Page 91 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Interactional Model of Stress 65

stressful or not. Due to the differences in stress perception it
may be that while one patient perceives a routine visit from
the tissue viability nurse as stressful, another may perceive it
as benign (or indeed, positive). Similarly, although the nurse
may consider the dressing change as routine, normal and
hence benign, the patient may not share this view. Furthermore,
a patient whom may have experienced a previous painful
experience during dressing removal may become highly
stressed and anxious: their appraisal is based on learnt behav-
iour. Therefore, it is necessary for clinicians to be aware of
such situations and consider patients on an individual basis.
Something which the clinician may view as routine clinical
practice may be considered highly stressful by a patient
(Upton 2011a , b ). Secondly, the interactional model is based
upon cognitive appraisal and is influenced by other psycho-
logical factors. Hence, it is possible for a patient to interpret
the same situation in a number of differing ways depending
on their mood- their cognitive appraisal is modified by their
emotional state. Finally, it is important to remember that a
patient can experience a stressful response irrespective of
whether the event was experienced, anticipated or imagined.
Within this model, the mere thought of having a dressing
change itself can be stressful for the patient (Upton 2011a , b ).
Lazarus and Folkman ( 1984 ) suggested two predominant
functions of coping; the alteration of the situation (problem-
focused coping), or regulation of emotional responses to the
situation (emotional-focused coping). Briefly, problem-
focused coping aims to reduce the stressful demands of
expanding resources associated with dealing with that
demand (e.g. this could include avoidance of dressing changes
due to the stress perceived beforehand and during the proce-
dure, or adopting a distraction strategy in order to help deal
with the perceived stress). Alternatively, emotional-focused
coping aims to regulate the emotional response through
behavioural coping or cognitive coping strategies. For exam-
ple, trying to stay calm throughout the treatment and
reducing their own stress or worry.