Running head: CLINICAL THEORY APPLICATION 1

Lazarus’s Stress, Appraisal, and Coping Transactional Model

Laura Perez

Azusa Pacific University

CLINICAL THEORY APPLICATION 2

Lazarus’s Stress, Appraisal, and Coping Transactional Model

Compared to grand nursing theories, middle-range nursing theories are narrower in scope

and can be used to connect grand nursing theories and nursing practice (McEwen & Wills,

2014). The purpose of this paper is to describe how, despite being a non-nursing theory,

Lazarus’s Stress, Appraisal and Coping Transactional Model is used as a middle range theory by

presenting concepts and propositions that hold great promise for increasing theory-based

research and nursing practice strategies.

Background

Richard S. Lazarus (1922-2002) received his bachelor’s degree from The City College of

New York in 1942 (Ekman & Campos, 2003). He pursued his doctorate degree from the

University of Pittsburgh in 1948 after serving in the military for three and a half years (Ekman &

Campos, 2003). He taught at Johns Hopkins University, Clark University, and from 1957 until

his retirement in 1991, at the University of California, Berkeley (Ekman & Campos, 2003).

Lazarus became a Guggenheim Fellow in 1969 and received two honorary doctorates, one in

1988 from Johannes Gutenberg University in Germany and the other in 1995 from Haifa

University in Israel (Ekman & Campos, 2003). In 1989 he was awarded the Distinguished

Scientific Contribution Award by the American Psychological Association (Ekman & Campos,

2003).

Before Lazarus, behavioral psychology and psychologists like B.F. Skinner had the

spotlight in the psychology community. However, Dr. Lazarus’s strong interest and dedication in

researching psychological stress and coping processes contributed substantially to the cognitive

revolution that occurred in psychology during the 1960's (Ekman & Campos, 2003). Inspired by

psychologist Kurt Lewin and by his research on autonomic discrimination without awareness,
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projective tests, perceptual defense, and motivational and cognitive factors in psychological

stress, Lazarus was encouraged to articulate a theory of his own (Ekman & Campos, 2003).

Lazarus was also motivated to organize the Berkeley Stress and Coping Project from the late

1950’s until the late 1980’s at the University of California, Berkeley (Ekman & Campos, 2003.)

The findings of his studies “indicated that appraisal of the significance of what is happening in

relationships within a particular environment was the fundamental basis of stress, the emotions,

and ways of coping” (Ekman & Campos, 2003, p.756).

Dr. Lazarus authored over 150 scientific articles and 20 books, including "Psychological

Stress and the Coping Process" (1966), "Stress, Appraisal, and Coping" (1984), and "Emotion

and Adaptation" (1999) (Ekman & Campos, 2003). All his writings continue to be read all over

the world and his work became and remains to be the basis of many popular treatments of stress

and coping, such as cognitive-behavior therapy (Ekman & Campos, 2003). His theoretical

approach to stress dominated the field and sparked interest in stress as a research topic beyond

psychology and into other disciplines such as medicine (Ekman & Campos, 2003).

Overview of the Model

The findings of Lazarus’s research formed the basis of his transactional model (see

Appendix B). Lazarus believed that humans are vulnerable to stress because of their environment

and lifestyle, thus, his transactional model looks at the interaction between the individual and

their environment (Lazarus & Folkman, 1984). Lazarus defined stress as “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). In other words, stress results

from an imbalance between the demands placed on the individual and their coping resources;

moreover, the way that the individual perceives the stressful event, rather than the actual
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environment itself. Lazarus identified this perception as an appraisal and explained that a

person’s evaluation of a stressor or events is classified as a cognitive appraisal (Lazarus &

Folkman, 1984).

According to Lazarus’s transactional model, when individuals encounter stress they make

a primary appraisal, which is defined as the “judgment that an individual makes about a

particular event or stressor” (McEwen & Wills, 2014, p.289). During the primary appraisal, the

individual considers whether they have a personal stake in the encounter with the environment

by evaluating the stressor as irrelevant, benign positive (outcome of the stressor is construed as

positive), or stressful (the stressor causes harm/loss, threat, and challenge) (Lazarus & Folkman,

1984). If the individual determines that they have a stake in the encounter with the environment,

they will make a secondary appraisal of the situation. Secondary appraisal is defined as “the

evaluation of how an individual responds to an event” (McEwen & Wills, 2014, p.289). During

the second appraisal, the individual explores and evaluates their internal coping options, such as,

willpower and inner strength; furthermore, their external coping options, such as, peers and

professional help are explored (Lazarus & Folkman, 1984).

Coping regulates the demands and emotions triggered by the appraised stress. Coping is

“changing cognitive and behavioral efforts to manage the internal or external demands placed on

the individual that are appraised as taxing or exceeding their resources” (McEwen & Wills, 2014,

p.289). There are two forms of coping: problem-focused and emotion focused. Problem-focused

coping is used when the individual feels that they have control over the situation, and can

consequently manage the source of the problem in four steps: defining the problem, generating

alternative solutions, learning new skills to deal with the stressor, and reappraise and find new

standards of behavior (Lazarus & Folkman, 1984). Emotion-focused coping is used when the
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individual feels as if they cannot manage the source of the problem and it involves acquiring

strategies that regulate stress, such as: avoiding the stressor, distancing away from the stressor,

accepting the stressor, seeking medical support, and turning to alcohol (Lazarus & Folkman,

1984). The goal of the individual is to successfully cope so that they can adapt. Adaptation is

defined as “the capacity of a person to survive and flourish” (Lazarus & Folkman, 1984, p. 182).

Achieving adaptation is important when faced with a stressor because it impacts their health,

psychological well-being, and social functioning (McEwen & Wills, 2014).

Metaparadigm Concepts

Lazarus does not describe the four metaparadigm concepts of nursing because it is a non-

nursing theory; yet, all aspects of the metaparadigm can be identified in this theory. The “person”

metaparadigm is relevant in this theory because it is focused on how an individual uniquely

copes with stressful situations and their psychological responses. Moreover, the way the patient

copes influences the aspects of the other metaparadigms. The “health” metaparadigm is

applicable to Lazarus’s theory because stress can play a huge role in the patient’s health. If the

patient does not cope positively and effectively with stressful situations, their health can

diminish. On the other hand, if the patient copes and adjusts well, they may have more positive

health outcomes. The “environment” metaparadigm is pertinent to Lazarus’s theory because

everything in the environment, for example, relationships, work, school, medical issues, or

planning for weddings can have an influence in the individual’s stress levels, whether it is

positive or negative. The “nurse” metaparadigm is applicable to Lazarus’s theory because it is

very essential for nurses to assess for stressors and help alleviate negative stressors when

providing patient care. Lazarus’s theory presents with the four metaparadigms that are essential

to patient care. For instance, nurses are always faced with the necessity to help patients cope with
CLINICAL THEORY APPLICATION 6

their emotions because emotional and mental health is a very important component of physical

healing.

Contributions to Nursing Practice and Nursing Research

Lazarus’s transactional model contributes to the nursing discipline and practice in several

ways, and these contributions can be seen as strengths related to patient care (See appendix A). A

strength of this theory is that it recognizes that everyone is unique and that everyone deals with

stress differently. This is very important for nurses because it helps provide individualized patient

care according to how the patient appraises and copes with their stressor. Another strength is that

nurses can use Lazarus’s theory as a framework to provide patient care in a holistic approach.

For example, nurses can use this theory to effectively assess a patient’s stressors and learn what

the stressor means to them. Moreover, nurses can examine the resources and support that the

patient has in coping with the stressors. After learning what factors could potentially prohibit

patients from effectively coping, nurses can help patients identify alternative methods for

managing psychological responses to their stressors. This is another strength of the transactional

model because nurses can help patients achieve problem-focused coping so they can effectively

adapt with their stressor and heal emotionally, spiritually, psychologically and physically.

A disadvantage in utilizing Lazarus’s theory is that it can be time consuming for nurses to

implement it into their practice. Nurses can have up to five patients, and taking the time to assess

a patient’s stressors and coping mechanism may be impossible. An additional disadvantage is

that to effectively apply this theory, one needs to understand the appraisal process of the patient

by knowing their desires and thoughts about all life events. Hence, if the patient is private in

nature or is mentally altered, it impedes nurses from determining the meaning of the patient’s
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stressors and coping resources, thus, hindering their opportunity to provide the patient with the

necessary resources that will help the patient to learn how to cope and adapt.

Research has also shown the importance of using Lazarus’s theory as a framework when

providing patient care. For example, Reyes (2015) performed a qualitative design guided by

Lazarus’s theory to assess and describe women’s cognitive, emotional, and coping responses

after meeting with a perinatal interdisciplinary team of specialists regarding the diagnosis of a

fetal anomaly. In Reyes’s (2015) study, three themes and six subthemes emerged while doing a

qualitative descriptive and semistructured telephone interviews with each participant. The themes

were defining the issue, establishing trust, and learning to deal. The subthemes were coping

behaviors, effects of additional testing, seeking stability, information gathering, creating bonds

with the interdisciplinary team, and integrating the information on the fetal condition. The

themes and subthemes represented women’s various coping behaviors. Stress appraisal was

consistent with Lazarus’s theory. The findings of this study are relevant to nursing practice

because it proved how essential it is for nurses to provide support, such as, interdisciplinary

counseling, to help influence women’s perceptions, help establish trust, and ultimately facilitate

coping for the remainder of pregnancy and into the postpartum period (Reyes, 2015).

Conclusion

As nurses, the goal is to help patients navigate through their stress and achieve a greater

state of adjustment and coping. Although Lazarus was a psychologist, he established a middle

range theory that provides nurses with a framework that they can use to approach and engage

with patients who are undergoing psychological and therefore, physical stress. Most importantly,

his theory gave rise to stress as a research topic in nursing that can help guide nurses to provide

more holistic patient care.

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References

Ekman, P., & Campos, J. (2003). Richard Stanley Lazarus (1922-2002). American Psychologist,

58(9), 756-757. doi:10.1037/0003-066X.58.9.756

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer Pub.

Co.

McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA:

Wolters Kluwer Health/Lippincott Williams & Wilkins.

Reyes, M. R. (2015). Influences of perinatal team counseling on women's perceptions and

coping after fetal diagnosis. JOGNN: Journal of Obstetric, Gynecologic & Neonatal

Nursing, 44: S68-S68. doi:10.1111/1552- 6909.12642

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Appendix A

Clinical Application of Lazarus’s Stress, Coping and Adaptation Transactional Model

Case Summary: M.V. is a 25-year-old male who was admitted on a voluntary basis at Aurora Las
Encinas Hospital for his desire to be treated for alcohol abuse to keep his job as a lineman, and to
keep his girlfriend’s and family’s support. M.V. stated he cannot stop the daily drinking on his
own because he has a lot of anxiety due to his Post Traumatic Stress Disorder (PTSD). Patient
was diagnosed with PTSD secondary to his combat experience from two tours of duty in
Afghanistan. He was in infantry, a gunner and a sniper. M.V stated that his PTSD started in 2011
when one of his fighters died and M.V. failed to rescue him. Since then, he claims to have
flashbacks and avoids situations that take him back to that memory.

Assessment of Behavior Nursing Goals Intervention Evaluation/Outcomes

Diagnosis
-Patient’s traumatic -Stress -Short-term goal: For -Assess what the stressor - M.V. expressed his
experiences during his two related to M.V to express his means to the patient and primary appraisal by
tours caused him to ineffective appraisals (primary their coping mechanisms. stating that he evaluated
acquire PTSD and have use of and secondary) of his -Assess the patient’s level his experiences during
flashbacks (relive the problem- traumatic war of anxiety and try to his two tours as
traumatic experiences). focused experiences and the determine the types of stressful.
-Patient appraises his coping use of alcohol as a situations that increase - M.V. expressed his
PTSD symptoms as methods as method of coping anxiety that result in second appraisal by
stressful. (M.V.’s Primary evidenced with stress due to his wanting to drink alcohol. verbalizing internal and
appraisal). by anxiety PTSD. - Educate M.V. how using external coping options.
- After evaluating internal and -Long-term goal: For emotion-focused coping -M.V. showed problem-
and external coping inadequate M.V. to be able to techniques (e.g. drinking focused coping (e.g.
options to deal with his coping skills demonstrate the alcohol and avoiding playing basketball,
stressor, M.V. appraised with ability to cope and situations) prohibits working out, relaxation
his stressor as something substitution adapt effectively by effective coping on his techniques, going to
that he was unable to cope of alcohol. using problem- diagnosis of PTSD. therapy and taking his
with (secondary focused coping - Provide patient with medications) to help him
appraisal). methods and without external coping effectively adapt.
-This caused M.V. to use resorting to alcohol options/resources to
emotion-focused coping abuse, by the time of explore: information to
mechanisms (abuse discharge from Alcoholics Anonymous,
alcohol). treatment. any professional help.
-His emotion-focused -Educate patient on
coping mechanism caused internal coping options to
him not to be able to explore: relaxation
adapt. techniques (focuses on
-Not being able to adapt breathing and muscle
affected his health and relaxation), thought
social functioning stopping (negative thought
is interrupted).
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Appendix B

Lazarus’s Stress, Coping and Adaptation Transactional Model