coping: a concept analysis elizabeth harmon university of

Running head: COPING: A CONCEPT ANALYSIS 1

Coping: A Concept Analysis

Elizabeth Harmon

University of South Alabama

COPING: A CONCEPT ANALYSIS 2

Coping: A Concept Analysis

Coping is an abstract concept capable of evoking a wide variation of mental images and

perceptions, which differ from person to person. The term is commonly used in all spheres of

nursing, as well as in other disciplines such as psychology, medicine, education, and architecture.

Acquiring a solid understanding of this concept is of particular importance in psychiatric nursing

because it is a term heavily used in the assessment and treatment of mental health disorders. In

order to determine the theoretical meaning of coping as it applies to nursing practice, Walker and

Avant’s (1995) structured approach to concept analysis was utilized, which included a thorough

literature review of multiple disciplines to examine the various uses of the concept and identify

defining attributes (Chinn & Kramer, 2011).

Defining the Concept

According to the Online Etymology Dictionary (n.d.), the term coping is derived from the

word ‘cope’, and two different etymologies were cited. The first etymology of coping referred to

an architectural term that originated in the 16th century and was defined as a type of cape for

priests. The second etymology originated in the late 14th century, and was defined as “come to

blows with.” The second definition derives from the Old French word couper (previously

colper), which meant to punch or hit, and from colp, meaning “a blow.” The meaning of the

word eventually evolved to “handle successfully” in the 17th century.

A variety of disciplines have developed their own definitions of coping. The Psychology

Dictionary Online (n.d.) defines coping as the use of mental and behavioral methods to control

the conditions of an event that appears to be beyond one’s abilities or to reduce the negative

feelings and conflict that results from various stressors. According to the online Architectural

Dictionary (n.d.), a coping is a protective cover that usually slopes to protect brickwork from


water. Webster’s Online Dictionary (n.d.) provides several multidisciplinary definitions of

coping as well. In dentistry, a coping is defined as “part of the dental crown that contacts the

prepared tooth,” and in industry it is “heavy worsted or carted cloth for men.” In mining, the

term coping is defined as “cutting or trimming marble or other stone by use of a grinding wheel.”

Interestingly, coping is also the name of a geographic location in Indonesia.

In reviewing the literature, other definitions of coping were further noted. Tandon,

Dariodis, Tucker, and Sonestein (2012) define coping as a conscious attempt to regulate

cognition, emotion, behavior, physiology and the environment in response to stressful stimuli.

Similarly, Horwitz, Hill, and King (2010) refer to coping as an active process that utilizes

behavioral or cognitive efforts to manage the internal or external sources of psychological stress.

Finally, Vera et al. (2012) describes coping as the manner in which an individual attempts to

manage internal and external demands that are perceived as overwhelming.

Significance in Psychiatric Nursing

Psychiatric nurses must have a clear conceptualization of coping in order to recognize the

specific patterns utilized by their patients and to discern the effectiveness of their skills. If

coping is ineffective, nurses will need to educate patients and assist them in developing

constructive ways to deal with life’s stressors. Three widely used coping patterns have been

identified: problem-focused, emotion-focused, and avoidance. In problem-focused coping,

individuals actively attempt to change stress-inducing circumstances. Individuals using emotion-

focused coping try to change their own negative emotions caused by the stressor. Avoidant

coping results when individuals use strategies to simply avoid the stressor. The frequent use of

both emotional-focused coping and avoidant coping are associated with ineffective coping

patterns (Horwitz et al., 2011).


When working with the adolescent population, a comprehensive understanding of coping

becomes even more crucial due to the turbulent nature of this developmental stage. Since coping

is not only used in response to a provoking event, but also dictates the associated emotion, the

recognition of effective strategies becomes even more important. According to Horwitz et al.

(2010), coping patterns that emerge at this age will influence coping styles and outcomes into

adulthood. They further note that researchers appear to have difficulty reaching a consensus on

how children and adolescents cope with stress. Persike and Seiffge-Krenke (2012) discovered

that in all societies around the globe, adolescence is a time filled with stressful experiences and

considerable changes, and the ability to cope with a wide variety of stressors is critical for

psychological health. Some degree of variation appears to exist based on race, gender, culture

and socioeconomic status, however coping deficits are among the main factors contributing to

the development of psychopathology in all cultures.

The maturational crisis of adolescence coupled with the situational crisis of an affective

disorder has an even more pronounced impact on coping. Nurses caring for adolescents with

psychiatric disorders need to be aware of how they cope with and experience mood disorders in

order to provide the best interventions (Meadus, 2007). It is imperative for these nurses to

realize that the coping abilities of adolescents are generally underdeveloped and inconsistent due

to the cognitive changes taking place. Because adolescents cope differently to stressors than

adults, they should be taught alternatives to active coping such as healthy distractions in the face

of uncontrollable stressors (Vera et al., 2012). Interventions should include a focus on reducing

or eliminating maladaptive coping patterns, enhancing problem-focused strategies, and teaching

new adaptive styles of coping (Horwitz et al., 2010).


Dimmock, Grieves, and Place (2008) found that individuals who frequently engage in

self-blame for their difficulties and setbacks often resort to negative coping patterns such as

substance abuse and self-harm. Ineffective patterns such as avoidance and emotional-focused

coping have resulted in the widespread increase of these behaviors among teens (Borrill, Flynn

& Roger, 2009). Young adult literature is filled with stories of self-harm that results from the

cumulative impact of stressful life events. The shame and secrecy surrounding these behaviors

leave adolescents with distorted perceptions of self. Increased media coverage has furthered

awareness of the issue and has led many researchers to consider this the next teen epidemic

(Miskec & McGee, 2007). Hall and Place (2010) describe two major groups of adolescents who

engage in self-harm behavior: emotionally troubled teens who do not know effective ways to

cope and teens who belong to a youth culture that encourages such behavior.

Defining Attributes

Numerous defining attributes of coping consistently appeared throughout the literature

including modify, manage, response, problem-focused, emotional-focused, avoidant, cognitive,

behavioral, regulate, physiological, and psychological. Therefore, coping can be conceptualized

as an adaptive method of dealing with both individual and environmental stressors that involve

either a physiological or psychological threat, which may or may not effectively address the

problem.

Antecedents are events that occur before coping is initiated and can include any internal

or environmental stressor that demands an emotional, cognitive, physiological, or behavioral

response. Consequences are the events that occur following coping responses, which can be

positive in nature if coping was effective, such as regaining a mental balance and equilibrium, or


negative if coping was ineffective, such as substance abuse or self-mutilating behaviors (Chinn

& Kramer, 2011).

Case Exemplar

A 14-year old female with a history of depression and self-mutilating behaviors presents

to the mental health clinic for her scheduled monthly visit. She has been seeing a counselor there

for a little over a year and has been learning cognitive behavioral therapy techniques in an effort

to manage her urges to cut. She has not engaged in that behavior since beginning therapy. In

addition, she has been seeing the psychiatric nurse practitioner regularly for medication

management. She was prescribed and antidepressant at the start of therapy and been compliant

with her scheduled medication regime. The patient reports to her therapist that she feels she has

regained balance in her life and no longer feels the urge to self-mutilate. She reports that she

has been using problem-focused coping and has modified her ineffective coping patterns and

replaced them with physical activity and exercise, which is a healthy response for dealing with

stress and appears to be working well. Based on the patient’s reports and observation, she

appears to be psychologically stable at this point and she will now slowly be weaned off the

antidepressant and go on a maintenance counseling schedule.

Borderline Case

An 18-year old male presents to a local multispecialty clinic for a complete physical in

preparation for college. He is about to begin his freshman year and plans to study architecture.

He has been trying to learn some of the important concepts and technical terms of the field

before he starts taking classes so he brought one of his textbooks with him to read while he is

waiting. As he is reading through his book, he comes across the term coping and notices that it

refers to the top or covering of a wall that is usually slanted to allow water to run off of it. The


patient muses to himself how a word can mean so many different things depending on the

context in which they are used.

Related Case

A 15-year old female presents to the mental health clinic for the first time accompanied by her

mother. She appeared very reserved and spoke in a soft voice. Her mother did most of the

talking during the session and reported that the patient has become increasingly withdrawn over

the past couple of years and seems to be depressed. She also stated that the family had recently

moved here from out of state and the depressive symptoms that her daughters has been

experiencing seemed to escalate shortly after beginning her new high school. Upon further

investigation it was found that the patient has been unsuccessful in developing friends at her new

school and that some of her peers have been cyber-bullying her for the past month. She has been

for the negative actions of her peers. She continues to go to class however, and has been able to

maintain a 3.5 GPA. When not in school, she usually retreats to her room and reads or listens to

music, but spends the majority of her life alone. This patient is demonstrating some positive

coping skills but is not fully engaged in changing her situation.

Contrary Case

A 17-year old male was admitted to the inpatient psychiatric unit at a local hospital. He

has a history bipolar disorder, attention-deficit disorder, and poly-substance abuse. He has been

non-compliant with his medications, has been in rehab twice (which was unsuccessful), and

consistently fails to take therapy seriously. He was brought to the emergency department by the

police after being picked up from a parking lot outside of the movie theatre for disturbing the

peace. He has recently dropped out of school and stated that he no longer cares if he lives or


dies. The patient has no interest in changing his maladaptive coping behaviors and does not

demonstrate any positive coping patterns.

Conclusions

Due to the abstract nature of the term coping and its use in numerous disciplines, a

structured analysis was conducted in order to identify the defining attributes of the concept that

are specific and relevant to nursing practice. Psychiatric nurses who work with the adolescent

population must understand the cognitive changes and stressors that occur during this period of

development, and how they affect the adolescent’s ability to cope. Nurses must also have the

ability to identify and treat individuals who demonstrate maladaptive coping patterns. Several

cases were presented in an attempt to further clarify what coping is and is not.


References

Borrill, J., Fox, P., Flynn, M., & Roger, D. (2009). Students who self-harm: coping style,

rumination and alexithymia. Counselling Psychology Quarterly, 22(4), 361-372.

doi:10.1080/09515070903334607

Chinn, P., & Kramer, M. (2011). Integrated theory and knowledge development in nursing (8th

ed.). St. Louis: Mosby Elsevier.

Coping. (2013). In Architectural Dictionary. Retrieved from

http://architecturaldictionary.org/?s=coping

Coping. (n.d.). In Online Etymology Dictionary. Retrieved from

http://etymonline.com/index.php?allowed_in_frame=0&search=coping&searchmode=no

ne

Coping. (n.d.). In Psychology Dictionary: World’s most comprehensive online psychology

dictionary. Retrieved from http://psychologydictionary.org/coping/

Coping. (n.d.) In Webster’s Online Dictionary. Retrieved from http://www.websters-online-

dictionary.org/definitions/coping

Coping. (2013). In Merriam-Webster’s online dictionary. Retrieved from http://www.merriam-

webster.com/dictionary/coping

Dimmock, M., Grieves, S., & Place, M. (2008). Young people who cut themselves – a growing

challenge for educational settings. British Journal of Special Education, 35(1), 42-48.

doi:10.1111/j.1467-8578.2008.00368.x

Hall, B., & Place, M. (2010). Cutting to cope -- a modern adolescent phenomenon. Child: Care,

Health & Development, 36(5), 623-629. doi:10.1111/j.1365-2214.2010.01095.x


Horwitz, A., Hill, R., & King, C. (2011). Specific Coping Behaviors in Relation to

Adolescent Depression and Suicidal Ideation. Journal of Adolescence, 34(5), 1077-1085.

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http://libproxy2.usouthal.edu/login?url=http://search.ebscohost.com/login.aspx?direct=tru

e&db=eric&AN=EJ937779&login.asp&site=ehost-live&scope=site

Meadus, R. (2007). Adolescents coping with mood disorder: a grounded theory study. Journal of

Psychiatric & Mental Health Nursing, 14(2), 209-217. doi:10.1111/j.1365-

2850.2007.01067.x

Miskec, J., & McGee, C. (2007). My scars tell a story: self-mutilation in young adult

literature. Children's Literature Association Quarterly, 32(2), 163-178.

doi:10.1353/chq.2007.0031

Persike, M., & Seiffge-Krenke, I. (2012). Competence in coping with stress in adolescents

from three regions of the world. Journal of Youth and Adolescence, 41(7), 863-879.

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e&db=eric&AN=EJ969376&login.asp&site=ehost-live&scope=site

Tandon, S., Dariotis, J., Tucker, M., & Sonenstein, F. (2013). Coping, stress, and social support

associations with internalizing and externalizing behavior among urban adolescents and

young adults: Revelations from a cluster analysis. Journal of Adolescent Health, 52(5),

627-633. doi:10.1016/j.jadohealth.2012.10.001

Vera, E., Vacek, K., Blackmon, S., Coyle, L., Gomez, K., Jorgenson, K., & ... Steele, J. (2012).

Subjective well-being in urban, ethnically diverse adolescents the role of stress and

coping. Youth & Society, 44(3), 331-347. doi:10.1177/0044118X11401432


Walker, I., & Avant, K. (2004). Strategies for theory construction in nursing (4th ed.). Norwalk,

CT: Appleton-Century-Crofts.

Concept Analysis on Copingby Elizabeth Harmon

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