Theory of Stress & Coping Alice C Theory of Stress & Coping Alice C. Benefield, BSN, RN University of Oklahoma Health Sciences Center Summary Major Concepts Conceptual Map Theory of Stress & Coping Applications In Nursing Practice and Research This theoretical framework is frequently made use of to determine effective coping strategies for patients with chronic and acute illnesses seen in clinical practice. Thomsen, Rydahl-Hansen, and Wagner (2010) utilized this theory to identify factors to be used in developing a research based questionnaire that will assist “health professionals in identifying coping resources helpful to patients with advanced cancer” (p. 3435). Ntoumanis, Edmunds and Duda (2010) conducted a research study to integrate the theory of stress and coping with the self-determination theory of motivation to understand how motivation affects the coping process. Their goal was to inspire further research and ultimately improve patient outcomes. The Theory of Stress and Coping is a middle range theory originally developed by Richard Lazarus in 1966 and later revised by Lazarus and Susan Folkman in 1984. This theory is a cognitive approach to stress and coping. Stress is viewed as a transaction, and the result (i.e. coping) is determined by how one perceives the transaction. Stress: “A particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his/her resources” (Lazarus & Folkman, 1984, p.18). One of three types of stress may be developed in the primary or secondary appraisal: harm, threat, or challenge. Appraisal: The judgment of events on one’s well-being. Occurs in three steps: Primary – Initial judgment to transaction Secondary – Assessment of how to respond to transaction Reappraisal – Appraisal after most recent data has been received Coping: The method by which one deals with strain and emotions of the stress appraisal. There are two types: Problem-focused coping – “changes the person-environment relationship” (Kuhns & McEwen, 2011, p. 289) Example: coming up with a plan Emotion-focused coping – “changes the meaning of the situation” (Kuhns & McEwen, 2011, p. 289) Example: participating in distracting activities Controlled Stress = Effective Coping Event/ Transaction Primary Appraisal Irrelevant Benign Positive Stressful Secondary Appraisal Coping Positive Coping 1. Problem-Focused 2. Emotion-Focused Reapprasial Adaptation Health Psychological Well-Being Social Functioning Negative Coping Operational Measures The Ways of Coping Questionnaire WAYS Developed by Lazarus & Folkman, 2005 “The WAYS is a process measure containing a wide range of thoughts and acts employed by people dealing with internally or externally stressful situations” (Kieffer & MacDonald, 2011, p. 27). • Measures the coping process • Contains 66 questions • Questions are answered on a four- point Likert-type scale • 8 factors tested: Confrontive Coping, Distancing, Self Controlling, Seeking Social Support, Accepting Responsibility, Escape-Avoidance, Planful Problem-Solving, Positive Reappraisal References Kieffer, K. M. & MacDonald, G. (2011). Exploring factors that affect score reliability and variability in the ways of coping questionnaire reliability coefficients: A meta-analytic reliability generalization study. Journal of Individual Differences, 32(1), 26-38. doi:10.1027/1614-0001/a000031 Kuhns, M. & McEwen, M. (2011). Theories from the behavioral sciences. In M. McEwen & E. M. Wills (3rd Ed.), Theoretical basis for nursing (pp. 274-299). Philadelphia: Lippincott Williams & Williams. Lazarus, R. S. & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer Publishing Company. Ntoumanis, N., Edmunds, J., & Duda, J. L. (2009). Understanding the coping process from a self-determination theory perspective. British Journal of Health Psychology, 14, 249-260. doi:10.1348/135910708X 349352 Thomsen, T. G., Rydahl-Hansen, S., & Wagner, L. (2010). A review of potential factors relevant to coping in patients with advanced cancer. Journal of Clinical Nursing, 19, 3410-3426. doi:10.1111/j.1365-2702. 2009.03154.x   Susan Folkman Richard Lazarus Printed by