Major coping behaviors of a hospitalized 3-year-old boy.

Heath used the active coping strategies of control, avoidance, and puppet play during the course of his postoperative recovery period. Regression, which existed in an earlier stage of development, was used to provide feelings of comfort, security, and control. The total number of coping behaviors utilized by Heath significantly increased from Phase 1 to Phases 2 and 3 of recovery (see Figure 1). This marked increase in coping behaviors during the latter two phases of recovery corresponded to the stabilization and improvement in Heath's physical condition. According to Josselyn (1955, p. 367), when an individual is ill energy that was once available for meeting the pressures of daily life is absorbed into the body as it struggles to master the illness. Barraclough (1937) states that when recovery begins and strength returns, the ill child will manifest a change in behavior which includes: increased interest in the environment; participation in ward activities; resumption of play; and return to the former carefree self. In Phase 1 of recovery, Heath was acutely ill. Since his energies had to be devoted to the inner processes of healing, Heath showed little interest in his environment. In the following two phases of recovery, Heath had more physical strength and energy which could be devoted to the process of active coping. Subsequently, the number of major coping behaviors utilized by Heath escalated. Through the repertoire of behaviors utilized in Heath's coping strategies during recovery from abdominal surgery, he was able to cope with his hospitalization. As a result, adaptation occurred which allowed the subject to achieve a degree of mastery of a stressful hospital experience.