FAMILY STRESS, COPING, AND ADAPTATION

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FAMILY STRESS, COPING, AND ADAPTATION
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FAMILY STRESS, COPING, AND ADAPTATION

• Families constantly face the need to modify
  their perceptions and lives.
• The stimulus for this change comes from within
  and without.
• Internal demands
• Normal, continually evolving family needs.
• The presence of unexpected family situations.
• External demands come from the familys
  interaction with changing society

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HOW WELL FAMILIES ARE COPING

• Continual demands force the family to adapt in
  order to survive, continue and grow.
• Family coping processes and strategies are
  essential for making this possible.

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• Crucial to the familys success in dealing with
  the demands placed on it are
• perceptions
• use of various resources and coping strategies
• Ineffective family coping leads to inadequate
  achievement of
• Affective and socialization functions
• Economic and health care functions.

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Assisting Family Adaptation

• Family nurses assess
• Family resources
• Coping strategies processes
• Family nurses intervene by
• Strengthening and encouraging adequate adaptive
  response.
• Reducing actual stressors within outside the
  family

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Qualities of Families

• Durability
• Despite societal changes, families remain basic
  institution for socialization
• Resilience
• the ability to withstand and rebound from
  disruptive life challenges

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BASIC STRESS AND COPING CONCEPTS

• Stress is the response or state of tension
  produced by the stressor(s)
• Unmanaged actual/perceived demands
• Tension/strain within a person or family.
• Reaction to a pressure-producing situation

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BASIC STRESS AND COPING CONCEPTS (2)

• Stressors
• physical, psychological or social events that
  require change or adaptation
• activates stress response
• life events significant enough to affect change
  in the family system
• accumulation (pile-up) of stressors increase
  stress in families

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BASIC STRESS AND COPING CONCEPTS (3)

• Family member/family perceptions
• the interpretations family members singularly or
  collectively make of their experiences
• families that are crisis prone consistently tend
  to perceive events in a distorted, subjective
  manner

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BASIC STRESS AND COPING CONCEPTS (4)

• Coping
• problem-solving efforts that are relevant to
  welfare, but tax the individuals resources
• Family coping
• interactive efforts of family members working as
  a whole to achieve and maintain balance over time
• family utilizes existing family resources and
  develops new behaviours

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BASIC STRESS AND COPING CONCEPTS (5)

• Family crisis
• disruptiveness, disorganization, or
  incapacitation in the family system.
• familys current resources adaptive strategies
  are ineffective
• Two types of situations cause crisis -
  developmental and situational events

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HILL (1949) ABCX FAMILY STRESS THEORY
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BASIC STRESS AND COPING CONCEPTS (6)

• Adaptation
• a process of managing the demands of the
  stressors through the use of resources, coping,
  and problem-solving strategies
• Family adaptation
• a process in which families engage in direct
  responses to the extensive demands of a stressor.
  
• involves the process of restructuring family
  patterns of functioning.
• (McCubbin and McCubbin, 1993)

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BASIC STRESS AND COPING CONCEPTS (7)

• Family coherence
• Confidence in ability to comprehend and manage
  challenges and give meaning to experiences
• Promotes family health and well-being

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TIME PHASE OF STRESS AND COPING STRATEGIES

• Antestress period
• Awareness of impending threat
• Preventative coping strategies
• Actual stress period
• Requires wide range of coping strategies
• Requires considerable energy
• May put usual family functions on hold
• Poststress period
• Return to balanced state
• May have higher, lower or same level of
  functioning as before

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FAMILY STRESS THEORIES

• ABCX model Hill, 1949
• Resiliency model McCubbin McCubbin, 1993
• Builds on concepts from ABCX and Double ABCX
  models

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HILLS ABCX MODEL OF FAMILY STRESS
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HILLS ABCX MODEL OF FAMILY STRESS (contd)

• Determinants of family crisis
• A - the event and related hardships
• B - the familys crisis meeting resources
• C - the definition the family makes of the
• event
• X - the crisis
• Double ABCX model is later modification
• Table 17-1, p. 469

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THE RESILIENCY MODEL OF FAMILY STRESS,
ADJUSTMENT, ADAPTATION

• Theoretical framework that emphasizes family
  adjustment and adaptation when families
  experience stressful life situations.
• This model builds on Hills ABCX model

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ASSUMPTIONS OF THE RESILIENCE MODEL

• Families face hardships and changes as a natural
  and predictable aspect of family over the life
  cycle.
• Families develop basic strengths .
• Families develop basic strengths and capabilities
  to protect the family.
• Families benefit from and contribute to the
  network of relationships and community resources.

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RESILIENCY MODEL OF FAMILY STRESS, ADJUSTMENT
ADAPTATION
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ADJUSTMENT PHASE OF THE RESILIENCY MODEL

• Familys response to minor event
• or
• Familys initial response to a major event

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ADJUSTMENT PHASE (contd)

• A - Stressor external or internal
• V - Vulnerability condition of family system
• T Family type usual patterns of functioning
• B Family resistance resources collective
  strengths of family
• C Appraisal of Illness Stressor meaning
  attached to the stressor/perception
• PSC Problem-solving/Coping familys decisions
  and actions

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OUTCOMES OF ADJUSTMENT PHASE

• Bonadjustment ability to make adjustments and
  manage stressor effectively
• X Crisis Maladjustment

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THE ADAPTATION PHASE OF THE RESIDENCY MODEL

• If minor changes are not adequately managed
• crisis situation (X)
• need for fundamental system changes
• adaptation phase

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THE ADAPTATION PHASE OF THE RESIDENCY MODEL
(contd)

• Pile-Up Stressors, Strains, Transitions
• Stressors pile-up and/or become chronic
• A existing family strains
• 6 categories of stresses
• The stressor event and the associated hardships.
• Normative transitions
• Preexisting family strains
• Situational demands.
• Consequences of the family effort to cope
• Intra-family strains and social ambiguity

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THE ADAPTATION PHASE OF THE RESIDENCY MODEL
(contd)

• R Family type T new patterns of functioning
• The regenerative family type
• The rhythmic family type
• The resilient family type
• BB Family resources B development of new
  resources
• BBB Social Supports
• CC Family appraisal revisit previous
  perceptions of situation
• CCC Schema and meaning familys beliefs,
  values and goals

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THE ADAPTATION PHASE OF THE RESIDENCY MODEL
(contd)

• PSC Problem-solving and coping
• the effort and resources families use to manage
  stressors.
• Four strategies of coping are
• reduce the demands
• obtain additional resources
• manage tensions and relieve stress.
• reappraise reframe
• Problem solving communication
• Incendiary or conflict-escalating type
• Affirming or a stress -reducing type

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OUTCOMES OF ADAPTATION PHASE

• Bonadaptation
• XX - Maladaptation and Crisis (ongoing)
  feedback loop to beginning of adaptation phase

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STRESSORS AND THEIR IMPACT

• Stressors have a significant impact on
  individuals
• FILE (Family Inventory of Life Events and
  Changes Scale)(McCubbin, Patterson, Wilson,
  1983)
• Each of the 71 life events is weighted as to how
  stressful it is (Table 17-2)

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MOST FREQUENT FAMILY STRESSORS

• economics/budgeting/finances
• childrens behaviour
• insufficient couple time
• lack of shared responsibility
• communication with children
• insufficient personal time
• guilt for not accomplishing more
• spousal relationship
• insufficient family social time
• overscheduled family calendar

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FAMILY COPING STRATEGIES

• Behavioural, cognitive and emotional coping
  strategies
• Problem or situation specific.
• Different circumstances and different problems
  demand different solutions.
• Coping strategies come from within the family or
  outside the family
• Table 17-3

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INTERNAL FAMILY COPING STRATEGIES

• Family relationship strategies
• Family group reliance
• Sharing
• Role flexibility
• Cognitive strategies
• Normalizing
• Controlling meaning
• Gaining information
• Communication strategies
• Openness
• Humour

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EXTERNAL COPING FAMILY STRATEGIES

• Community strategy
• Social support strategies
• extended family
• Friends, neighbours
• self-help groups
• formal social supports
• Spiritual strategies
• seeking advice from spiritual leader
• having faith
• prayer
• seeking renewal/connectedness with nature

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DYSFUNCTIONAL FAMILY COPING STRATEGIES

• Denial of Family Problems
• emotional exploitation of family members
  scapegoating, threat
• family myth
• triangling
• emotional distancing
• dominance/submission patterns

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DYSFUNCTIONAL FAMILY COPING STRATEGIES (contd)

• Family Dissolution and Addictions
• loss or abandonment by family member
• drug/alcohol addictions
• Family Violence
• spousal abuse
• child abuse
• elder abuse
• sibling abuse

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FACTORS INFLUENCING COPING

• Gender difference
• Sociocultural variations
• e.g. paternalism, use of religion/faith,
  information-seeking
• Impact of health alterations
• strategies are often situation specific

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FAMILY ASSESSMENT AREAS

• Family Stressors, Strengths And Perceptions
• Review what stressors are being experienced by
  the family?
• What strengths counterbalance the stressors?
• What is the familys definition of its situation?

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Contd

• Family Coping Strategies
• How is the family reacting to the stressors?
• To what extent does the family use the internal
  coping strategies?
• To what extent does the family use the external
  coping strategies?
• What dysfunctional coping strategies has the
  family used or is the family using?

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• Adaptation
• How is the family functioning?
• Is the family in crisis?

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ECOMAP
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NURSING DIAGNOSES FOR STRESS COPING

• Ineffective family management of therapeutic
  regimen
• Readiness for enhanced family coping
• Compromised family coping
• Disabled family coping
• Risk for other-directed violence
• Interrupted family processes

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Examples of Nursing Diagnoses (contd)

• Dysfunctional family processes alcoholism
• Dysfunctional grieving
• Impaired home maintenance
• Spiritual distress
• Risk for spiritual distress
• Readiness for enhanced spiritual well-being

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FAMILY NURSING INTERVENTIONS

• Assisting Families to Cope
• Encourage all family members to be involved
• Mobilize families
• Praise family efforts and accomplishments
• Respect familys values, interests and goals
• Teach families effective ways of coping.
• Encourage families to normalize their family life
  and family distress.

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• Assisting Families to Cope (contd)
• Help families receive the spiritual support they
  need.
• Help families reframe and relabel their problem
  situation.
• Refer crisis-prone families.
• Help families enhance and utilize social support
  systems.

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OTHER NURSING INTERVENTIONS

• Preventative
• Anticipatory teaching
• Self-help groups
• Social network family therapy (Table 17-8)
• Family crisis intervention
• Empowering families
• Recall BPG model
• Protection of families at risk of violence
• Referrals of families with complex problems