INFLUENCE OF STRESS, COGNITIVE APPRAISAL, RESILIENCE, AND SOCIAL SUPPORT ON COPING OF OLDER WOMEN WHOSE SPOUSES HAVE UNDERGONE CORONARY ARTERY BYPASS SURGERY by Suzanne K. Mamocha A Dissertation Submitted in Partial Fulfillment of the Requirements of the Degree of Doctor of Philosophy in Nursing at The University of Wisconsin-Milwaukee May 2003 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. INFLUENCE OF STRESS, COGNITIVE APPRAISAL, RESILIENCE, AND SOCIAL SUPPORT ON COPING OF OLDER WOMEN WHOSE SPOUSES HAVE UNDERGONE CORONARY ARTERY BYPASS SURGERY by Suzanne K. Mamocha A Dissertation Submitted in Partial Fulfillment of the Requirements of the Degree of Doctor of Philosophy in Nursing at The University of Wisconsin-Milwaukee May 2003 ibr Professor Date Date 11 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ABSTRACT INFLUENCE OF STRESS, COGNITIVE APPRAISAL, RESILIENCE, AND SOCIAL SUPPORT ON COPING OF OLDER WOMEN WHOSE SPOUSES HAVE UNDERGONE CORONARY ARTERY BYPASS SURGERY by Suzanne K. Mamocha The University of Wisconsin-Milwaukee, 2003 Under the Supervision of Professor Jane Leske, PhD, RN Purpose: To describe the influence of stress, cognitive appraisal, resilience and social support on coping of older women in relation to the coronary artery bypass graft surgery (CABG) of their spouse. Many older men are having coronary artery bypass graft surgery (CABG) and as the population ages these numbers are anticipated to increase. Surgery is a stressful experience and how the spouse of the patient appraises the surgical event may enhance her coping. Additionally, it is anticipated that resilience and social support will impact spousal coping. Design: A survey assessing the influence of stress, cognitive appraisal, resilience, and social support on coping was distributed to all women 55 years or older, whose spouses underwent CABG in the previous three months within one of five Midwestern hospitals. The theoretical framework for this study combined Lazams and Folkman’s theory of stress and coping and Wagnild and Young’s resilience theory. Methods'. Descriptive statistics and multiple regression were used to answer the research questions. Stress was measured by the Family Inventory of Life Events (FILE: McCubbin, Patterson & Wilson, 1983), cognitive appraisal by the Spouse Perception Scale (SPS: Palmer, iii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 1965; Silva, 1976) resilience by the Resilience Scale (RS: Wagnild & Young, 1993), social support by the Social Support Inventory (SSI: McCubbin, Patterson & Glynn), and coping was measured by the Ways of Coping Questionnaire (WCQ: Folkman & Lazarus, 1988). Findings: The women were 55-81 years of age with a mean age of 66 years. In regression analyses seeking to predict different ways of coping, demographic variables had an unexpectedly strong role. Positive aspects of these female spouses, specifically resilience, positive CABG appraisal, and seeking social support, had most frequent and consistent positive correlations with positive reappraisal coping and distancing coping. Higher levels of these positive aspects were associated with lower levels of reported stress. Overall, ways of coping as measured by the WCQ were not strongly predicted by demographic variables or by the components of the stress and coping process measured in this study. While statistically significant, the amount of variance in ways of coping (WCQ) predictable by these variables was not large, never exceeding 20% in the regression analyses. Conclusions: In a sample of 96 women whose spouse were undergoing CABG surgery, personal characteristics such as resilience and family characteristics predicted ways of coping with this particular stressful event. This study has implications for nursing practice to better identify and support the coping efforts of nonresilient women. This research was supported in part, by the Eta Pi Chapter of Sigma Theta Tau International research grant for 2002. Major professor Date IV Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS Page LIST OF TABLES.......................................................................................................... viii LIST OF FIGURES........................................................................................................ x CHAPTER - INTRODUCTION................................................................................... 1 Problem............................................................................................................... 1 Purpose of the Study .......................................................................................... 3 Specific Aims of the Study ................................................................................ 4 Conceptual Framework for the Study ............................................................... 4 Specific Variables Examined in the Conceptual Framework ............... 8 Stress................................................................................................. 8 Cognitive Appraisal........................................................................ 9 Resilience ......................................................................................... 10 Social Support.................................................................................. 12 Coping.............................................................................................. 13 Research Questions ............................................................................................ 15 Assumptions ........................................................................................................ 16 Conceptual Definitions ...................................................................................... 17 Operational Definitions ...................................................................................... 18 Significance ......................................................................................................... 19 Summary............................................................................................................. 24 CHAPTERII-REVIEW OF LITERATURE............................................................ 25 Stress.................................................................................................................... 25 Stress and Life Events ............................................................................... 26 Methodological Issues Related to Stress and Life Events Studies 28 Cognitive Appraisal........................................................................................... 29 Historical References of Cognitive Appraisal ................................. 30 Classic Studies of Cognitive Appraisal ................................................... 30 Recent Literature ....................................................................................... 32 Cognitive Appraisal and Coping Responses ........................................... 33 Methodological Issues in Cognitive Appraisal/Perception ................... 37 Resilience ............................................................................................................ 37 Resilience and Stress ................................................................................. 38 In Older Women .............................................................................. 38 Resilience in Children ..................................................................... 40 Resilience and Cognitive Appraisal ........................................................ 41 Resilience and Social Support ................................................................. 41 v Reproduced with permission of the copyright owner. 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TABLE OF CONTENTS-Continued Page Resilience and Coping .............................................................................. 44 Methodological Issues in Resilience ....................................................... 44 Social Support..................................................................................................... 45 Social Support and Older Adults ............................................................ 47 Social Support and Stress ......................................................................... 49 Social Support and Cognitive Appraisal ................................................. 50 Social Support and Coping ...................................................................... 51 Methodological Issues in Social Support................................................ 52 Coping................................................................................................................. 53 Coping Strategies...................................................................................... 53 Methodological Issues in Coping............................................................ 56 Summary of Literature Review......................................................................... 57 CHAPTER III - RESEARCH DESIGN AND METHODS....................................... 59 Design................................................................................................................. 59 Sample.................................................................................................................