Cognitive Appraisal of Pain and

211 Pages·2012·3.6 MB·English

Cognitive Appraisal of Pain and „Other‟ Chronic Stressors in Adults Living with Sickle
Cell Disease (SCD):
Correlates and Predictors of Emotional and Quality of Life Outcomes

Phyllis Teabout Bazen

Submitted in Partial Fulfillment of the Requirements
For the Degree
Doctor of Philosophy

Supervised by:

Professor Mary H. Wilde
School of Nursing

University of Rochester
Rochester, New York
2011
COGNITIVE APPRAISAL IN SCD ii

Dedication

This dissertation is dedicated to all of the courageous adult participants who have
contributed greatly to the knowledge and increased awareness of health care providers
and researchers about the patient defined salient pain and non pain stressors encountered
on a daily basis while living with Sickle Cell Disease.

In addition, special dedication is warranted to acknowledge the memories of
participant P.S., and my dear friend Robert Lewis Hawkins, who were courageous
warriors and advocates for Sickle Cell Disease awareness who are now resting in Heaven.
Soli Deo Gloria
COGNITIVE APPRAISAL IN SCD iii

Curriculum Vitae

Phyllis Teabout Bazen is a Family Nurse Practitioner who was born in Richfield
Springs, New York October 20, 1959. She received her Bachelor of Science Degree in
1984 and her Master of Science Degree in 1994 from Syracuse University, both in the
field of Nursing. She also was appointed as a Clinical Teaching faculty member during
her years at Syracuse University in the undergraduate and graduate programs of Nursing.
During her professional nursing career she has worked in a variety of clinical
settings including Critical Care, Hematology-Oncology, Internal Medicine, Nursing
Administration, Pain Management and Family Practice. She maintains American Nurses
Credentialing certifications as a Family Nurse Practitioner, Acute Care Nurse
Practitioner, and Pain Management Nurse.
During the years spent in Internal Medicine at University Hospital, Syracuse,
New York she became aware of and was an advocate for adult patients living with Sickle
Cell Disease. She is the Founder and Executive Director of the Central New York Sickle
Cell Disease Association, a non-profit organization dedicated to increasing the awareness
of sickle cell disease among health professionals and empowering individuals and
families to meet and overcome the challenges of living with sickle cell disease. She is a
well known speaker within the sickle cell community and has been an invited lecturer for
numerous national presentations and educational workshops on a variety of topics,
primarily sickle cell disease.
She attended the University of Rochester (2000 – 2011) to obtain the Doctor of
Philosophy Degree in the School of Nursing under the tutelage of Mary T. Dombeck,
RN, Ph.D., Kathleen B. King, Ph.D., and Mary H. Wilde, RN, Ph.D. who served as her
COGNITIVE APPRAISAL IN SCD iv

advisors while she developed her research. She participated as a research assistant for
Bernadette Melnyk, Ph. D., Principal Investigator of the KYSS (Keeping Your Children
and Yourself Safe and Secure) campaign; Kathleen B. King, Ph.D., Principal Investigator
of the Healthy Heart Grant, Monroe County Health Department and the Women‟s Health:
Pregnancy and Beyond: A feasibility study to identify women with a history of
gestational diabetes mellitus, and Nancy F. Feinstein, Ph.D. Project Coordinator of the
Monroe County Health Department School-Based Pediculosis Project. She also
participated as a Teaching Assistant in the clinical undergraduate and academic graduate
nursing programs.
COGNITIVE APPRAISAL IN SCD v

Acknowledgements

I would like to thank all of the dedicated professors, colleagues, and staff at the
University of Rochester, School of Nursing and Strong Memorial Department of
Medicine who encouraged and supported me in the successful completion of this
research:
Mary H. Wilde, Ph.D.
Mary T. Dombeck, Ph. D
Robert Cole, Ph.D.
Kathleen B. King, Ph. D
Madeline Schmitt, Ph.D.
Jeanne Grace, Ph.D.
Bethel Powers, Ph. D.
Charles Francis, MD
Nancy F. Feinstein, Ph. D.
Christina Koulouglioti, Ph. D.

I also am deeply indebted to my son, Charles Edward Bazen, III, (Chas) for his
never ending unconditional love, support, courage and great sense of humor throughout
this journey that he has traveled daily with me while at home and aboard the USS Nimitz.
Mary Teabout Watson and Jennifer Teabout Williams are two women I am
honored to call my sisters. I am forever indebted to them for their presence and essence
during the most critical times of this journey when they went above and beyond to care
for me as only sisters can.
I also extend special thanks and appreciation to Wally R. Smith, MD, Ph.D.,
Director of the Adult Sickle Cell program at Virginia Commonwealth University in
Richmond, Virginia for his invaluable mentorship and dedication shared with me and to
this research.
COGNITIVE APPRAISAL IN SCD vi

I also acknowledge my appreciation to the American Society of Pain Management
Nurses (ASPMN), Delta Sigma Theta Tau Sorority, Sigma Theta Tau International
Honor Society of Nursing and the Syracuse Area Black Nurses Association (SABNA) for
the financial scholarships awarded toward the completion of this research.
And last but not least, I say “Thank You” to Mattie Schmitt, Ph.D., (former
program director) and Carol Root (retired Administrative Assistant) for their open door
policy and unsurpassed love and support during the early years of planning this research.
COGNITIVE APPRAISAL IN SCD vii

Abstract

The purpose of this cross sectional descriptive study, guided by Lazarus‟ Stress
Appraisal theory (1999), was to: (1) explore the relationships between the cognitive
appraisals of patient defined pain and Other chronic stressors, negative mood, and quality
of life satisfaction of adults living with SCD, (2) test the mediating effect of pain and
non-pain threat appraisals on negative mood and quality of life perceptions,(3) examine
the potential moderating effect of health care provider threat appraisal on the relationship
between patient defined pain and non-pain stress and quality of life and, (4) collect
narrative data that will be used in future research in adults with SCD.
According to Lazarus (1999), cognitive appraisals represent an individual‟s
personal beliefs about the relevance and meaning of a stressor within transactions in the
environment and the significance of its outcome to his/her personal wellbeing. Over a
two year period, ninety-seven adults (18 years and older) completed in-person or
telephone interviews completing questionnaires that measured pain and non pain SCD
stressors, cognitive appraisals of SCD illness, SCD pain, negative mood, and quality of
life.
Patient defined pain and non pain (Other) stressors were significant predictors of
increased negative mood and lower quality of life satisfaction. The most frequently
encountered stressor was related to health care provider relationships, and socioeconomic
status related to SCD disability was appraised as the most stressful. Hierarchical
regression analyses demonstrated that the ability to control SCD pain mediated the
relationship between pain severity and negative mood. The pervasiveness of SCD pain on
COGNITIVE APPRAISAL IN SCD viii

all aspects of life was the single most important underlying stressor that contributed to
both the frequency and severity of patient defined non pain stressors.
Gaining a more in depth awareness and understanding of the cognitive appraisal
of pain and non pain stressors would help health care providers to focus more intently on
the person living with SCD. Moreover, it also would provide the first steps in identifying
significant predictors and designing health care provider driven interventions to improve
the quality of life of adults living with SCD.
COGNITIVE APPRAISAL IN SCD ix

Table of Contents

Chapter One Problem and Significance 1
Background to the Problem 7
Stressor Identification in SCD Research 7
Quality of Life in Sickle Cell Disease 9
Study Rationale 11
Study Purpose 12
Chapter Two Orientation to the Problem 13
Lazarus‟ Cognitive-Motivational-Relational Theory of 14
Stress and Emotion
Stress 14
Cognitive Appraisal 16
Appraisal Antecedents 16
Appraisal Domains 17
Coping 18
Stress Emotions 19
Core Relational Themes 20
Review of the Literature 22
SCD Pain 22
Health Care Provider Relationships 25
Health Care Utilization 29
Family and Social Relationships 30
Cognitive Appraisal in Sickle Cell Disease 31
Negative Mood in Sickle Cell Disease 34
Depression 34
Quality of Life in Sickle Cell Disease 37
Pilot Study 41
SCD Stress Questionnaire Construction 42
Participant Interview Procedure 45
SCD Stress Questionnaire Individual Item Analysis 46
New Variable – SCD Pain 48
Pilot Study Summary 50
Chapter Three Methodology 53
Study Aims and Design 53
Research Questions 53
Theoretical Hypotheses 54
Inclusion and Exclusion Criteria 56
Statistical Power Analysis 56
Definition, Measurement and Operationalization of 57
Variables
Demographic Variables 58
Independent Variables 58
Mediator Variables 61
COGNITIVE APPRAISAL IN SCD x

Moderator Variable 62
Dependent Variables 63
Recruitment Methods 65
Participant Interview Procedures 70
Human Subjects 72
Methods of Analysis 74
Chapter 4 Results 79
Sample Demographics 79
Internal Consistency & Reliability of Study Instruments 85
Dependent Variables 87
Negative Mood 87
Quality of Life 90
Correlation Analyses 94
Research Questions 99
Hypotheses Testing 111
Chapter 5 Discussion 124
Theoretical Constructs 125
Study Hypotheses 135
Supported 135
Hypotheses Not Supported 138
Strengths 141
Limitations 144
Future Research Directions 149
Future Implications 153
Conclusion 153
References 155