Coping as a theoretical concept has been most extensively described by Lazarus and Folkman (1994). They divide it to include two processes: appraisal and coping. Appraisal evaluates situations with two questions: What is at stake? And what can I do about it? Stress develops if there is a discrepancy between the demands of the situation and the individual’s perceived capabilities. Coping is a process of managing the discrepancy between external demands and internal resources to deal with those demands. There are two types of coping: coping directed at the situation; and management of emotional responses related to the situation.
Surgery is a stressful event that may require a coping response. Coping could potentially be part of the healing process. Control has been defined as the perceived ability to have power over events, people, or condition. This control can also include a belief that one has the ability to regulate his own emotional response. Coping and control are strongly related in the literature and are often overlapping concepts. If one perceived himself as having control he will expect to be able to manage the discrepancy between external demands and internal resources, and will therefore believe that he can cope.
Bandura, Taylor, Williams, Mefford, and Barchas (1995) discussed control, or at least perceived control, as an important factor in stress reduction. They devised a study monitoring plasma catecholamines to measure the stress response while spider phobics were taught to gain control over spiders. Actually, only 10 subjects were able to attain a sense of control or coping self-efficacy. These subjects displayed a high epinephrine and nonepinephrine secretion when they doubted their self-efficacy. As their self-efficacy increased, their catecholamine reactivity subsided (Freidman two-way analysis, x2 (2) = 5.
32, p< . 04 for epinephrine and x2 (2) = 4. 04, p < . 05 for nonepinephrine). The author concluded that as there is increasing evidence that the nervous system (catecholamines) can affect considerable control over the immune system. Results of this sort may be relevant to healing. Seeman and Seeman (1993) published a longitudinal study. The authors wanted to find out how mortality was related to social support. A random sample of 2,229 men and 2,496 women between the ages of 30 and 69 were included in a nine-year follow-up study.
In this study, social support was measured by marital status; contacts with close friends and relatives (measured by three questions); church membership; and informal and formal group association. Mortality data were collected from the Death Registry. All but 302 respondents were Moch (1998) discussed a need for balancing control and uncontrol needs. She described a societal norm that control was perceived to be the most desirable state but there are times when one cannot have control. Uncontrol is an acceptance or the letting go of the need to control.
She proposed that the nurse’s role is to help the patient achieve a control and uncontrol balance rather than always striving for control Perhaps the healing process includes an acceptance of reduced control. Another interactional measure that has a large body of literature connecting it with health is social support. There are a variety of social support measures which have been compared with psychological and psychiatric symptoms, physical and somatic symptoms, use of health care services, blood measures, recovery from depression, physical and emotional recovery from an automobile accident and general causes of mortality (Broadhead, et al.
, 1993). None of these are clearly healing, except perhaps recovery from depression or an automobile accident. It is generally thought that social support enhances health outcomes, but there is confusion about the multiple definitions of social support and whether it is quality or quantity that is important in social contact. Mortality was related to social support in a nine-year follow-up study of a random sample of 2,229 men and 2,496 women between the ages of 30 and 69 were included in a nine-year follow-up study.
In this study, social support was measured by marital status; contacts with close friends and relatives (measured by three questions); church membership; and informal and formal group association. Mortality data were collected from the Death Registry. All but 302 respondents were accounted for and for this group of 302 were not found to differ in their health profile from the larger sample. A chi square was used to analyze the data. Men who were married had a significantly lower death rate than those who were not (p < . 001). There was no significant difference with women.
More friends and relatives combined with a higher number of contacts were related to a significantly lower number of deaths (p , . 001). Church membership also was related to a lower number of deaths than non-church membership (p, . 05). Group membership was related to a significantly lower death rate in women only (p<. 05). The association between social ties and mortality was found to be independent from socioeconomic status, smoking, alcohol consumption, utilization of preventive health services, year of death, and self-reported physical health status.
This study is important because it taps such a large sample. As with any study of this size, potentially important details, such as quality of social contacts, are difficult to obtain. Kiecold-Glazer, Gardner, et al. , (1994) compared psychological modifiers to immunocompetence. They compared blood counts of natural killer cells (NK) (part of the immune system specific to antitumor and antiviral activity) were compared to scores on the UCLA Loneliness Scale and the Social Adjustment Rating Scale. The subjects were first year medical students, with a mean age of 23.
Blood samples were taken one moth after a major exam at the first day of final exam week. The tests were administered at the first or presumably low stress contact. An analysis of variance was used to analyze the results. A significant change in NK activity was noted between the first and second blood tests (F = 9. 87, P<. 001). Subjects with high life events scores had significantly lower NK activity (F = 8. 19, P < . 006) and those who scored high on loneliness also had low NK activity. The authors concluded that stressful life events and loneliness both appear to be associated with NK activity.
They also concluded that immunosuppression is associated with increased distress in a young and otherwise healthy population. Lifestyle Several health habits are well established as contributors to overall health and prolongation of life. The most conclusive health habits are sleeping seven to eight hours per day; eating a balanced, well-timed diet, including breakfast; maintaining a near-prescribed weight; not smoking; and regular physical activity (Califano, 1997). We do not know for sure that these same factors are relevant in healing, but we can speculate that their importance may apply there, as well.