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Definitions :
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
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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
Adaptation to stress :
Adaptation to stress Bonadaptation (regenerative power ) Maladaptation (vulnerability)
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
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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 :
Recovery of family from stressor events and return to previous level of functioning however, the process does not always result in this outcome
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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 before
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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:
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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.
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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
Stressors? :
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 familys ability to cope - Risk of breakdown / crisis Change in life style/ structure >>>>ADAPTATION
Resilience :
Resilience
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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 :
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
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Resiliency Model of Family Stress, Adjustment, and AdaptationFamily 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.
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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 :
DEVELOPMENTAL THEORY An outgrowth of several theories of development Duvall (1977) described 8 developmental tasks of the family through out its 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
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Stage II Families with infants Integrate infants into family unit Accommodate to new parenting and grand parenting roles Maintain marital bond
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Stage III Families with preschoolers Socialize children Parents & children adjust to separation
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Stage IV Families with Schoolchildren Children develop peer relations Parents adjust to their children's, peer and school influence
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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
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Stage VI Families as launching centers Parents & young adults establish independent identities Renegotiate marital relationship
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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
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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
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Include family in the work plan Anticipatory guidance Crisis intervention