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Family Stress, Coping


Without effective family coping processes, affective, social, ... Families who coped this way do better than those with focus on sick member. Internal Strategies ... – PowerPoint PPT presentation

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Title: Family Stress, Coping

Family Stress, Coping Adaptation
  • Family Nursing Research, Theory Practice (5th
  • Friedman, M., Bowden, V. Jones, E.

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.

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.

Family Adaptation
  • Involves restructuring of family patterns of
  • 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).

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).

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

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.

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

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

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)

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

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

Internal Strategies
  • 2. Cognitive Strategies
  • Reframing Passive Appraisal
  • Positive outlook maintaining hope key to
  • 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.

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

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

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

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

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

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

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

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

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
  • Scapegoat begins to take on the assigned role
    internalizes it

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
  • Extreme authoritarianism /submissiveness to
    achieve family equilibrium

Dysfunctional Coping Strategies
  • (2) Family Dissolution Addictions
  • (3) Family Violence /abuse
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