FAMILY STRESS THEORY

Nirmala Roberts
Paediatric Nursing
Definitions

 Stress = Tension resulting from depleted family

resources - an imbalance that must be corrected.
 Stressors = Drastic life events that change the family
system (death of spouse, financial crisis,
unemployment.
 Distress = extreme psychological pressure resulting
from facing repugnant and/or unenjoyable challenges.
 Eustress = extreme psychological pressure resulting
from facing enjoyable and/or beneficial challenges.
The prudent family member will feel stress, look for the
stressor(s), determine whether or not Distress or
Eustress is happening, and make appropriate
adjustments in the family system
 Some facts about Stress
 Stress is normal
 Stress disturbs equilibrium. Coping is used
to maintain equilibrium.
 Individuals and families view stressors and
resources according to their own
perception
 Individuals and families adapt to stress
 Adaptation is influenced by –
– Perceived stressors
– Perception of the situation
– Resources or coping strategies available
 Important – to consider the contexts of
family stress within community and cultural
contexts in which a family resides to
understand why and how families are
stressed, and how they respond
 Family stress comes in many forms
 Normal stressors - Getting married, adjusting to living
in a new group, having babies, unemployment
 Abnormal stressors,- Famine, war, natural disasters,
massive economic collapse, murder, assault, incest
 The individual is prepared by family & society
If it ain't broke - Don't fix
it!
 Most families live long and relatively
happy lives
The Family Stress Theory….

 Explains how families react to

stressful events
 Suggests factors that promote
adaptation to stress
Family stress theory
 Acute stressors when accumulated can lead
to family crises (physical, emotional, or
relational) Eg., Domestic violence,
substance abuse (relapses), illness from
weakened immune systems, divorce,
accidents, children being abused, or
neglected, etc.
 Significant factors to look for - :
 the changes in daily routines,
 the number of changes in daily routines,
 the length of time since there were changes
in daily routines, (i.e. the family stressors)
Conceptual Model of Family
Stress
Impact of Stress on Family
 Can be muted, or buffered with protective factors which
help families to survive multiple contextual stressors,
and to continue to competently parent despite chronic
and acute stressors.
 These protective factors are –
 Social relationships (B Factor) -
• Within family variables, e.g. attachment, positive family
bonds, effective communication
• Across family variables: i.e. social isolation vs. informal
and formal social support networks;
 Perceptions (C Factor) – Include –
• Range in cognitions and attitudes between hope and
personal effectiveness vs. despair
• Helplessness.
These two complex factors relate together with the acute
stressors and ongoing social context of chronic
stressors, to predict family crises.
Adaptation to stress

 Bonadaptation (regenerative power )

 Maladaptation (vulnerability)
Positive relationship between
illness and stress.

 Stressors when too many (at a time) i.e., too many

changes in their daily routines and circumstances, are
at increased risk within one year for having an
accident, for becoming physically ill, for having an
impaired immune system, for becoming violent, or for
relapsing
 Not only individuals, but families that experience too
many stressors at one time are at increased risk for
experiencing aggravated family crises.
However, not ALL families with multiple stresses have
crises. Why not? What are the factors which protect a
person or family unit from having a family crisis.
Professor Reuben Hill's
theory of family stress
 Two complex variables act to buffer the family from acute stressors
and reduce the direct correlation between multiple stressors and
family crisis.
 These are formulated as the ABCX theory of family stress
 "B" variable - The complex of internal and external family resources
and social support available to the family, i.e., the social
connectedness within the family, as well as social connectedness
outside the family. Social isolation would significantly increase the
impact of the multiple stresses on the family functioning; in
contrast, positive social supports would minimize the impact.
 "C" variable - The perception factor, is the second predictor of the
extensiveness of the impact of stress on the family - the shared
family cognition and perceptions held about the stressors, e.g., the
extent to which the family perceived the changes as a disaster vs.
an opportunity.
Hill suggested that some families had positive appraisals which they
could make of changes, which increased their ability to accept their
circumstances.
This theory has been expanded by Mc Cubbin
HILL'S ABCX MODEL OF FAMILY
STRESS

(B) Internal Family Resources

& Informal/Formal Social

Supports
Family (A) -----------------------> Family Crisis (X)

Stressors

(C) Family Perception

& Parental Self-Efficacy
 High stress + social isolation (the "B" variable) for families
>>> dysfunctional family outcomes.
 Lack of "B" and "C" variables are similarly potent and equally
predictive of a family crisis.
 If a family experiences multiple stressors and
1) they are socially isolated and emotionally disconnected
to one another, and
2) they are depressed, hopeless, and disempowered,
Then, they will be at increased risk for illness, accidents, child
abuse and neglect, and substance abuse, delinquency and
school failure .
With a positive set of cognitions, an empowered attitude, and
an active informal and formal support network, there would
be a reduction in the likelihood that the stressful life
experiences would result in a family crisis.
 Recovery of family from
stressor events and return to
previous level of functioning

however, the process does not always result in this outcome

Sometimes families find that overcoming and surviving a crisis actually makes them
stronger and more resilient due to the realization of talents and abilities unseen
 Logically, some families find that
recovery is beyond their grasp, Either
they stagnate at a lower level of
functioning, or find themselves dealing
with new crises before repairs can be
made on the initial disturbance:
Theorists after Hill, such as McCubbin, refer to this phenomenon
as crisis "pile-up", in which additional crisis situations further
reduce the family's ability to cope and function.
 
 The interaction between (a) stressors, (b)
family resources, and (c) perception of
events as stressors is what defines a crisis
for any individual family.
 A family that is aware of its resources, will
not perceive the most devastating events
as crises.
 If stressors are adequately dealt with by
family resources, the stressor will be
perceived as a minor thing
 Effect of Stress on Family
Perception of crisis

Family with many Temporary disorganization of members Family with less

resources resources
Perception of crisis – acc to the level of
Fewer crises, functioning & perceived magnitude
shorter Suffer more
disorganizatio frequent crises,
n, steep angle ‘The angle of recovery determines the return longer periods of
of recovery & to normal disorganization,
returns to pre flatter angles of
or higher than recovery, and are
pre crises less likely to return
level of to their former
functioning functionality.
Stressors?
 Events that cause stress & have potential to affect a
change in a family
 Predictable (…parenthood) &
 Unpredictable (illness, unemployment..)
 Are cumulative – Involves simultaneous demands from
work, family & community life
 Too many in a short time
– Can overwhelm family’s ability to cope
- Risk of breakdown / crisis
 Change in life style/ structure >>>>ADAPTATION
Resiliency Model of Stress (Adjustment,
and Adaptation)
- McCubbin and McCubbin

 Emphasizes - Stressful situation is not

necessarily pathologic/ detrimental to
family
 Demonstrates – Need of family to
make fundamental/ structural /
systemic changes to adapt
Resilience
Resiliency Model of Stress

In family crisis -
 The pileup of family demands (stressors, strains, transitions)
is related to family adaptation, and this is a negative
relationship;
 Family typologies based on specific strengths of the family
system (cohesion, adaptability, family hardiness, family time
and routines) are related to family adaptation, and this is a
positive relationship;
 Family resources are related to family adaptation, and this is
a positive relationship;
 The family's positive appraisal of the situation is related to
family adaptation, and this is a positive relationship; and
finally
 The range and depth of the family's repertoire of coping and
problem-solving strategies when employed to manage a
crisis situation are related to the level of family adaptation,
and this is a positive relationship
Family Health defined..

It is the family resiliency or the

ability of the family to
respond to and eventually
adapt to the situations and
crises encountered over the
family life cycle"
Resilience – A characteristic
that families use to achieve
that balance and harmony
 Patterns of resilience can be assessed at the individual and/or
family level.
 Resilience of a child - assessed through responses and behaviors
of the child
 Resilience of family - Through family process, i.e., patterns of
successful coping and adapting, intrafamily relationships, and
family support systems. Nine aspects of resilient families dealing
with a chronic illness situation have been identified. These include:
 balancing the illness with other family needs,
 maintaining clear family boundaries,
 developing communication competence,
 attributing positive meanings to the situation,
 maintaining family flexibility,
 maintaining a commitment to the family as a unit,
 engaging in active coping efforts,
 maintaining social integration, and
 developing collaborative relationships with professionals
(Patterson, 1991
Role of nursing
 Promote family members' health, recovery
from illness, or maximum functioning within
specific health limitations
 Enhance family strengths, assist families in
maintaining linkages with community
supports, and aid families in arriving at a
realistic appraisal of what is the best "fit" for
them in their particular situation.
 Thus, assist families in the process of
adaptation
 Resiliency Model of Family Stress, Adjustment, and
Adaptation
Family adaptation is described in the Resiliency Model
for Family Stress, Adjustment, and Adaptation as the
"outcome of the family's efforts over time to bring a fit
at two levels: the individual to family, and the family to
community. This process ranges on a continuum from
optimal bonadaptation to maladaptation " ( McCubbin,
1993, p. 50). The model is comprised of two distinct
parts: the Adjustment Phase and the Adaptation
Phase. Each phase describes the family's ability to
cope with illness, or stressors looking at family
strengths, resources, and coping/problem-solving
abilities.
 There were four assumptions within the original family
stress model developed by Rueben Hill in 1949
(Friedman, 1998). These were:
 Unexpected or unplanned events are usually
perceived as stressful.
 Events within the families, such as serious illness, and
defined as stressful, are more disruptive than stressors
that occur outside the family, such as war, flood, or
depression.
 Lack of previous experience with stressor events leads
to increased perceptions of stress.
 Ambiguous stressor events are more stressful than
non-ambiguous events (Friedman, 1998, p. 88).
DEVELOPMENTAL
THEORY
 An outgrowth of several theories of
development
 Duvall (1977) described 8 developmental
tasks of the family through out it’s life span
– Family – A small group, a semi-closed
system of personalities that interacts with
the larger sultural social system
– Changes in one part effects a series of
changes in the other parts
Duvall’s Developmental
Theory
 Based on the predictable changes in structure,
function and roles of the family
 Age of the older child id the marker for stage transition
 Arrival of first child marks the transition from Stage I to
Stage II
 As the first child grows and develops, the family enters
subsequent stages
 At every stage family is at a developmental task
 At the same time, each member of the family must
achieve individual developmental task
Duvall’s Developmental stages
of the Family
 Stage I – Marriage & independent
home – The joining of families
 Reestablish couple identity
 Realign relationships with extended
family
 Make decisions regarding parenthood
 Stage III – Families with preschoolers
 Socialize children
 Parents & children adjust to
separation
 Stage IV – Families with
Schoolchildren
 Children develop peer relations
 Parents adjust to their children's, peer
and school influence
 Stage V – Families with teenagers
 Adolescents develop increasing
autonomy
 Parental focus on midlife marital and
career issues
 Parents begin shift toward concern for
older generation
 Stage VI – Families as launching
centers
 Parents & young adults establish
independent identities
 Renegotiate marital relationship
 Stage VII – Middle aged families
 Re-invest in couple identity with
concurrent development of
independent interests
 Re-align relationships to include in-
laws and grand children
 Deal with disabilities & death of older
generation
 Stage VIII – Aging families
 Shift from work role to leisure and
semiretirement or full retirement
 Maintain couple and individual
functioning while adapting to the aging
process
 Prepare for own death and dealing with
the loss of spouse and/ or siblings and
other peers
Application in Nursing
Practice
 Assess the level of accomplishment of
the families
 Assess the effect of illness on family
development
 Plan means to assist families to
achieve the developmental task for
that stage
 Include family in the work plan
 Anticipatory guidance

 Crisis intervention
FAMILY NURSING
INTERVENTIONS
 Behaviour modification
 Case management & coordination
 Collaborative strategies
 Contracting
 Counseling
 Empowering through active participation
 Environmental modification
 Family advocacy
 Family crisis intervention
 Networking (self-help groups, social support)
 Providing information & technical expertise
 Role modeling
 Role supplementation
 Teaching strategies – stress management, lifestyle modification,
anticipatory guidance