Nurse's Pocket Guide

STRESS OVERLOAD
with Navajo parents, it is important to look at how they
define family (can be nuclear, extended, or clan), who are
the primary caregivers, and what are their social goals.
• Identify client locus of control: internal (expressions of
responsibility for self and ability to control outcomes “I didn’t
quit smoking”) or external (expressions of lack of control
over self and environment “Nothing ever works out”). Knowing
client’s locus of control will help in developing a plan of
care reflecting client’s ability to realistically make changes
that will help to manage stress better.
• Assess emotional responses and coping mechanisms being used.
• Determine stress feelings and self-talk client is engaging in.
Negative self-talk, all or nothing/pessimistic thinking,
exaggeration, or unrealistic expectations all contribute to
stress overload.
• Assess degree of mastery client has exhibited in life. Passive
individual may have more difficulty being assertive and
standing up for rights.
• Determine presence/absence/nature of resources (e.g.,
whether family/SO(s) are supportive, lack of money, problems
with relationship/social functioning).
• Note change in relationships with SO(s). Conflict in the family,
loss of a family member, divorce can result in a change in
support client is accustomed to and impair ability to manage
situation.
• Evaluate stress level using appropriate tool (e.g., Stress & Depression,
Self-Assessment Tool, etc.) to help identify areas of most
distress. While most stress seems to come from disasterous
events in individual’s life, positive events can also be stressful.
NURSING PRIORITY NO. 2.To assist client to deal with current
situation:
• Active-listen concerns and provide empathetic presence,
using talk and silence as needed.
• Provide/encourage restful environment where possible.
• Discuss situation/condition in simple, concise manner.
Devote time for listening. May help client to express emotions,
grasp situation, and feel more in control.
• Deal with the immediate issues first (e.g., treatment of acute
physical/psychological illness, meet safety needs, removal
from traumatic/violent environment).
• Assist client in determining whether or not he or she can
change stressor or response. May help client to sort out
things over which he or she has control, and/or determine
responses that can be modified.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
660 Cultural Collaborative Community/Home Care