A the topic of interest to this mental health nurse. I work with adolescents and their families. I teach the adolescents about the signs of stress and how it can take a toll on your physical health. My own family is a blended family, and we manage a great deal of stress. My ex-husband lost his life to mental health last September and my children have fears about this significant event. My fiancé’s ex also struggles with mental health, and we manage the effects on my stepchildren. A life controlled even though these situations we face but if not, the effects on our physical and mental health in the long-term can be debilitating.
The Current Family Health Issue Scholarly Paper development through research on the Metropolitan State University Library search engines. The Allina Health Knowledge Network is the website for my employer which also has Library search options available to nursing. The sites offered in the scholarly paper overview are reviewed and included. The topics for the literature address defining family health and the effects of chronic stress, the application of ethical concepts, and ethical nursing actions. The physiological aspects of stress were greatly appreciated new knowledge and insight of future work.
In defining family health and effects of chronic stress, there are many different avenues. According to Christopher Hogan, “Stress is a state that can be precipitated by a range of factors, including unpleasant circumstances, that, when chronic, has the signs and symptoms of anxiety in its suffers, such as poor sleep, impaired concentration, and irritability,”. He explains that stress describes as ‘it varies’ because one individual’s impression of their stress is very different from another individual’s. The Wikipedia definition of chronic stress “is the response to emotional pressure suffered for a prolonged period of time in which an individual perceives he or she has little or no control,. The Yerkes-Dodson law or the fight or flight response is explained as a good response to stress because we need to raise awareness to perform above the components level. We may need to defend ourselves or flee from a potential threat.
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The father of stress, Hans Selye, developed the ‘general adaptation syndrome’ that we are alarmed, a resistance to the challenge and if not met continues until exhaustion. We are all individuals, having our own experiences and expectations. Hogan even paraphrases Shakespeare related to stress and the nature versus nurture concept, “Some are born stressed, some achieve stress, and some have stress thrust upon them,”. Those born in poverty, the motivated to succeed, and the child of a suicide parent are examples of embedded, guided or handed different types of stress. The prevalence of family health and effects of chronic stress measurement in a study utilizing the National Longitudinal Survey of Youth (NLSY) 1979 data collected in the United States of those between the ages of 14 to 22, economic status is also an assessment. The study started in 1979, interviews conducted annually from 1979 to 1994, then every two years after that. The length of the survey gave the ability to assess long-term effects of childhood low economic status and psychological impact into adulthood. The research is to evaluate the chronic stress effects of the disadvantaged family and an adolescent entering adulthood with risk for depression.
As stated by Mossakowski, “According to social stress theory, a major risk factor for depression is exposure to stress, whereas vulnerability to stress depends on protective factors, such as psychosocial resources,”. Social support through family and particularly friendships in childhood can influence our perceptions of self-concept or more our self-esteem. Reflecting on childhood, we go to a neighbors or friends house and, as a child, you notice how different things are or ran in the home versus your own. Hopefully, the encounters are a positive promotion of social comparison, but if a child develops a negative self-image of their family economic status, it can affect their internal psychosocial self-esteem view of their life, their family. Mossakowski declares, “According to the life course perspective, the effects of chronic stress add up over a number of years and can significantly damage mental health by intensifying symptoms of depression over time,” . The length of the stress making it chronic is shown to correlate with depression versus acute stress.
The study collected information on the parental education and parental occupational prestige, demographics (female, age, race), mental health (depressive symptoms, self-esteem) and poverty status. The results did produce a statistically significant effect that those individual with parents of low socioeconomic levels were more likely to have depressive symptoms in young adulthood. Health disparities of chronic stress develop due to the consistently elevated stress hormones, ultimately affecting our immune systems. As stated by Hyla Cass, M.D., “It can lead to a wide range of problems from anxiety and depression to overt physical conditions such as high blood pressure, ulcers, migraine headaches, back pain, weight gain and diabetes,”. The physical diseases often develop due to the inadequate coping mechanisms used to relieve distress.
The principle of mens san in corporo sano “a healthy mind in a healthy body”. Hogan also talks about frustration tolerance or the ability to cope with being told no or not winning a game. Stress can mean many different things to each human. We do need to teach about stress but as caregivers, we also need to assess and tailor to the individual’s expectations and perception. The Centers for Disease Control and Prevention (CDC) analyzed the National Survey of Children’s Health (NSCH) of 2011-2012 concerning risk factors of mental, behavioral, and developmental disorders (MBDDs) in children. Parents give the data, and chronic stress is a common theme. The main topics included: health care, the family with fair or poor maternal or paternal mental health, challenging to get by on family’s income, community neighborhood in poor condition, lack of support in a region. Bitsko states, “Chronic stress in early childhood can impact lifelong health. A chronically activated physiologic stress response impacts the sympathetic nervous system, metabolism, and the brain, resulting in increased risk for high blood pressure, obesity, inflammatory diseases, and mental and behavioral disorders,” (2016). The promotion of resources and education of coping mechanisms for these families is critical to a change in managing many chronic health disease processes.
The goals of Minnesota Priority Health Areas of the Eliminating Health Disparities Initiative can give those dealing with chronic stress hope for management of their health. All the objectives can promote improvement for a Minnesotan struggling with a chronic disease which includes stress. The goals state the information and skill is available to them to live a healthy life, the environment is conducive of growth, and the four r’s ‘receive the right care, right place, right time. The objectives of the Initiatives all correlate to chronic stress. The individuals that have chronic stress would be healthier is the ate better including more fruits and vegetables. Physical activity stimulates many physiological benefits in managing stress. Managing tobacco and alcohol use increases overall health. Many people that are stressed turn to these substances for relief, but they need education of the physiological effects on their body.
Chronic stress effects on family health is a current and on-going problem of importance to nurses. The American Association of College of Nursing (AACN) heart and soul is research. Their position statement includes the utmost concerns for public health and families. They focus on studying, evaluating, and policy updating to aid in a holistic approach to improving health care for families (American Association of College of Nursing. Nursing is education driven, therefore, the vision of the AACN to give care based on evidence is excellence. Some basic ethical concepts are honesty, integrity, justice, equality, and respect. Ethical concepts and principles complement each other in our actions daily. Ethical principles include beneficence; to do good, non-maleficence; to do no harm, respect for autonomy, fairness, truthfulness, and justice, (American Nurses Association, 2015). Chronic stress and family health regarding ethics can take shape in many forms.
The long work hours at a high demand place of employment for a parent can stress everyone in the family out due to not seeing their loved one. The parent may want respect for autonomy in their choice of profession and feel a need for respect from the family. A child might struggle with being honest and truthful with the parent that they would like more of their time. The parent may feel guilty if not able to manage time with family and being successful in his or her career. The parent is providing financially but not physically, beneficence versus non-maleficence, fairness to the family members and trust can become an interfamilial stressor.
The ANA code of ethics for Nursing with Interpretive Statements is the nuts and bolts of nursing. If someone is considering becoming a nurse, they should read The Code before committing. As stated in the preface of The Code, Nursing encompasses the protection, promotion, and restoration of health and well-being; the prevention of illness and injury; and the alleviation of suffering, in the care of individuals, families, groups, communities, and populations. All of this is reflected, in part, in nursing’s persisting commitment both to the welfare of the sick, injured, and vulnerable in society and to social justice. Nurses act to change those aspects of social structures that detract from health and well-being. The ethical implications, principles, and concepts of being a nurse held to high standards of professionalism, (American Nurses Association, 2015).
The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. When a nurse is committed to a family, it means that she is devoted to their care. The nurse’s loyalty is through helping the family with their chronic stress issues. Nurses feel a duty and responsibility to the family. A second ethical concept in the Code is from, “Provision 3: The nurse promotes, advocates for, and protects the rights, health, and safety of the patient,” . Promoting health is a nurse’s knowledge and skill gifting to the patient or in this case the family. The nurse will advocate for the family to others that they are not comfortable or able to explain their stressors. A protector of the family’s rights, they may not even know their rights. A shield of safety, the nurse. The family’s health is protected by the nurse educating them on prevention, management, and long-term effects of their chronic stress.
Nurses interventions and acts of compassion show their beneficence (American Nurses Association (ANA) & Ethics Advisory Board 2011). The family with chronic stress needs guidance in the knowledge of management. The nurse can assess what is causing the on-going stress and give resources, inform the provider of referral need and care coordination. Support groups are an excellent service to aid in stress reduction. Listening to the family and connecting them with services can give the family hope. Many families dealing with chronic stress have been subjected to avoidance from healthcare professionals due to the extent of their circumstances. The nurse can show fidelity through “loyalty, dedication, and truthfulness,” (American Nurses Association (ANA) & Ethics Advisory Board 2011). Honesty and fairness about the stress can open avenues never attempted dependent on the situation. Nurses build trusting relationship through fidelity to the family. The work of a nurse can show the family she cares about helping them with the management of their chronic stress.
To promote advocacy to address family health and the effects of chronic stress a nurse may find herself educating state legislators on implementing state policy. The Obama home-visiting initiative is a home-visit program that starts during pregnancy, but it is limited and not able to reach all families in need (Thompson & Haskins, 2014). The most critical advocacy the public or family health nurse could aid in is establishing a “medical home” or primary care clinic. The preventative screenings can give healthcare personnel the opportunity to assess if a child or family member is experiencing chronic stress. Income, Nutrition, and Childcare assistance programs are other significant areas a nurse can advocate for a family in need to promote health and decrease stress levels.
A family health nurse collaborating with knowledge of Pediatricians to address chronic stress increases positive outcomes. A technical report by the American Academy of Pediatrics states, The toxic stress causing physiological imbalances consistently into adulthood is a pathway of disease. If we can educate legislators on the biological effects of toxic stress. Such as, the impact on immune function in turn causing poor health outcomes as cardiovascular disease, viral hepatitis, liver cancer, asthma, chronic obstructive pulmonary disease, autoimmune diseases, poor dental health and depression. The full return on investments that reduce toxic stress in early childhood is likely to be much higher.
Federal and state programs that focus on managing and preventing will produce less expense for the healthcare of chronic diseases. Nursing and Pediatricians working together developing programs with interventions to promote healthy childhood development in the critical stages and new outcome for the future is promising. Reducing health disparities and fostering social justice as a family health nurse is a superior job. Adler and Stewart define health disparities as, “A difference in health status between social groups that is not only unnecessary and avoidable, but in addition, is considered unfair and unjust,”. Connecting families with the resources available through government funding can help, but many still suffer. An example in Mexico a program call PROGRESA are giving financial incentives if a family complete preventive shots, physicals, and dental care for a set timeframe. Research is key to guiding policy and federal participation to assist improvement. Family health nurses can collaborate with care coordination and social work as a team to facilitate managing chronic stress and decrease the lifelong effects on the family.
Family Health and the effects of chronic stress is prevalent and problem in need of support. The health disparities are numerous and significant. Nationally and locally families require help to overcome the effects of chronic stress. Family Health Nurses can make a stance to improve the outcomes through interventions and education. The ANA Code of Ethics and Ethical Principles guide our mission of improving outcomes for Family Health. As advocates collaborating with other disciples, we can reduce health disparities and promote family health.
References
- Adler, N. E., & Stewart, J. (2010). Health disparities across the lifespan: Meaning, methods, and mechanisms. The Biology of Disadvantage. New York Academy of Sciences, 1186, 5-23. doi: 10.1111/j.1749-6632.2009.05337.x
- American Association of Colleges of Nursing (AACN). (2018). Nursing Research. Retrieved April 29, 2018, from http://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Nursing-Research
- American Nurses Association. (2015, January). Code of Ethics PDF. Retrieved April 23, 2018, from https://www.nursingworld.org/coe-view-only
- American Nurses Association (ANA), & Ethics Advisory Board 2011. (n.d.). Short Definition of Ethical Principles and Theories Familiar words, what do they mean? Retrieved April 23, 2018, from https://metrostate.learn.minnstate.edu/d2l/le/content/3919114/viewContent/32392585/View
- Bitsko, R. H., PhD., Holbrook, J. R., PhD., Robinson, L. R., PhD., Kaminski, J. W., PhD., Ghandour, R., DrP.H., Smith, C., EdS., & Peacock, G., M.D. (2016). Health care, family, and community factors associated with mental, behavioral, and developmental disorders in early childhood – united states, 2011-2012. 65(9) 221-226. Atlanta: U.S. Center for Disease Control. Retrieved from Nursing & Allied Health Database Retrieved from http://mtrproxy.mnpals.net/login?url=https://search-proquest-com.mtrproxy.mnpals.net/docview/1781115357?accountid=12415
- Cass, H. (2006, Jan). Stress and the IMMUNE SYSTEM. Total Health, 27, 24-25,10. Retrieved from http://mtrproxy.mnpals.net/login?url=https://search-proquest-com.mtrproxy.mnpals.net/docview/210165667?accountid=12415
- Chronic stress. (2018). In Wikipedia. Wikimedia Foundation. Retrieved April 29, 2018, from
- http://en.m.wikipedia.org
- Hogan, C. (2013). Chronic stress an approach to management in general practice. Australian
- Family Physician,42(8), 542-545. Retrieved April 21, 2018, from http://mtrproxy.mnpals.net/login?url=https://search-proquest-com.mtrproxy.mnpals.net/docview/1430962786?accountid=12415
- Minnesota Department of Health. (2012). Healthy Minnesota 2020: Chronic Disease &
