Family Stress, Coping Adaptation

1. Family Stress, Coping & Adaptation Family Nursing: Research, Theory & Practice (5th ed)

2. Family Coping Continual demands force families to adapt in order to survive Without effective family coping processes, affective, social, economic & health care functions cannot be achieved. Nurses can assist families to adapt. Goal: to strengthen & encourage adaptive responses & reduce stressors on family.

3. Family Coping An active process where the family utilizes existing family resources and develops new behaviors and resources to strengthen the family unit and reduce the impact of stressful life events. (McCubbin, 1979). A family crisis results when current resource and adaptive strategies are not effective in handling the stressors.

4. Family Adaptation Involves restructuring of family patterns of functioning. �the process in which families engage in direct responses to the extensive demands of a stressor, and realize that systemic changes are needed within the family unit, to restore functional stability and improve family satisfaction and wellbeing� McCubbin & McCubbin (1993, p.57).

5. Stressors & Their Impact Most widely used tool to assess life changes in families is Family Inventory of Life Events & Changes (FILE). Families with higher scores have been found to have lower family functioning and poorer health (McCubbin & Patterson, 1991).

6. Stressors & Their Impact Five most stressful life events are: (1) a child member dies (2) parent or spouse dies (3) spouse/parent separated or divorced (4) physical or sexual abuse in the home (5) member becomes physically disabled or chronically ill

7. Family Coping Strategies Are stressor specific (e.g. cognitive strategy of �accepting the situation� may be helpful to those who have lost a job, but not to couples coping with infertility). Most harmful coping behaviors: suppressing emotions; taking out feelings on others; not sharing extent of stressor with others; denying, avoiding, or running away from problems.

8. Family Coping Strategies Internal Strategies (from within the family) (1) Relationship (2) Cognitive (3) Communication External Strategies (outside supports & resources) (1) Community links (2) Social Support systems (3) Spiritual

9. Internal Strategies I. Relationship Strategies Family Group Reliance (cohesiveness) Some families cope by becoming more reliant on their own resources �Pulling together to weather the storm� Establishment of greater structure (more rigid routines) to increase control in their lives Closing of family boundaries

10. Internal Strategies I. Relationship Strategies Greater Sharing Together Sharing of feelings and thoughts Strengthening of family cohesion Very high cohesion = enmeshed Very low cohesion= disengaged Level of cohesion influenced by culture Family rituals helpful

11. Internal Strategies Relationship Strategies Role Flexibility Ability of mates to change or share roles when needed is important Flexible roles associated with better functioning

12. Internal Strategies 2. Cognitive Strategies Normalizing Acknowledging a chronic condition, but defining family life as normal View the social effects of having a member with a chronic condition as `minimal� Families who coped this way do better than those with focus on sick member

13. Internal Strategies 2. Cognitive Strategies Reframing & Passive Appraisal Positive outlook & maintaining hope key to resiliency Influenced by family beliefs Beliefs shape how families experience and interpret their environment Religious beliefs play important role Passive acceptance of situation helpful to some families, especially where situation inevitable.

14. Internal Strategies 2. Cognitive Strategies Joint Problem Solving Family able to discuss a problem, seek logical solutions, & reach consensus on what to do Collaborative problem-solving approach

15. Internal Strategies 2. Cognitive Strategies Gaining Information & Knowledge Increases sense of control and fear of unknown Provision of information a major nursing intervention Assisting family to use Internet effectively to gain accurate information important nursing role

16. Internal Strategies 3. Communication Strategies Being Open & Honest Good communication vital during periods of stress or crisis Communication must be direct, clear, open, & honest

17. Internal Strategies 3. Communication Strategies Use of Humor Humor & laughter invaluable in coping & can bolster immune system

18. External Family Coping Strategies Maintaining Active Links with Community Continuing long-term associations with clubs, organizations & community groups

19. External Family Coping Strategies 2. Social Support Strategies In addition to extended family & network of health care professionals, there are neighbors, employers, classmates, teachers, & cultural or recreational groups as potential supports Many people don�t seek needed external supports for variety of reasons

20. External Family Coping Strategies 3. Spiritual Strategies Spiritual or religious beliefs often at core of a family�s ability to cope

21. Dysfunctional Coping Strategies Can temporarily reduce stress, but do not solve the problem and have long-term deleterious effects. (1) Denial of Family Problems (2) Family Dissolution & Addictions (3) Family Violence

22. Dysfunctional Coping Strategies Denial of Family Problems Scapegoating reduces tension in family at expense of one member Scapegoat becomes focus of family�s problems, hiding the real problem but results in state of equilibrium Scapegoat begins to take on the assigned role & internalizes it

23. Dysfunctional Coping Strategies (1) Denial of Family Problems Triangulation � used to reduce tension in a dyad by focusing on a third member Emotional distancing � creation of a fa�ade of cohesiveness; affective communications very limited Extreme authoritarianism /submissiveness to achieve family equilibrium

24. Dysfunctional Coping Strategies (2) Family Dissolution & Addictions (3) Family Violence /abuse