Coping and Nursing Research Topic
Coping In Nursing Topic
Coping is one of the most prolific topics in all of nursing research. Thousands of studies have been conducted by nurse researchers on coping, mainly with chronic illness, acute conditions, and treatment stress; family responses related to illness/disease; child/adolescent illness and hospitalization; specific illness, disease, diagnosis, medical treatment, and hospitalization stressors; caregiving, and sequelae such as distress.
Prominent are studies of individuals and families facing chronic illness. The most frequent disease/illness situations in nursing coping research are cancer and cardiac disease or events.
Coping is an exceedingly
important area of nursing re- search since coping has important observable and
measurable effects on health outcomes.
Exceptions Coping in Nursing Research
With few exceptions, coping in nursing research is defined using the definition and theory of psychologists Lazarus and Folkman (1984).
They define coping as "constantly changing
cognitive and behavioral efforts to manage specific external and/or internal
demands that are appraised as taxing or exceeding the resources of the
person" (p. 141). This definition accentuates the fact that coping is a
process requiring effort, free of positive or negative evaluation, focusing on
“what the person actually thinks or does" (p. 142).
Nursing Research Portrays
Nursing research portrays coping as part of a dynamic process consisting of a stressor, appraisal, resources, coping, and outcomes.
Stress in this perspective is defined as a "relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well being" (Lazarus & Folkman, 1984, p. 19).
Stress involves appraisal of the stressor for well being (primary appraisal) and what can be done to manage the situation (secondary appraisal).
Stressors in nursing
research can be categorized as an "internal or external event, condition,
situation, and/or cue" (Werner, Frost, & Orth, 2000, p. 10) that has
the potential to bring about or actually activates significant physical,
psychological, social, or spiritual reactions. They can be either normative or
catastrophic.
Problem Focused And Emotion Focused
Lazarus and Folkman (1984) also
distinguish between problem focused and emotion focused coping. Problem-focused
strategies are "directed at managing or altering the problem causing the
distress" (p. 150). Emotion focused coping is "coping that is
directed at regulating emotional response to the problem" (p. 150).
Coping Theories
Other coping theories tested in
nursing re- search with individuals include Scott, Oberst, and Dropkin's
Stress-Coping Model incorporating anxiety in the stress and coping process. The
theory most often employed in nursing research on family coping is the
Resiliency Model of Family Stress, Adjustment, and Adaptation (McCubbin &
McCubbin, 1996).
Coping Resources
Coping resources examined in nursing can be categorized as social, psychological, spiritual, and other, such as finances and education. The social resource most studied is social support (Underwood, 2000).
Nursing research has shown that social support "works through main, mediating, and moderating (buffering) mechanisms" (Underwood, p. 372). These processes are active and dynamic, and there is evidence that specific functions of social support and other resources become important in certain situations and specific phases of illness, health crisis, or treatment.
Generalizations indicate that context deter- mines social support needs; social support can come from a variety of sources such as confidant or network; perceived support availability is often more strongly related to coping effectiveness than actual support received.
Social support has both positive and negative aspects; and there is a negative association between social support and deleterious outcomes such as depression and anxiety (Underwood).
Instruments most frequently utilized for measuring social support with individuals are Norbeck's Social Support Questionnaire and Weinert's Personal Resource Questionnaire. Evidence is growing that support is an important family resource, particularly when families are faced with caregiving stress/burden.
Family instruments include McCubbin and colleagues' Social Support Index, and Fink's Family Social Support Index (DeMarco, Ford-Gilboe, Friedemann, McCubbin, & McCubbin, 2000).
Hardness In Psychological Resources
Hardiness is the psychological resource most studied in nursing coping research (Ford-Gilboe & Cohen, 2000). Hardiness, a personality phenomenon encompassing. commitment, challenge, and control, especially health-related hardiness conceptualized by Pollock, has been shown to be related to positive health outcomes for adults.
Emerging as important in family nursing research, there is support that hardiness mediates "the relationships between stressful life events and family adaptation" (Ford-Gilboe & Cohen, p. 427).
It includes control,
challenge, commitment, and confidence. Evidence is growing that hardiness
enhances coping for both individuals and families.
Coping Resources Gaining Nursing Research
Other coping resources gaining nursing research attention include hope, control, sense of coherence, and self-efficacy. Antonov sky defined sense of coherence as an enduring orientation rendering events and stimuli.
Comprehensible, manageable, and meaningful. Family sense of coherence is conceptualized as an "explanation of how these resources may contribute to health" (Antonov sky, 1998, p. 8). Coping can be differentiated as coping style or coping strategies (behaviors). Coping style suggests typical responses across situations.
Coping strategies are what people actually do in the face of stress. Nurse researchers examine coping strategies much more frequently than coping styles. Choice of strategies has been found to differ based on illness phase, specific stressors, and/or resources.
People in many health/illness situations use a mix of problem-focused and emotion focused strategies. Theoretically, problem-focused strategies are specifically tailored to the situation, while more global emotion-focused strategies are used across situations (Lazarus & Folkman, 1984).
Instruments used most often to assess coping strategies in nursing research are the Jaloweic Coping Scale, the Ways of Coping Questionnaire, and the Family APGAR Over the last decade, there has been remarkable growth in the nursing research on coping in several areas. One of these areas is family coping.
Another area is coping in children/adolescents (Stewart, 2003), where Lazarus and Folkman's theory is most often applied. Most of these studies concentrate on serious illness, traumatic situations, and developmental transitions.
While most investigations tap stressors specific to the situation,
many also focus on behaviors based on Ryan-Wenger's taxonomy of children's
coping strategies. Another newer area is spiritual coping (Baldacchino &
Draper, 2001). Many researchers have found that spiritual coping strategies
enhance positive health outcomes.
Specific Finding In Nursing Coping Research
Specific findings of nursing coping investigations are numerous; several generalizations stem from the research. Problem-focused coping is consistently related to positive health outcomes and general well-being.
Optimism is an important strategy for individuals, facilitating constructive action, choice among options, and retaining control. Positive social support for adults, children, and. families is related to positive health outcomes, and may function through obtaining assistance, supporting self-esteem, receipt of advice or information, and/or presence of a confidant.
Use of spiritual resources or coping strategies, such as prayer or religious attendance, is related to positive health out- comes. Exerting control is also associated with positive outcomes. Emotion-focused strategies, often associated with more negative outcomes, can be beneficial, especially in situations where there are few options.
Coping strategies change over the
course of illness stages. Less desirable coping strategies are associated with
negative outcomes. Finally, coping strategies perceived by participants as most
effective are often not those they engage in frequently.
Research designs most frequently used are descriptive/correlational and qualitative or interpretive. Longitudinal research is becoming more prevalent. Most studies employ selfreport instruments, but interviews are gaining in popularity.
Nurse researchers
investigating coping are too numerous to mention, coming from all nursing
specialty areas and many countries. Exemplary programs of research include
those of Grey, Hagedoorn, Hinds, Hoskins, Jaloweic, J. Johnson, M. McCub- bin,
Nail, Northouse, and Ryan Wenger.
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