Category: Stress

Abstract

The purpose of this paper is to develop a middle-range nursing theory by utilizing the process of theory derivation. Theory derivation is the mechanism that was employed in this project in which a procedure and process that offered an efficient mechanism to understand a phenomenon that had previously lacked description in nursing. The steps of this process are outlined, concluding with definitions and a description of the middle range theory of unified trauma theory of high-stress fatigue, which was developed. In the conclusion of this paper, the implications for nursing are discussed along with areas where further research may contribute to a broader understanding of this phenomenon.

Introduction

Traditionally, the evaluation of trauma care mainly focused on survival, complications and the length of hospital stay as the main contributing factors. However, the mortality rate in large populations of severely injured patients has tremendously declined in the past years by twenty percent (Bardenheuer et al, 2000, p. 355). Nevertheless, the importance of both short-term and long-term outcomes after major trauma has become of global concern in the recent past due to the ongoing development of sophisticated trauma care (Holbrook et al, 1999, p. 751). Researchers have also found out that post-injury functional limitation is a clinically significant complication in trauma patients at discharge and 6-month after follow-up (Holbrook et al, 1999, p. 767). All the same, post-injury depression, serious extremity injury, and the period of stay in the intensive care unit also have a significant impact on the quality of well-being outcome (Holbrook et al, 1998, p.321).

Holbrook et al. 1998 in the first report provided novel and challenging evidence that the importance of dysfunction after major injury had been underrated (p. 322). Little is, however, known to have an empirical foundation to guide the understanding of the phenomena. Although many experiences of trauma patients have been described in the literature, no theories have been found to describe the patients’ experiences after discharge and more Specific on the impact of high-level stress and fatigue that it comes with.

Furthermore, the possibility that IL-6 might participate directly or indirectly in the symptomatology of fatigue in trauma patients is more fascinating and worth further investigation. This is especially due to the lack of evidence about predicting sickness behavior symptoms in early trauma patients. Investigation of IL-6 may also provide valuable information for the prediction of sickness behavior symptoms as early as possible in trauma patients.

Theory derivation is therefore essential in gaining a better explanation and predictions about a phenomenon that is currently poorly understood, or lacks present means of studying (Walker and Avant, 2010, p.241). Theory derivation can help nurses modify a theory from another discipline to creatively develop a theory related to nursing. The steps in theory derivation are not linear and require repetition until the developed theory is suitably inclusive (Walker & Avant, 2010, p. 250). Therefore, the purpose of this paper is to develop a middle-range nursing theory utilizing the process of theory derivation. The theory derivation process was utilized to help in offering an efficient mechanism to understand a phenomenon that had previously lacked proper description in trauma nursing. Throughout this paper, the steps of this process are outlined, concluding with definitions and a description of the middle range theory of unified trauma theory of high-stress fatigue, which was developed. This derived theory represents promising areas in cytokine, psychoneuroimmunology, and trauma research. At the end of this paper, the implications for nursing are discussed along with areas where further research may contribute to a broader understanding of this phenomenon.

Background and Significance

The basic principle of Psychoneuroimmunology (PNI) is that an individual’s adaptive response to the environment involves coordinated interactions between the nervous, endocrine, and immune systems. The biological pathways that connect the brain to the cells and tissues of the immune system include direct innervations of lymphatic tissue by the central nervous system and a shared communication network in which cells of the nervous, endocrine, and immune systems use common molecules and receptors to jointly modulate biological activity. An expanding body of evidence suggests that emotions play a big role in the development and progression of disorders that involve immune processes (Myers, 2008, p.701). Furthermore, accumulated evidence in the research field of PNI has indicated that there is an existence of reciprocal communication pathways between nervous, endocrine and immune systems (Schiepers et al, 2005, p.215).

The adverse physiological and psychological traumatic event is bound to induce a series of reactions. These reactions include; sustained proinflammatory cytokine production and persistent pro-inflammation-based behavioral symptoms such as fatigue, poor sleep, and depressive mood in trauma patients (Irwin, 2008, p. 96). There is evidence confirming that trauma patients exhibit elevations in pro-inflammatory cytokine production, especially IL-6 (Segal et al, 1997, p. 46).

Peripheral proinflammatory cytokines are capable of signaling the brain to induce behavioral symptoms like fatigue, sleep disturbance and depressive mood (Dantzer, 2001a, p.228: Dantzer, 2004a, p. 400.: Dantzer and Kelley, 2007, p.157: Myers, 2008, p. 805). Cytokine-to-brain signaling provides a theoretical base consistent with the evidence demonstrating an association between proinflammatory cytokines and behavioral symptoms of fatigue, sleep disturbance and depressive mood (Foex et al, 1993, p. 373). Pro-inflammatory cytokines such as IL-6 play a significant role in developing depression and can mediate its psychological, behavioral and neurobiological manifestations (Dantzer et al, 2010, p.312).

The cytokine hypothesis of depression recommends that external psychological stressors and internal organic inflammatory diseases or condition stressors induce the inflammatory process (Schiepers et al, 2005, p. 216). Additionally, it has been shown through research that psychological stress might induce an inflammatory response with increased production of pro-inflammatory cytokines (Maes et al, 1999, p. 834). Cytokines had been shown to induce behavioral changes related to some symptoms of depression causing neuroendocrine changes in animals that are similar to those in depressed patients (Wollman and Yirmiya, 2002, p. 189). (Biffl et al, 1996, p. 652) summarized the properties of IL-6 and characterized its response to injury. There are also clinical studies that describe the IL-6 response to trauma (Ayala et al, 199, p. 171: Kremer et al, 1996, p. 269: Maruszynski and Pojda, 1995, p. 883: Ohzato et al, 1993, p. 1560: Segal et al, 1997, p. 43). However, despite the fact that IL-6 is considered to be a mediator of the physiologic short-term phase reaction to injury, excessive and prolonged post injury elevations are associated with increased morbidity (Gebhard et al, 2000, p. 292).

“The result of a hyperactive proinflammatory state marked by excess production of proinflammatory cytokines such as IL-1, IL-6 and TNF and IFN gamma may contribute to the pathogenesis of various human diseases such as allergy, autoimmunity, obesity, depression and atherosclerosis” (Sternberg, 2006, p. 146). It is thus theorized that cytokines released in response to infection or inflammation alert the brain to any real or potential threats and initiate behaviors that are thought to be important for survival (Frink et al, 2009, p. 78). Some even refer to the ability of the immune system to alert or communicate with the brain as a “sixth sense” (Blalock and Smith, 2007, p. 109). Sickness behavior is believed to be adaptive in that it forces an individual to rest and withdraw from activities so that physiological processes can more effectively produce healing (Blalock and Smith, 2007, p. 110). It is now known that proinflammatory cytokines released during infection, inflammation, injury and even psychological stress can signal the brain to initiate behavioral changes that facilitate adaptation to these threats. And as mentioned earlier, cytokine-to-brain signaling has been implicated in mood disorders, particularly depression and fatigue that accompany illness (Dantzer, 2009, p.262).

In summary, it can be evidenced that there is compelling evidence to implicate cytokines’ role in fatigue. The investigation of acute circulating inflammatory markers’ responses is a fruitful area that may provide insight into the role of psychoneuroimmunological processes in trauma patients (Johnson et al, 2005, p.79). Therefore, the purpose of this paper is to explain the theory derivation process, provide an overview of the parent theory of “unified engineering theory of high stress level fatigue” which was utilized in this project as well as to present a new middle range theory of unified trauma theory of high stress level fatigue.

Theory Derivation Process

Theory derivation is an efficient and useful way to develop theory in an area of interest to the discipline when there is a lack of a structural representation of related concepts that are significant to practice. The process of theory derivation involves assessing the equivalence of a theory in a related field, where the explanation and understanding of the phenomenon in that field offers insight and an improved comprehension to areas in one’s own discipline. It is through the analogous process of assessing and comparing related work from outside the discipline that one can gain an improved comprehension and perspective in an area of practice that has not been well defined or articulated. The theory that is utilized from an associated field is modified to fit the new field. Sets of inter-related concepts or pieces of the fundamental elements of the theory structure are revised and transferred to the new field, where there is a more cohesive and systematic view of a phenomenon that previously lacked description (Walker and Avant, 2010, p.180).

There are several steps that are involved in theory derivation. The process begins with being aware of the theory development that currently exists within the profession. If there is adequate and useful theory available, this process would be excessive and unnecessary. One needs to be familiar with the literature related to the phenomenon. The next step in this process is to choose a parent theory, which is usually a theory from another field of practice. The established theory from outside of the discipline offers resourceful information on the phenomenon of interest that is being examined. Once the parent theory is chosen, the author determines relevant information from the parent theory and incorporates either all of the theory or only those parts that are relevant to the derived theory. The final step in theory derivation is to define the relevant concepts and structure from the parent theory. The author then refines and develops concepts, assumptions and theoretical propositions for the purpose of applying the derived theory to the phenomenon of interest in nursing. This process of deriving theory provides the nursing profession with a method for developing new knowledge and gaining a deeper understanding of the phenomenon of interest (Walker and Avant, 2010, p. 112).

Parent Theory

• Scope of theory: Valluri (1961, p.18), proposed “A unified engineering theory of high stress level fatigue” which enables an understanding and allows prediction of the various aspects of fatigue from the same basic model. The proposed model combines certain features of dislocation theory of metals with elasto-plastic analysis of the stress distribution near a crack, and determines an estimate of fatigue life to failure based on estimates of the rate of crack transmission.
• Assumptions: The assumptions of this model include:
  • “ This theory predicts the shape of the familiar stress versus number of cycles curve extending from one fourth of a cycle at the ultimate static tensile strength down to several million cycles and incorporates no additional assumptions in predicting cumulative damage during fatigue” (Valluri, 1961,p. 19).
  • “The theory distinguishes the order of application of stresses in cumulative damage. The weighting factor frequently associated with high stress levels in cumulative damage is implied in the basic model itself” (Valluri, 1961, p. 19).
  • “The theory also discusses the dependence of fatigue upon the several commonly observed variables, some quantitatively and some qualitatively, as well as residual static strength in fatigue and its dependence on material properties” (Valluri, 1961, p. 19).
  • “The inherently statistical nature of the fatigue problem is emphasized and this is attributed to an internal stress existing at the level of the pattern structure” (Valluri, 1961, p.19).
  • “This stress is thought to be due primarily to the existence of a network of dislocations and the solute atoms of alloying elements”. (Valluri, 1961, p. 19).

Concepts and definitions

• Damage in stress- controlled fatigue is defined as the product ‘equivalent’ surface crack length of the longest strain range, both in exponential form (Fatemi and Yang, 1998, p. 17).
• Crack: “the concept of crack is well developed in the engineering discipline and it is defined as a fracture type discontinuity characterized by a sharp tip and high ratio length and width to opening displacement. More so, a line of fracture without completes separation.” (Davis, 1992, p.69).
• Stress: stress in engineering is defined as the load exerted by a force divided by the capacity of the material to resist. More precisely, it is the load in relation to capacity to resist (Rothbart, 2006, p. 105).
• Fatigue: the concept of fatigue in engineering refers to the behavior of materials under the actions of repeated stresses and train. It is defined as the progressive structural damage occurring in a material subjected to conditions that produce fluctuating stresses and strains at some points that may result is cracks or complete fracture after sufficient number of fluctuation (Stephens and Fuchs, 2001, p. 164).
• Structural failure: “is defined as the reduction of the capability of a structural system or component to such a degree that it cannot safely serve its intended purpose. Precisely, it is the system or the components inability to sustain the load for which it was designed.” (Janney, 1986, p. 89)

Derived Theory for Nursing

Scope of theory

In the process of theory derivation, the author may use the entire parent theory or only those portions that are pertinent to the concept of interest (Walker and Avant, 2010, p. 78). The parent theory of “unified engineering theory of high stress level fatigue” was utilized in the development of this middle range theory that includes the linear structure of the theory and the concepts. The proposed “unified trauma theory of high stress level fatigue” encompasses the concept of fatigue which is dependent on previous cracks, high stress level, sustained proinflammatory cytokine production (IL-6), the cluster of other symptoms such as depression and poor sleep. It emphasizes that the high stress is primarily due to the existence of physiological and psychological traumatic event. These physiological and psychological traumatic events lead to high stress level and sustained proinflammatory cytokine production (IL-6). External interventions can avoid fatigue and buffer the effect of stress before fatigue occurs. Success or failures of external interventions (buffers) are the determining factors if the trauma patient will be fatigued. Crack is another important concept in the theory, where the result of previous cracks before the injury such as previous psychological or physical health may impact susceptibility and resistance to fatigue. Precisely, the more previous cracks exist, the more the patient is susceptible to fatigue. For instance, the trauma patient can have no cracks or zero cracks. This theory therefore proposes that stressors will not latch on in the absence of cracks.

The purposes of this middle range theory development are to provide trauma nursing with an improved understanding of the various aspects of stress and fatigue with the consideration of previous cracks and the impact of buffers referred to as the external interventions. Most importantly, this theory emphasizes on the importance of assessing fatigue in trauma patients as follow up measures after discharge, because if fatigue is left unchecked, it will lead to deterioration and worsening health outcomes. This proposed theory emphasizes the importance of developing nursing interventions that can be efficiently targeted to improve outcomes of trauma patients after discharge and buffer stressors. Assessing fatigue and stress is essentially a valuable in tool determining the success and evaluation of external therapeutic intervention

Concepts and definitions

There are four derived concepts from the parent theory in unified engineering theory of high stress level fatigue. A model that represents the image of the middle range theory of unified trauma theory of high stress level fatigue included in the Appendix. The four concepts include:

• Crack: the person’s state before the injury, which includes the previous mental (emotional) and physical health before the event of injury.
• Stress: it can be defined as a negative emotional experience accompanied by predictable biochemical, physiological, and behavioral changes that are directed toward adaptation either by manipulating the situation to alter the stressor or by accommodating its effects (Baum, 1990, p. 654). In the proposed theory, stress is defined as the impact of trauma or rather how the stressor has an effect on the person. In relation to the type of injury to the person physiologic state whether it is going to have an effect or not.
• Fatigue: originally fatigue is defined as a multidimensional experience characterized by distress and decreased functional status related to a decrease in energy (Stein et al, 2004, p. 21). Fatigue is experienced across 5 domains; general, emotional, physical, mental, and vigor domains (Stein et al, 2004, p.22). In the proposed theory, Fatigue is defined as the person’s response to the stressors and the inability for the person to reach for external interventions that would buffer the effect of stressors and be successful. Fatigue eventually leads to deterioration.
• Deterioration: is defined as the worsening of the patient’s condition after experiencing fatigue.

Assumptions

There are three proposed assumptions for the derived theory, which include: 1. Damage is cumulative, 2. Fatigue is statistical. 3. Dislocation occurs in networks.

Propositional Statements

Propositional statements indicate the relationships between the main conceptual ingredients of the theory (Polit and Hungler, 1987, p. 360). In the unified trauma theory of high stress level fatigue there are five relational statements. Which include:

• Fatigue is dependent on previous cracks, high stress level, sustained proinflammatory cytokine production (IL-6), and the cluster of other symptoms such as depression and poor sleep.
• Physiological and/or psychological traumatic events lead to high stress level and sustained proinflammatory cytokine production (IL-6)
• Fatigue can lead to deterioration
• External interventions can buffer the effect of stress before fatigue occurs and avoid fatigue.
• More cracks leads to more susceptibility and resistance to fatigue.

Significance in Nursing

• Potential Utility in Practice: This theory provides new insights for clinical practice and enhances the ability to support individuals with after traumatic events. It also provides clinicians with a useful theoretical framework to guide them through their practice. It provides new information that stimulates research questions where we are provided with the opportunity for scientific inquiry. It is through continued examination and data becoming substantiated over time that we become confident in recognizing new knowledge.
• Potential Utility in Research: The derived theory can help in designing a conceptual model for a research program, as it can also provide a rich source of potential hypotheses for studies. It is hoped that it can help in achieving a body of knowledge about the phenomena of interest. Further research that would aid in testing this theory would be to implement it in clinical practice and measure the relation between the fatigue and stress in trauma patients. Both should be targeted by early treatment interventions and neurobiological research. Lastly, the model could serve well in the development of fatigue and stress measurement tools specific to trauma patients. The goal is to improve the health of trauma patients after discharge for better functional outcomes. This theory could be used for routine screening of trauma patients to identify the risk for fatigue.

Conclusion

Theory derivation process has been helpful in offering an efficient method to understand the phenomenon that had previously lacked description in trauma nursing. It is hoped that the proposed unified trauma theory of high stress level fatigue can provide a framework for understanding trauma patients.

Reference List

Ayala, A., Wang, P., Ba, Z. F., Perrin, M. M., Ertel, W., & Chaudry, I. H. (1991). Differential alterations in plasma IL-6 and TNF levels after trauma and hemorrhage. The American Journal of Physiology, 260(1 Pt 2), R167-171.

Bardenheuer, M., Obertacke, U., Waydhas, C., Nast-Kolb, D. (2000) Epidemiology of Severe Multiple Trauma- A Prospective Registration of Preclinical and Clinical Supply. Unfallchirurg, 103,355–363.

Baum, A. (1990). Stress, intrusive imagery, and chronic distress. The Journal of health psychology, 9(6), 653-675.

Biffl, W. L., Moore, E. E., Moore, F. A., & Peterson, V. M. (1996). Interleukin-6 in the injured patient: Marker of injury or mediator of inflammation? Annals of Surgery, 224(5), 647-664.

Blanchard, E. B., Hickling, E. J., Freindenberg, B. M., Malta, L. S., Kuhn, E., & Sykes, M. A. (2004). Two studies of psychiatric morbidity among motor vehicle accident survivors 1 year after the crash. Behaviour Research and Therapy, 42(5), 569-583.

Blanchard, E. B., Hickling, E. J., Taylor, A. E., & Loos, W. (1995). Psychiatric morbidity associated with motor vehicle accidents. The Journal of Nervous and Mental Disease, 183(8), 495-504.

Blaszczynski, A., Gordon, K., Silove, D., Sloane, D., Hillman, K., & Panasetis, P. (1998). Psychiatric morbidity following motor vehicle accidents: A review of methodological issues. Comprehensive Psychiatry, 39(3), 111-121.

Bob, P., Raboch, J., Maes, M., Susta, M., Pavlat, J., Jasova, D., Vevera, J., Uhrova, J., Benakova, H., & Zima, T. (2010). Depression, traumatic stress and interleukin-6. Journal of Affective Disorders, 120(1-3), 231-234.

Dantzer, R. (2001a). Cytokine-induced sickness behavior: Mechanisms and implications. Annals of the New York Academy of Sciences, 933, 222-234.

Dantzer, R. (2001b). Cytokine-induced sickness behavior: Where do we stand? Brain, Behavior, and Immunity, 15(1), 7-24.

Dantzer, R. (2004a). Cytokine-induced sickness behaviour: A neuroimmune response to activation of innate immunity. European Journal of Pharmacology, 500(1-3), 399-411.

Dantzer, R. (2004b). Innate immunity at the forefront of psychoneuroimmunology. Brain, Behavior, and Immunity, 18(1), 1-6.

Dantzer, R. (2009). Cytokine, sickness behavior and depression. Immunology and Allergy Clinics of North America, 29(2), 247-264.

Dantzer, R., & Kelley, K. W. (2007). Twenty years of research on cytokine-induced sickness behavior. Brain, Behavior, and Immunity, 21(2), 153-160.

Dantzer, R., O’Connor, J. C., Freund, G. G., Johnson, R. W., & Kelley, K. W. (2008). From inflammation to sickness and depression: When the immune system subjugates the brain. Nature Reviews Neuroscience, 9(1), 46-56.

Dantzer, R., O’Connor, J. C., Lawson, M. A., & Kelley, K. W. (2010). Inflammation-associated depression: From serotonin to kynurenine. Psychoneuroendocrinology, 16(8), 27-29.

Dantzer, R., Wollman, E. E., Vitkovic, L., & Yirmiya, R. (1999). Cytokines, stress, and depression: Conclusions and perspectives. Advances in Experimental Medicine and Biology, 461, 317-329.

Dantzer, R., Wollman, E. E., & Yirmiya, R. (2002). Cytokines and depression: An update. Brain, Behavior, and Immunity, 16(5), 501-502.

Davis, J. (1992). ASM materials engineering dictionary. ASM International. ISBN 0871704471, 9780871704474.

Fatemi, A. & Yang, L. (1998). Cumulative fatigue damage and life prediction theories: a survey of the state of the art for homogeneous materials. International Journal of Fatigue, 20 (1), 9-34.

Foex, B. A., Lamb, W. R., Roberts, T. E., Brear, S. G., Macartney, I., Hammer, M., & Brenchley, P. E. (1993). Early cytokine response to multiple injury. Injury, 24(6), 373-376.

Frink, M., van Griensven, M., Kobbe, P., Brin, T., Zeckey, C., Vaske, B., Krettek, C., & Hildebrand, F. (2009). IL-6 predicts organ dysfunction and mortality in patients with multiple injuries. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 17, 49.

Gebhard, F., Pfetsch, H., Steinbach, G., Strecker, W., Kinzl, L., & Brückner, U. B. (2000). Is interleukin 6 an early marker of injury severity following major trauma in humans? Archives of Surgery (Chicago, Ill.: 1960), 135(3), 291-295.

Holbrook, T., Anderson, J., Sieber, W., Browner, D., Hoyt, D. (1999). Outcome after major trauma: 12-month and 18-month follow-up results from the Trauma Recovery Project. Journal of Trauma, 46(5):765-771.

Holbrook, T., Anderson, J., Sieber, W., Browner, D., Hoyt, D. (1998). Outcome after major trauma: discharge and 6-month follow-up results from the Trauma Recovery Project. Journal of Trauma, 45(2):315-323.

Janney, J. (1986). Guide to investigation of structural failures. ASCE: New York.

Kelley, K. W., Bluthe, R. M., Dantzer, R., Zhou, J. H., Shen, W. H., Johnson, R. W., & Broussard, S. R. (2003). Cytokine-induced sickness behavior. Brain, Behavior, and Immunity, 17(1), 112-8.

Kremer, J. P., Jarrar, D., Steckholzer, U., & Ertel, W. (1996). Interleukin-1, -6 and tumor necrosis factor-alpha release is down-regulated in whole blood from septic patients. Acta Haematologica, 95(3-4), 268-273.

Maes, M., Lin, A. H., Delmeire, L., Van Gastel, A., Kenis, G., De Jongh, R., & Bosmans, E. (1999). Elevated serum interleukin-6 (IL-6) and IL-6 receptor concentrations in posttraumatic stress disorder following accidental man-made traumatic events. Biological Psychiatry, 45(7), 833-839.

Maruszynski, M., & Pojda, Z. (1995). Interleukin 6 (IL-6) levels in the monitoring of surgical trauma. A comparison of serum IL-6 concentrations in patients treated by cholecystectomy via laparotomy or laparoscopy. Surgical Endoscopy, 9(8), 882-885.

Myers, J. S. (2008). Proinflammatory cytokines and sickness behavior: implications for depression and cancer-related symptoms. Oncology Nursing Forum, 35(5), 802-7.

Ohzato, H., Monden, M., Yoshizaki, K., Ogata, A., Nishimoto, N., Gotoh, M., Kishimoto, T., & Mori, T. (1993). Systemic production of interleukin-6 following acute inflammation. Biochemical and Biophysical Research Communications, 197(3), 1556-1562. Web.

Polit, D. & Hungler, B. (1987). Nursing Research: Principles and Methods (3^rd edition), Philadelphia: J.B. Lippincott Co.

Rothbart, H. (2006). Mechanical design handbook: measurement, analysis, and control of dynamic systems. New York: McGraw-Hill Professional. ISBN: 0071466363, 9780071466363.

Schiepers, O. J., Wichers, M. C., & Maes, M. (2005). Cytokines and major depression. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 29(2), 201-217.

Schnyder, U., Moergeli, H., Trentz, O., Klaghofer, R., & Buddeberg, C. (2001). Prediction of psychiatric morbidity in severely injured accident victims at one-year follow-up. American Journal of Respiratory and Critical Care Medicine, 164(4), 653-656.

Segal, J. L., Gonzales, E., Yousefi, S., Jamshidipour, L., & Brunnemann, S. R. (1997). Circulating levels of IL-2R, ICAM-1, and IL-6 in spinal cord injuries. Archives of Physical Medicine and Rehabilitation, 78(1), 44-47.

Shapira-Lichter, I., Beilin, B., Ofek, K., Bessler, H., Gruberger, M., Shavit, Y., Seror, D., Grinevich, G., Posner, E., Reichenberg, A., Soreq, H., & Yirmiya, R. (2008). Cytokines and cholinergic signals co-modulate surgical stress-induced changes in mood and memory. Brain, Behavior, and Immunity, 22(3), 388-398.

Stein, K. D., Jacobsen, P. B., Blanchard, C. M., & Thors, C. (2004). Further validation of the multidimensional fatigue symptom inventory-short form. Journal of Pain and Symptom Management, 27(1), 14-23.

Steptoe, A., Hamer, M., & Chida, Y. (2007). The effects of acute psychological stress on circulating inflammatory factors in humans: A review and meta-analysis. Brain, Behavior, and Immunity, 21(7), 901-912.

Stephens, R. & Fuchs, H. (2001). Metal fatigue in engineering. Canada: Wiley-IEEE. ISBN 0471510599, 9780471510598.

Valluri, S. (1961). A unified engineering theory of high stress level fatigue. Aerospace Engineering, 20, 18-l 9.

Valluri, S. R. ( 1961). A theory of cumulative damage in fatigue. Report No. ARL 1X2. Aeronautical Research Laboratory. Office of Aerospace Research. United States Air Force.

Walker, L. & Avant, K. (2010). Strategies for Theory Construction in Nursing. New Jersey: Pearson Education.

Data collection

The study aimed to understand the benefits of using the mindfulness-based stress reduction (MBSR) approach to reduce stress in nurses. Data were collected from nurses (n=25) working at Lehigh Valley Hospital and Health Network (LVHHN). The assessment was conducted for 8 weeks in the first quarter of 2004. The study adopted a quantitative method of data collection to ensure the application of many statistical computations (Cohen-Katz et al., 2005). Data were collected from nurses who could communicate in English and who did not have a history of suicide or substance abuse. The study participants were either assigned to the treatment group or control group. The qualitative stage of the study involved the analysis of 46 documents that were used to collect data from the study participants. The following tools were used to collect data:

1. “Getting to Know You Forms”
2. E-mails
3. Interviews
4. Focus groups
5. Final evaluation forms

The methods of data collection could allow study participants to provide wrong responses. For example, a respondent could provide a wrong answer to a question if he or she felt that the answer could expose her private life. To avoid this problem, the study could have used more methods of data collection. For example, the study could have employed observation to collect data. With this method, researchers could record the exact behaviors they observed in nurses participating in the study.

Data analysis

The data collected were analyzed using a thematic analysis of documents used to gather data. A codebook that accommodated 32 items was used to analyze data using a collaborative approach by the research team. To test the codebook, a random selection of 5 interview documents was used. Initially, the codebook method was found to be cumbersome to code all the 32 items in the study documents. To solve the problem, only 6 items were used in the coding process. An agreement was reached when about 2 or 3 researchers provided the same coding results. To ensure thoroughness in the data analysis, the principal investigator coded 41 documents, which were then assessed and verified by the entire research team. After the manual coding, data were entered into the computer and analyzed using NVivo software (Cohen-Katz et al., 2005). The research team erred in reducing the number of items in the codebook because the smaller number of items could have resulted in less accuracy of study findings. The study authors have not provided the type of statistical computations they conducted on the data. It is required that the study authors have to provide the names of statistical tests they use to analyze data.

Practical implications of the study

The study determined that female nurses were the most vulnerable to stress and burnout in the hospital. It was also demonstrated that the factors contributing to stress and burnout were more related to family issues than to work matters (Cohen-Katz et al., 2005). The study has practical implications in nursing care because nursing leaders would develop and implement strategies aimed to improve nursing care using the MBSR approach. The study is also important because it provides a list of questions to explore in the future to better apply MBSR in nurses.

References

Cohen-Katz, J., Wiley, S., Capuano, T., Baker, D. M., Deitrick, L., & Shapiro, S. (2005). The effects of mindfulness-based stress reduction on nurse stress and burnout: a qualitative and quantitative study, part III. Holistic nursing practice, 19(2), 78-86.

Introduction

In early life, health-related behaviors influence risks for disorders that relate to an individual’s lifestyle (Mikolajczyk, El Ansari & Maxwell, 2009). Therefore, it is important to explore young people’s health behaviors. In this respect, university students present a suitable sample to identify the relationship between their health habits, BMI, and stress levels. 9.5% of college and university students in the U.S are obese, as they fall in the ≤30kg/m2 BMI, range while 21.9% fall in the ≤25kg/m2 range, which signifies that they are overweight (Huang et a., 2010). International college students pursuing their undergraduate studies in the US tend to be overwhelmed by the new environment and lifestyles, which results in stress among them. In the US, “35% of the college students are obese or overweight” (Franz & Feresu, 2013, p. 10). This assertion implies that these students have adopted lifestyles that are detrimental to their health (Wardle, Haase & Steptoe, 2006). For instance, Asian international students in the US have reported significant cases of obesity in the new environment. In this regard, aspects such as dieting, physical activities, and BMI tend to cause stress among them during their studying period. Conducting a study to investigate the problem of BMI levels and stress among domestic and international students in the US is critical. This paper will explore the relationship between body mass index (BMI) and stress levels among college and university students in the US.

Assumptions

The study assumes that students in the highest BMI deciles are overweight and obese to facilitate the determination of their perceptions on body weight issues. Individuals in the lower deciles are assumed to be thin and their stress-related issues are not correlated with BMI (Franz & Feresu, 2013). The study also assumes that the samples under study are representative of the aspects of BMI and stress-related problems in all colleges and universities in the US.

Significance of the study

The study is significant since it seeks to explore the differences in BMI and stress levels among domestic and international students in the US. The study facilitates the determination of whether BMI is a factor that induces stress among undergraduate students studying in the US. Additionally, the research adds value to previous studies conducted to explore the relationship between BMI and stress amongst university students.

Limitations

Determining where the overweight begins in the middle BMI deciles is challenging, and thus it interferes with the uniformity of the sample population. There were limitations in the assessment of weight perceptions and weight-losing efforts since the number of items used to determine weight-related behavior was limited. Small sample sizes for studies conducted in particular universities limit the generalization of findings on BMI and stress levels among students in the US. Individuals tend to provide lower weight reports and over-report on their height, thus affecting the correct BMI measurements.

Literature Review

The Journal of American College Health published an article titled, “Assessing overweight, obesity, diet, and physical activity in college students” by Huang et al. (2010). The authors focus on conducting a study among college students to identify their physical activities, dietary habits, and obesity issues (Huang et al., 2010). The article provides information based on the BMI of students between 18 and 29 years of age. The study results indicate poor dietary habits as 18 to 24-year-olds consumed less than five fruit servings in a day. The dietary trend was noted among domestic and international students, especially from Asia. Obesity issues were attributed to inadequate participation in physical activities amongst college students.

The article, “Body image and weight control in young adults: international comparisons in university students from 22 countries” by Wardle et al., (2006), was published in the International Journal of Obesity and it is essential for this study. The authors observed that most “men in the upper BMI deciles were not aware that they were overweight, and thus they put less effort to lose weight” (Wardle et al., 2006, p. 649). Less than 75 % of overweight women in the higher BMI deciles endeavored to reduce weight (Wardle et al., 2006). However, in the US, the awareness levels were higher for both men and women in the upper levels as compared to the other 21 countries. The article is essential since it portrays the perceptions of male and female students in different deciles on their weight issues.

“Dieting Behavior of Asian College Women Attending a US University” by Tsai, Hoerr, and Song is another resourceful article published in the American Journal of College Health. The study conducted by Tsai, Hoerr, and Song (2010) portray how self-esteem and eating habits affect Asian college students pursuing their undergraduate programs in the US. In comparison to the domestic students, the Asian students were more affected by low esteem issues, which induced more stress resulting in low concentration in their studies. In this regard, the literature adds value to understanding how self-esteem issues related to obesity induce stress among Asian college students studying in the US.

Franz and Feresu (2013) authored the article, “The relationship between physical activity, body mass index, and academic performance and college-age student”, which is applicable to this study. The research was conducted to identify how BMI and physical activity affect the academic performance of university students. It was identified that students “in the average BMI categories scored highly in their ACT and GPAs as compared to the overweight category” (Franzl & Feresu, 2013, p. 9). Therefore, the study portrays that the performance of obese students including international students was average due to the emotional imbalances caused by the weight-related complexities.

An article by Futoshi Kobayashi, viz. “Academic achievement, BMI, and fast food intake of American and Japanese college students”, provides informative literature for use in this study. Kobayashi (2009) focuses on the relationship amongst three variables, viz. the BMI, the GPA, and fast food consumption amongst Japanese and American students. The results of his study indicate a negative correlation between GPA and BMI among American students, which is contrary to the Japanese students’ case. The Journal of Biomedical Sciences published an essential article that explains how dietary issues induce stress among Korean college girls. The article shows the correlation between poor nutrition and dietary habits and the induction of life stress among Asian students (Park, You & Chang, 2010). In this regard, poor nutrition and dietary habits among the Korean students indicated the obesity disparities as attributed to economic, cultural, and individual personality factors.

According to Serlachius, Hamer, and Wardle (2007), the study identifies the factors that induce stress among freshmen in the new environment coupled with how it contributes to high obesity rates in the UK. The study facilitated the comparison of the common risk factors that exist in the UK and the US, and thus it enhanced gauging the stress levels and the impact on academic performance.

The article “Gender differences in health habits and motivation for a healthy lifestyle among Swedish university students” considers the disparate lifestyles among students from different cultures including the US implying disparities in health habits. Von Bothmer and Fridlund (2005) also examine the “motivation for healthy living habits between male and female college students in Swedish universities” (p. 107).

The book, “Perspectives on Stress among College Students”, provides an examination of the factors that cause stress among culturally diverse students in various colleges and universities (Adigwe, 2008). The study sample for the examination of obesity and stress-related issues comprised Hispanic, African-American, and Caucasian students in a college based in Washington D.C. The study deduced that obese and overweight college students experienced varying levels of stress regardless of their cultural backgrounds. Additionally, the article, “Food consumption frequency and perceived stress and depressive symptoms among students in three European countries” is essential for this study since it facilitates a comparative analysis of eating habits and their implications on both mental and physical health. There are differences according to gender and country in the aspects of perceived stress, depressive symptoms, and food consumption frequencies (Mikolajczyk et al., 2009).

Study Design

The study design adopted utilized a mixed research design that combines descriptive and analytical methods. The descriptive methods are qualitative whereby data collection tools such as surveys are used to determine the students’ perspectives on their weight issues and stress levels. The analytic aspect of the research design adopted both parallel and crossover randomized groups. The measurement of height and weight for the determination of BMI included the use of measurement tools and asking the participants to give their reports. Statistical tools were used to determine BMI and GPA results among students in a bid to identify the correlation between weight aspects and stress results as depicted in the students’ academic scores.

Discussion

Based on the literature review, study research results have given meaningful findings on the correlation between BMI and stress among college and university students. Research results indicate that 78% of college students have replaced fruits servings with fast foods, which implies that they propagate their health-related risk factors that have implications for their physical and mental health. On the other hand, reduced physical activities among college students from different cultural and racial backgrounds increased their chances of obesity implying that they developed dissatisfaction with their physical appearance, thus resulting in stress (Tsai et al., 2010).

Analyzing the BMI results from various universities in more than 22 countries indicated that men in the lower deciles accepted that they were overweight and they worked towards losing weight. Women perceived themselves as overweight along the BMI deciles, but with inconsistent efforts towards weight loss (Wardle et al., 2006). In this regard, different perceptions on the weight issue tend to induce depression among males and females pursuing undergraduate programs in various universities. Consequently, men and women portray different mechanisms of coping with stressful situations. Domestic and international overweight students in the US tend to experience high levels of stress that affect their grades negatively. Poor dieting, lack of physical exercise, and post-modern lifestyles induce stressful experiences.

References

Adigwe, P. (2008). Perspectives on Stress among College Students: Stress and College Students. Saarbrucken, Germany: VDM Publishing.

Franz, D., & Feresu, S. (2013). The relationship between physical activity, body mass index, and academic performance and college-age students. Open Journal of Epidemiology, 3(1), 4-11.

Huang T., Harris K., Lee, R., Nazir, N., Born, W., & Kaur, H. (2010). Assessing Overweight, Obesity, Diet, and Physical Activity in College Students. Journal of American College Health, 52(2), 83-86.

Kobayashi, F. (2009). Academic achievement, BMI, and fast food intake of American and Japanese college students. Nutrition & Food Science, 39(5), 555-566.

Mikolajczyk, T., El Ansari, W., & Maxwell, A. (2009). Food consumption frequency and perceived stress and depressive symptoms among students in three European countries. Nutrition Journal, 8(1), 31-34.

Park, J., You, J., & Chang, K. (2010). Dietary taurine intake, nutrients intake, dietary habits and life stress by depression in Korean female college students: a case-control study. Journal of Biomedical Science, 17(1), 1-40.

Serlachius, A., Hamer, M., & Wardle, J. (2007). Stress and weight change in university students in the United Kingdom. Physiology & Behavior, 92(1), 548–553.

Tsai, C., Hoerr, L., & Song, W. (2010). Dieting Behavior of Asian College Women Attending a US University. Journal of American College Health, 46(4), 163-168.

Von Bothmer, M., & Fridlund, B. (2005). Gender differences in health habits and in motivation for a healthy lifestyle among Swedish university students. Nursing and Health Sciences, 7(1), 107–118.

Wardle, J., Haase, A. M., & Steptoe, A. (2006). Body image and weight control in young adults: international comparisons in university students from 22 countries. International Journal of Obesity, 30(1), 644–651.

Introduction

The nursing profession is laden with situations that can lead to stress if improperly managed. Coworkers need to collaborate to provide holistic care. Patients and nurses ought to work together to provide comprehensive care. Medical doctors must understand key aspects of the care process. If nurses inappropriately handle any of these situations, they could develop stress. Communication is one of the platforms for eliminating such misunderstandings and ensuring that nurses provide error-free care.

Communication skills choice to manage stress

I chose communication skills as a stress-management tool because it may minimize instances of poor patient safety. For instance, when one needs to carry out a bedside handover, effective communication is vital because it ascertains that the next batch of nurses understands patients’ needs. Communication failure could place patients’ safety at risk and this would increase stress levels (Christie & Robinson, 2009).

Intercultural issues may come in the way of effective service provision. A nurse who does not have a good command of the national language will have difficulties in understanding what patients, doctors, lab technicians, accountants, and other individuals have to say. This could lead to stress because one could have the right technical knowledge but lack the communication skills needed to apply them. As an international nursing student, I have come in contact with patients who do not understand my accent and have had difficulties when communicating with me. Unless one can assure the patient of their competence through effective communication, this could lead to rejection of the nurse and stress within the care environment.

In the process of providing care, nurses do not just work with patients; they also interact with family members and close associates. Communicating with this category of persons can go a long way in preventing potential mishaps and misunderstandings. For instance, a post-surgery patient may have developed complications during the surgical procedure. What seemed like a simple process may turn out into a problematic one that necessitates intensive care.

The family members of the patients could feel anxious about their loved ones and may also express concern about the hospital’s ability to care for the patient. If left untamed, this situation could lead to stress because the family members may be tempted to act impulsively. Nurses must use effective communication skills to analyze non-verbal signs in such family units (Waters & Whyte, 2012). They could detect this anxiety and alleviate it by reassuring the family members of their commitment to the patient’s recovery.

Importance of communication skills in my nursing program and my future profession

The nursing profession is one in which care is a central aspect of the vocation. Therefore, one’s ability to communicate can make the difference between perceptions of care or negligence among patients and other stakeholders. Nurses must come into contact with a series of people who express themselves differently. How the nurse engages and listens to them affects how well he or she responds to their needs.

Complaints can arise in nursing care from time to time. Patients may approach a nurse about a certain issue and the caregiver may need to respond immediately. Alternatively, administrators may notify nurses about a certain challenge that has arisen in the institution. Effective communication can create a culture of transparency in the institution because nurses would know how to deal with such situations. If it was an oversight on their part of the hospital, they could apologize and explain how the situation will not arise again. However, if it is a case of mismatched expectations, then the concerned nurse can still explain the limitations of care provision in the hospital.

Good communication will be essential in my profession because it will assist me in understanding patients’ emotional and physical needs. Pain alleviation, medical administration, and eradication of emotional worries can all be carried out effectively if a nurse is a good communicator. The person will seek creative ways of finding out about a patient’s situation. Effective communication is imperative in nursing because it builds trust between patients and healthcare providers such that they can stick to their prescribed treatments. Patients in healthcare institutions require a stress-free environment to recover fully. If their caregivers communicate effectively with them, then chances are that they would experience less stress. This may manifest in the form of physical outcomes such as low blood pressure or other tangible benefits (Wallis, 2011).

Examples of scenarios where effective communication alleviated stress

In one situation, I was responsible for the measurement of vitals during a morning round. I realized that most of the patients were going through the preset procedures and meeting the doctor as required. However, a group of three adults had been at the waiting station for close to two hours. One of them was an elderly person while the other two appeared to be in their mid-thirties. I decided to ask them into the measurement unit and explained what they were supposed to do. They told me that they had not bothered to submit their details to us because they had assumed that we would call out the patient’s name when it was her turn.

The group had started with the records department and had assumed that their information would be conveyed to us. Since there was a lot of traffic in the waiting area, they could not tell whether this was the right procedure or not. I explained that one must notify the measurement unit of their presence and then hand in documentation for the same. They seemed relieved after I furnished them with this information. If I had not asked them to enter the measurement unit, they would likely have continued to do the same. They might have reported the matter to my supervisor or continued to crowd the waiting area. This would have been a source of stress on my part and the patients.

During my third semester, I had to check on a diabetic patient’s medication. The concerned doctor asked me to ensure that he stuck to his treatment program. I was not sure how to go about it because I had not seen or cared for the patient before. As I was administering the medication, I engaged in small talk with him. I asked him whether it was his first time to be admitted because of the condition and he stated that it was not. He had been diabetic for over twenty years and had managed to keep the symptoms of the ailment at bay. However, this superficial situation caused him to become overconfident and he lost track of his nutritional regimen as well as his fitness goals. I asked him how the admission had affected his normal routine and he replied that it had interrupted his job as well as his family time.

I quickly established that the patient’s key motivation would be spending time with his family as well as staying at work. I devised a follow-up program in which I would visit the patient twice a week throughout his entire hospital stay; he promised to stick to the treatment program. Through light conversation and effective listening, I was able to extract useful information about the patient’s values. If he did not open up to me, I might have been unable to convince him to stick to treatment and this would have created conflict between his doctor and me.

In the third case, I had borrowed a personal digital assistant from a senior nurse. When using the device, a doctor rebuked me about it and claimed that I was wasting time on personal emails rather than focusing on patients’ needs. I was highly stressed about this because the doctor had misunderstood the purpose of the tool. At the end of the day, I explained to him that it was a personal digital assistant. Furthermore, I was using it to investigate movement strategies of patients with bedsores. Through appropriate use of tone and language, I got the doctor on my side and alleviated stress.

Conclusion

Effective communication can eliminate stress by ensuring patient safety. Nurses who communicate well with each other and other medical personnel will streamline transitions and protect patients from harm. It also assists in intercultural interactions between patients and nurses. Furthermore, communication leads to better health outcomes as it boosts treatment compliance, physical and emotional wellbeing of the patient, and also eradicates stress from family members who might object to a treatment issue. The case studies illustrate first-hand how communication skills prevent and dissipate stress.

References

Christie, P. & Robinson, W. (2009). Using a communication framework at handover to boost patient outcomes. Nursing Times, 105(2), 13-15.

Wallis, C. (2011). Effective communication: Principle of nursing practice. Nursing Standard, 25(32), 35-37.

Waters, A. & Whyte, A. (2012). Communicating with compassion. Nursing Standard, 8(26), 2.

According to the transaction-based theory, stress results from the operations between people and their surroundings. The transactions heavily rely on the intensity of the external stressor. For instance, an individual will assess the stressor and the socio-cultural resources at their disposal. The initial stage in dealing with a stressful circumstance is to evaluate the circumstance. The primary evaluation of a stressor refers to an individual judgment about the stressor.

Making a primary evaluation will enable a person to determine the relevance of an event, whether it is positive, manageable, challenging or stressful. The secondary evaluation entails facing the stressor. The secondary evaluation of a stressor requires a person to assess his or her ability to cope with the stress. During the secondary evaluation, an individual is required to determine how he should respond to the particular situation he is facing. This will help to regulate the problem and to develop ways of coping with the problem or the stressor.

Complexity science looks into various aspects of living systems that are not adequately addressed in conventional approaches. Complexity science refers to the study of a complex adaptive system (CAS). It studies the relationships that exist between various agents within a system, and their ability to adapt to the system. Complexity science also involves several theories, as well as concepts. Therefore, complexity science employs the use of several theories to explain the complex adaptive system.

A complex adaptive system refers to several parts which are interconnected and which function within a broader system. A complex adaptive system is a network made up of several agents. The agents may include individuals, states, and species. For example, in a health care organization, several agents such as the nurses, doctors, and patients form a larger system. The decisions made by the individual agents within the system determine the overall behavior of the system.

The study of complexity science enables researchers to investigate how various parts that form a larger network are connected. This enables researchers to understand the various components of a complex adaptive system hence positively influencing the entire system. Complexity science is important to this study because it enables a person to understand the causes of stress within a system. Within a health care organization, complexity is exhibited in terms of overload, and uncertainty.

Therefore, it is crucial to understand the complexity that exists within a health care organization. Understanding the nature of complexity is important because the environment influences the decisions that are made by the health care workers such as nurses. For instance, the health care environment will determine how the nurses undertake their roles and the overall outcome.

The nursing environment has grown to exhibit a higher level of complexity. As a result, this complexity has greatly increased the level of stress among nurses. The recognition of the nature of complexity that exists in the nursing environment is important as it can help to tone down the issue. This study explores the impact of Emotional Intelligence on the performance of nurses in their roles, as well as how Emotional Intelligence enables nurses to deal with job stress.

Emotional Intelligence is the ability of an individual to recognize and manage his emotions positively to reduce stress and to enhance social interactions with others. Persons with high Emotional Intelligence can understand their emotional state, as well as other people’s emotional state. High Emotional Intelligence often leads to healthier relationships and greater accomplishments at work.

It is important to understand the role of Emotional Intelligence on the performance of nurses. The level of Emotional Intelligence of nurses will determine how they manage the stress, which arises from their job. This will result in a negative or positive effect on their performance. Understanding the relationship that exists between Emotional Intelligence and stress will enable health care organizations to develop systems that will help to improve the performance of nurses. The process of self-organization determines the results of a complex adaptive system. The outcomes of a complex adaptive system are largely influenced by the patterns of interrelationships that exist among the various agents that form a larger system. The outcomes are usually unpredictable.

The complex adaptability system, which is made of nurses, tends to perform better when they have developed higher Emotional Intelligence. A high level of Emotional Intelligence will enable the nurses to adapt, as well as, to co-evolve as the work environment changes. However, it is challenging to predict how a CAS will co-evolve because it is non-linear. Linearity means that there is a correlation between the size of input into a system and the output. Therefore, in a complex adaptive system, the input does not correlate with the output. This means that increased input into a complex adaptive system will not necessarily increase the outcome. It is therefore very difficult to predict the magnitude of change based on the size of the input.

Exposure to Stress: Occupational Hazards in Hospitals. (2008). Centers for Disease Control and Prevention. Web.

The article under consideration dwells upon the causes of the occupational stress with the examples, points at the potential adverse health effects of occupational stress, and describes how stress can be controlled in the workplace. The value of the article is that it provides the detailed discussion of the two cases connected with the problem. Much attention in the paper is devoted to the health care workers as to the most stressful jobs.

The main outcomes of the stress in the work place of healthcare employees may result into physical and psychological symptoms, turnover, absentee­ism, and even medical errors. Considering some ways of coping with stressful situations, it is important to point to organizational and worker-focused interventions. The author dwells upon the importance of those interventions and describes the process. Much attention should be paid to combating with the stress in the workplace as healthcare employees do not have the right for mistakes even because of the personal problems.

Surviving Field Stress for First Responders. (2005). Agency for Toxic Substances and Disease Registry. Web.

This source is aimed at discussing the physical, emotional, and mental stressors people face in case of a technological disaster or terrorist attack. Dwelling upon smell, sound, noise, pain and other unusual feelings people experience as the stressors, the source considers the outcome to the healthy condition. The most spread outcomes are vasoconstriction and increased heart rate, increased blood sugar or increased motor respond.

The stress response is the problems which cause those problems. People are to understand that they should limit stressful situation, but in case with the work it may be complicated. The whole article is devoted to the outcome of stress in the health care relation and stress classifications. It is possible o cope with stress at the workplace, it is just important to understand the source of the stress and to try to eliminate it. The health care problems people suffer from in case of chronic stress at workplace may be devastating for many human organisms.

Griffin, R. M. (2010). 10 Health Problems Related to Stress That You Can Fix. Web MD. Web.

This article is focused on the 10 health problems related to stress. The author does not discuss the reasons of the stress, therefore, the stress in the workplace may be also the cause of the issues discussed in the article. Asthma, heart disease, obesity, diabetes, headaches, depression and anxiety, gastrointestinal problems, Alzheimer’s disease, accelerated aging, and premature disease are the main problems people may experience because of the stress.

Griffin (2010) says that the main mistake of people is that they think that stress is in their head. However, this is wrong as stress is the response of the organism to the stressor which leads to the problems with health. Therefore, people are to get rid of the stressor to make sure that the causes of the health problems are reduced. The desire to cope with the problem on the mental level leads to nothing.

Weiss, S. (2009). Leading patient groups support workplace wellness provisions in house health reform bill. American Cancer Society Cancer Action Network. Web.

This article dwells upon the bill which was developed by the American Cancer Society Cancer Action Network (ACS CAN), the American Diabetes Association and the American Heart Association who worked with House leaders. the most important aspect of this bill is the penalizing the “workers who do not meet certain health targets by charging them higher health care premiums continues the status quo by making health coverage unaffordable for those who need it most” (Weiss, 2009, n.p.). Even though, there is no direct mentioning of the stress as the cause of the health care problems, the work may cause much complications and the main idea of this bill is to make sure that employees are protected by the law.

Walker, E. P. (2010). ‘Wellness’ Provision in Health Care Bill Meets Protest. ABC News. Web.

The health care problems connected with stress and other reasons at the workplace are going to be controlled by the law. A new wellness program, is developed by the Senate which is going to be one of the main health care bills for the employees and employers. Thus, those companies which do not meet the wellness program will have to pay their employees more to 30 per cent. Moreover, those people who lead the healthy life are also going to be rewarded.

This aspect is interesting and should be considered. However, the idea is just the hypothesis which is to be developed. Still, reading this article it becomes obvious that people who have stress in the workplace cannot be called healthy and, that is why they will either fail to get increase in payment, or they will have to cope with the issues which cause their stress.

Galentine, E. (2009). Healthy Workforce Act may help, but employers, advisers must continue to promote wellness. Web.

The attention of this source is paid to wellness program which is going to be promoted by the government. Even though that the author of the article has also expressed the opinions of those who look skeptically at the bill and its usefulness, it is obvious that people will have a desire to improve their healthy condition. The main idea of the bill is to make people think about their health themselves, however, not all people will do it believing that having created such a bill government cares for the health employees, therefore, it should think about how to improve it.

Still, the general healthcare condition of the employees of the companies which will meet the demands of the wellbeing program is going to improve. The author of the article has gathered the points of view of different people about the new bill and the wellbeing program, however, the conclusions are not made, the reader should draw the personal ones.

Bertera, R. L. (1991). The effects of behavioral risks on absenteeism and health-care costs in the workplace. Journal of Occasional Medicine, 33(11), 1119-1124.

The article under consideration presents the research which was conducted among 45,976 employees in a large, diversified industrial company. The research was devoted to the impact of behavioral risk factors on absenteeism and health-care costs. The results of the research stated that the absenteeism and health-care costs were not required for the company as the costs were too high.

Looking at this research from the point of view of the stress in the work place, it may be concluded that employers are to care for the health condition of their employees as in this case the more advantage is going to be seen in the cost aspect. Even though this is not the result of the research, the article helps to adjust it to the stress in the work place and to the reasons why it is important to help employees to lead the healthy lives.

Heubeck, E. (2007). Workplace Stress and Your Health. WebMD. Web.

The article under consideration dwells upon the cases when the employees feel stressed. The most frequently met cases are negative work relationship and unjust environment. Those employees who work in such conditions are to think about their health as even though they do not have any signs except from stressful condition from time to time, it may lead to too complicated conditions.

People are to be heard if they have problems as when people try to come through the problem personally, they are unable to overcome the issue in most cases. Stress is the reaction of the organism to the stressor, and two reasons mentioned above are the ideal stressors which cause many problems. The article also considers the ways how to cope with the stressful situations. Such variants as the expression of the personal opinion of dissatisfaction, direct talk to those employees who create problem. People are to do something as it is inadmissible to remain the situation as it is.

Gabel, M. (2012). Overworked and Under Pressure – Stress on the Job. Northwestern Peak Performance Health Care. Web.

Even though this article dwells upon the negative effect of the stressful situations, the positive aspects of stress are discussed. The author says that the close deadline and the necessity to provide an ideal performance may be impacted by stress and the result may be better. However, in most cases stress impacts negatively human organism and may lead to mental disorders and health illnesses. The author states that stress in the workplace has become the central problem in the modern society.

Many people want to get more money that is why they work more. Others are just unable to lose their jobs, that is why they continue working in at the positions they do not like. The loss of the job is one more stressor which contributed to health problems.

Mojoyinola, J. K. (2008). Effects of job stress on health, personal and work behaviour of nurses in public hospitals in Ibadan Metropolis, Nigeria. Ethno-Medicine, 2(2): 143-148.

The article under consideration aimed to investigate “investigated the effects of job stress on the physical health, mental health personal and work behaviours of nurses in public hospitals in Ibadan Metropolis, Nigeria” (Mojoyinola, 2008, p. 143). The results of the research help understand the effective management of stress, ways to reduce the effect from it and prevent the healthcare problems in the future. Being devoted to the health of the nurses, it should be stated that the medical workers are more frequently subjected to stress than other employees.

The ways to cope with stress for medical workers are important as the level of the stress of the nurses impacts their performance. Being aware of the responsibilities of the nurses, the conclusion may be drawn about the importance of the coping with stress in the workplace of medical workers.

Reference List

Bertera, R. L. (1991). The effects of behavioral risks on absenteeism and health-care costs in the workplace. Journal of Occasional Medicine, 33(11), 1119-1124.

Exposure to Stress: Occupational Hazards in Hospitals. (2008). Centers for Disease Control and Prevention. Web.

Gabel, M. (2012). Overworked and Under Pressure – Stress on the Job. Northwestern Peak Performance Health Care. Web.

Galentine, E. (2009). Healthy Workforce Act may help, but employers, advisers must continue to promote wellness. Web.

Griffin, R. M. (2010). 10 Health Problems Related to Stress That You Can Fix. Web MD. Web.

Heubeck, E. (2007). Workplace Stress and Your Health. WebMD. Web.

Mojoyinola, J. K. (2008). Effects of job stress on health, personal and work behaviour of nurses in public hospitals in Ibadan Metropolis, Nigeria. Ethno-Medicine, 2(2): 143-148.

Surviving Field Stress for First Responders. (2005). Agency for Toxic Substances and Disease Registry. Web.

Walker, E. P. (2010). ‘Wellness’ Provision in Health Care Bill Meets Protest. ABC News. Web.

Weiss, S. (2009). Leading patient groups support workplace wellness provisions in house health reform bill. American Cancer Society Cancer Action Network. Web.

In order to provide the high quality care, nurses should use effective assessment tools which assess on-physical measures. According to Jean Watson’s Theory of Human Caring, much attention should be paid to the patient’s physical, psychological, and emotional state in order to promote healing (Caruso, Cisar, & Pipe, 2008, p. 126). Thus, it is important to examine such assessment tools focused on measuring the psychological state as Adult Life Stress Measurement, Beck Depression Inventory, and Coping Resources Inventory for Stress in order to concentrate on the mind-body-spirit dimensions and discuss the role of the tools in expanding the nurses’ abilities to provide the high quality care.

Adult Life Stress Measurement

Adult Life Stress Measurement is based on the checklist the main task of which is to determine the stressors in the form of life events which can affect the person’s stress level. Having determined the events which are discussed as stressful, the patient is measured according to the certain score which reflects the level of the life stress affected by the experienced events (Lu, Hsu, Chan, Cheen, & Kao, 2012, p. 254). Furthermore, following Watson’s Theory of Human Caring, the examiner also pays attention to the patient’s reactions to questions to determine the extent to which the patient is at risk of developing the pathological state.

The measurement is appropriate for adults who experienced many significant changes in their life during a certain period of time and for representatives of different genders and ethnicities. Different variants of the test are free and available online. The strengths of the assessment tool are in the opportunity to use the test quickly because it is rather short. The checklist is effectively organized to reduce the time for analyzing the results.

Adult Life Stress Measurement can be discussed as valid if it is necessary to make quick conclusions about the patient’s psychological state at the current stage of life. To assess the stress level completely, the more detailed test is necessary. Adult Life Stress Measurement can significantly improve the nursing process at the first stages of assessing and diagnosing because of providing quick credible results which reflect the patient’s life stress level. This information can be used to determine the risks for the further increase in the stress level and for barriers in treatment.

Beck Depression Inventory

Beck Depression Inventory is a self-report assessment tool which is actively used to identify the symptoms of depression and its severity in adolescents and adults. There are several variants of the inventory which differ in the length of the questionnaire. The patients are asked to rate their symptoms of depression according to the scale. The time necessary to complete the test is about 5-7 minutes (Stulz & Crits-Christoph, 2010, p. 927).

This tool is useful to be used among adolescent and adult patients who demonstrate symptoms of depression in order to state the extent to which the diseases developed. The test is not expensive, and it can be purchased on specialized websites which also provide the analysis of the results. The test is easily administered, and the results are highly valid because the test provides the information about the variety of depression symptoms.

Beck Depression Inventory is actively used by nurses when it is necessary to state what paths to choose to cope with the patient’s depression. The severity of depression is easily determined with the help of the inventory in 5-7 minutes, providing nurses with the opportunity to deliver the care effectively and in time.

Coping Resources Inventory for Stress

Coping Resources Inventory for Stress (CRIS) is a complex inventory including six scales and measured according to several items and certain scores. The CRIS is used to determine different levels of stress in adults, and it is useful in relation to diverse populations because it provides the complete picture of the person’s psychological state. However, the inventory is rather long and complex, and it can be administered mainly by professionals in the sphere (Matheny, Aycock, & Curlette, 2003, p. 1261). The results are valid because the stress symptoms are measured according to many factors. The CRIS can enhance the assessment and improve the quality of the care because it is useful to predict the disease development, emotional fatigue, and provide the information on life satisfaction.

Applying the Tools to the Vulnerable Population

While using the discussed tools to assess the stress and depression levels in the vulnerable population consisting of the ethnic minority groups, it is possible to focus on the effectiveness of Adult Life Stress Measurement and Beck Depression Inventory because the completion and administration of the tests take only few minutes, and the results are valid. Culture and ethnic background influence the psychological health of the patient significantly, and to assess the patient fully, it is necessary to use Adult Life Stress Measurement and Beck Depression Inventory. Coping Resources Inventory for Stress is more complex, and it is useful in working with the adult minor population who suffers from stress as a result of life situations.

Conclusion

The use of such assessment tools as Adult Life Stress Measurement, Beck Depression Inventory, and Coping Resources Inventory for Stress is necessary to provide nurses with the opportunity to note any changes in the patients’ state and health and to create the positive relationships with patients based on support, trust, and respect. Following Watson’s Theory of Human Caring and using assessment tools, nurses can create the positive healing environment and contribute to improving the patients’ health.

References

Caruso, E., Cisar, N., & Pipe, T. (2008). Creating a healing environment: An innovative educational approach for adopting Jean Watson’s Theory of Human Caring. Nursing Administration Quarterly, 32(2), 126-132.

Lu, F., Hsu, Y., Chan, Y., Cheen, J., & Kao, K. (2012). Assessing college student-athletes’ life stress: Initial measurement development and validation. Measurement in Physical Education and Exercise Science, 16(4), 254-267.

Matheny, K., Aycock, D., & Curlette, W. (2003). The Coping Resources Inventory for Stress: A measure of perceived resourcefulness. Journal of Clinical Psychology, 59(12), 1261-1277.

Stulz, N., & Crits-Christoph, P. (2010). Distinguishing anxiety and depression in self-report: Purification of the Beck Anxiety Inventory and Beck Depression Inventory-II. Journal of Clinical Psychology, 66(9), 927-940.

Introduction

According to the World Health Organization, stress is one of the leading health problems. Stress is known to cause physical sicknesses such as stomach ulcers and cardiovascular diseases. It also causes psychological conditions such as low self esteem. Other health problems associated with stress include asthma, severe headaches, reproductive disorders, nervous breakdown among others. People suffering from mental or physical stress are also said to be less productive (Varvogli & Darviri, 2011). Thus, to improve productivity and the general wellbeing of its employees, a company ought to offer stress management program. The purpose of s stress management program is to help employees manage environmental stressors. All factors considered, Transcendental Mediation seems to be the most appropriate stress management technique for employees dealing with environmental stressors.

Transcendental Mediation technique

When undertaken carefully, Transcendental Mediation (TM) is an effortless and simple to administrate stress management technique. Unlike Transcendental Meditation Movement, TM is not a religion and has very little to do with spiritual healing. It helps a patient improve his or her psychological awareness and wakefulness through a series of mantras. Mantras are defined as meaningless but calming sounds that can only be mediated. This implies that these sounds can only be experienced through meditation and cannot be verbalized. Patients undergoing TM are advised not to share their mantras with others. Patients are supposed to take 15 to 20 minutes session of meditation twice every day. During each session, a patient meditates on his or her mantra in a deep restful state. This allows the patient to gain absolute wakefulness, which is different from daydreaming. Research indicates that regular TM enables patients reduce the effects of multiple environmental stressors by reinstating normal body functions. It also improves frontal and central cognitive activity. TM is also said to improve neuroimaging as well as cerebral blood flows (Varvogli & Darviri, 2011).

Time frame

TM is an effortless and time limited stress management technique. Patients can be trained through a seven step program. The seven step program begins with introductory lesson, which are followed by four teaching sessions and a final recap session. Each session takes between one and a half to two hours. Training must be administered by a qualified TM teacher. During training, the TM teacher gives feedback to the patient about progress. This implies that successful TM training can take seven days. However, it is important to allow one day internalization period between sessions (Varvogli & Darviri, 2011). As such, TM can successfully be undertaken in two weeks.

Cost and materials

Unlike other stress management techniques, TM does not require specialized equipment. Nevertheless, each patient requires private sessions with a TM teacher. As such, a secluded space is vital for successful training. Since TM is to be undertaken in a corporate setting, a meditation room seems relevant. TM can only be undertaken by a qualified TM instructor, and as such hiring one seems relevant. These two are the relevant ‘materials’ for TM (Herron, 2011).

The cost of TM services has increased tremendously over the years. However, TM experts develop a costing structure based on the patient’s needs and level of patient’s annual income. The cost for group clients is cheaper than the cost for individuals. Full TM training costs an average of US $ 1500 per individual and US $ 400 for a personal mantra. The company can pay almost half the cost per individual for a group policy. Additionally, one of the rooms within the company premises can be modified for TM sessions. Refurbishment work is likely to cost not more than US $ 1500 (Herron, 2011).

Advantages of Transcendental Meditation

As indicated earlier, TM is an effortless and time-limited therapy. TM is also a cost effective method of managing stress. Additionally, there are numerous benefits such as improved wakefulness and awareness associated with TM. Other than improving people’s ability to deal with environmental stressors, TM also enhances better mental and physical health. Furthermore, research indicates that TM is associated with improved emotional intelligence. Improved emotional intelligence accrues numerous benefits for individuals, such as enhancing emotional response to environmental stressors, the ability to refute negative emotions, increased awareness of ones emotional needs and the ability to meet those needs (Varvogli & Darviri, 2011). There are also numerous demerits associated with TM. TM requires total patient cooperation. Additionally, many people are likely to associate TM with Buddhism. Atheists are also likely to perceive TM as being too spiritual and thus reject it (Herron, 2011).

Working in a busy organization is likely to expose employees to environmental stressors. This negatively affects employee’s mental and physical wellness. This leads to reduced productivity. To protect employee’s wellbeing as well as sustain high productivity, the company should offer TM to its employees as the main stress management techniques. Therefore, it is highly recommended that the company develops a wellness program based on TM.

Conclusion

Stress is one of the leading health concerns globally. It is associated with numerous mental and physical health problems. Working in a busy organization is likely to expose employees to environmental stressors. This affects employees’ wellbeing thus reducing their productivity. To protect employee’s wellbeing and sustain high level productivity, employers ought to help employees manage stress. Thus stress management techniques seem relevant. There are numerous stress management techniques. However, transcendental meditation seems to be the most beneficial as it enables people to deal with emotional and physical stress. This not only improves the general well being but also enhances productivity.

Reference List

Herron, R. (2011). Changes in Physician Costs among High-Cost Transcendental Meditation Practitioners Compared With High-Cost Nonpractitioners Over 5 Years. American Journal of Health Promotion, 26(1) 56-60.

Varvogli, L. & Darviri, C. (2011). Stress management techniques: evidence-based procedures that reduce stress and promote health. Health Science Journal, 5(2) 74 – 89. Web.

Week 1: Data Collected and Analyzed in Terms of Project Effectiveness

Data collection and evaluation a crucial step of the project realization. The DNP student began by systemizing the empirical data, which consisted of survey results and personal observations. The participants utilized a twelve-week program consisting of daily forty-five-minute mindfulness meditation sessions. Then, they filled an Expanded Nursing Stress Scale survey, which allowed the DNP student to evaluate the practice’s effectiveness.

The primary objective was to determine whether such mindfulness practices are, indeed, capable of reducing occupational stress levels in the field of nursing, as suggested by Heredia et al. (2017). Accordingly, the task consisted of comparing two data sets. The first test results were collected prior to the intervention, whereas the second data set was obtained upon completing the practical stage of the project.

Week 2: Nursing Implications and Outcome of the Project

Having collected sufficient information in regards to the project results, the DNP student utilized an analytical framework comparing pre- and post-intervention data sets. This process showed a significant decrease in participants’ occupational stress levels following the completion of the project. Accordingly, it was possible to conclude that mindfulness meditation programs were a promising stress-reduction instrument in the clinical environment. Therefore, the outcome of the project correlated with the theoretical framework synthesized in the course of the integrative review. As for nursing implications, the project introduced a promising avenue in terms of stress management techniques in high-morbidity patient work.

Week 3: Professional Mentoring

Professional mentoring was a crucial component of the discussed project. The DNP student attempted to demonstrate the maximum level of research independence. Nevertheless, it was important not to confuse independence and subjectivity. Professional mentoring allowed the DNP student to introduce professional insight into the project and increase its value. There were regular meetings and on-line consultations, during which the mentor received project updates and provided feedback. The DNP student later compared the proposed solutions with their own theoretical trajectory.

Week 4: Professional Growth

The DNP project was an experience of exceptional value in terms of the student’s professional growth. True mastery in one’s area of expertise is attained through an in-depth understanding of all implicit aspects. In the case of this project, the DNP student was able to review at length the issue of occupational stress in nursing. During Week Four, the DNP student systemized professional knowledge obtained during the study and analyzed it through the prism of professional growth. Prior to beginning the study, the DNP student filled a questionnaire devoted to occupational stress management. Once the study was completed, the questionnaire was filled in again, revealing a better understanding of the issue.

Week 5: Short- and Long-term Goals

Week Five was dedicated to determining the long-term and short-term objectives of the project. In the short term, the DNP student expects to acquire a better understanding of the issue and attempt to present the findings to the professional nursing community. Simultaneously, long-term goals are more ambitious, as this project has the potential to improve the field of nursing in general. Theoretical findings and practical implications present a framework of reference for all professionals experiencing increased occupational stress due to working in high-morbidity environments.

Week 6: Preceptor/Mentor as a Role Model

As determined during Week 3, professional mentoring was an important element contributing to the success of this project. The preceptor, indeed, provided the DNP student with a role model, serving as a source of professional insight. There were weekly updates and discussions between the DNP student and the preceptor, which ensured the proper research direction.

Week 7: The Use of Elevator Pitch for Project Promotion

In order to attain both short- and long-term objectives, it is important to be able to present the findings to the public. In fact, true mastery consists of the ability to present profound research in a concise, convenient form. Accordingly, the DNP student devoted Week 7 to elevator pitch practice, using a stopwatch. The goal was to condense the information in a short yet understandable manner while preserving all key aspects of research.

References

Heredia, L., Gasol, L., Ventura, D., Vicens, P., & Torrente, M. (2017). Mindfulness-based stress reduction training program increases psychological well-being, and emotional regulation, but not attentional performance. A pilot study. Mindfulness & Compassion, 2(2), 130-137. Web.

In recent years, the understanding of the physiologic changes associated with combat related PTSD is growing. As Soldiers return from combat, rapid treatment, and promising medication is important. The introduction of Prazosin offers safer and outstanding results for treating the veterans with combat-related PTSD whose nightmares were reduced. Although preliminary evidence for the use of Prazosin for the management of combat-related PTSD appears promising, there seems to remain an urgent need for further research. The current climate of the United States in two wars, suggests that there be an ongoing effort to find new and effective medication interventions.

A variety of traditional agents have been used with questionable efficacy in treatment of PTSD patients. Such agents include anxiolytics, mood stabilizers, antidepressants, antipsychotics and adrenergic-receptor-inhibiting drugs. Selective serotonin reuptake inhibitors (SSRI) have been in use as a first line agent for treatment of PTSD. It is known to cause insomnia in a few patients. SSRI is known to have stimulating effects on sleep like increasing the number of arousals, suppressing REM sleep and decreasing total sleep time. Two SSRIs fluvoxamine and paroxetine have shown a small improvement in insomnia and among these two, only fluvoxamine has been describe as having effect on PTSD related nightmares. However use of fluvoxamine has been limited due to its drug-drug interaction. Antidepressants have also been used to treat PTSD and have shown significant effects in reducing nightmares and awakenings. They also improve the ability to fall asleep but despite these, they are used rarely because of the potential of hepatotoxicity and daytime sedation. Trazodone has been used as a first line agent in treatment of PTSD but it is associated with the risk of priapism which is a concern to male patients thus its use is limited. All the traditional agents have shown to have several side effects and cannot be fully relied on in treatment of PTSD.

Of all adrenergic-receptor- inhibiting agents, prazosin has the largest body data with regard to sleep disturbances. It is the most lipids soluble agent thus it enters the brain easily. It is relatively nonsedative and has been clinically available on a generic basis. Prazosin is orally active and has low effect on cardiac function because of its alpha-1receptor selectivity. After the use of the product among combat soldiers, there were notable positive changes which included a decrease from nightmares four to five nights a week. No patient deteriorated and no side effects were reported. According to Raskind, side effects that come along with use of prazosin can be managed and sustainable use can be for long as far as it’s used in the correct manner. Prazosin is known to cross the blood-brain barrier when taken orally. The optimal dosage has not yet been determined but it has been theorized that patients with recent traumas may respond to lower dosages than those with distant traumas.

Since 2005, soldiers in combat have been using prazosin for chronic PTSD and it has proved to be effective. However further studies should be carried out to determine whether prazosin would have the same effect on solders who are in hot and dehydrating areas. Most of the studies have been conducted in a combat setting thus it is important for further studies to be carried out to determine if prazosin would be effective in other settings. Further studies should be carried out to compare the efficacy of prazosin and SSRIs.