Family Stress, Coping

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Family Stress, Coping Adaptation

• Family Nursing Research, Theory Practice (5th
  ed)
• Friedman, M., Bowden, V. Jones, E.

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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.

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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.

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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).

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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).

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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

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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.

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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

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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

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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 (e.g. shiva)

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Internal Strategies

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

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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

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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.

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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

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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

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Internal Strategies

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

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Internal Strategies

• 3. Communication Strategies
• Use of Humor
• Humor laughter invaluable in coping can
  bolster immune system

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External Family Coping Strategies

• Maintaining Active Links with Community
• Continuing long-term associations with clubs,
  organizations community groups

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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 dont seek needed external supports
  for variety of reasons

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External Family Coping Strategies

• 3. Spiritual Strategies
• Spiritual or religious beliefs often at core of a
  familys ability to cope

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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

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Dysfunctional Coping Strategies

• Denial of Family Problems
• Scapegoating reduces tension in family at expense
  of one member
• Scapegoat becomes focus of familys problems,
  hiding the real problem but results in state of
  equilibrium
• Scapegoat begins to take on the assigned role
  internalizes it

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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

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Dysfunctional Coping Strategies

• (2) Family Dissolution Addictions
• (3) Family Violence /abuse