1.3 Reaction to Stress and Hospitalization

The patient who is entering a hospital is under many emotional pressures. Fear of death, disfigurement, pain, or a prolonged illness, and loss of control of the surrounding environment are just a few of the emotional concerns being faced. People react to stress in many ways. The Practical Nurse must be able to recognize the signs and symptoms of stress and identify the coping mechanisms being utilized by the patient in order to provide effective nursing care.

Factors Influencing Whether a Person Will Seek or Avoid Professional Help

Some of the factors that influence a person seeking or avoiding professional help are:

a. The degree and extent of symptom distress.

b. Expectation of return to health if treatment is instituted.

c.   Fear of diagnostic and treatment procedures.

d. Fear of discovery of serious illness.

e. The self-concept that one is always healthy.

Factors Causing Stress in the Hospital

Some of the factors that cause stress in the hospital are:

a. Unfamiliarity of surroundings.

(1)  Having strangers sleep in the same room.

(2)  Having to eat cold or tasteless food.

(3)  Being awakened in the night by the nurse.

b. Loss of independence.

(1)  Having to eat at different times than usual.

(2)  Having to wear a hospital gown.

(3)  Not having the call light answered.

c.   Separation from spouse.

d. Separation from family.

e. Financial problems.

f.  Isolation from other people.

(1)  Having an unfriendly roommate.

(2)  Not having friends visit.

(3)  Having staff in too much of a hurry to talk, or more importantly, listen.

g. Lack of information.

(1)  Not having questions answered by staff members.

(2)  Having nurses or doctors who talk too fast. Nervousness and preoccupation often make it difficult to fully concentrate on what is being said. Needless to say, patients often have plenty on their minds, so it is crucial that you explain things patiently and slowly and be prepared to repeat instructions and explanations. Do not assume that because you have explained something once, your job is done.

(3)  Not knowing the reasons for (or the results of) treatments.

h. Threat of severe illness.

(1)  Fear that appearance will be changed after hospitalization.

(2)  Being hospitalized after an accident and suspecting the worst.

(3)  Thinking he/she may have cancer.

i.  Problems with medications.

(1)  Having medications cause discomfort (that is., chemotherapy).

(2)  Not getting relief from pain.

(3)  Not getting pain medication when needed.

Stages of the Illness Experience

a. Denial or Disbelief in Being Ill.

(1)  Patient may avoid, refuse, or even forget needed care.

(2)  Patient may appear to flee toward health in trying to escape illness.

b. Acceptance of Being Ill.

(1)  Becomes dependent on health care personnel.

(2)  Focuses attention on symptoms and the illness.

(3)  Gradually becomes less dependent.

c.   Recovery, Rehabilitation, or Convalescence.

(1)  May be a short or long period, depending on how much the patient's life-style must change as a result of the illness.

(2)  Patient goes through a process of resolving his/her perceived loss or impairment of function.

Emotional Responses to Illness and Hospitalization

a. Fear.

(1)  An emotional response characterized by an expectation of harm or unpleasantness.

(2)  Usually associated with behavior that attempts to avoid or flee a threatening situation.

(3)  Patient is usually aware of the specific danger and has some understanding into the reasons for the fear.

(4)  Common indications of fear include:

(a)  Tachycardia (rapid heart rate).

(b)  Dry mouth.

(c)  Constipation.

(d)  Hypertension.

(e)  Increased perspiration.

(f)    The "fight or flight" reaction (alertness and readiness for action in order to avoid or escape harm)

b. Anxiety.

(1)  An emotional response characterized by feelings of uneasiness and apprehension of a probable danger or misfortune.

(2)  Patient who is anxious usually is unaware of the cause of the anxiety.

(3)  Behaviors are similar to those seen with the fear, but are not usually as dramatic.

(4)  Because the patient does not know its specific cause, he/she usually focuses on the physiologic symptoms of anxiety, to include:

(a)  Fatigue.

(b)  Insomnia.

(c)  Diarrhea or constipation.

(d)  Urgency.

(e)  Nausea.

(f)    Anorexia.

(g)  Excessive perspiration.

c.   Stress.

(1)  A state of strain or tension.

(2)  Occurs in situations, which require an increased and often prolonged effort to adjust.

(3)  Any factor that disturbs the physical, psychological, or physiological homeostasis of the body may be stressful.

(4)  As with fear, the body tries to rid itself of the factor causing the stress.

(5)  Physical signs of stress include:

(a)  Ulcers.

(b)  Hair loss.

(c)  Insomnia.

d. Over Dependency or Feelings of Helplessness.

(1)  Over dependency is a response characterized by feelings of helplessness while trying to search for help and understanding (to an extent beyond what is considered normal).

(2)  Helplessness is a response characterized by feelings of being unable to avoid an unpleasant experience.

(3)  While healthy people may show some degree of dependence on others during illness, this dependence often increases to the point of being harmful to the patient.

(4)  The over dependent patient may be fearful or angry.


There are as many reactions to illness as there are patients. Your kindness and understanding will help your patient to go through the hospitalization experience with a minimum of stress and anxiety.