DNP 601 Module 5 Interdisciplinary Philosophies and Theories Group Paper Example

What Works and How People Cope: Pragmatism and Stress-Coping Theory Applied to Life With a Defibrillator

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

DNP 601: Theoretical Foundations for Advanced Practice Nursing

Instructor Name

Month Day, Year

What Works and How People Cope: Pragmatism and Stress-Coping Theory Applied to Life With a Defibrillator

Introduction

Nursing has long drawn on philosophies and theories from other disciplines. Our group examined one philosophy, pragmatism, and one theory, the stress, appraisal and coping theory of Lazarus and Folkman, and applied both to a population our members see in cardiac, emergency and primary care settings: adults living with implantable cardioverter defibrillators (ICDs).

Pragmatism as a Philosophy

Pragmatism, associated with American philosophers Charles Peirce, William James and John Dewey, holds that the meaning and truth of ideas lie in their practical consequences. Knowledge is judged by whether it works in experience, and inquiry begins with real problems. For nursing, pragmatism supports evidence-based practice and quality improvement, which ask whether an intervention improves outcomes in a particular setting. It also supports using multiple methods, since the question, not a fixed method, drives inquiry.

Pragmatism's limitation is that "what works" requires a judgment about whose goals count. A device clinic may define success as fewer unscheduled visits, while a patient defines it as returning to work without fear. A pragmatic nurse must make those values explicit.

Stress, Appraisal and Coping Theory

Lazarus and Folkman (1984) defined stress as a relationship between a person and the environment that the person appraises as taxing or exceeding their resources and endangering well-being. Primary appraisal judges whether an event is irrelevant, benign or stressful, and if stressful, whether it represents harm, threat or challenge. Secondary appraisal judges what can be done. Coping means the efforts people make to handle those demands; problem-focused coping tries to alter the situation, while emotion-focused coping manages the feelings it stirs up.

This theory shares roots with uncertainty in illness theory (Mishel, 1988), which also uses appraisal as danger or opportunity, but it is broader, applying to any stressor.

Application to Adults Living With an ICD

Clinical practice: A shock, or the fear of one, is a stressor that patients appraise differently. Some see the device as protection, a challenge they can manage; others see constant threat. Advanced practice nurses can assess appraisal directly, asking what the patient believes a shock means, and support problem-focused coping, such as a written shock plan, alongside emotion-focused strategies, such as relaxation and peer support. Long-term research suggests uncertainty decreases after the first year and that higher uncertainty predicts lower quality of life (Flemme et al., 2005), so early coping support matters.

Education: Patient education can be designed around secondary appraisal, giving patients clear options so that a shock becomes manageable rather than overwhelming. Staff education can teach nurses to recognize threat appraisals in questions like "What if it fires while I am driving?"

Leadership: A pragmatic leader would test a coping-support program in one clinic, measure what matters to patients and clinicians, and spread it if it works.

Research: Carroll et al. (2014) proposed expanding uncertainty theory to describe chronic uncertainty in ICD patients. A study combining appraisal and uncertainty measures could test whether coping interventions reduce both.

Health care delivery: Coping support could be built into routine device follow-up, including remote monitoring contacts, rather than added as a separate service.

Strengths and Limitations

Pragmatism's strength is its focus on real problems and outcomes; its limit is the need to define whose outcomes count. The stress and coping theory's strengths are its clear concepts, broad research base and direct clinical usefulness. Its limits are that it focuses on individual appraisal and can underplay structural stressors, such as cost of care or job insecurity, and that coping categories can oversimplify complex responses.

How Our Group Worked

Each member drafted one section from their own practice: the device clinic, an emergency department and a primary care practice. We met twice by video to agree on the shared population and on definitions, and one member edited the full draft so terms such as appraisal and coping were used the same way throughout. For the live presentation, each member presented the application area closest to their practice, and we rehearsed transitions so the talk would sound like one argument rather than three.

Contribution to Nursing Knowledge

Both offer nursing tools it might not have developed alone. Pragmatism provides a philosophical justification for evidence-based and quality improvement work. The transactional model offers a tested framework for understanding responses to illness that complements nursing theories such as Mishel's. Integrated thoughtfully, interdisciplinary knowledge strengthens nursing science rather than replacing it.

Conclusion

Applying pragmatism and stress-coping theory to life with an ICD showed our group how interdisciplinary ideas can shape practice, education, leadership, research and care delivery. The key is to use them in service of nursing's focus on the whole person.

References

Carroll, S. L., McGillion, M., & Arthur, H. M. (2014). Living with an implantable cardiac defibrillator: A model of chronic uncertainty. Research and Theory for Nursing Practice, 28(1), 71-86. https://doi.org/10.1891/1541-6577.28.1.71

Flemme, I., Edvardsson, N., Hinic, H., Jinhage, B.-M., Dalman, M., & Fridlund, B. (2005). Long-term quality of life and uncertainty in patients living with an implantable cardioverter defibrillator. Heart & Lung, 34(6), 386-392. https://doi.org/10.1016/j.hrtlng.2005.05.003

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer.

Mishel, M. H. (1988). Uncertainty in illness. Image: The Journal of Nursing Scholarship, 20(4), 225-232. https://doi.org/10.1111/j.1547-5069.1988.tb00082.x