NLE Foundations of Psychiatric & Mental Health Nursing — Stress, Anxiety, Coping & Crisis InterventionConcept Map

Concept

Stress and Adaptation

Sub Concepts

• Definition of stress and stressors
• Selye's General Adaptation Syndrome (GAS)
• Alarm reaction (fight-or-flight)
• Stage of resistance
• Stage of exhaustion
• Local Adaptation Syndrome (LAS)
• Physiological and psychological responses

Relationship To Central

Foundation for understanding how the body responds to demands and environmental threats

Concept

Anxiety

Sub Concepts

• Definition and distinction from fear
• Four levels of anxiety
• Perceptual field changes
• Mild anxiety (heightened perception, optimal learning)
• Moderate anxiety (narrowed perception, selective inattention)
• Severe anxiety (greatly reduced perception, somatic distress)
• Panic (distorted perception, psychiatric emergency)

Relationship To Central

Core psychiatric symptom that requires precise level assessment to guide nursing intervention

Concept

Nursing Approach by Anxiety Level

Sub Concepts

• Mild anxiety interventions
• Moderate anxiety interventions
• Severe anxiety interventions
• Panic interventions
• Communication techniques
• Environmental modifications
• Safety considerations

Relationship To Central

Determines appropriate intervention strategy and ensures patient safety

Concept

Coping Mechanisms

Sub Concepts

• Adaptive (constructive) coping
• Maladaptive (destructive) coping
• Defense mechanisms (unconscious)
• Problem-solving
• Seeking support
• Sublimation
• Denial
• Projection
• Displacement
• Repression
• Regression

Relationship To Central

Conscious and unconscious strategies used to manage stress and anxiety

Concept

Crisis Theory

Sub Concepts

• Definition of crisis
• Self-limiting nature (4-6 weeks)
• Not an illness
• Opportunity for growth
• Aguilera's balancing factors
• Maturational (developmental) crises
• Situational crises
• Adventitious (social) crises
• Philippine relevance: natural disasters, typhoons, earthquakes

Relationship To Central

Theoretical framework for understanding acute disequilibrium and therapeutic opportunity

Concept

Crisis Intervention

Sub Concepts

• Safety assessment (suicide/homicide risk)
• Crisis assessment
• Precipitating event analysis
• Focus on immediate problem
• Here-and-now orientation
• Short-term goal setting
• Active, directive nursing role
• Resource mobilization
• Support system activation
• Anticipatory planning
• Restoration of pre-crisis functioning

Relationship To Central

Active, short-term, focused nursing approach to restore functioning during acute disequilibrium

Concept

Pharmacological Management

Sub Concepts

• Benzodiazepines (lorazepam, diazepam, alprazolam)
• Mechanism: GABA agonists
• Rapid onset, short-term use
• Dependence and tolerance risks
• Respiratory depression warnings
• Buspirone (non-benzodiazepine)
• Non-sedating, non-dependence-forming
• 2-4 week onset
• SSRIs (sertraline, fluoxetine, escitalopram)
• First-line for long-term anxiety disorders
• Beta-blockers for performance anxiety
• Medication teaching and monitoring

Relationship To Central

Medication support for anxiety and crisis management; supplements but does not replace therapeutic interventions

Concept

Nursing Management Priorities

Sub Concepts

• Accurate anxiety level assessment
• Safety assessment and assurance
• Environmental stimulus reduction
• Presence and staying with client
• Communication adaptation
• Timing of teaching and learning
• Medication administration
• Response monitoring
• Respiratory status monitoring
• Family involvement
• Follow-up and referral

Relationship To Central

Systematic approach to assessment, safety, and intervention across anxiety and crisis situations

Concept

Patient and Family Teaching

Sub Concepts

• Anxiety trigger recognition
• Early warning sign identification
• Relaxation and coping skills
• Deep breathing techniques
• Progressive muscle relaxation
• Grounding techniques
• Physical activity benefits
• Crisis as time-limited event
• Reducing mental health stigma (Filipino context)
• Emergency contact provision
• NCMH crisis hotline
• Family support mobilization
• Medication compliance teaching

Relationship To Central

Education and support to promote resilience, early intervention, and health-seeking behaviors

Concept

Legal and Ethical Framework

Sub Concepts

• Republic Act 9173 (Philippine Nursing Law)
• Professional Regulation Commission (PRC) standards
• Scope of psychiatric-mental health nursing practice
• Patient rights and dignity
• Confidentiality in mental health care
• Voluntary vs. involuntary admission principles
• Duty to warn and protect
• Ethical decision-making
• Standards of care

Relationship To Central

Professional practice standards guiding psychiatric and mental health nursing in the Philippines

To

General Adaptation Syndrome

From

Stress

Strength

strong

Relationship

Stress triggers the body's three-stage physiological response mechanism

To

Anxiety

From

General Adaptation Syndrome

Strength

strong

Relationship

Alarm and resistance stages produce the physical and psychological manifestations of anxiety

To

Nursing Approach

From

Anxiety Level

Strength

strong

Relationship

Assessment of anxiety level directly determines and guides all subsequent nursing interventions

To

Coping Mechanisms

From

Anxiety

Strength

strong

Relationship

Coping mechanisms are the conscious and unconscious strategies used to manage anxiety

To

Crisis

From

Coping Mechanisms

Strength

strong

Relationship

Crisis occurs when usual coping mechanisms fail to resolve stressors

To

Crisis Intervention

From

Crisis

Strength

strong

Relationship

Crisis intervention is the active, focused nursing response to acute disequilibrium

To

Crisis Types

From

Crisis Theory

Strength

strong

Relationship

Crisis theory categorizes crises into three types: maturational, situational, and adventitious

To

Pharmacology

From

Anxiety

Strength

moderate

Relationship

Medications are prescribed to manage anxiety symptoms alongside therapeutic interventions

To

Benzodiazepines

From

Severe Anxiety

Strength

strong

Relationship

Benzodiazepines provide rapid relief for severe anxiety and panic episodes

To

SSRIs

From

Chronic Anxiety

Strength

strong

Relationship

SSRIs are first-line medications for long-term management of anxiety disorders

To

Patient Education

From

Crisis Intervention

Strength

moderate

Relationship

Teaching supports crisis resolution and prepares client for future stressors

To

Mild Anxiety Teaching

From

Anxiety Assessment

Strength

strong

Relationship

Mild anxiety provides optimal perceptual field for learning and skill development

To

Selective Inattention

From

Moderate Anxiety

Strength

strong

Relationship

At moderate anxiety level, client exhibits selective inattention and narrowed focus

To

Safety Priority

From

Severe Anxiety

Strength

strong

Relationship

Severe anxiety requires safety-focused interventions without teaching or problem-solving

To

Psychiatric Emergency

From

Panic

Strength

strong

Relationship

Panic is the most extreme anxiety level and constitutes a psychiatric emergency

To

Coping Assessment

From

Defense Mechanisms

Strength

moderate

Relationship

Nursing assessment identifies which defense mechanisms client relies upon and their adaptiveness

To

Problem Resolution

From

Adaptive Coping

Strength

strong

Relationship

Adaptive coping resolves the source of anxiety and promotes client growth

To

Continued Distress

From

Maladaptive Coping

Strength

strong

Relationship

Maladaptive coping provides only temporary relief without solving underlying problem

To

4-6 Week Resolution

From

Crisis Self-Limiting

Strength

strong

Relationship

Crisis resolves within 4-6 weeks toward higher, same, or lower functioning

To

Crisis Outcome

From

Aguilera Balancing Factors

Strength

strong

Relationship

Perception of event, situational supports, and coping mechanisms determine crisis trajectory

To

Philippine Disasters

From

Adventitious Crisis

Strength

strong

Relationship

Natural disasters, typhoons, and earthquakes are adventitious crises highly relevant in Philippine nursing

To

Here-and-Now Focus

From

Crisis Intervention

Strength

strong

Relationship

Crisis intervention focuses on immediate problem rather than long-standing personality issues

To

Suicide Homicide Risk

From

Safety Assessment

Strength

strong

Relationship

First step in crisis intervention is assessing for suicide and homicide risk

To

De-escalation

From

Nursing Presence

Strength

moderate

Relationship

Calm nurse presence and short, simple communication lower client's anxiety

To

Stimulus Reduction

From

Environmental Modification

Strength

moderate

Relationship

Calm, quiet, low-stimulus environment reduces anxiety escalation

To

Mild-Moderate Anxiety

From

Relaxation Techniques

Strength

strong

Relationship

Deep breathing, muscle relaxation, and grounding are taught at mild-moderate anxiety levels

To

Help-Seeking Behavior

From

Mental Health Stigma

Strength

moderate

Relationship

Philippine cultural context requires stigma reduction to encourage crisis help-seeking

To

Psychiatric Nursing Practice

From

RA 9173

Strength

moderate

Relationship

Philippine Nursing Law defines scope and standards for psychiatric-mental health nursing

To

Pre-Crisis Functioning

From

Crisis Intervention

Strength

strong

Relationship

Goal of crisis intervention is restoration to at least pre-crisis level, not personality change