INDICATORS OF STRESS
Indicators of stress and the stress response include both subjec-tive and objective measures. Chart 6-1 lists signs and symptoms that may be observed directly or reported by the person. They are psychological, physiologic, or behavioral and reflect social be-haviors and thought processes. Some of these reactions may be coping behaviors. Over time, each person tends to develop a characteristic pattern of behavior during stress that is a warning that the system is out of balance.
Laboratory measurements of indicators of stress have helped in understanding this complex process. Among the measures, blood and urine analyses can be used to demonstrate changes in hormonal levels and hormonal breakdown products. Reliable measures of stress include blood levels of catecholamines, corti-coids, ACTH, and eosinophils. The serum creatine/creatinine ratio and elevations of cholesterol and free fatty acids can also be measured. Immunoglobulin assays may be determined. With greater attention to neuroimmunology, improved laboratory measures are likely to follow. Increases in blood pressure and heart rate can also be measured.
In addition to using laboratory tests, researchers have devel-oped questionnaires to identify and assess stressors, stress, and coping strategies. Many of these are discussed in the research monograph developed by Barnfather and Lyon (1993), which was based on a synthesis conference held by nurse scientists on the state of the science in stress and coping nursing research. Some examples of the research instruments that nurses com-monly use to measure levels of client distress and client func-tioning can be found in a variety of research reports (Cronquist, Wredding, Norlander, Langius, & Bjorvell, 2000; Starzonski & Hilton, 2000). Miller and Smith (1993) provided a stress audit and a stress profile measurement tool that is available in the pop-ular lay literature.