Family Stress,

Coping &
Adaptation

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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. sholat jamaah,
makan bersama)
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 Internal Strategies

I. 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
2. Cognitive Strategies
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
1. 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 don’t 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 family’s 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
(1) Denial of Family Problems
• Scapegoating reduces tension in
family at expense of one member
• Scapegoat becomes focus of family’s
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

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