Nursing and Family Stress Theory

Critique and Analysis of Family Stress Theory Nursing theory explains the relationship between concepts to enhance understanding and knowledge about a phenomenon (Walker & Advant, 2005). Theoretical frameworks for nursing of families provide a foundation for guiding the development of family centered care and research (Friedman, Bowden, & Jones, 2003). The application of theory helps to guide nursing practice, education, and research and supports the development of evidence-based nursing strategies and interventions for both the individual and the family as the client. This paper will critique and provide an analysis of the family stress theory. A brief introduction of the history and author of this theory will be provided and the major concepts and assumptions of the theory described. The rationale for selecting this theoretical model as it relates to family nursing practice will be provided and its strengths and weaknesses identified. In addition, a discussion of the application of the Family Stress Theory in current nursing research will be presented. Finally, ideas for future research needed to continue to develop this theory for its application in family nursing practice will be explored. Family Stress Theory The family stress theory was introduced by Professor Reuben Hill in the late1940s after the Great Depression (McDonald, n. d. ). McDonald (n. d) explains that Hill based his observations on families who survived the economic challenges of the Great Depression and those families who did not. Friedman, Bowden, and Jones (2003), explain that Hill based his research on the effects of separation and reunions as a result of war time on families. In both cases, the Family Stress Theory helps to explain why some families are able to adapt and survive when faced with stressors while other families encounter crisis. Hill’s Family Stress Theory has served as a framework for the development of more contemporary family stress models, such as the Resiliency Model, and as a foundation for clinical practice and crisis intervention (Friedman, Bowden, and Jones, 2003). Major Concepts Hill describes the importance of social relationships and positive perceptions which serve as buffers in protecting the family from crisis (McDonald, n. d. ). In developing the family stress theory, Hill formulated an ABCX framework which helps to define the stress, identify the family resources, explore the family’s perception of the stressor, and the crisis. The A variable is identified as the provoking stressor or event that the family encounters. Family experiences and strengths as well as family and community resources represent the B variable. This variable includes the family’s social support structure, both internal and external, which impact the magnitude of the stress on the family (McDonald, n. d. ). The family perception of the degree of stress produced by the provoking stressor or event represents the C variable. Combined, these three variables influence how a family copes, reacts, and manages the situation and determines whether or not the situation becomes a crisis, the X variable. Past experiences, adequate and available resources, time, and support all impact how a family is able to adapt and change to the situation. The application of the family stress theory helps to predict the potential for a family crisis. According to McDonald (n. d. ), â€Å"the combination of high stress with social isolation (the â€Å"B† variable) for families has been highly correlated with many forms of dysfunctional family outcomes† (para. ). Hill’s family stress theory provides a framework for a family as client focused assessment and the development of evidence-based nursing interventions that strengthen the family and promote positive outcomes. Family Stress Theory’s assumption about Family and Nursing The Family Stress theory is middle range theories developed by Hill and as th e variability of families are recognized through research, the traditional ABCX theoryevolved to different family stress theory and developed the conceptualization and the assumption of what family is about. In 1996, McCubbin and McCubbin outlined the theory’s assumption of a family in crisis (Smith & Liehr, 2008, p. 227) : Families over the course of life face hardships and changes as a natural and predictable aspect of family life. Families develop basic competencies, patterns of functioning, and capabilities to foster the growth and development of family members and the family unit, and to protect the family from major disruptions in the face of transitions and changes. Families develop basic and unique competencies, patterns of functioning, and capabilities designed to protect the family from unexpected or non-normative stressors, and strains and to foster the family’s recovery following a family crisis or major transition or change. Families draw from and contribute to the network of relationships and resources in the community, including its ethnicity and cultural heritage, particularly during periods of family stress and crises. Families faced with crisis situations demanding changes in the family’s functioning work to restore order, harmony, and balance even in the midst of change. In the Family Stress theory’s metaparadigm, nursing is responsible in assisting families in the process of adaptation by promoting the family member’s health, help to recover from illness, assist the family member to function within the specific health limitation, support and develop family’s strengths, assist in the use of community resources available, facilitate the family in appraisal of the situation and help the family decide what is best for the situation (Beckett, 2000) . The Family Stress Theory in Family Nursing Stress can affect intimate relationships in the family setting. Although stress is normal and natural in the family setting, severe stress can lead to serious family situations such as domestic violence, alcoholism, substance abuse, and even child neglect. The outcome of the family’s situation during the stressful event depends on how the family responds and thrives to the stressful situation. A stressful event can be in the form of an acute or chronic illness in the family, sudden role changes,hardships in the family life cycle, separation, and death of a family member. The use of Family Stress Theory in Family Nursing assists the nurses in exploring the family system’s behavior and response to situational stressors and transitional events. The Family Stress theory was useful in the family’s coping ability regarding the care of the child with extraordinary needs (Crawford, 2002) . A child with special needs is a stress to both parents because time is needed to develop competency in caring for such child in the family. The use of community and family resources should be offered and considered to adapt to the crisis. One literature also applied the theory in remarriage in families and suggested that â€Å"remarriage and adjustment to step family living are conceptualized as life transition in the framework of the Family Stress Theory † (Crosbie-Burnett, 1989, p. 323) . Identifying all the variables present in any stressful event and the family’s capability of adapting to the stress using all resources available will assist the nurse in developing the nursing process by making a thorough family internal and external environmental assessment, assist the family in creating a goal and planning for strategies to resolve the issue, providing the family possible interventions in managing the stressor event, improving coping abilities, and enhancing the family’s strength during the stressful event. The nurse is also responsible in following-up and evaluating the effectiveness of the intervention to either continue the current management or change the coping strategy. Family Assessment In the use of qualitative and quantitative studies, families have different patterns to the response of stress. Assessing family resources, coping strategies, and processes provides the function for assisting families in adaptation and attainment of a higher level of wellness (Friedman, Bowden & Jones, 2003, para 3). Families engage in different management and coping strategies when dealing with stressful events. The nurse will have to assess the healthiness or dysfunctional aspects of the family. During the assessment period, the nurse set specific goals that will help the family with coping mechanisms of stress. The foundation for achieving the goals will depend on family support, financial resources and coping strategies. Families remain strong and durable even during today’s economic crisis. Despite all the economic, social and political pressures, most families can e considered to be functioning satisfactorily (Friedman, Bowden & Jones, 2003, para 4). The theoretical model family stress identifies two types of situations that will cause a family to enter into a crisis. Those situations are classified as developmental and situational events. Events that are identified as psychosocial growth of a family are noted as developmental events. Some examples are retirement, a child entering hi gh school or college, or adoption. The examples denote the normal life cycle affecting the entire family unit. Unexpected events are considered situational events such as death, loss of job, or the loss of the home due to fire. The family’s financial resources and coping mechanisms will help the family adapt and work through the crisis. The nurse can take the listed examples and help the family develop goals in becoming healthy and strong family again. Critique of the Family Stress Theory The use of the family stress theory by nurses with advanced training is a key indicator for creating care paths that enhance the effectiveness of outcomes for positive family health. Family clinicians use the stress theory to facilitate a collaborative learning process between family members with special emphasis on the different family processes: parenting, balancing work, dealing with childhood issues, and maintaining stability in home life. The stress theory is used as a helpful tool for identifying sources of stress that lend a head start for developing strategic plans to assist with managing them. Further applicability of the stress theory offers a supportive resource for identifying coping mechanisms of individual family members and determining how effective their coping strategies are during stressful family situations. The theoretical framework for the stress theory also serves as a tool for explaining how families adjust and adapt as one system during stressful events (Friedman, Bowden, & Jones, 2003, p. 470). Information for identifying coping mechanisms for families of culture can be acquired by using a cultural genogram to gather information about their trengths and weaknesses. The clinician uses the information to apply it to the stress theory framework to assist the family with developing feasible ways of dealing with stressful events. Continued research efforts incorporating the use of the stress theory critical for developing innovative family care plans for helping families avoid and decrease stress levels. Further family-focused research can be generated to addres s the coping behaviors of culturally diverse families during stressful situations (Friedman et al. , 2003). The new wave of multi-types of families supports the need for intervention research that serves as evidenced-based practices to help not only culturally diverse families but also all families to deal with stress. Strengths The strengths identified in using the family stress theory are that the model is easy to understand and easy to translate into therapy and intervention. During the assessment period of explaining the model and how it relates to the situational crisis of the family, it is important that families understand the system. The nurse will explain adaptation, family adaptation, family coherence and family resilience. During the educational process, the concepts can be defined and described in a manner the family can view the crisis and place the event in the family unit’s perspective. As the nurse translated the model into therapy sessions and intervention processes, the family will not have difficulty working together needed to heighten family growth. The nurse and family will work together to establish goals. During the intervention session the family will engage with the stressors affecting the family. The family will work extensively to return the unit to the whole family concept. Weaknesses Weaknesses identified are limited to the discussion of aspects in the family dealing with stress and punctuation or interruptions. The family may be limited on providing pertinent information in the discussions. The nurse can help set goals based on the provided information. Shame and guilt play intricate roles in how much information is provided. The family will need to engage in the discussion and work sessions in order to return to the functional family unit. Punctuation or interruptions occur during the meetings with the nurse and family. Unforeseen activities causes disorganized scheduled meeting. A specific time should be allotted for the meeting to alleviate interruptions. The nurse and family can make stride if the sessions are uninterrupted. Family Nursing Research The trends of nursing care have evolved over the years from being a patient centered care industry into an industry focused around family centered care. The focus of providing family centered care has resulted in an emergent need to develop concepts, assessment measures and clinical skills customized to the care being provided. For this reason, family nursing research has detonated although much of the research is in its infancy stages. Much of the current literature on family nursing pertains to pediatric nursing and family, however the call for family nursing research for the adult world of nursing is emerging as well. One particular study conducted by staff researchers at The University of North Carolina at Chapel Hill spotlight on how families care for a child with chronic illness and debilitating diseases. The byproduct of this research study is the FaMM (Family Management Measure). Although the FaMM was cultivate through the use of the Family Management Style Conceptual Framework (FMSF), the FaMM measures how a family manages during stressful situations, which is a direct correlation to the family stress theory. In addition to spotlighting, the purpose of the study is â€Å"that it will further the development and testing of interventions and the comprehensive assessment of families' efforts to manage chronic conditions† (Knafl et al. , 2007). Based on analyzing the investigations leading up to the FaMM, researchers had ne primary question and challenged themselves to discover a way to make the eight conceptual dimensions of the FMSF into a measureable assessment tool with a high percentage of reliability and validity. Second, an evaluation tool (FaMM) and a hypothesis was developed to support the inquiry. The hypothesis converged to explain how â€Å"data from the FaMM will contribute to clinicians’ and researchers’ ability to understand more fully family functioning in the context of childhood chronic conditions† (Knafl et al. , 2007). Even though the research study appears to be qualitative in methodology with its categorical approach to establishing measurements it is overwhelmingly quantitative. Each of the established measurement guidelines or categories becomes conclusive with a percentage score as a means to evaluate against ranges. The ranges help to determine whether the family has the ability to manage many of the stress factors associated with care of a chronically ill child. The results of the research demonstrated a high validity as well as reliability. In particular, the reliability of the test ranged between 72% to 90% for mothers and 73% to 91% for fathers, both demonstrating above 50% reliability. The future of family nursing research should branch out to include all forms of family; for example, children being raised by grandparents, homosexuals, foster parents and,other forms of guardianship. With the Family Stress Theory more research is needed to determine the long-lasting effects of stress on the family unit and ways to offset these effects. Furthermore, the research from family stress theory is useful to family nursing practice in that it gives nurses a starting point to initiate interventions, treatment and, other diagnoses. Conclusion Family stress theory provides nursing staff with both intrinsic and extrinsic information to use in providing better services, care,and outreach to families. The concepts and assumptions identified in the theory arecurrently being researched for efficiency in providing the best application measures for family nursing practice. Despite the weakness identified in the theory, the strengths of the theory far outweigh. In closing, the family stress theory can be used to guide nursing practice in acute care settings but also can provide in sight on primary prevention methods. References Beckett, C. (2000). Family theory as a framework for assessment. Unpublished manuscript, Northern Arizona University, Flagstaff, Arizona. Retrieved from http://jan. ucc. nau. edu/~nur350-c/class/2_family/theory/lesson2-1-3. html Crawford, D. (2002). Keep the focus on the family. Journal of Child Health Care, 6, 133-146. doi: 10. 1177/136749350200600201 Crosbie-Burnett, M. (1989, July). Application of Family Stress Theory to remarriage: A Model for assessing and helping stepfamilies. Family Relations, 38, 323-331. Retrieved from http://www. jstor. org/pss/585060 Friedman, M. M. , Bowden, V. R. , & Jones, E. G. (2003). Family Nursing: Research, Theory and Practice (5th Ed. ). Upper Saddle, NJ: Prentice-Hall. Knafl, K. , Deatrick, J. , Gallo, A. , Dixon, J. , Grey, M. , Knafl, G. , & O’Malley, J. (2007). 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