A Multidimensional Model of the Antecedents of Stress and Coping Appraisals: An Approach to Studying Patients' Perceptions of Post Cardiac Surgery Pain and Their Coping Strategies

Abstract

Lazarus壓力與適應理論早已被調查病病人的壓力與適應經驗的護理者推崇為一有相 當價值的概念架構。然而，學者應用此理論在了解台灣護理問題時，甚少針對此理論 的概念、可用與限制性，提出深入批判。此外，目前亦缺乏考慮台灣文化的理論主張 以供學者探討台灣病人的壓力經驗，例如心臟手術後的疼痛問題。為了協助台灣加護 護理專業人員更加了解如何以Lazarus理論為基礎，發展出一考慮台灣文化的概念架 構，以探討台灣病人如何視心臟手術後之疼痛為壓力；作者首先回顧壓力概念的發展 與Lazarus理論的核心概念，再針對Lazarus理論應用於此護理現象的利弊提出評判。 在此基礎上，作者嚐試發展出一多層次壓力前提與適應評估模式，以供護理人員評估 其個案對心臟手術後疼痛的觀感及其對應適應行為。此外，有關了解此護理現象的理 論主張及此模式在臨床護理、護理研究與理論發展上的應用亦一併被提出說與討論。 Lazarus’ stree and coping theory has been recognized as a valued conceptual framework for nursing scholars who are interested in studying their client’s experiences of stress and coping. However, little data provide in-depth critiques in concepts, availability and limitations of employing Lazarus’ theory in nursing phenomena in Taiwan, nor did data provide culturally sensitive propositions for Taiwanese nursing scholars to better understand their clients’ stress experience such as post cardiac surgery pain. In order to help Taiwanese critical care nurses better understand the process of theoretical development while assessing their clients’perceptions of post cardiac surgery pain, the historical perspective of the concept of stress and the core components of Lazarus’ theory are examined. Following is a critical critique of Lazarus’ theory as a conceptual framework with which to study how patients perceive post cardiac surgery pain as a stressor. A multidimensional model of the antecedents of stress and coping appraisals for nurses to assess their clients’ perceptions of pain and the resulting coping behaviors is further developed based on the aforementioned critiques. Finally, suggestions for testing theoretical propositions related to this phenomenon, as well as implications for nursing practice, research, as theory are delineated and discussed.