to do with the internal restructuring of the person
in challenging encounters. It involves mental con-
struction of concept formation (Roy, 1988a, 1988b,
2001). Concepts allow the person to organize infor-
mation into manageable units or related data. For
example, an understanding of the relationships
among the concepts of hearing loss, aging, and self
guides the person’s behavior in a given situation. In
the situation of hearing loss, the person may mod-
ify or change the meaning of the term “hearing
loss,” which may in turn reduce the threat to the
person and to his or her sense of self. Realistic
concept formation results in effective coping.
Therefore, to promote this adaptive coping process,
nursing interventions need to identify how the per-
son represents the problem, what meaning and con-
cepts are attached to the person’s experience, and
what strategies can be used for effective adaptation.
Coping processes of knowing awareness involves
individuals’ efforts in searching for coping re-
sources and strategies, retrieving information, rec-
ognizing workable methods or experience in the
past, and learning from or comparing with others
who have experienced similar or different encoun-
ters. Taylor (1983) viewed downward and upward
social comparison as one effort of coping and
adaptation. In using an upward comparison, the
person may select a physically disadvantaged per-
son who adapts effectively as a role model for the
purpose of self-enhancement. Cognitively, a person
may use downward comparison to compare his or
her hearing problem to the more serious problems
of other individuals, so as to reduce the threat of
hearing loss and to enhance a sense of self. Such
cognitive comparisons may serve the purpose of
preventing discrepancies between a desired sense of
self and the current self-perception. Another source
of the knowing-awareness dimension of coping
and adaptation processing in older persons is how
they address and integrate their historical self into
their current life. This coping strategy provides a
source of pride for older persons. Nurses can facil-
itate older people’s adaptation to chronic condi-
tions by encouraging them to review the course of
their lives in perspective, to draw on sources of pos-
itive life experiences, and to identify relevant infor-
mation that promotes effective coping.
Coping processes of self-perception refers to
self-awareness, self-analysis, emotion, and con-
sciousness (Zhan, 1993a). This processing serves
three functions in adaptation. First, self-awareness
signals the need for adaptive efforts. A case in point
is the inability to discriminate pain. In such cases,
in order to survive, the person must be trained to
recognize and react to strong stimuli, such as the
danger of handling sharp objects. Maintenance of
self-consistency involves efforts of self-adjustment
as the person interacts with the environment. If a
discrepancy is sensed, cognitive processes of self-
awareness, analysis, and emotions are activated to
reduce that discrepancy.
Second, self-analysis and emotions interrupt on-
going behavior patterns, so that the person can at-
tend to a more salient danger in order to deal with
it. For example, keeping in touch with emotion di-
rects the person’s attention and efforts toward goals
imperative and important for the person in a given
situation. In a study of coping strategies, Folkman
and Lazarus (1988) found that stressful health
events elicited greater use of emotion-focused cop-
ing responses than use of problem-focused coping
strategies. Keeping in touch with emotions creates a
sense of the emergency, without which adaptive
reactions would be too pallid.
Third, self-consciousness and self-analysis in-
volve a person’s efforts to restore a sense of self
through self-enhancing evaluation (Taylor, 1983).
Self-enhancing evaluation may involve how an in-
dividual perceives the encounter. If older people
view hearing loss as a challenge rather than as a
threat, the anxiety associated with hearing loss may
be minimized. Emotionally, older people with
hearing loss may be less overwhelmed, and their
self-structure hence would be protected. However,
the relationship between perceiving the encounter
as a threat or as a challenge can shift as an en-
counter unfolds (Lazarus & Folkman, 1984). The
individual’s coping resources and personality may
influence how he or she views the encounter.
Therefore, nursing intervention needs first to assess
how the person affected perceives the stressful en-
counter and then to develop strategies that encour-
age perceptions of being challenged rather than
being threatened. It is critical to keep in mind that
the relationship between the threat and the chal-
lenge is recursive, in part depending on the individ-
ual’s interaction with the external environment. As
the environment is altered, cognitive perception
may be changed. For example, as a supportive envi-
ronment is given and a person searches for more re-
sources, the perceived encounter can be changed
from negative to positive.278 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration