'Preparative waiting' and coping theory with patients going through gastric diagnosis

This paper reports a study of how hospitalized patients with gastro-intestinal problems going through diagnostic workups experience and handle the situation. It presents a theory of 'preparative waiting' and discusses it in relation to Lazarus' theory of appraisal, stress and coping.

The pre-diagnostic phase is reported to be the most stressful time of the illness for patients, but there is little research on this with patients in gastric units. According to Lazarus, appraisal and coping are concurrent, and stress must be understood as both an intra- and an inter-personal process.

A grounded theory design was chosen to conduct and analyse 18 in-depth interviews with 15 patients in a gastric unit at a Norwegian university hospital. The data were collected in 2002-2003.

Participants' main concern was found to be how to prepare themselves for the results of the investigation and for life afterwards. The substantive grounded theory of 'Preparative waiting' presented here explains how they acted to do so. To be in the diagnostic phase meant to be in a process of continuously attempting to make sense of one's situation. Participants could judge their case to be harmful, a threat, a challenge, a benefit, or combinations of these. Their searches for realistic interpretation were balanced with searches for hopeful signs. This, together with lowering and rising of awareness, prevented them from despair. The process of understanding and handling the situation was concurrent, and was influenced by their relationships with family, friends, fellow patients, healthcare personnel and God.

To the degree that patients trusted that nurses understood and were sensitive to the complex processes of appraising and coping, they became patients' key support persons. By providing adjusted information, coordinating care and examinations, respecting privacy, and inquiring about existential concerns, nurses could promote patients' ability to prepare for receiving the diagnosis and life after.