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Family Coping. Continual demands force families to adapt in order to surviveWithout effective family coping processes, affective, social, economic
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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 façade 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