Health care workers have experienced increasing stress because of the Covid-19 pandemic. The transactional model of stress and coping can be an effective instrument of stress relief for them. Several studies confirm the severity of the issue in relation to the medical workers’ psychological well-being. Simultaneously, there is scientific evidence proving the effectiveness of emotion-based coping in the case of serious issues, over which a person does not exercise control. Findings suggest that health care workers can benefit from in-depth analysis and emotion-based coping, as per the transactional theory.
In the year 2020, the whole planet has faced an unprecedented challenge in the form of the novel coronavirus pandemic. Covid-19 has influenced all parts of the world, entailing severe consequences in terms of people’s everyday lives and work. Naturally, health care is one of the sectors, which was affected the most by the pandemic. Nurses play a pivotal role in this system, being the cornerstone of health care service delivery. Being on the front line of the pandemic, nurses remain particularly vulnerable to the detrimental impact of Covid-19-related circumstances. As a result, they experience increased levels of stress, which affects their general well-being. The transactional model of stress and coping provides valuable insight into this matter. The purpose of this paper is to examine the effect of the Covid-19 pandemic on the general well-being of nurses in the context of the transactional theory.
In order to acquire an in-depth understanding of the discussed issue, a variety of resources were examined at length. As the matter at hand is directly related to health care professionals, medical research databases remained the focus of the present study. The United States National Library of Medicine contains an array of relevant literature available. However, while the Covid-19 pandemic is a topical issue today, it has emerged recently, which is why there may be a shortage of quality research related to the topic. In addition, the amount of relevant data is limited, as well, since the situation is the state of current development. Nevertheless, it was possible to select four articles, which discuss the issue of the pandemic and its psychological effects in the context of health care workers. The selection criteria suggested that the articles should be peer-reviewed and published in the English language in journals, which are relevant to medical practitioners. The date of publication was not a matter of interest since there is little or no literature on coronavirus dated before the year 2020.
The discussed issue is examined within the framework of the transactional theory of stress and coping. In 1966, Richard Lazarus laid the foundation of this model by defining stress as a relationship which exists between an individual and the environment in which they live (Folkman, 2013). This environment is considered to be important for the person, providing them with the necessary coping resources. This theory adopts two central concepts, which are an appraisal and coping (Folkman, 2013). The first notion implies a person’s assessment of the current events’ importance in their life, whereas the second one refers to the effort they make to have their needs met. On the level of appraisal, the theory’s authors distinguish three particular patterns, which lead to stress: harm (already suffered damage), threat (expected damage), and challenge (demands, which must be met) (Folkman, 2013). Consequently, once these patterns are determined as stress factors, it is possible to start the coping process by proactively working toward reducing external and internal conflicts between one’s needs and reality. This theory is relevant today, as Covid-19 poses an array of challenges, threats, and harm for nurses.
The central issue of the present study was examined by consulting the relevant literature. First of all, Sun et al. (2020) presented an interesting perspective from China, and this country was in the vanguard of the global fight against the coronavirus. A qualitative study in the form of interviews was conducted to evaluate the psychological consequences of the pandemic on medical workers. The results showed considerable levels of stress, anxiety, and depression symptoms in nurses and each of the conditions stemmed directly from the work process in the middle of a pandemic. However, while negative aspects prevailed in the majority of situations, positive emotions existed simultaneously (Sun et al., 2020). Medical practitioners reported personal growth, which led to their higher levels of gratefulness and affection. As this is a single qualitative study, it can be placed on level 5 of the evidence hierarchy, and it does not report an IRB approval, which serves as a limitation.
At the same time, the pandemic has had a truly global scale, which entailed comprehensive research worldwide. Schechter et al. (2020) focused on the impact of Covid-19 on health care professionals’ well-being in New York City. Their cross-sectional study focused on medical workers of a large facility, whose total number was 657, during the peak of the pandemic. Findings listed by Schechter et al. (2020) support previous claims of Covid-19-induced stress, as its symptoms were found in over half of the patients. Simultaneously, the incidence of depression and anxiety was also on the increase. Most of the respondents referred to the necessity of an effective coping strategy. This study was conducted by a large group of researchers, and the sample size is considerable, as well. Therefore, the findings appear to be credible in terms of the presented symptoms and numbers. The nature of this cross-sectional study puts it on level five of the evidence hierarchy.
Once the problem is determined, it is important to consider possible solutions to it. Vagni et al. (2020) expand on the topic, confirming previous findings regarding extreme stress levels of health care workers. However, they provide a more in-depth examination of the issue, as coping mechanisms are discussed, as well. Stress levels of health care professionals are compared with those of emergency service workers. The latter demonstrated a more problem-oriented approach to coping, whereas medical practitioners remained vulnerable to excessive stress and secondary trauma due to the nature of their work (Vagni et al., 2020). The authors of this research discuss the matter in relation to Lazarus’ and Folkman’s transactional theory, which enhances the usefulness of this article for the present research. This level-five research is a single descriptive study, and IRB approval is not attached. The data collected in the process was correctly evaluated and analyzed before presenting it to the readers. Overall, the credibility of this research is doubtless, and its relation to the transactional theory strengthens its importance in the discussed context.
While Covid-19 may be a recent development, which has not yet been examined from all perspectives, the transactional theory has been effectively applied in other spheres. Even though this application does not necessarily correspond with the discussed setting, analysis of such studies will enable quality development in this area. The transactional theory of Lazarus and Folkman became the central point of the study by Shavaki et al. (2020). They examined its effectiveness in mothers whose children have diabetes, which is a highly stressful situation for parents. While this theory has not been tested in the discussed environment, these findings make it a promising tool. Shavaki et al. (2020) saw the potential of the transactional theory in this regard and used it in this qualitative study. Their findings confirm the effectiveness of the model, as mothers who focused on their attitude and feelings about diabetes managed to improve their well-being significantly. Consequently, their children and the entire families benefited from the mothers’ positive, proactive position. This level-five research proves the viability of the transactional theory in the form of a single qualitative study.
As it becomes evident from previously listed findings, the Covid-19 pandemic has significantly increased the amount of stress experienced by nurses and other practitioners. Therefore, an effective instrument must be proposed to them to reduce the mental implications of the current situation. It appears that the transactional model has much potential in this area, as it allows each individual to evaluate their own sources of stress. Covid-19 is both harm and a threat within the framework of Lazarus’ and Folkman’s (2013) theory. First of all, it has already caused much pain and suffering, which medical workers observe on a daily basis. Secondly, health care professionals, similar to the rest of the world, constantly worry about the potential effect of Covid-19 on them, as well as their friends and relatives. If they effectively evaluate and classify the sources of stress, it will be possible to determine the relationship between the present situation and their needs. Consequently, it will be possible to develop appropriate behavioral patterns, which will alleviate stress and improve the quality of life.
The transactional theory dictates that all stress is merely a system of appraisal and response methods. It also suggests several coping mechanisms, and the primary division exists between problem-focused and emotion-focused approaches (Folkman, 2013). In the first case, one’s actions following the self-evaluation aim at the practical side of the issue. In the second scenario, the person attempts to change the problem’s effect on their psychological well-being. While this model does not eradicate the issue in practice, it still improves the way the person feels about it. Emotion-based coping must be proposed to nurses and other practitioners working in the Covid-19 era. This approach seems effective in the circumstances, which cannot be influenced. The pandemic is a global concern, and one person can only make a small contribution to the overall fight against the outbreak, making problem-oriented coping ineffective. Shavaki et al. (2020) described a similar situation in relation to children’s diabetes, and their research showed the positive effect of an attitude change. Medical professionals should act in the same manner as mothers from the aforementioned study. Health care workers must carefully analyze the stress factors and deliberately reduce their impact,
In conclusion, the Covid-19 pandemic has had dire consequences in terms of people’s mental condition, and health care workers have been particularly vulnerable. Presented research demonstrates that the issue is significant in scope and scale, making it topical. Effective stress relief mechanisms are required in this scenario, and the transactional theory proposed by Lazarus and Folkman seems to be a good choice. It describes stress as the relationship between one’s inner aspirations and the actual situation. Medical practitioners can benefit from it through an in-depth evaluation of stress-causing aspects. Once they discern the source of the negative effect in the greater context of the pandemic, health care workers will be able to implement effective emotion-based coping techniques.
References
Folkman S. (2013) Stress: Appraisal and coping. In M.D. Gellman & J.R. Turner. (Eds.) Encyclopedia of behavioral medicine. Springer.
Schechter, A., Diaz, F., Moise, N., Anstey, D. E., Ye, S., Agarwal, S., Birk, J. L., Brodie, D., Cannone, D. E., Chang, B., Claassen, J., Cornelius, T., Derby, L., Dong, M., Givens, R. C., Hochman, B., Homma, S., Kronish, I. M., Lee, S. A. J., … Abdalla, M. (2020). Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. General Hospital Psychiatry, 66, 1-8.
Shavaki, M. A., Harandy, T. F., Rahimzadech, M., & Pourabbasi, A. (2020). Factors related to behavioral functioning in mothers of children with type 1 diabetes: Application of transactional model of stress and coping. International Journal of Endocrinology and Metabolism, 18(2).
Sun, N., Wei, L., Shi, S., Jiao, D., Song, R., Ma, L., Wang, H., Wang, C., Wang, Z., You, Y., Liu, S., & Wang, H. (2020). A qualitative study on the psychological experience of caregivers of COVID-19 patients. American Journal of Infection Control, 48(6), 592-598.
Vagni, M., Maiorano, T., Giostra, V., & Pajardi, D. (2020). Coping with COVID-19: Emergency stress, secondary trauma and self-efficacy in healthcare and emergency workers in Italy. Frontiers in Psychology, 11.