Date of Award


Degree Name

Doctor of Nursing Science


elderly, Gerontology, nursing, rural areas, Social psychology, Stress management, urban areas, wellness


Using a stress-coping theoretical framework, this path analytic study examined the effects of hardiness, self-esteem, social support, and stress on coping, service utilization, and well-being of elderly women. Fifty-five rural and fifty-five urban females living in the community comprised the sample whose mean age was 75 years. The overall level of well-being of these women was high. Hardiness was associated with greater social support and well-being. Self-esteem was related to lower stress. Hardiness and self-esteem were also associated with decreased use of emotion-focused coping. Stress had a positive relationship with service utilization and a negative relationship with well-being. Problem-focused coping was positively associated with well-being. The causal model applied to each subgroup showed a higher number of relationships among selected variables in the urban sample as compared to the rural sample. In both samples a lower level of well-being was associated with greater stress. The urban sample also reported significantly more stress and utilized more services while the rural sample reported a significantly greater level of well-being. The results of the study imply that psychosocial factors contribute to the well-being of elderly women and that there are some differences between urban and rural women. Nurses need to reconceptualize their practice when working with elderly in the community. A psychosocial approach is at least as important as the medical approach in helping people adjust to their functional limitations. Community health nurses must place more emphasis on those factors which help aged people to remain as independent as possible in their advanced years.

Document Type

Dissertation: Open Access



Included in

Nursing Commons