of getting rid of health covers for employees (Collins, Davis, Schoen, Doty & Kriss, 2006).
As the aging population continues to grow, the nursing burnout syndrome will continue to risk the health and safety of all patients in the U.S. If this state of affairs is let to continue, the government will eventually be forced to spend a considerable amount of money to provide healthcare services to needy citizens. Efforts by the federal and state government to deal with this development are, however, not enough and should be complemented by others. Employers and insurers should work closely with the government to provide long-term solutions. Emphasis should be placed on tackling work-related fatigue and providing helpful training to satisfy and motivate nursing staff (Hasson & Arnetz, 2007).
When dealing with burnout, prevention rather than intervention should be encouraged. Many healthcare counselors see no quick fix for burnout. They recommend that support groups should be created and counseling programs implemented. A task force can also be created to review solutions.
Finally, it is very important to note that burnout is such a serious concern for healthcare service providers both in nursing institutions and within the home healthcare field. It causes physical, emotional, and behavioral harms that greatly degrade the quality of services offered. By actively monitoring the work environment, healthcare institutions can help decrease incidences of burnout and boost staff morale.
Collins, S., Davis, K., Schoen, C., Doty, M. M., and Kriss, J. L. (2006). Health Coverage for Aging Baby Boomers: Findings from the Commonwealth Fund Survey of Older Adults. Web.
Dunnan, T. (2007). Baby Boomers Changing Health Care. Web.
Hasson, H. & Arnetz, J. E. (2007). Nursing staff competence, work strain, stress and satisfaction in elderly care: a comparison of home-based care and nursing homes. Web.
Jansen, P., Kerkstra, A., Abu-Saab, H. H. & Van Der Zee, J. (1996). The effects of job characteristics and individual characteristics on job satisfaction and burnout in community nursing. International Journal of Nursing Studies, 33, 407–421.
Identifying and analyzing a concept is a very vital element of hypothesis formulation and through the models built from the analysis. In any kind of a research understanding the topic in question is a fundamental issue. When the concept of topic at hand is not clear the researcher ends up making assumptions and the predicted results will not be relevant to real life. Stress is a very common happening in the society and in the nursing sector they deal with all manner of stress.
Leading life as expected with the presence of stress call for the victim to make changes to their lives. Managing of stress is a complicated thing due to the connivance of life course, daily activities, stress and the way the three intermingle with each other. When one is undergoing stressful moments in life the involvement of this individual in his daily activities normally becomes more stressful. Therefore it calls for the individuals to adapt to the happenings which make it difficult to bear all the events of life at the moment. In view of this nursing workers are highly needed to handle the issues surrounding stress will calls them to have a clear concept on stress for them to be able to intervene.
In nursing stress is a diagnosis which involves rearrangement of the psychological setup therefore it involves the prediction of a way of adjusting to it through the individual’s life. Stress is mostly an imposed element on the developmental changes which implies it has major impact on health. Stress is branded by unmet expectations in the family, work place, health, in friendship, environment and others. The study of stress is mostly linked with health and psychological matters. Chronic and acute stress has been researched on in relation to health impacts but the area of chronic stressors still calls for more study.
In the nursing practice anxiety is at times taken in for stress for the two share symptoms and behavioral changes in response. The two highly resembles. They can be handled and corrected in a clinical setup but they must be differentiated. The characters that distinguish anxiety from stress must be well-known. This analysis will bring out the concept and the characteristics of stress in relation to nursing as diagnosis. It will put effort to analyze the term stress, its use, characteristics and changes and effects over the years.
Literature review
The word stress has been unwrapped in different ways. Stress can be defined as a state in which environmental changes impacts positively or negatively on the physical and psychological forms of a person causing disturbances.
It is seen as responses to threats but mighty not specific. Seyle (1975) described stress in three different stages which include response to the stressor, adaptation and exhaustion when the adaptation fails. The approach which he gives though it may some limitation it brings out stress as an element affected by many factors. Its completion in understanding calls for understanding of other factors. It is actually the result of different operations between the person and the environment. He clearly shows that stress occurs when one careful considers the relationship between the environmental stressors and the person as a threat to his well being.
The extent of stress is determined by the interaction between the resources available to handle the demands of the situation and the demands themselves as the individual perceives them. The ability of an individual to deal with stress is determined by the capability of the person to control and predict the occurrence of a stressful moment or situation. With the help of the transactional model of stress by Lazarus and Folkman (1984) the development of potential stressors is by the environmental and personal factors, which end up in causing stress.
The pressures and the issues that cause stress are known as stressors. This in simple terms can be said to be something that puts extraordinary demands or relatively high demands on an individual. They are therefore both positive and negative events which strain you on the higher side of your ability. The stressors depend more on the perception one has of the event this because what is stressful to one individual is a joy to another. Most of the external and internal causes of stress are self generated. They are created by the individual himself or imposed by the society then they become ingrown in the individual.
Reflecting on the teaching of Selye (1975), stress negative affects health and he established the relationship with the physical stressors. Stress is a situation or condition that’s occurrence is a challenge to a person’s well-being. They situations are categorically the daily hassles, life events and chronic stress. They are well-known to differ in intensity and the duration they last. Life events are things that evidently interrupt and change the usual behaviors. There are the things which have occurred in the recent pasts; this is considered for the recent past affects the current situation of a person. Due to the nature of life events they can only be measured from their onset.
Chronic stress is the long term matters that threaten personal well-being. Financial deprivation and work stress are good examples of chronic stress. It is differentiated from life events by the long duration of time it lasts. One of the short comings of the available literature is the lack of definition of the length of time for an event to quality to be chronic stress. Assumption leads one to believe that the chronic stressors must be really intense though not much has been done to determine the intensity.
Hassles are the normal happenings we encounter daily but they are stressful. They help determined sources of stress i.e., long term and ongoing. Hassles do not vary widely in their intensity but as defined they are interactions with the environment that are of low intensity.
Uses of the concept stress
Stress is activated by a lot of activities and things which differ from one culture and race to another depending on the kind of activities the individuals are exposed to. The stressful events are associated with physical and psychological constraints. Health Problems have resulted from the work conditions that people are exposed to like increased responsibilities and tight demands that people have to meet. Selye (1985) has it that stress is non-specific for it may result from different factors combined.
Some models portray stress as an indication that is likely to cause disruptions in the life of somebody. This particular model brings together internal and external factors and shows their interactions. It therefore bridges the relationship between the individuals and the environment that they interact with on daily basis. It helps us understand that the way in which one appraises the event determines the magnitude of stress. The stressors have different reactions to different persons and have different results to different individuals e.g., some may produce anxiety and others excitements. This kind is a theory brings out the motivational aspect of stress.
Some studies have found that some factors like race, marital status, and sex among others are the causative aspects of the different kinds of stress there is. The different positions held by people in the society which defines their social economic variations affects how people deal with the issues that they face in life. It has been verified that the socio-cultural structures has highly influenced the individual person’s influence of stress.
The society has been found very relevant in putting up the standards of the things which cause stress and the things perceived to be stressful. The same society comes up with the measures to take to avoid or overcome stress. Therefore if the members of the society follow the dictation of the society to the later they are doomed to the failures exhibited by the society (APA, 2010).
Due to this note differences it call for the definition of stress which takes much of the physiological and the cognitive domains be revised to incorporate the social and the cultural aspect to make if more appropriate in this age. In another more precise mode stress illustrates unease emotional experience unto which the body responds physiologically, behavioral and biochemically.
Definition of stress
The term stress has varying definition. The definition of stress is strain and pressure. The dictionary gives many definitions which all depicts a constraining force or influence. The definitions also depict the consequences of the pressures on the victim. Seyle (1975), defined stress as any circumstance that threatens a person’s well-being and therefore the person burdened with the responsibility of coping with it. In His theory he identified the major types of stress as conflict, change, pressure and frustration.
Stress can be said to be any state in one’s life which interferes with the complete equilibrium of the domains of a human being which include the physical, mental and emotional. From the above definition it is clear that most of the times we are under stressful conditions in our lives and we have been able to manage these times. This definition puts us in a dilemma of thinking if there is good and bad stress for lack of equilibrium is normal in our day to day lives.
More precisely, anybody-change which may call for an emotional, physical or mental adjustment or response can be said to be a stress reaction. The aftermaths of stress are anger, anxiety, nervousness or a feeling of frustration. Bad stress involves changes that one has to keep up with when they are out of control while good stress is controlled stimulation. This therefore helps in the growth of an individual in life.
The term Stress has been applied in putting across situations characterized by negative feeling experienced by people. As mentioned earlier not all stress attributed responses are negative for a certain percentage of stress is very crucial for survival. A good example of a crucial stressful moment is during birth all over the world it’s termed as one of the most stressful situation in life. According to Bernard & Krupat (1994), this stress is very important for it prepares the baby for the outside world. Some amount of stress is therefore vital for the survival but extended stress can cause bad effects.
In the heath fraternity stress has been seen as physiological and neurological reactions which give a functionally adaptive service (Franken, 1994). In the recent past the research on stress has been directly related to body reactions towards stress and the cognitive situations which have an effect to the view of stress. Through this series of studies it has come out clearly that different people subjected to the same stressful conditions respond differently to these situations.
According to Levi (1984), stress is the body’s general plan of keeping up with the influences, strains, demands and the changes which it is exposed to socially, mentally and physically. According to this definition the adaptation to external forces which cause discomfort especially caused by the individual’s inability to meet his needs according to the environment at the moment is stress.
Antecedents and consequences
Stress has a psychological focus which lies in its definition as a certain relationship where the interaction of the person with the environment goes beyond the available resources hence endangering the person. The primary baseline shows that the first phase of stress is defined by harm, challenge and the secondary considerations affirms more on the coping means and resources. The impact of stress is moderated by the factors like personality, health affecting lifestyles and some social factors.
The health impairing consequences of stress include poor nutrition, lack of exercise, and smoking which do not help improve the situation. The answer to developing for improvement is responding to stress physiological, emotionally and behaviorally. Stress has also an impact on the psychological functions for example low task performance or none, posttraumatic stress disorder (PTSD) and others. Physically it causes a condition referred to as type A behavior immune functioning and cancer.
Measurement issues of stress
Norbeck’s (1984) Life Event Questionnaire is the tool that has been used to determine stress. It’s a checklist of eighty items where the person is to indicate the things that have happened to their lives in the past year as guided by the questionnaire. The items calls for one to indicate good or bad and they are analyzed as of no effect to extreme effect.
The following categories are covered in the items; social matters, personal, school, close friends, health, love, family and others, they therefore handle all the domains of a human life (Sinha, 2008). The linker scale used gives three scores the sum of the negative events, a positive events score and the total score for the events.
Defining attributes
For one to distinguish stress from other concepts related to it, addressing the defining characteristics is very important. Stress can be defined exceptionally by five attributes. The first one is the presence of a feeling of threat or danger. The source of the danger may be known or unknown. This is followed by responses in all aspects like behavioral, psychological and physiological. The presence of the subjective responses is the fourth attribute while adaptation and coping behaviors climax the attributes.
Stress expressed is more defined; the expression prepares the person for the encounter of new stressors of stimuli. Neurophysiologic manifestations of stress are due to the sympathetic stimulation of the nervous system. These results to hormonal reactions and changes for example there is increased release of the adrenal hormone, gastrointestinal activities shoot. The person also sweats more in the palmer and there is dryness in the mouth. Most victims have increased alertness to the source of threat and mostly their concentration is focused on the threat.
Case presentations of the concept stress
The cases that are identified with stress are model case, related case, contrary stress and borderline case.
Model case
A professional woman was sitting alone after working hours in her office in the seventh floor of her workplace trying to finish some papers. Suddenly, this woman heard a fire alarm. She stood up to look through the window to get a grasp of what is happening. The sound of the alarm was irritating to the years. Without knowing what was going on she ran down the stairs instead of using the elevator. Getting to the front door she would not move out for she had left her clocking card in the office. She was sweating extremely and wasn’t composed. Back to the office she ran and sat down composed herself out and slowly put things in order and left.
Related case
A young man left his country to go for further studies in a foreign country. He started feeling symptoms of withdrawal and sleepless nights which he would not relate with anything for he had good company and no hassles for survival. But he explained this as a threat to his well being. There was no specific source that he could not relate it to anything in particular.
Contrary case
A teenager girl who is advised by the mother to avoid wrong company and friend but still she insists on doing it. She got information on maintaining good grades but she despites the good advice of the parents. His colleges in class would talk to her and try to convince her of the dangers of her behavior being such a bright girl in school. Finally some of the friends withdrew from the group after facing some challenges in their lives due to her company. She faced rejection and loneliness. The friends realigned their lives and left her in a miserable state.
Borderline case
This case is about a woman, who was so much fearful and ill at the same time. Have been deceased by her husband lived with her son. At night she used to keep on calling the son due to panic. The son move to another state and the mother kept on calling him at midnight. The son felt so helpless so moved the mother in to a new home with a helper. Though she was nicely treated and taken care of, she continuously lived in anxiety and the health condition did not change in fact it deteriorated.
Invented case
This is mostly out of fanaticizes and dreams. Joy a young daughter of a prominent man in the government was sleeping and at around 2.00 am she dreamt that she was a promotion examination. She could not handle any of the test questions. He started scratching her head and rubbing fingers. She kept on moving on her desk looking at the other students with the expectation they would help.
Conclusion
Therefore in conclusion management of stress begins with the identification of the causative factors which the person strategizes on how to bring them under control. Involving oneself in activities that keep one active is a small thing but has a lot of reward to reap. Some forms of mild anxiety and depression could be treated naturally or without any form of medicine through being active which makes the hormones in the body to be active also. When the level stress has exceeded the normal functioning of the body and taken a prolonged duration of time then it is advisable to seek professional attention before it deteriorates.
Reference List
American Psychological Association (APA). (2010). Stress in America Press Room US: A PA. Web.
Bernard, L. C., & Krupat, E. (1994). Health Psychology: Biopsychosocial Factors in Health and Illness. New York: Harcourt Brace College Publishers.
The contemporary working environment is characterized by stress. In all professions, people experience stress as a result of the demands of their works. Equally, nurses experience stress as a result of the demands of their job. Consequently, this affects their performance. Findings of previous studies indicate that stress levels of nurses have increased in the last decade and that this has been implicated on their performance.
Moustaka and Constantinidis (2010) point out that stress has been increasingly affecting nurses in the last decade. Although some causes of stress are specific to the institution and the role and type of work, it has been identified that other roles are general. They argue that, “High levels of stress result in staff burnout and turnover and adversely affect patient care” (p. 1). Therefore, it is evident that stress could lead to underperformance that would affect the way patients receive care and management of their conditions.
Considering this, it is therefore necessary that the causes of stress are identified. By understanding the causes of this stress, policy makers can design appropriate means of reducing the stress level and hence implicating positively on the performance of the nurses which would result to improved patient care. The study will hence focus on the main causes of stress among practicing nurses. Stress leads to poor performance by nurses. This leads to inadequate care for patients. Consequently, it leads to further complications that require much input in terms of time and finances. In addition, there is increased physical, psychological and emotional pain to patients.
Research Objectives
Given the impact of stress on the overall wellbeing of patients, this study intends to identify the overall stress level among nurses. Then, the study will try to pinpoint specific causes of stress among practicing nurses. Specific objectives of this study include identifying whether there is a relationship between other factors at home and workplace stress.
Research Questions
To attain the mentioned objectives, the following questions will be necessary. First, given the Holmes and Rahe Stress Scale, how many nurses score beyond the 300 mark? This question will assist in identifying the stress level of individual nurses and the overall institutional or role level. What factors in their lives do they find most pressing and occupying most of their thoughts? This question is necessary because it will identify the main causes of stress by the specific individuals. Do other factors outside the workplace have impact on the performance of the nurse? This question is important because it will assist in identifying role of work specific stress factors and other factors that do not work specific.
Significance and rationale
As argued earlier by Moustaka and Constantinidis (2010), stress has been increasing among nurses for the last one decade. Unfortunately, increase in stress means decrease in performance. It is therefore necessary to identify the main causes of stress so that a solution can be defined from these revelations. It is necessary to know a cause to find a solution.
Literature Review
Clancy and McVicar (2002) argue that workplace stress can be defined in terms of the perception of demand and the perception of their capacity to meet these demands. When there appears a mismatch between these two, the individual’s threshold becomes overstepped hence stimulating a response to the situation. Consequently, an individual’s chances of being stressed depend on the capacity of the threshold. This can be determined by his characteristics, the experiences that he has undergone in life, and the context of the demands. Given this argument, it is thus not true to argue that a single factor might act as a stressor in all nurses. Neither can a single factor be a stressing factor for a nurse at all time (MacKenzie, 2002).
In their argument on the effect of stress on performance, Healy and McKay (1999) argue that not all stages of stress can be detrimental. They emphasize the transition point that leads to severe distress. At this point, they argue, is where most detrimental and work inhibiting qualities of the nurse begin to appear. They conclude by highlighting the importance of identifying factors that promote transition. Being the most dangerous stage of stress, identifying factors that promote it would enable policy makers design ways of avoiding these factors. Consequently, fewer nurses will be subjected to these factors leading to fewer instances of severe stress and hence increased productivity.
In their argument, Plant, Plant and Foster (1992) argue that stress is an aspect that should be approached as a continuum. He identifies the four steps as psychological or physical indicator; this is the event that leads to excitement or fear. This leads to the second step which is eustress. This involves the increase in arousal or mental acuity. From this step, there is distress which is the third step of the continuum. This is the result of the reaction to mental acuity or arousal. It includes signs of emotional inclinations like unease, emotional instability, sadness, apprehension, fatigue, increased levels of alcohol consumption and smoking.
This leads to the final step of the continuum, severe distress. This leads to burnout. McGowan (2001) and Tyler & Ellison (1994) point out to the role of this continuum to an individual’s performance. In his argument, he argues that problems with performance start from the transition point between distress and severe distress. It leads to chronic absenteeism, poor health outfit, problems in retention of staff (Phillips, 1996).
Smith, Brice, Collins Mathews and McNamara (2000) point out on the importance of identification of stressing factors. In their argument, they purport that any stress intervention approach by any organization must be in position to identify the root cause of stress. Given the unpredictability of the nature of stressors in nursing, it is however difficult to identify the stressing factors in general. This finding is echoed by Healy and McKay (1999) who stress on the important role played by the transition to severe distress. They argue that the best stressors whose intervention can lead to reduction of stress level are those that lead to transition to severe distress (Smith & Gray, 2001).
French, Lenton, Walters and Eyles (2000) contribute to the importance of identification of stressing factors that would lead to severe distress. They offer a wide range of possible stressors within the greater field of nursing. Among them was friction with physicians, lack or insufficient preparation before undertaking a task, misunderstandings with peers, collision with supervisor, intensity of workload, cases of discrimination, patients’ death and family issues.
These are identified as major factors that lead to stress among practicing nurses. MacKenzie (2002) builds on these factors by pointing out that they contribute greatly on transition to severe stress. However, he argues that it is necessary to understand that the effect of these factors varies from one individual to the other. Furthermore, there are expected temporal changes within the factors. This could further lead to variability of their effect on the individual.
Methodology
This study will involve a random sampling where nurses will be chosen randomly from different institutions. Practicing nurses from both gender and will be used in this study. Individual ages of the nurses will not be a great factor, but the period of service will be considered. This will be important in identifying the level of experience that the nurse has. The nurses will also be required to specify their marital statuses.
This will be relevant in identification of domestic roles in stress determination. It will be important to identify the level of stress within married nurses and their single counterparts. In addition, married nurses with children will be measured against married nurses without children. There will also be the identification of the level of education and the job scale. It will involve nurses on the whole continuum of service. It will involve senior nurses down to the student nurses. This will be necessary to identify whether the level of career can contribute to stress or not.
Given that the chosen data collection method is the use of interviews and questionnaires, identification of pertinent question that would lead to answering of the research questions is necessary. To properly meet the research objectives, the questions will be arranged in two major groups. The first will be personal information and the second will be professional information. Identification of personal information is necessary because it will allow the researcher to know the way the nurse lives at home. It is through such information that some stresses that originate from domestic environment will be separated from actual workplace stress.
The questions in this category will include marital status, number of children if any, profession of husband, age of children, et cetera. Professional part will include questions pertinent to the type of work done. This will include the number of years she has been in service, the level of her education, the type of patients he deals with, the shift in question et cetera.
Design Model
The main objective of the study was identification of the causes of stress for practicing nurses, the most important step was a model to identify the level of stress. Nurses will be required to answer some questions that will be assessed upon the Holmes and Rahe Stress Scale to identify the level of stress that the respondent has. The scale will be necessary for the identification of stress level which will be a variable in the whole study. It will be determined against causes to identify the role of a cause and its intensity on the individual.
Respondents will then be made to identify the factors that they think would affect their productivity. The effects of these factors will further be placed within a continuum that will identify the factors as very weak, weak, strong and very strong. Within this scale, it will be possible to identify the effect of the given factor in relation to the level of stress. Increased level of stress will be analyzed to show the main causes that would have led to increased stress.
Being a qualitative research, the study shall employ the use of structured questionnaires to identify the position of respondents. Respondents will be given a chance to identify causes and the intensity of their impact on the working ability of the respondent. The received data shall be analyzed on the scale of that will identify very, weak, strong or very strong. The intensity and impact of each cause shall be identified depending on its rating on the response from the respondent. This shall be compared with the respondent’s measure on the Holmes and Rahe Stress Scale. The identified impact will be used against the number of time it appears in the respondent’s daily schedule.
This will then be followed by the determination of frequency of the factor. All these variables shall be measured against the level of stress. Using this approach, it shall be possible to identify main causes of stress on practicing nurses.
Summary and Conclusion
The effect of stress on performance is great and negative. It is therefore necessary to avoid stress among nurses to avoid underperformance that leads to deaths among patients. On the other hand, not all stages of stress cause negative effects. Studies point out that stress should be taken as a continuum. It contains various stages that vary in impact. The most destructive stage is the transition towards severe stress. To avoid negative effects of stress, it is necessary to avoid every factor that tends to promote this transition. By curbing the development of stress, it will be possible to reduce the rate of deaths that occur as a result of negligence of nurses. It will also reduce absenteeism and employee turnover. It is therefore necessary that policy makers ensure that factors that cause stress are identified.
Reference List
Clancy, J. & McVicar, A. (2002). Physiology and Anatomy: A Homeostatic Approach. London: Arnold.
French S.E., Lenton R., Walters V. & Eyles J. (2000) An empirical evaluation of an expanded nursing stress scale. Journal of Nursing Measurement 8, 161–178.
Healy, C. & McKay, F. (1999). Identifying sources of stress and job satisfaction in the nursing environment. Australian Journal of Advanced Nursing, 17, 30 – 35.
MacKenzie L. (2002) Lessons from the past. Nursing Standard 16, 20–21.
McGowan B. (2001) Self-reported stress and its effects on nurses. Nursing Standard 15, 33–38.
Moustaka, E. & Constantinidis, T. (2010). Sources and effects of work related stress in nursing. Health Science Journal, 4(4), 210-216.
Phillips S. (1996) Labouring the emotions: expanding the remit of nursing work? Journal of Advanced Nursing 24, 139–143.
Plant, L., Plant, A. & Foster, J. (1992). Stress, alcohol, tobacco, and illicit drug use among nurses: A Scottish study. Journal of Advanced Nursing, 17, 1057-1067.
Schmitz N., Neumann W. & Opperman R. (2000) Stress, burnout and locus of control in German nurses. International Journal of Nursing Studies 37, 95–99.
Smith A., Brice C., Collins A., Mathews V. & McNamara R. (2000) The Scale of Occupational Stress: A Further Analysis of the Input of Demographic Factors and Type of Job. Norwich: HSE Books.
Smith P. & Gray B. (2001) Reassessing the concept of emotional labor in student nurse education: role of link lecturers and mentors in time of change. Nurse Education Today 21, 230–237.
Tyler P.A. & Ellison R.N. (1994) Sources of stress and psychological well-being in high-dependency nursing. Journal of Advanced Nursing 19, 469–476.
The Wholeness meeting was held on January 14, 2015, to deal with stress in school. The Doctor of Medicine, director of the adult service at Loma Linda behavioral medicine center, was the guest speaker. The major objectives of the meeting were to know stress reactions and the accumulation of stress on students. The information the MD delivered was quite approving and very helpful for students to help them in their studies. The speaker informed the audience about the effects of stress. They include: causing blood platelets to clot due to change in shape from circular to spikey, compromises mild stress and person’s body’s defense mechanism, as a result of an increase in sugar and carbohydrates levels, one’s collagen and cartilage gets firmer. Serious stress affects one’s hippocampus as well as decreases a person’s short memory. Traumatic stress may lead to memory loss and lessen memory retention. Panic stress, which is commonly observed in students, kills brain cells at a low pace. Stress leads to cancer, abnormal pain, an increase in the rate of the breathing system, and a reduction of desire for sex.
The audience was advised to understand their personality. Various personalities respond to stress differently. Introverts, when depressed, isolate themselves and even have suicidal thoughts. Extraverts’ personalities relieve stress themselves by interacting with other people. Judgers’ personalities are generally activity-oriented, fast decision-makers, produce to perform lists, get their function done before taking part in, and are not really procrastinators. Perceiver’s personality mix work and entertainment together, tend to be encouraged by deadlines, appreciates liberty, tends to be explorers, and therefore is unstable. They may be more vulnerable to chronic diseases. Sleeping approximately 8 hours per night, doing exercises and some sport once a week, proper nutrition, doing what makes one happy and laughing to increase oxygen and rapid blood flow, meditating for several minutes, taking a variety of healthy diet such as a lot of fruits, taking regular breaks and sleeping, trying to see positive side can help reduce stress.