Rosemberg Marie-Anne S, Li Yang, Seng Julia
Department of Systems, Populations and Leadership, University of Michigan, School of Nursing, Ann Arbor, MI, USA.
School of Nursing, University of Michigan, Ann Arbor, MI, USA.
J Clin Nurs. 2017 Dec;26(23-24):5191-5205. doi: 10.1111/jocn.13753. Epub 2017 Mar 22.
To elucidate the historical development of the allostatic load concept, alongside its use in nursing research, and to explore how allostatic load has been investigated among two stress-vulnerable populations.
'Stress' is a prominent term in understanding the development of disease. Allostatic load is among several approaches undertaken to quantify the magnitude of stress and understand how stress can affect health.
We explored the advent of allostatic load including its antecedents, and consequences. We used an exemplar case to apply the concept. We reviewed studies that used allostatic load among workers and women of childbearing age.
There remains a need to consolidate a common definition and operationalisation of allostatic load. Despite this need for further work, allostatic load is a good fit for nursing science which focuses on the client, environment and health. Only 12 studies explored allostatic load among workers (n = 6) and women of childbearing age (n = 6). In some studies, allostatic load was used as a predictor while in others it was used as an outcome. None of the studies considered it as a mediator.
The concept of allostatic load holds promise for nursing researchers to operationalise a holistic view of multiple stressors and to quantify their effects on health. Studies are needed to affirm the role of allostatic load as a potential mediator between multiple stressors and outcomes. Longitudinal studies are also needed to demonstrate a causal pathway from stressor exposure to tertiary outcomes such as chronic conditions and morbidity.
Allostatic load is a useful concept for nurses working with stress-vulnerable populations. With the use of an interpretable allostatic load index, nurses will be able to intervene at various stages of the allostasis-adaptation process (stress-response) and adjust interventions accordingly.
阐明应激负荷概念的历史发展及其在护理研究中的应用，并探讨在两个易受压力影响的人群中对应激负荷是如何进行研究的。
“压力”是理解疾病发展过程中的一个突出术语。应激负荷是为量化压力程度并了解压力如何影响健康而采用的几种方法之一。
我们探讨了应激负荷的出现，包括其前身和后果。我们使用一个示例案例来应用这一概念。我们回顾了在工人和育龄妇女中使用应激负荷的研究。
仍有必要巩固应激负荷的通用定义和操作方法。尽管需要进一步开展工作，但应激负荷非常适合以服务对象、环境和健康为重点的护理科学。仅有12项研究探讨了工人（n = 6）和育龄妇女（n = 6）中的应激负荷。在一些研究中，应激负荷被用作预测指标，而在另一些研究中则被用作结果指标。没有一项研究将其视为中介变量。
应激负荷概念有望帮助护理研究人员实施对多种应激源的整体看法，并量化它们对健康的影响。需要开展研究来确认应激负荷作为多种应激源与结果之间潜在中介变量的作用。还需要进行纵向研究，以证明从应激源暴露到诸如慢性病和发病率等三级结果的因果途径。
应激负荷对于护理易受压力影响人群的护士来说是一个有用的概念。通过使用可解释的应激负荷指数，护士将能够在应激适应过程（应激反应）的各个阶段进行干预，并相应地调整干预措施。
