Research on nursing practice. Stress.

Clearly, there is not agreement among nurse researchers regarding a definitional orientation to stress that best fits nursing's orientation to human experiences. Varying theoretical orientations are used to explain stress or stress-related phenomena, for example, stress as a stimulus, stress as a response, and stress as a transaction. The studies are fairly evenly distributed among the four definitional categories. The various approaches do not represent expanding theoretical explanations of stress, but rather are incompatible approaches to explaining stress. More disconcerting than the lack of direction in research efforts, however, is that all too commonly the measurement of the variables and the methodology were not "linked" or consistent with the theoretical framework. For the most part the research efforts reviewed fell short of theory testing. Even for those studies that were designed to contribute to theory development, it was rare to find research reports that included implications regarding theory in the discussion sections. Additionally, discussion sections of the reports typically did not identify alternative explanations for the findings. Quasi-experimental, ex post facto, and causal comparative studies typically were flawed with validity problems. If nursing is to strengthen its contribution to knowledge in the area of stress, more emphasis will need to be placed on congruence between design and measurement, and on issues of statistical rigor, validity, and reliability. Although some might argue that it is too early to expect a coalescing of definitional orientations, it is important to point out that considerable confusion regarding stress phenomena results from a nonsystematic or nondeliberative mixture of incompatible orientations to or definitions of stress. It is little wonder that the vast number of opinion articles that appear in the nursing literature include varied definitions of stress, often making conflicting recommendations regarding the nursing assessment of stress and nursing intervention strategies to assist a person in stress management efforts.