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.