# Situation: A 52-year-old office supervisor is seen at the clinic for depression after he was passed over for a promotion. He denies thoughts of suicide. He says, 'Losing the promotion is a real blow. I don't see how I can manage the bigger workload they gave me with no one to help.' Using Lazarus and Folkman's transactional model, which nursing action addresses the appraisal he is struggling with?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630074  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 52-year-old office supervisor is seen at the clinic for depression after he was passed over for a promotion. He denies thoughts of suicide.

He says, 'Losing the promotion is a real blow. I don't see how I can manage the bigger workload they gave me with no one to help.' Using Lazarus and Folkman's transactional model, which nursing action addresses the appraisal he is struggling with?

## 보기

1. Help him see the setback as a challenge, not a threat
2. Help him list the people and resources he can draw on **✔ 정답**
3. Teach him progressive muscle relaxation for tension
4. Encourage him to express his anger at the decision

**정답: 2**

## 해설

In the transactional model, primary appraisal asks whether a situation is a threat, harm, or challenge, and secondary appraisal asks whether one has the resources to cope. He has already judged the event as harm; his statement that he cannot manage with no one to help is a negative secondary appraisal, so identifying resources targets it directly.

## 심화 해설

Transactional Model: Where This Patient Is Stuck

Lazarus and Folkman’s transactional model describes stress as a two-step cognitive process. In primary appraisal, the person asks, “What does this event mean for me?” and labels it as harm, threat, or challenge. In secondary appraisal, the person asks, “Do I have what it takes to handle this?” — evaluating available coping resources, social support, and personal capacity.

This patient has already completed primary appraisal. His statement “Losing the promotion is a real blow” reflects an appraisal of harm — a loss that has already occurred. The more clinically significant part of his statement is the second half: “I don’t see how I can manage the bigger workload they gave me with no one to help.” This is a negative secondary appraisal — he perceives his coping resources as insufficient for the demands he faces. The nursing action that directly targets secondary appraisal is helping him identify the people and resources he can draw on, which is why option 2 is correct.

The distinction among the options rests on which appraisal component each one addresses. Option 1 (“see the setback as a challenge”) would reframe primary appraisal, but the patient has already judged the event as harm; reframing alone does not address his stated concern about lacking help. Option 3 (progressive muscle relaxation) is an emotion-focused coping technique that reduces physiological arousal but does not modify the appraisal itself. Option 4 (expressing anger) facilitates emotional ventilation but does not help him re-evaluate whether he has adequate resources.

| Appraisal Component | Question the Person Asks | This Patient’s Response | Nursing Action That Fits |
| --- | --- | --- | --- |
| Primary appraisal | Is this a threat, harm, or challenge? | “A real blow” — harm | Reframe as challenge (option 1) |
| Secondary appraisal | Do I have the resources to cope? | “No one to help” — perceived resource deficit | Identify available people and resources (option 2) |
| Coping response | What can I do to manage the stress? | Not yet engaged | Relaxation, emotional expression (options 3 and 4) |

Key point! The patient’s depression and sense of being overwhelmed are tied to a perceived lack of support, not merely to the loss itself. Interventions that expand his awareness of coping resources directly modify secondary appraisal.

Watch out! Do not select option 1 simply because “challenge” sounds positive. Primary appraisal reframing is useful when a person has not yet labeled the event, but this patient has already moved past that stage. His functional impairment is rooted in the belief that he cannot cope with what is being asked of him.

The empirical literature supports the clinical importance of appraisal-focused intervention. In a quasi-experimental study of hemodialysis patients, training based on the Lazarus and Folkman model significantly improved stress appraisal, with the authors emphasizing that correctly appraising a stressful situation is the first step toward effective coping [2]. Similarly, a structural equation modeling study in a psychosomatic inpatient sample confirmed that perceived personal resources and stress appraisal operate as linked constructs within the transactional framework — meaning that when a patient perceives resources as inadequate, the appraisal of the situation worsens, and vice versa [3]. This reinforces why a nursing action that builds the patient’s perceived resource base is more precisely targeted than generic relaxation or emotional expression.

A theoretical synthesis extending the transactional model to mental health nursing practice notes that the framework remains the primary structure for stress management in nursing, while also cautioning that meaning-making efforts which do not resolve can evolve into rumination [1]. For this patient, simply encouraging him to dwell on the unfairness of the decision (option 4) risks reinforcing a ruminative loop rather than moving him toward problem-focused coping. The more constructive path is to help him inventory what support actually exists — colleagues, family, employee assistance resources, or his own past successes in managing heavy workloads — because this directly corrects the negative secondary appraisal that is driving his distress.

In a longitudinal study of patients facing a major life stressor, appraisal components predicted emotional responses over time, supporting the view that appraisal is not a one-time event but an ongoing process that shapes subsequent coping and mood [4]. For this patient, an initial negative secondary appraisal, if left unaddressed, can consolidate into a stable belief that he is helpless, deepening the depressive presentation. The nursing action of resource identification interrupts that trajectory at the point where it is most modifiable.References (research sources)

- [1]From Cognitive Restructuring to Spiritual Purification: A Theoretical Synthesis of the Transactional Model and Islamic Psychology.Research articleHapsah H, Saleh A, Arafat R, Yusuf A. (2026) · DOI: 10.1111/jpm.70157

- [2]Effectiveness of interventions based on lazarus and folkman transactional model on improving stress appraisal for hemodialysis patients in Tehran.Research articleMorrowati Sharifabad MA, Ghaffari M, Mehrabi Y, Askari J, Zare S, Alizadeh S (2020) · DOI: 10.4103/1319-2442.279935

- [3]A Modified Version of the Transactional Stress Concept According to Lazarus and Folkman Was Confirmed in a Psychosomatic Inpatient Sample.Research articleObbarius N, Fischer F, Liegl G, Obbarius A, Rose M (2021) · DOI: 10.3389/fpsyg.2021.584333

- [4]Investigating the cognitive precursors of emotional response to cancer stress: re-testing Lazarus's transactional model.Research articleHulbert-Williams NJ, Morrison V, Wilkinson C, Neal RD (2013) · DOI: 10.1111/j.2044-8287.2012.02082.x

## 임상 시나리오

Targeting Secondary Appraisal in DepressionLazarus and Folkman's Transactional Model
When a patient says "I can't manage with no one to help," they have already completed primary appraisal as harm. The nursing priority is secondary appraisal: helping them identify coping resources and social support.

Directly ask, "Who can you call on?" and "What has helped before?" List people, services, and personal strengths. This converts a negative secondary appraisal into a more balanced one.

CautionDo not stop at reframing the event as a challenge; that targets primary appraisal and misses the stated concern about insufficient help. Relaxation techniques reduce arousal but do not change the appraisal.

## 핵심 개념

- **Primary appraisal** — Initial cognitive evaluation of whether an event is harm, threat, or challenge.
- **Secondary appraisal** — Evaluation of whether one has sufficient coping resources and social support to manage the demand.
- **Transactional model** — Lazarus and Folkman's framework describing stress as a dynamic interaction between person and environment through cognitive appraisal and coping.
- **Harm appraisal** — Assessment that damage or loss has already occurred.
- **Coping resources** — Internal and external assets, including social support, skills, and tangible help, used to manage stress.

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