Judith M. Stefano
Patient Safety Nurse Coordinator, Patient Safety & Regulatory Affairs, Hospital Annex C, Stony Brook University Medical Center, Stony Brook N.Y., USA

Korespondenční autor: Judith M. Stefano (

ISSN 1804-7181 (On-line)

Full verze:
Full version

Submitted:9. 8. 2010
Accepted: 13. 10. 2010
Published online: 27. 12. 2010


It is now realized that patient safety represents a health provider imperative that must be supported from every component of a health care facility, regardless of its size or medical specialty. Recent studies conducted by the Lucian Leape Institute at the National Patient Safety Foundation demonstrate that health care delivery remains unsafe despite improvement initiatives over the past decade. Accordingly, the institute has put forward the following five concepts that aim to ‘meaningfully’ improve the safety of the health care system: transparency, care integration, patient/consumer engagement, restoration of joy and meaning in work, and medical education reform. This paper proposes that anticipatory stress – both before and during health-related procedures – affects overall safety. Therefore, a reduction in the anticipatory stress response can heighten patient safety. It is argued that the notion of anticipatory stress in relation to typical health care patient experiences, including its effect on communication with health care providers, is a vital concern that needs to be addressed. In addition, it is suggested that health care providers can also be affected by anticipatory stress – a situation that may also endanger patient well-being. As a way forward, the need for a more comprehensive educational program that can reduce the negative impacts of anticipatory stress on patient safety with regard to both patients and health care providers is examined.

Keywords: stress; anticipatory stress; patient safety; proactive care


1. Chrousos GP, Gold PW (1992). The concepts of stress and stress system disorders: Overview of physical and behavioral homeostasis. JAMA. 267, p. 1244–1252.

2. Esch T, Stefano GB (2002). An overview of stress and its impact in immunological diseases. Modern Aspects of Immunobiology. 2: 187–192.

3. Esch T, Stefano GB, Fricchione GL, Benson H (2002a). Stress in cardiovascular diseases. Medical Science Monitor. 8: RA93–RA101.

4. Esch T, Stefano GB, Fricchione GL, Benson H (2002b). The role of stress in neurodegenerative diseases and mental disorders. Neuroendocrinol. Lett. 23: 199–208.

5. Fricchione GL, Stefano GB (1994). The stress response and autoimmunoregu­lation. Adv. Neuroimmunol. 4: 13–28.

6. Leape L, Berwick D, Clancy C, Conway J, Gluck P, Guest J, Lawrence D, Morath J, O’Leary D, O’Neill P, Pinakiewicz D, Isaac T (2009). Transforming healthcare: a safety imperative. Qual. Saf Health Care. 18: 424–428.

7. Lucian Leape Institute. Unmet Needs: Teaching Physicians to Provide Safe Patient Care. 2010. Boston, MA, National Patient Safety Foundation. Ref Type: Report.

8. McEwen BS (1998). Protective and damaging effects of stress mediation. New Eng. J. Med. 338: 171– 179.

9. Stefano GB (1991). Stereospecificity as a determining force stabilizing families of signal molecules within the context of evolution. In Comparative aspects of Neuropeptide Function (ed. Stefano GB and Florey E), pp. 14–28. University of Manchester Press, Manchester.

10. Stefano GB, Scharrer B (1994). Endogenous morphine and related opiates, a new class of chemical messengers. Adv. Neuroimmunol. 4: 57–68.

11. Stefano GB, Leung MK, Bilfinger TV, Scharrer B (1995). Effect of prolonged exposure to morphine on responsiveness of human and invertebrate immunocytes to stimulatory molecules. J. Neuroimmunol. 63: 175–181.

12. Stefano GB, Scharrer B, Bilfinger TV, Salzet M, Fricchione GL (1996a). A novel view of opiate tolerance. Adv. Neuroimmunol. 6: 265–277.

13. Stefano GB, Scharrer B, Smith EM, Hughes TK, Magazine HI, Bilfinger TV, Hartman A, Fricchione GL, Liu Y, Makman MH (1996b). Opioid and opiate immunoregulatory processes. Crit. Rev. in Immunol. 16: 109–144.

14. Stefano GB, Goumon Y, Casares F, Cadet P, Fricchione GL, Rialas C, Peter D, Sonetti D, Guarna M, Welters I, Bianchi E (2000). Endogenous morphine. Trends in Neurosciences. 9: 436–442.

15. Stefano GB, Fricchione GL, Slingsby BT (2001). Is stress stress? Placebo 3: 101–110.

16. Stefano GB, Cadet P, Zhu W, Rialas CM, Mantione K, Benz D, Fuentes R, Casares F, Fricchione GL, Fulop ZI, Slingsby BT (2002). The blueprint for stress can be found in invertebrates. Neuroendocrinol. Lett. 23: 85–93.

17. Stefano GB, Benson H, Fricchione GL, Esch T (2005). The Stress Response: Always good and when it is bad Medical Science International, New York.

18. Stefano GB, Stefano JM, Esch T (2008). Anticipatory Stress Response: A significant commonality in stress, relaxation, pleasure and love responses. Med. Sci. Monit. 14: RA17–RA21.

19. Vogel WH, Bower DB (1991). Stress, immunity and cancer. In Stress and immunity (ed. Plotnikoff NP, Margo AJ, Faith RE, Wybran J), pp. 493–507. CRC Press, Boca Raton.

20. Watson SJ, Akil H (1991). The brain’s stress axis: An update. In American psychiatric association press review of psychiatry (ed. Tasman A and Goldfinger S), pp. 498–512. American Psychiatric Press, Washington, D. C.

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