MN 502 NSU Stress Based on A Nursing Theoretical Perspective Discussion

MN 502 NSU Stress Based on A Nursing Theoretical Perspective Discussion MN 502 NSU Stress Based on A Nursing Theoretical Perspective Discussion Develop a scholarly paper that includes the following criteria: A definition of the concept of Stress utilizing various sources (articles are provided on the attachments and must be cited on the paper) Define the criteria of the concept Discuss the uses of the concept Define the attributes of the concept Identify antecedents and consequences Theoretical perspectives of the concept (theories that use the concept: Neuman systems Model) Provide an example of the significance of the concept to nursing practice from the organizational setting The scholarly paper should be 5-6 pages excluding the title and reference pages. The paper should include level 1 and level 2 headings. The paper should begin with an introductory paragraph that includes the purpose statement. The introductory paragraph and purpose statement allow the reader to understand what the paper/assignment is going to address. MN 502 NSU Stress Based on A Nursing Theoretical Perspective Discussion The paper should include a conclusion. Write the paper in third person, not first or second person (meaning do not use ‘we’ or ‘I’ or “you”). Include a minimum of three (3) references from professional peer-reviewed nursing journals (review in Ulrich Periodical Directory) to support the paper. Students may use the course textbook in addition to scholarly journals. ***Historical references may be used as appropriate. (Definition of historical reference: reference to a well-known person, place event or literary work that adds meaning to the paper.) APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations). ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS .pdf contentserver.pdf nuf.12409.pdf contentserver__1_.pdf Research Article Perceived Stress and Wellness in Early Adolescents Using the Neuman Systems Model Thomas J. Yarcheski, PhD, Noreen E. Mahon, PhD, FAAN, Adela Yarcheski, PhD, FAAN, and Michele M. Hanks, AB, MA The purpose of this study was to examine the relationship between perceived stress and wellness in early adolescents and to test primary appraisal as a mediator of this relationship using the Neuman Systems Model as the primary framework. The sample consisted of 144 adolescents, ages 12–14, who responded to instruments measuring perceived stress, primary appraisal, and wellness in classroom settings. Correlational analysis supported the three hypothesized relationships. A series of regression analyses indicated that primary appraisal was a weak mediator of the relationship between perceived stress and wellness. Implications for nursing and recommendations for future studies were addressed. Keywords: perceived stress; primary appraisal; wellness; early adolescents Earlier research identified stress as an important factor in understanding wellness in adolescents (Sleet & Dane, 1985). Yet, the relationship between stress and wellness in adolescents has been underexamined. An ideal approach for nurses to study this relationship is to use the Neuman Systems Model (Neuman, 2002). This nursing model considers the occurrence of stressors and the reaction of the person to stressors, such as primary appraisal of the stressors, in relation to the outcome of wellness. The purpose of this study was to examine the relationship between perceived stress and wellness in early adolescents and to test appraisal of stress as a mediating variable in this relationship. Early adolescents were selected for study because this phase of development is considered a highly stressful period in the life cycle (Petrill, Plomin, Defries, & Hewitt, 2003). developmental periods’’ (p. 483). Lorion (2000) viewed wellness as a component of normative developmental processes that reflects the capacity of the individual to adapt to situational demands and to cope with stressful events. Furthermore, Lorion (2000) considered adolescence as a developmental phase when individuals develop the capacity to meet situational demands that influence wellness. Adolescence is a phase of life with Thomas J. Yarcheski, PhD, at the time of the study, was an associate professor at the School of Management, Health Services Management, State University of NY Institute of Technology, Utica, New York. Noreen E. Mahon, PhD, FAAN, is a professor at the College of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey. Adela Yarcheski, PhD, FAAN, is a professor at the College of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey. DEVELOPMENTAL PERSPECTIVES ON WELLNESS Michele M. Hanks, AB, MA, is a doctoral candidate at University of Illinois, Urbana-Champaign. Cowen (2000) stated that wellness is related to ‘‘the different demands and challenges of different JOSN, Vol. 26 No. 3, June 2010 230-237 DOI: 10.1177/1059840509358073 # 2010 The Author(s) 230 Vol. 26 No. 3, June 2010 great potential for wellness (Gondoli, 1999), and variables related to wellness need to be studied during this phase of development. Wellness within the Neuman Systems Model has not been studied in adolescents (Fawcett & Giangrande, 2002) and no such studies are available to date. ‘‘Adolescence is a phase of life with great potential for wellness, and variables related to wellness need to be studied during this phase of development.’’ MN 502 NSU Stress Based on A Nursing Theoretical Perspective Discussion CONCEPTUAL FRAMEWORK AND HYPOTHESES The Neuman Systems Model (Neuman, 2002) was used in this study as the primary conceptual framework; the transactional model of stress by Lazarus and Folkman (1984) provided additional theoretical support. From a holistic perspective, Neuman (2002) defined one’s level of wellness as the degree of system stability whereby all parts and subparts of the client system are in harmony with the whole of the person. In the Neuman System Model (Neuman, 2002), stressors can be intrapersonal (internal), interpersonal (relationships), or extrapersonal (external forces), all of which contribute to the wellness level experienced by the person. In the current study, perceived stress was defined as the degree to which individuals find their lives unpredictable, overloading, and uncontrollable (Cohen, Kamarck, & Mermelstein, 1983), which captures intrapersonal, interpersonal, and/or extrapersonal situations in one’s life that are perceived as stressful. Available literature indicates that the relationship between perceived stress and wellness has been examined in adults but not adolescents. As expected, a statistically significant inverse correlation (r ¼ .51, p < .01) was found between perceived stress and wellness in a study of 60 adults (Degges-White, Myers, Adelman, & Pastoor, 2003), but this relationship was not replicated in 179 West Point cadets (r ¼ .10, not significant [NS]; Myers & Bechtel, 2004) or in 234 cadets at the Citadel (r ¼ .03, NS; Gibson & Myers, 2006). The authors offered no substantive or methodological reasons for nonsupport of the 231 relationship in the military samples, but they suggested additional research in the area. In the Neuman Model (Neuman, 2002), stress contributes to wellness. Reactions to stressors, such as primary appraisal of stressors, are proposed as mediating variables in the stress–wellness relationship (Neuman, 2002), creating the basis for the mediational model examined in this study. Primary appraisal of a stressor (Lazarus & Folkman, 1984) is the initial interpretation of the meaning of a stressful situation, including the degree to which the situation is appraised as threatening and/or personally significant in terms of one’s level of wellness. Thus, a stressful situation stimulates an individual’s primary appraisal of the situation (Lazarus & Folkman, 1984; Neuman, 2002). In the primary appraisal process (Lazarus & Folkman, 1984), the individual evaluates the stressful situation, which, in turn, influences his or her level of wellness. This set of relationships has not been examined previously. Four hypotheses were tested in this study. First, an inverse relationship was hypothesized between perceived stress and wellness in early adolescents. Second, a positive relationship was hypothesized between perceived stress and primary appraisal of the stressful situation. Third, an inverse relationship was hypothesized between primary appraisal and wellness. Fourth, in the mediational model, primary appraisal was hypothesized to mediate the relationship between perceived stress and wellness. It was expected that when primary appraisal is controlled for statistically, the magnitude of the relationship between perceived stress and wellness would diminish. METHOD Design This study was a cross-sectional, correlational research design. A mediational model constructed from theory and previous research was tested using regression analyses described by Baron and Kenny (1986), which is consistent with the correlational study design. Sample Power analysis determined that a minimum of 75 subjects were needed based on a medium 232 THE JOURNAL OF SCHOOL NURSING effect size index of f2 ¼ .15 (which is comparable to an r ¼ .30 for a medium effect size used in correlational analysis), a .MN 502 NSU Stress Based on A Nursing Theoretical Perspective Discussion 05 level of significance, and a power of .82 for regression analysis (Cohen, 1988). Participants were drawn from a large public middle school in a middle-class suburban community in the northeast. Recent data estimate the population to be about 25,000; the modal income is between $75,000 and $100,000 per year. Approximately 5% of adolescents at the study school received a free or reduced rate for lunch. Of 160 students approached to participate in the study, 144 gave informed consent and had parental consent as well. The sample of convenience consisted of 70 boys and 74 girls, 12–14 years of age (M ¼ 12.5; SD ¼ .36). Fifty-seven percent of the students were in the seventh grade, while the remaining 43% were in the eighth grade. About 72% were Euro-American, 18% were Asian American, 6% were African Americans, and 4% were Latinos, as reported by the students on a demographic data sheet. Instruments The Wellness Factor of the Laffrey Health Conception Scale (Laffrey, 1986) for adolescents consists of the dimensions of eudaimonistic (wellbeing and humanness), role performance, and adaptive health (Yarcheski, Mahon, & Yarcheski, 2005). The Wellness Factor consists of 21 items responded to on a Likert format scale, ranging from 1 (strongly disagree) to 6 (strongly agree). Scores can range from 21 to 126; higher scores indicate a greater degree of perceived wellness. Examples of wellness items on the scale are ‘‘feeling great—on top of the world’’ and ‘‘creatively living life to the fullest.’’ The original Laffrey Health Conception Scale has content validity and construct validity established with adults (Laffrey, 1986). Yarcheski et al. (2005) established content validity for the Laffrey instrument for adolescents; construct validity was established using factor analysis. In the current sample, the coefficient a reliability was .94. The Perceived Stress Scale (PSS) measures the degree to which situations in one’s life are assessed as stressful; specifically, the tool assesses the frequency with which respondents find their lives to be uncontrollable, unpredictable, and overloading within the past month (Cohen et al., 1983). In the current study, the time frame used was 2 weeks, to be consistent with the Primary Appraisal Scale discussed below. The PSS is a 14-item, 5-point summated rating scale from 0 (never) to 4 (very often). Scores can range from 0 to 56; higher scores indicate a higher degree of perceived stress. Examples of items are ‘‘How often have you felt nervous and ‘stressed’?’’ ‘‘How often have you been able to control irritations in your life?’’ and ‘‘How often have you dealt successfully with irritating life hassles?’’ Cohen et al. (1983) developed items on the PSS from the literature on stress theories, providing content validity for the instrument. They also provided evidence of concurrent and predictive validity for the PSS using data obtained from college students. Cohen et al. reported the following coefficient a reliabilities: (a) .84 in a sample of 332 college freshmen and (b) .85 in a sample of 114 college students. Yarcheski, Mahon, and Yarcheski (1999) reported a coefficient of .87 in early adolescents. In the current sample, the coefficient a reliability was .87. The Primary Appraisal Scale measures the degree of threat individuals perceived related to a specific stressful event within the past 2 weeks (Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen, 1986). Respondents rate the degree of perceived threat experienced relative to each of the 13 items on a 5-point summated rating scale from 1 (does not apply to me) to 5 (applies a great deal to me). Scores can range from 13 to 65; higher scores indicate a greater perception of threat regarding the specific stressful event. Examples of items are: In your stressful event, did you ‘‘face the possibility of not achieving an important goal at school?’’ and ‘‘face the possibility of losing the affection of someone close to you?’’ MN 502 NSU Stress Based on A Nursing Theoretical Perspective Discussion The items were created from an analysis of subjects’ responses to open-ended questions, thus assuring the content validity (Folkman & Lazarus, 1980). Construct validity was established through factor analysis (Folkman et al., 1986). Yarcheski et al. (1999) reported a coefficient a of .89 in early adolescents. In the current sample, the coefficient a reliability was .87. Procedure The University Institutional Review Board gave approval to conduct the study. Access to the Vol. 26 No. 3, June 2010 233 Figure 1. Results of testing the mediation model. school setting was obtained from school administrators before conducting this study. One week prior to administering the instruments, the researchers approached seventh and eighth graders in classroom settings for voluntary participation at which time the purpose of the study and the procedures involved were discussed. All students were told that there were no consequences for nonparticipation in the study. Letters about the study and informed consents were sent home to parents for review. On the date the instruments were administered, only students who submitted signed parental consent forms participated in the study. These students also signed statements of assent. Students responded anonymously to paper and pencil self-report instruments in classroom settings, which took approximately 30 min. The researchers monitored the data collection process and were available for questions and student concerns during and following the testing periods. The students who did not participate in the study sat in the rear of the classroom and used this time for independent study. Data Analysis Data were entered and analyzed using the PC version of Statistical Package for the Social Sciences (Norusis, 1986). Descriptive statistics for the study variables and coefficient a reliabilities for the study instruments are presented in Table 1. Pearson correlations were used to test the three bivariate hypotheses, all of which were supported. Relative to the first hypothesis, a statistically significant inverse correlation was found between perceived stress and wellness (r ¼ .44, p < .001). Relative to the second hypothesis, a statistically significant positive correlation was found between perceived stress and primary appraisal of the stressful situation (r ¼ .51, p < .001). Relative to the third hypothesis, a statistically significant inverse correlation was found between primary appraisal and wellness (r ¼ .47, p < .001). Relative to the fourth hypothesis, primary appraisal was proposed as a mediating variable in the relationship between perceived stress and wellness. Results for testing the mediational model (see Figure 1) was completed in three regression analyses specified by Baron and Kenny (1986). The first regression equation revealed that perceived stress positively influenced primary appraisal (F(1, 142) ¼ 49.79, p < .001), explaining 26% of the variance in primary appraisal. In the second regression equation, perceived stress negatively influenced wellness (F(1, 142) ¼ 34.74, p < .001), explaining 20% of the variance 234 THE JOURNAL OF SCHOOL NURSING in wellness. In the third regression equation, primary appraisal negatively influenced wellness (t ¼ 3.88, p ¼ < .001), explaining 10% of the variance in wellness. In this third equation, which included both perceived stress and primary appraisal, perceived stress added 8% to the explained variance in wellness beyond the 10% contributed by primary appraisal. When controlling for primary appraisal, the proportion of variance in wellness accounted for by perceived stress was reduced from 20% to 8% and the standardized regression coefficient was decreased from. vvMN 502 NSU Stress Based on A Nursing Theoretical Perspective Discussion .44 to .28, as derived from the second to the third equation. Although perceived stress still had a statistically significant influence on wellness in the third equation (t ¼ 3.34, p < .001), the loss of 12% of explained variance in wellness by perceived stress was due to the mediation of primary appraisal. These results indicated that primary appraisal is a partial mediator in the relationship between perceived stress and wellness in early adolescents. DISCUSSION Based on the descriptive statistics reported in Table 1, the group of early adolescents in the current study had moderate levels of perceived stress and primary appraisal. These moderate levels of perceived stress and primary appraisal are comparable to those reported in previous research for early adolescents (Yarcheski et al., 1999). The early adolescents in the current study also reported a fairly high level of wellness for which there are no previous descriptive statistics in the literature. ‘‘The early adolescents in the current study also reported a fairly high level of wellness for which there are no previous descriptive statistics in the literature.’’ Perceived stress was inversely related to wellness in early adolescents, as hypothesized. This finding is consistent with the basic premise in the Neuman Systems Model, suggesting that the person’s continuous relationship to stress factors has TABLE 1. Descriptive Statistics and a Coefficients for Study Variables for Early Adolescents (N ¼ 144) Variable Mean Standard Deviation Perceived stress Primary appraisal Wellness 25.92 9.38 4–52 .87 27.52 11.28 14–59 .87 90.86 20.94 34–112 .94 Range a Coefficient some negative bearing on system stability conceived of as wellness (Neuman, 2002). The finding is also consistent with earlier research that identified stress as a major factor in understanding wellness in adolescents (Sleet & Dane, 1985). Thus, the current finding adds support for use of the Neuman Systems Model with adolescents and provides evidence for school nurses and other health professionals, who promote wellness in relation to reducing stress among adolescents. As hypothesized, perceived stress was positively related to primary appraisal of stressors in early adolescents. This finding provides support for the proposed relationship in the Neuman Systems Model (Neuman, 2002) that a person reacts to the occurrence of stress. In the current study, the variable of primary appraisal represented the reaction to stressors and was derived from the Lazarus and Folkman (1984) transactional model of stress. Other reactions to stressors need to be examined in relation to perceived stress in the Neuman Systems Model, such as coping or seeking social support. This is the first study that examined the relationship between perceived stress and primary appraisal in early adolescents. This finding provides empirical support for school-based interventions aimed at stress management programs. In these programs, school nurses and school psychologists can work together in helping students understand life events that are either good stressors (e.g., graduation) or bad stressors (e.g., family conflict) as well as daily hassles (e.g., missing the school bus) that they are likely to encounter. Understanding life events and daily hassles has the potential to influence how the students will interpret these events in their lives and manage the associated stress. Primary appraisal was inversely related to wellness in early adolescents, as predicted. As conceptualized within the Neuman Systems Model, this Vol. 26 No. 3, June 2010 finding suggests that reactions to stressors, as represented by primary appraisal, disrupt the degree of system stability, known as wellness (Neuman, 2002). Thus, when early adolescents appraise a stressful situation as potentially threatening, it negatively affects their level of wellness. When stressful situations are perceived as threatening, the school nurse needs to practice primary prevention whereby the perceived threat is modified or eliminated for early adolescents. For example, in the primary appraisal process, early adolescents may evaluate the stressor of taking tests as threatening. Nurses can collaborate with teachers to work with students to help them reappraise testtaking from a negative to a positive perspective. When students appraise test-taking as an opportunity to achieve educational goals as opposed to a threat of possible failure, primary appraisal should have less of a negative influence on their wellness. Primary appraisal was hypothesized as a mediating variable in the relationship between perceived stress and wellness in early adolescents. The findings suggested that primary appraisal is a partial mediator in the relationship between p …MN 502 NSU Stress Based on A Nursing Theoretical Perspective Discussion Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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