Journal of Nursing Measurement, Volume 22, Number 3, 2014

The Validation of the Coping and

Adaptation Processing Scale
Based on the Roy Adaptation Model
Muder Alkrisat, PhD, RN
Vivien Dee, PhD, RN, NEA-BC, FAAN
Azusa Pacific University, California

Background and Purpose: To establish the psychometric soundness for Coping and
Adaptation Processing Scale (CAPS) using the Roy adaptation model as theoretical frame-
work. Method: A descriptive, cross-sectional survey of a convenience sample of 199 nurses
working in different acute health care facilities in California. The internal consistency of
the multifactor CAPS questionnaire was explored using Cronbach’s alpha coefficient.
Factors correlation was examined using Pearson product moment correlation. The factor
structure was studied using confirmatory factor analyses. Results: In the confirmatory fac-
tor analysis, the indices of fitness highly supported these results. The Cronbach’s alpha
coefficient for the total score was .81 and varied between .31 and .78 in the 5 domains.
A positive and significant correlation emerged between CAPS factors and total scores
(r 5 .91, p , .01) ranging from .17 to .81. CAPS showed acceptable validity and reliability
for measuring the coping of nurses in acute setting. Future studies using the scale might
lead to the improvement of the subscales measurement. Conclusion: The psychometric data
suggests that CAPS is a highly suitable instrument to measure coping processes.

Keywords: Roy adaptation model; coping; CAPS; adaptation; psychometric properties;

confirmatory factor analysis

I
n a systematic review for conceptualization and measurement of coping conducted by
Garcia (2010), it was concluded that the empirical weaknesses in coping assessment
significantly challenged and limited the applicability and relevance of coping data.
Moreover, there were gaps that exist between the acknowledged need for identifying indi-
vidual ways of coping, subtypes of coping behaviors, and development of measures that
can distinguish these subtypes. Skinner, Edge, Altman, and Sherwood (2003) completed
an evaluation of 100 coping assessment tools used in different studies. They identified
more than 400 ways of coping that were measured in these tools, demonstrating the
breadth and depth of coping measurement and the resultant challenges in interpreting,
generalizing, and acting on coping data.
In early conceptualization, coping was identified as an indicator of ego maturity;
therefore, coping was assessed by clinicians using extensive interviews. As it became
separated from ego psychology, coping was seen as a manifestation of personality
traits; hence, dispositional coping styles were assessed by questionnaires that tapped
on one or two dimensions of coping (Skinner, 2007). Various self-report measures have

368 © 2014 Springer Publishing Company

http://dx.doi.org/10.1891/1061-3749.22.3.368
The Validation of the Coping and Adaptation369

been developed to assess coping behaviors. Within the occupational well-being arena,
the Ways of Coping Checklist (WCC) developed by Lazarus and Folkman (1986) is a
widely used instrument. The WCC went through several revisions and was subsequently
revised into the Ways of Coping Questionnaire (WCQ), via a modification of both the
scale items and the response format (Lazarus & Folkman, 1986). Although substantial
deficiencies were identified by Stone, Greenberg, Kennedy-Moore, and Newman (1991),
WCQ remains the most frequently used instrument in nursing despite the published
theoretical and empirical criticisms of this instrument. According to Lazarus and
Folkman (1986), psychological stress is indicated by two processes: cognitive appraisal
and coping as central mediators within the person–environment transaction. Lazarus and
Folkman (1984) postulated that the appraisal of an event rather than the event itself pro-
duces stress, which implies that individuals perceive a situation as being stressful when
their work demands threaten their ability to cope, when their work does not fulfill their
needs, when they feel they have little power over their work, or when they have little
occupational or external support.
Several studies have documented that nurses experience high levels of stress
related to individual, social, environmental, occupational, and organizational factors
(Abualrub & Al-Zaru, 2008; Edwards & Burnard, 2003; McGrath, Reid, & Boore,
2003). Stress-influencing factors might be categorized as personal or situational; these
factors influence the perception of stressful conditions and the demand for coping
responses. However, influencing factors may have a direct effect on both the appraisal
of stress and the coping responses that follow (Lazarus & Folkman, 1984). Lazarus
(1993) defined appraisal as the personal evaluation of a particular event as stressful,
harmful, threatening, challenging, or benign, which eventually acts as an intervening
variable that consequently influences coping responses and individual well-being.
Similar to Lazarus’s coping framework, the Roy adaptation model (RAM) views
individuals as an adaptive holistic system that interacts with environmental stressors
(i.e., stimuli). Roy suggested two subsystems to help in the coping process: the regula-
tor and the cognator. In the regulator subsystem, individuals respond to environmental
stimuli automatically through innate, physiological adaptive processes. The regula-
tor subsystem might influence changes in the environment through neural chemical
endocrine channels. In the cognator subsystem, the individual reacts to environment
stressors through cognitive and emotional channels that involve perceptual and infor-
mation processing, learning, judgment, and emotion; however, both subsystems work
to maintain the integrity of the individual and balance with the environment (Fawcett,
2005; Roy, 2009).

COPING AND ADAPTATION PROCESSING SCALE

The 47 items were derived from RAM. The items of the instrument describe short state-
ments about how an individual responds to a crisis or an extremely difficult event. The
participants evaluate the coping responses using a Likert scale ranging from 4 (always) to
1 (never). Possible scores range from 47 to 188, with a higher score indicating more con-
sistent use of the identified coping strategy. There are five subscales, which are interpreted
within the middle-range theory of RAM’s coping and adaptation processing. They are (a)
Resourceful and Focused, (b) Physical and Fixed, (c) Alert Processing, (d) Systematic
Processing, and (e) Knowing and Relating.
370 Alkrisat and Dee

Theoretical Framework
RAM represents a reciprocal interaction worldview (Fawcett, 2005) that regards indi-
viduals as having interactive dimensions. It assumes that the interactions between people
and their environments are reciprocal and that changes may occur in either. Roy posits
that stimuli originating externally to the person and from within the person provoke a
response as a point of interaction between the person and the environment (Fawcett, 2005;
Fitzpatrick & Whall, 2005; Pejic, 2005; Roy, 2009; Roy & Andrews, 1999).
In the early 1970s, Roy viewed the person as an adaptation organism. She considered
nursing care primarily as involving the manipulation of physical systems to obtain adapta-
tion in the person using a stimulus–response behavioral model. In 1976, Roy modified RAM
to accommodate issues of person/human self-perception and further developed the adaptive
mode of self-concept to include self-consistency, self-ideal, and the moral-ethical-spiritual
self (Roy, 2011). In later works, Roy expanded her discussion to focus on awareness, pur-
posefulness in the universe, enlightenment and faith, and mutual relationships with God and
the world as integral components of a human being; Roy also redefined adaptation to stress
as the mutuality of persons and environment (Roy, 2009; Roy & Andrews, 1999).
The ability of the individual to respond positively depends on the situation and on
internal resources. RAM’s underlying assumptions include adaptation as a function of
stimuli and that living system reactions are nonlinear but are multifaceted and are complex
processes that include unique interactions (Roy, 2009; Roy & Andrews, 1999) represent-
ing the assumptions associated with humanism and creativity; assumptions associated
with veritivity include purposefulness of human existence, unity of purpose, activity and
creativity, and value and meaning of life (Roy, 1988, 2009).

Coping Processes Versus Adaptation Processes

The model identified coping processes that have been integrated into two subsystems: regulator
and cognator. In the regulator subsystem, individuals respond to environmental stimuli through
physiological adaptive processes, which create automatic innate responses that guarantee certain
changes in the environment through neural chemical endocrine channels. In the cognator sub-
system, individuals respond to stimuli including regulator subsystem outputs through the four
adaptive modes: role function, physiological, self-concept, and interdependence (Roy, 2009;
Roy & Andrews, 1999). The cognator subsystem influences the environment through cognitive
and emotional channels that involve arousal, attention, sensation, perception, coding, concept
formation, memory, language planning, and motor response. These functions are channeled into
the brain centers for appropriate responses (Fawcett, 2005; Roy, 2009; Roy & Andrews, 1999).
Roy conceptualized a person as an open, adaptive system with a coping cognator
mechanism and regulator mechanism interacting to maintain adaptation in the four adap-
tive modes: physiological, self-concept, role function, and interdependence (Chiou, 2000;
Roy, 2009). Roy presents the physiological mode as the basic biological function that
aims to maintain the basic human physiological needs for oxygenation, nutrition, elimina-
tion, activity and rest, protection, the senses, fluids and electrolytes, neurological func-
tion, and endocrine function (Fawcett, 2005; Roy, 2009, 2011; Roy & Andrews, 1999).
The role function mode refers to development, performance, and mastery of the person’s
primary, secondary, and tertiary roles based on his or her position within society. The
interdependence mode focuses on maintaining social integrity and emphasizes behaviors
underlying the development and maintenance of satisfying relationships with significant
others. The self-concept mode focuses on how the person perceives himself or herself.
The Validation of the Coping and Adaptation371

This mode emphasizes the psychological, spiritual, and psychiatric integrity of the person
(Fawcett, 2005; Fitzpatrick & Whall, 2005; Roy, 2009; Roy & Andrews, 1999).
According to Roy (2009), the self-concept mode consists of two subareas: the physi-
cal self and the personal self. The physical self consists of two components: (a) the body
sensation that refers to how one feels and experiences the self as a physical being and
(b) the body image that indicates one’s perception about one’s physical appearance and
health and illness states. The personal self is viewed as having three components: (a) self-
consistency, which strives to an organized system of ideas about self; (b) self-ideal, which
refers to personal component that relates to what the person would like to be or is capable
of doing; and (c) moral-ethical-spiritual self, which refers to that aspect of the personal
self that includes a belief system and an evaluation of how one is related to the universe.
The complex relationships among the adaptive modes and the regulator and cogna-
tor subsystems reflect the integrated, holistic nature of the person (Barone, Roy, &
Frederickson, 2008; Roy, 2009). The perception process is found in both the regulator and
cognator and is viewed as the process linking these two subsystems. Input to the regula-
tor is transformed into perception. Perception is a process of the cognator. The responses
following perception are fed back to both the cognator and the regulator (Dobratz, 2002;
Fawcett, 2005; Roy, 2009).
Roy (2009) viewed perception as an interactive process by which the cognator sub-
system provides interpretation for sensory stimulus and the conscious appreciation of
stimulus through complex cognitive processes that involve the human nervous system to
create human behavior. The model presented the cognition process within the field of con-
sciousness characterized by both awareness and arousal, which can be presented through
a person’s readiness to act and reflect on one’s actions based on evaluation of external and
internal stimuli. The self-awareness process requires self-consciousness and realization of
an inner reality that can manifest itself in mental health.
Roy defined adaptation as a process and outcome whereby thinking and feeling per-
sons, as individuals and in groups, use conscious awareness and choice to create human
and environmental integration. Adaptation is described on three levels of the life pro-
cesses: (a) integrated, where the structures and functions of the life processes work to
meet needs; (b) compensatory, where the cognator and regulator are activated to integrate
life processes; and (c) compromised, when an adaptation problem occurs from inadequate
integrated and compensatory life processes (Roy, 2009; Roy & Andrews, 1999).

METHODOLOGY

Aim
The aim of this study was to test the psychometric properties of the Coping and Adaptation
Processing Scale (CAPS) with nurses in the acute care settings.

Design
A correlational, cross-sectional design was used. The study was conducted in one of the
educational centers that provide continuing education classes, test preparation s­ervices,
­professional development workshops, and certification programs for the ­registered nurse (RN)
and licensed vocational nurse (LVN) who are working in acute care medical, surgical, inten-
sive, pediatric, and behavioral facilities located in Southern California.
372 Alkrisat and Dee

Sample
There were 199 RNs and LVNs who responded to the questionnaires. Nurses were consid-
ered eligible if they were willing to complete the survey, older than age 21 years, able to
read and speak English, either RNs or LVNs, employed in clinical settings for more than 1
year on a full-time or part-time basis, and had studied in the center for one class or more.

Institutional Review Board Approval

Prior to starting the data collection, approvals from both the Institutional Review Board (IRB)
at Azusa Pacific University (APU) and the educational center were obtained. A flyer was
used to recruit nurses to participate in this study. The flyer language and design were also
approved by both APU IRB and the educational center. Flyers were posted in nursing lounges
in the center to encourage voluntary participation.
There was little or no risk to participating and no direct benefit to the participant. The
risk and/or inconvenience of participating in the study could have resulted in emotional dis-
comfort. The participants were informed that they were under no obligation to participate
in the study at any time. The participants were given the option to drop out of the study if it
became too distressful. Confidentiality and anonymity were maintained. To ensure privacy,
the data was collected and coded; the respondent’s identity was neither revealed nor tracked.

The Coping and Adaptation Processing Scale

The CAPS consists of 47 items, each of which is a short statement about how an individual
responds to a crisis or an extremely difficult event. The participants evaluate the coping
responses using a Likert scale ranging from 4 (always) to 1 (never). Possible scores range
from 47 to 188, with a higher score indicating more consistent use of the identified coping
strategy. However, the following items have been recorded before carrying out the analy-
sis: 5, 8, 13, 15, 20, 23, 24, 29, 33, 35, 39, 43, 45, and 47.

Procedure and Data Collection

The participants who responded to the recruitment flyer indicated their willingness to partic-
ipate in the study and received an envelope that included two copies of informational letters
explaining the purpose of the study, two copies of the informed consent, survey instruments,
and a return envelope addressed to the investigator and stamped to make it feasible for the
participants to return the survey without increasing any cost to them for returning the survey.
The survey consisted of two parts: the demographic questionnaire to collect information
regarding the subject’s demographics characteristics and the CAPS questionnaire. The sur-
vey was printed on double-sided paper and stapled in a booklet format. Participants were
instructed to keep a copy of the informational letter and consent form for future reference.

Data Analysis
The Statistical Package for Social Science (SPSS Version 18) was used to compute
descriptive statistics, Pearson product–moment correlation, and reliability coefficients. To
obtain reliability indicators, the internal consistency with Cronbach’s alpha was used to
ensure that all the items are measuring the same concept.
To confirm the factor structure of CAPS, LISREL (Jöreskog & Sörbom, 2006) was used
to perform a confirmatory factor analysis. In the analysis, the goodness of fit was examined
The Validation of the Coping and Adaptation373

to determine the general overall model fit with respect to the sample data and variances.
In structural equation modeling, there are no single goodness indices that can be used to
measure the fit. Thus, several indices were calculated and reported as each index contribute
different statistical information into the overall fit of the model. In line with this practice, it
was decided to report the following indices: relative chi-square (chi-square/degrees of free-
dom [CMIN/DF]), goodness-of-fit index (GFI), Bentler’s ­comparative fit index (CFI), the
root mean squared error of approximation (RMSEA), and other incremental fit indices (IFI).

RESULTS

There were 199 nurses who returned their questionnaires for analysis out of 218; the
response rate was 91.3%. The age range of the sample was between 18 and 55 years old;
77.4% were female, and 58.3% were married. The greatest proportion of respondents was
women (77.4%) who had more than 10 years of experience (60%). The areas of specializa-
tion most frequently noted were intensive care unit (ICU; 26.6%), general units (23.6%),
and telemetry (16.6%). Most of the sample (88.9%) had 1 or more years of experience in
the current hospital. Although the survey was sent to all nurses (both RNs and LVNs), the
responses indicated that the sample consisted mostly of 81.9% RNs (Table 1).

TABLE 1.  Demographic Characteristics of the Nurses

n %
Gender
 Male  45  22.6
 Female 154  77.4
Total 199 100.0
Age
  18–24 years   9   4.5
  25–34 years  63  31.7
  35–44 years  79  39.7
  45–54 years  33  16.6
  Older than 55 years  15   7.5
Total 199 100.0
Marital status
 Married 116  58.3
  Not married  82  41.2
  No response   1   0.5
Total 199 100.0
Nursing level
 RN 163  81.9
 LVN  36  18.1
Note. RN 5 registered nurse; LVN 5 licensed vocational nurse.
374 Alkrisat and Dee

TABLE 2.  Means and Standard Deviation for Most Frequent Coping
Processes (N 5 199)
Items M SD
Call the problem what it is and try to see the whole picture 3.63 3.10
Gather as much information as possible to increase my options 3.50 0.65
Feel good knowing that I’m handling the problem the best I can 3.39 0.70
Too often give up easily 1.90 0.80
Keep my eyes and ears open for anything related to the event 3.52 0.65
Put the event into perspective for seeing it for what it really is 3.36 0.65
Try to get more resources to deal with the situation 3.46 0.60
Look at the event in a positive light, as an opportunity or challenge 3.38 0.70

Descriptive Data for Coping and Adaptation Processing Scale

Responses to each of the five subscales were analyzed to ascertain the percentage answered
for each possible category. Responses were separated into the five subscales and on total
score. In the frequency category, several items were deemed as occurring very frequently
by the respondents (Table 2). The highest mean was, “Call the problem what it is and try
to see the whole picture” (M 5 3.63, SD 5 3.1) and the least used behavior to cope was,
“Too often give up easily” (M 5 1.90, SD 5 0.80).

Reliability
Reliability of the CAPS was measured by using internal consistency Cronbach’s alpha
coefficient. The CAPS had an alpha coefficient of .81. Internal consistency reliability
of 0.70 or higher was considered acceptable for this newly developed scale (Munro,
2005). Table 3 summarizes the mean, standard deviation, and reliability scores for
each factor.

TABLE 3.  Coping and Adaptation Processing Scale Factors Reliability

Average No.
Item Cronbach’s of
Scale M Min Max Values SD Alpha Items
Total score for CAPS 143.3 1.90 3.63 1.73 14.18 .81 47
Resourceful and Focused   3.25 2.78 3.52 0.74  3.92 .77 10
Physical and Fixed   2.26 2.09 3.10 1.06  5.52 .78 14
Alert Processing   3.11 2.57 3.38 0.81  3.23 .68  9
Systematic Processing   3.40 3.14 3.63 0.49  3.90 .31  6
Knowing and Relating   3.26 2.99 3.39 0.41  3.41 .78  8

Notes. CAPS 5 coping and adaptation processing scale.

The Validation of the Coping and Adaptation375

TABLE 4.  Correlations Between Coping and Adaptation Processing Scale Factors
and Total Score (N 5 199)
Scale 1 2 3 4 5 6
Resourceful and Focused 1
Physical and Fixed 0.13 1
Alert Processing 0.76** 0.13 1
Systematic Processing 0.51** 0.10 0.46** 1
Knowing and Relating 0.78** 0.20** 0.72** 0.43** 1
TCAPS 0.83** 0.53** 0.79** 0.66** 0.81** 1
Notes. TCAPS 5 total coping and adaptation score.
**Correlation is significant at the .01 level (two-tailed).

Convergent and Discriminate Validity

A correlation between Resourceful and Focused and Knowing and Relating factor is
statistically significant and positive (r 5 .78, p , .001), and there is significant correla-
tion in the positive influence of Resourceful on Alert Processing (r 5 .76, p , .001).
Furthermore, there is a positive significant relationship between Resourceful and Focused
and Knowing and Relating factors on the total score of CAPS. However, all subscales have
positive and significant correlation with Resourceful and Focused (Table 4).

Construct Validity
Construct validity was determined by confirmatory factor analysis (CFA) using
LISREL 8.80. CFA was used to confirm the factor structure of the CAPS and to examine its
model fit. Factor structure of the CAPS was based on the principal component of the origi-
nal items. Model fit parameters were estimated using maximum likelihood. As shown in
Table 5, all unstandardized factor loadings were statistically significant. The highest load-
ing factor was for Resourceful and Focused with the value at 0.91 (x2 5 478.190,  p , .05).
According to the eigenvalues and the screen plot, all factors were defined as relating
factors. Moreover, the factor loadings for CAPS model indicates that Resourceful and
Focused subscale was the highest score and accounted for 91% of the variance of the CAPS

TABLE 5.  Factor Loading for Coping and

Adaptation Processing Scale Factor
Factors Coefficients
Resourceful and Focused 0.91
Physical and Fixed 0.17
Alert Processing 0.84
Systematic Processing 0.54
Knowing and Relating 0.85
376 Alkrisat and Dee

TABLE 6.  Indices of Goodness of Fit for Coping and Adaptation Processing
Scale (CAPS)
Model df x2 x2/df p GFI CFI RMSEA IFI
CAPS 5 7.64 1.53 0.17 0.99 0.99 0.02 0.99
Notes. GFI 5 goodness-of-fit index; CFI 5 comparative fit index; RMSEA 5 root mean
square error of approximation; IFI 5 incremental fit indices.

model, whereas Physical and Fixed accounted for the least at 17%. The contribution of
other subscales ranged between 54% and 85%. All indicators had moderate-to-large stan-
dardized loadings, suggesting that the items were reliable indicators of their corresponding
factors. The unstandardized weights are highly sensitive to model constraints, whereas the
standardized regression weights provide more intuitive information about the strength of
factor loadings. All items loaded significantly onto their respective subscales. However,
judgments about the relative importance of these predictors are difficult because they are
highly correlated (Tabachnick & Fidell, 2007).
The reliability of the observed variable was measured in terms of the correlations of the
items with the latent variables (factors). All values were satisfactory, which showed that
the items were reliable and that the factors explained a respectable portion of the variance
of all questions that loaded on it.

Confirmatory Factor Analysis

CFA was used to determine the five factor structure of the CAPS. The CFA was conducted
using the five factors version of the CAPS, and the results are presented in Table 6. The CFA
model was tested to determine whether the sample data would support the five-factor structure
revealed in the original structure. Using LISREL 8.80 to perform the CFA, it was found that the
model highly fit the data (x2[5] 5 7.64; GFI 5 0.99; CFI 5 0.99; RMSEA 5 0.02; Table 6).

DISCUSSION

Demographic Characteristics
The sample in the study was compared to the studies already conducted in published
articles across the United States to determine how representative it was of the popula-
tion of interest; moreover, the characteristics of the sample were also similar to the
studies conducted in the acute settings (Abualrub, 2004; California Board of Registered
Nursing, 2009; Zander & Hutton, 2010).

Psychometric Properties
This study focused on establishing the psychometric soundness for CAPS. A systematic
review was conducted to find eligible articles describing the CAPS. The following data-
bases were searched for relevant articles published between 1988 and September 2012:
Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE,
Cochrane, Health Source: Nursing/Academic Edition, PsychINFO, and many other data-
base engines.
The Validation of the Coping and Adaptation377

The search was guided using a combination of terms such as nursing, nurs*, stress, Roy,
RAM, cop*, adaptation, and coping. Moreover, a systematic scan for the reference lists of
key review articles that were identified in the electronic search and of all eligible articles.
Finally, several universities’ library databases were reviewed and included. The search
indicated no other study examined the psychometric appropriateness of CAPS.
The CAPS based on RAM was developed to bridge the conceptualization and measure-
ment gap in WCQ. The CAPS view coping as a process of adaptation and consider both
multidimensionality and hierarchical (McCurry, Revell, & Roy, 2010; Roy, 2009).
This study found that nurses used three main coping factors: (a) Systematic Processing,
which reflects the personal and physical strategies to cope with stressful situations (e.g., call
the problem what it is and try to see the whole picture, give myself time in the situation
and do not act until I have a full grasp of the situation); (b) Knowing and Relating, which
is related to use of self and others, memory, and imagination (e.g., feel good knowing that
I’m handling the problem the best I can, try to recall strategies/solutions that worked for
me in the past); and (c) nurses ranked Alert Processing as the third highest dimension of
coping and adaptation, which reflects using behaviors that represent both the personal and
physical self (e.g., can follow a lot of directions at once, even in a crisis; am less effective
under stress; feels alert and active throughout the day during the crisis).
This study found that nurses identified their coping processes as they are interacting
with their environmental stimuli with overlapping between different coping processes.
RAM views the individual (nurse) as a holistic system constantly interacting with different
stimuli from the workplace (external) as well as with the internal environment. A nurse’s
response to a constantly changing environment depends on his or her coping process.
The positive correlational findings among all the processes are congruent with RAM,
which categorized coping processes into two subsystems: the regulator and the cognator.
The regulator subsystem responded to environmental stimuli automatically through innate,
physiological adaptive processes. The regulator subsystem process changes included
responses through neural-chemical-endocrine channels (e.g., trying to recall strategies/
solutions that worked in the past). On the other hand, the cognator subsystem responds to
stimuli from the environment and involves psychological, social, physical, and physiologi-
cal factors, including regulator subsystem outputs (Fawcett, 2005). The coping processes
presented through the cognator can be manifested through changes in the environment
and through cognitive and emotional channels that involve perceptual and information
processing, learning, judgment, and emotion (e.g., brainstorm as many possible solutions
as possible, even if they seem far out; experience changes in physical activity). The find-
ings indicated that both the regulator and cognator subsystems responded together to cope
with the changing internal and external environment to maintain the health integrity of the
nurses (Fawcett, 2005; Hanna, 2005; Perrett, 2007).
The CFA testing illustrated that the measurement model of the CAPS was valid. The
findings generally confirmed CAPS five-factor coping instrument, suggesting the instru-
ment performed with no significant differences across the sample. A 47-item version of
the CAPS produced the best goodness-of-fit and was considered to be acceptable, although
correlations between some factors suggest they are not wholly independent. The 47-item
CAPS produced improved squared multiple correlations and factor loadings.
The internal consistencies of the five factors of the CAPS were satisfactory because
Cronbach’s alpha met the criterion of .70 (Munro, 2005). The reliability estimates for the
use and effectiveness scales of the total instrument revealed that the CAPS had an adequate
internal consistency. However, the items in the Physical and Fixed coping factors have
378 Alkrisat and Dee

weaker internal consistency as compared to other subscales. One mechanism by which the
reliability of the Physical and Fixed coping subscale might be improved is to incorporate
additional relevant items. Another way to improve reliability is to review CAPS items to
ensure phrasing is clear and specific. Also, include items that are relevant to nurses’ experi-
ences (Kimberlin & Winterstein, 2008).

Limitations
The limitation of this study included collecting the data from a convenience sample—
obtained from an educational center—was based on the assumption that the population
was homogeneous. However, this assumption does not reflect the true picture of the attri-
butes of the population in relation to the different variables of the study.
Another limitation was incorporating LVN sample in analysis, which based on the researchers’
notion that coping reflects the functioning of an entire system (Goldenberg & Waddell, 1990),
concluded that age of the respondent, number of years of full-time teaching, and tenure status
were most often significant factors relating to coping with different levels of stress. Therefore,
it is recommended to conduct a separate study to measure the psychometric properties of
CAPS with LVN.

CONCLUSION

The purpose of this study was to explore the psychometric properties, generalizability, and
applicability of the CAPS for use in the nurses’ population. A CFA revealed that the five-
factor structure with 47 items confirmed the five-factor model as a good fit for the data,
suggesting the soundness of the CAPS psychometric properties in the nursing context.
All five factors correlated moderately with each other as well as with the total scale.
The findings also indicated high correlation among the scale factors, the Pearson cor-
relation coefficients for the relations between CAPS total scores and CAPS factors ranges
from 0.53 to 0.83, and among the factors from 0.17 to 0.91, the correlations are statistically
significant (p , .001) and positive, indicating that for all factors are significantly associ-
ated with high coping among nurses, which correspond to the fact that nurses identified
their coping processes as they are interacting with their environmental stimuli while over-
lapping between different coping processes. RAM views the individual (nurse) as a holistic
system constantly interacting with different stimuli from the external as well as with the
internal environment. A nurse’s response to a constantly changing environment depends
on his or her coping process.
The high performance of these variables might have been because of the respondents’
knowledge concerning the actual event and their relevance to the participants. The weakness
in Physical and Fixed factor performance can be improved by adding more items or mak-
ing the items more explicit. However, these findings supported the assumptions presented
in RAM. The focal stimuli were found to provoke greater use of coping processes among
nurses who purposefully used these coping efforts to manage focal stimuli. Therefore,
participants that reported using higher levels of coping processes had stress levels. Further
attention should be given to the interpretation of this relationship, which depends on the
types of coping processes used in this study. Therefore, coping with stress is the process and
outcome for nurses in acute settings who choose behavioral and cognitive coping strategies
to create human and environmental integration that promotes survival, growth, and integrity.
The Validation of the Coping and Adaptation379

RAM assumptions were supported by the findings of this study; Roy postulated that
human coping processes are linked to adaptive goal/outcome (Keil, 2004). Therefore, the
intrinsic values/beliefs in the moral-ethical-spiritual self operate with personal value and
worth when the nurse is exposed to any internal or external stimuli.

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Correspondence regarding this article should be directed to Muder Alkrisat, PhD, Azusa Pacific
University, 701 E. Fotthill Boulevard, P.O. Box 7000, Azusa, CA 91702. E-mail: mkrisat@yahoo
.com or Vdee@apu.edu