BiWei Dong Elizabeth Hopewell Sarah Kline Robyn Simmons

1
The Theory of Family Stress and
Adaptation(McCubbin and Patterson)

• BiWei Dong
• Elizabeth Hopewell
• Sarah Kline
• Robyn Simmons
• Julie Wellborn

2
Theory Overview

• An individual familys experience of stress,
  crises, and subsequent adaptation is an ongoing
  and dynamic process.
• The process of adaptation is affected by the
  familys response to a stressful event, their
  available resources, and presence or absence of
  effective coping strategies.
• Adaptation exists on a continuum from positive
  adaptation (bonadaptation) to maladaptation,
  resulting in increased or decreased family
  functioning.

3
Development of the theory

• The original family stress theory was developed
  by Reuben Hill (1949), who studied families
  responses to war, war separation, and eventual
  reunion after WWII.
• The ABCX Model detailed how the three factors
  (the ABC components) of a stressor event, the
  familys perception of that stressor, and the
  familys existing resources interacted to predict
  the likelihood of a crisis (X) occurring.

4

• Sociologists McCubbin and Patterson (1983)
  developed the Double ABCX Model, which added
  postcrisis variables (e.g. coping mechanisms) to
  explain how families recover from crisis and
  achieve adaptation over time.
• Theory originally based on longitudinal research
  involving families in which a father/husband was
  a POW or MIA during the Vietnam war.
• Families facing a stressor event experience
  phases of adjustment and adaptation, exemplified
  by a range of processes in which the variables
  interact.

5
An Inductive Research Approach

• Example of a bottom-up approach
• Specific observations regarding the families
  involved in the study led to the identification
  of patterns and regularities, resulting in
  broader theoretical statements and hypotheses.
• These hypotheses have been tested extensively in
  subsequent studies (in various disciplines),
  leading to the validation of the theory.

6
Later Developments

• The FAAR (Family Adjustment and Adaptation
  Response) Model (1988) emphasizes adaptation as
  the key outcome
• More recent models incorporates additional
  variables (i.e. community relationships) to
  explain how families function in periods of
  tranquility as well as stress.
• New emphasis on resiliency

7
Current Nursing Research

• Current nursing research uses this model
  extensively to study family adaptation while
  dealing with chronic and life threatening
  illness.
• Example LoBiondo-Woods 2004 work on examining
  the relationship of family stress, severity of
  the stressor, uncertainty, coping, and family
  adaptation from the pretransplantation to the
  posttransplantation phase of liver
  transplantation in children.

8
Explicit Assumptions

• Families over the course of life face hardships
  and changes as a natural and predictable aspect
  of family life.
• Families develop basic competencies, patterns of
  functioning and capabilities to foster the growth
  and development of family members and the family
  unit, and to protect the family from major
  disruptions in the face of transitions and
  changes.

9

• Families develop basic and unique competencies,
  patterns of functioning, and capabilities
  designed to protect the family from unexpected or
  non-normative stressors and strains and to foster
  the familys recovery following a family crisis
  or major transition or change.
• Families draw from and contribute to the network
  of relationships and resources in the community,
  including its ethnicity and cultural heritage,
  particularly during periods of family stress and
  crises.

10

• Families faced with crisis situations demanding
  changes in the familys functioning work to
  restore order, harmony and balance even in the
  midst of change.
• McCubbin, M.A., McCubbin, H. I. (1996).
  Resiliency in families A conceptual model of
  family adjustment and adaption in response to
  stress and crises. In Family assessment
  Resiliency, coping and adaptation (p. 14).
  Madison University of Wisconsin Press.

11
Implicit Assumptions

• Families like to live an orderly and balanced
  life and are willing to cope with stress.
• The family variables are existent prior to their
  connections to each other and they can be clearly
  distinguished

12
World View

• Model grew out of a systems theory/holism
  approach
• Holism focuses on alleviating problems within a
  system by emphasizing on the system as a whole
  and understanding that member parts ultimately
  aggregate to create that whole.
• Assumptions
• all phenomena can be viewed as a web of
  relationships among elements, or a system.
• all systems have common patterns and behaviors
  that can be understood and used to develop
  greater insight into the behavior of complex
  phenomena.

13
Systems theory and the Double ABCX Model

• The family is viewed as the system, where
  experiences of one family member affect the
  experiences of other family members.
• Family systems theory and the Double ABCX model
  highlights the integral influence of the family
  system on each individual member's development
  and vice-versa
• Systems theory (and the Double ABCX model)
  recognize interactions of the parts are not
  "static" and constant but "dynamic" processes.

14
Relevant Metaparadigm Elements

• Person (family) viewed as encountering hardships
  and changes as an inevitable part of family over
  the lifecycle
• Environment (within the family system) viewed as
  an open system and a component of the larger
  community and society. Families benefit from and
  contribute to the network of relationships and
  resources in the community.
• Health family resiliency or the ability of the
  family to respond to and eventually adapt to the
  situations and crises encountered
• Nursing the role of nursing is to not only
  promote family members health, but also to
  support and enhance family strengths, to assist
  families in maintaining linkages with community
  supports, and to aid families in arriving at a
  realistic expectation of what the best fit for
  them in their situation.

15
Concepts ABCX Components

• Stressor (A)
• Life event or transition impacting the family
  unit that has the potential for changing the
  family social system.
• Defined as distinct from stress.
• Can occur in any aspect of the familys life-
  roles, functions, goals
• Examples include chronic illness in children,
  cancer, and elder care

16

• Existing Resources (B)
• All families have some level of resources.
• Concept of existing resources is the familys use
  of community and intrafamilial systems. i.e. SES,
  parents education
• May be adequate or inadequate depending on the
  nature of the stressor event or familys level of
  functioning

17

• Perception of the Stressor (C)
• Defined by Hill (1958) and McCubbin and Patterson
  (1983) as the meaning the family assigns to the
  crisis event and the total circumstances that
  lead to the crisis.
• In lay terms how well does the family define the
  problem, grasp the problem and understand the
  situation?

18

• Crisis (X)
• Defined as the demand for change.
• Continuous variable that reflects the sum of the
  familys disorganization, turmoil, disruption
  which is triggered by an event.
• In the model- crisis is regarded as the familys
  inability to retain stability.
• If the family is able to meet the demands of the
  stressor than the crisis may be averted.
•  

19
ABCX Component Interactions

• Stressor (A) ? interacts with resources (B) ?
  familys perception of stressor/how stressor
  defined (C) ? produces the crisis (X).

20
Concepts Double ABCX Components

• Pile-up (Aa Factor)
• The effect of managing changes, strains, and
  stressors over the time continuum.
• These stressor pile-up and accumulate affecting
  each member.

21

• Existing and New Resources (bB)
• Allow the family to adapt and meet demands and
  needs by potentially adding expanded resources.
• Existing resources usual mechanisms of support
  New expanded resources ? new resources
  strengthened or developed in response to the
  crisis or as a result of the pile-up of
  stressors.
• A family in the face of crisis will call on
  existing resources in order to prevent an event
  from creating further crisis.

22

• Family Perception of the Stressor (cC)
• The way the family views, defines, and the
  significance given to the stressor.
• The family that aims at understanding the meaning
  of the crisis can help the other members manage
  and cope, utilize/develop resources adaptation.
• The familys perception of the crisis is key and
  is the central factor to its coping.

23

• Adaptation (xX)
• Realized when there is a balance between levels.
• The family has accommodated, compromised, worked
  together and defined/recognized the meaning in
  the crisis.
• Considered at the individual family member level,
  unit, and community level.
• Adaptation exists as a continuum from
  bonadaptation to maladaptation.
• Bonadaptation is positive family has achieved
  balance utilization of resources, coping
  mechanisms, accepts and understands crisis.
• Maladaptation is negative typified by family
  imbalance
•  

24
(No Transcript)
25
A Disscussion of Clarity

• The theory reads easily (parsimonious).
• Major concepts are operationally defined, and are
  presented clearly, and consistent throughout the
  theory (semantic clarity/consistency).
• Relationships between the concepts can be easily
  presented visually/graphically (structural).
• Causes and consequences are carefully separated.
• Multiple applications are available in the
  literature .
• Serves to further clarify the major concepts and
  relationships between variables.
• Provides both content and construct validity.

26
Congruence Is the theory internally consistent?

• Theory makes logical sense.
• Variables have been operationally defined with
  reliable instruments.
• Some concepts may be too limited in definition.
• Crisis event is too narrow concept of a
  situation may be more accurate.
• The number of concepts can be cumbersome with
  extensions of the model.
• Clarity and congruence can be diminished with
  extensions
• Example Individual resources are interchangeable
  with family resources, even though they are
  conceptualized separately.
• Researchers must identify whether they are
  testing part of the model or the total model.
• Researchers must identify and define which
  variables they are testing.

27
A True Middle Range Theory!

• Theory of Family Stress and Adaptation meets the
  qualifications of a Middle Range theory
• Moderately abstract, i.e., stressor, perception,
  etc.
• Organized within the limited scope of families
  adaptation to stress
• Limited number of variables, which are testable
  in a direct manner
• Strong relationship with research and practice in
  various disciplines, directly applicable to
  nursing actions/practice

28
Putting Theory into Practice

• Current nursing research focuses on family
  adaptation to chronic illness.
• Requires nurses to understand the stages of
  illness and how families respond to the illness
  process
• Theory assumptions help to guide practice that
  recognizes family needs beyond a one-time event

29
A Sample Nursing Plan

• An established relationship of trust is inherent
• Assess what aspects of the disease and family
  dynamics present the most stress
• Assess and plan for coping strategies
• Develop both a short- and long- term plan for
  individuals and family
• Physical and psychological parameters
• Incorporate the unique strengths and
  vulnerabilities of each individual family member

30
Areas for further testing

• Current concept variables have been tested
  repeatedly with validated instruments
• Family Inventory of Life Events Changes (FILE)
  used to measure pile-up (reliability .78)
• Coping Health Inventory for Parents (CHIP) used
  to measure coping (reliability .89)
• Prediction models need to be tested to determine
  which variables of the model and in what order
  best explain family adaptation in applied
  situations

31
Areas for further testing (cont.)

• Ethnicity and cultural components
• Intervention studies that foster adaptation and
  adjustment
• The use of instruments (i.e. FILE) in
  increasingly complex family structures
• Current reliability and validity testing focuses
  on traditional family roles of mother and father

32
Future Developments (?)

• Increasing number of stressors faced by
  families
• Increasing prevalence of chronic disease
• Increasing complexity of family structure
• Although the model in its entirety can be
  cumbersome, the elements can easily be broken
  down and applied to an almost infinite
  combination of factors.

33
(No Transcript)
34
References

• Hill, R. (1949). Families under stress
  Adjustments to the crises of war, separation,
  and reunion. New York Harper
• Lavee, Y., McCubbin, H., Patterson J. (1985).
  The double ABCX modelof family stress and
  adaptation An empirical test by analysis of
  structural equations and latent variables.
  Journal of Marriage and the Family. 42(4)
  811-825.
• LoBiondo-Wood, G., Williams, L., Kouzekanani, K.,
  McGhee, C. (2000). Family adaptation to a
  childs transplantation Pretransplant phase.
  Progress in Transplantation. 10. 81-87.
• McCubbin, H.I., Patterson, J. M. (1983). The
  family stress process The double ABCX model of
  adjustment and adaptation. Marriage and Family
  Review, 6(7), 7-37

35
References (continued)

• McCubbin, M.A., McCubbin, H. I. (1989). Familis
  coping with illness The Resiliency Model of
  Family Stress and Adaptation. In C. Danielson, B.
  Hamel-Bissel, P. Winstead-Fry (Eds.).
  Families, health, and illness Perspectives on
  coping and intervention. St. Louis Mosby.
• McCubbin, M.A., McCubbin, H. I. (1993). Family
  coping with health crises The Resiliency Model
  of Family Stress and Adaptation. In C. Danielson,
  B. Hamel-Bissel, P. Winstead-Fry (Eds.).
  Families, health, and illness . New York Mosby.
  
• Patterson, J.M. (1988). Families experiencing
  stress. The family adjustment and adaptation
  response model. Family Systems Medicine, 7(4),
  428-442.

36
References (continued)

• Van Sell, S. L. I. A. Kalofissudis.
  Formulating Nursing Theory. Retrieved October
  25, 2008 from http//www.nursing.gr/theory/theory.
  html.