Overview of Resiliency Model of Family stress, Adjustment, and Adaptation

By: Karina Megasari Winahyu

Course Advisor: Dr. Kanokwan Wetasin Dr. Sunanta Thongpat Dr. Panarut Wisawatapnimit

Master of Nursing Science Boromarajonani College of Nursing Nopparat Vajira Graduate School, Kasetsart University March, 4th 2013

CHAPTER I INTRODUCTION Family stress theory was created by Hills in 1949. Hill observed some phenomena of family that go through separation and getting together within family member in the warfare. Family Stress Model illustrated that same stressor occurrence in families can create different reaction to the stressor. Hill explained his model as The ABCX Model. Hill explained each element of his model such as A as crisis or precipitating event/ stressor; B as family crisis meeting resources; C as the definition the family makes the event; X as the crisis in family. Hill described the model as the crisis-proneness and freedom from crisis among families (Hill, 1958, p. 143 as cited in Friedman, Bowden, & Jones, 2003 ). Additionally, this model had developed by McCubbin and Patterson in 1983 to be Double ABCX Model. The difference from both models was additional of post-crisis variable to forecast the way family pull through and adapt from crisis (McCubbin & Patterson, 1982, 1983b as cited in Schneider, 2010). It highlighted of family adaptation rather than adjustment; additional factors of family type; problem solving capability; higher level of family perception (Robinson, 1999). After that this model has developed to be Resiliency Model of Family Stress, Adjustment, and Adaptation by McCubbin and McCubbin in 1991. This model emphasized family adjustment, adaptation, and resiliency as family ability to make progress from unfavorable events. This model has used to provide family nursing care in family setting by Nurse Family Practitioner. Therefore, this paper would overview Resiliency Model of Family Stress, Adjustment, and Adaptation that developed by McCubbin and McCubin and review the application of theory.

CHAPTER II Resiliency Model of Family Stress, Adjustment, and Adaptation I. Concept of Theory Resiliency Model of Family Stress, Adjustment, and Adaptation is developed from Hills ABCX Model and expanded the Double ABCX Model. Otherwise, Resiliency model of Family Stress consist of two period, adjustment and adaptation phased. The adjustment phase provided family to have a few changes in family behavior and it has probability to be permanently family functioning (Rungreangkulkij & Gilliss, 2000). The adjustment stage is firmed by cooperation of elements such as: stressor, pile up demand, family typology, familys resources, familys appraisal of stressor, and problem solving and coping strategies. On the other hand, adaptation phase consist of two types, bonadaptation and maladaptation. Adaptation phase is determined by some elements such as: pile up of commands in family, family typology, familys sources, social support, family schema judgment and significance, and familys problem solving and coping. Resiliency Model of Family Stress provided an explanation of each components of theory with the purpose of its utilization to provide family nursing care. According to McCubbin and McCubbin (1991), first element is Stressor (AA) that consists of normative alteration, previous tension, and internal and external uncertainty. The second element is resources of family (BB, BBB). Sources of family defined as family can fulfill the demand of stressor and oppose the crisis (McCubbin & Patterson, 1983 as cited in Robinson, 1999). Resources consist of personal resource such as: family characteristic, intellectual, control capability, and self-esteem; Family system resources such as solidity, adaptability, and

structure of family; Communication resources and social support such as support from family member and companion, availability of community sources. Resource of family is very important to manage stressors that impinge family. It can be family strength to master stressful situation. The resources should mobilize adequately to achieved family outcome. The third element is family typology. McCubbin developed the formula to be family typology (R). It described as family form of behavior and normal function of family (McCubbin & Patterson, 1983 as cited in Robinson, 1999). According to McCubbin and McCubbin in 1996 (as cited in Rungreangkulkij & Gilliss, 2000) family typology consist of four types of patterns that associate to coping with stressful event: regenerative family, rhythmic family, resilient family, and traditional family. Family typology is one of main element that influence to family adaptation. The fourth element is situational and family appraisal (CC, CCC). Family appraisal described familys point of view of stressor or event. According to McCubbin and McCbubbin (1993) as cited in Hanson, Duff, & Kaakinen (2005), family appraisal is significant aspect in family adaptation because it showed familys definition related to illness and the meaning of illness for them, family perception related to utilize the resource to settle the problems or stressor. McCubbin & McCubbin (1993) explained that family members will consider the circumstances differently depending on their age, gender, role in the family, and experience. Trying to comprehend the situation is challenging and it is achieved only through persistence, endurance, negotiation, understanding, and shared loyalty. It means that respond of stressor of family member will not the same each other. The way family member reacts to the stressor need to achieved by some characteristic that will lead into family adaptation.

The fifth component of major concept is family problem solving and coping. It formulated by PSC. Coping is described as particular effort by which the individual or family endeavor to decrease the effect of stressor on family and to administer the situation (McCubbin & McCubbin, 1993 as cited in Robinson, 1999). There are four methods to evaluate family coping such as: family action to diminish the quantity and intensity of demands; achievement of additional sources; organizing the pressure that related to current stressor; strategies for improve the situation more positive, convenient, and suitable (Robinson, 1999). Family s coping effectively used if family utilize it resources to reduce, maintain, and alleviate the demand of stress. Family also manage the stressor through problem solving communication by consoling and supporting to each family member. The sixth element is family adaptation that defined as an adaptive or good function of family that supple to shift the roles, degree of commitment, and patterns of interaction as it exceed through a range of level of stress and transformation (McCubbin & McCubbin, 1993 as cited in Robinson, 1999). Adaptation is ranged from bondadaptation to maladaptation. Bondadaptation is characterized by: positive physical and mental health of individual family members; optimal role functioning and development of individual members; the maintenance of a family unit so that it can accomplish life-cycle tasks. Maladaptation is characterized by the negative end of the continuum (Kosciulek, McCubbin, & McCubbin, 1993). Family outcome is described by family adaptation. The way to achieve this adaptation phase is to master and manage the stressful event through balancing factors that influence to increasing the stressor existence and factors that leading to resiliency process.

CHAPTER III Analysis & Evaluation I. Analysis of Model Theory scope is middle range theory because the concepts and proposition relatively can more tangible and it can use and describe family in stressful situation. Linkage among concepts are explicated logically, naturally appeal; It link together well. Each of major concepts has explained clearly and the words were easy to understand. Instrument also provided to evaluate or assess each concepts of theory that means the testability is exist. Metaparadigm elements described by McCubbin and McCubbin in 1989 (as cited in Beckett, 2000) involved four componenets; person, health, environment, and nursing. Person is viewed as family that comes across hardship and alteration as a predictable element of family cycle. Environment viewed in family system described as an open system and an element of the broader community and society. Families gave advantages from and contribute to the system of relationships and resources in the community, moreover; Health defined as family resiliency or the capacity of family to take action to and eventually get used to the situations and crises encountered. The other metaparadigm is nursing that described as the responsibility of nursing is not only to encourage family members health, but also to maintain and enhance family strengths or resources, to assist families in maintaining linkage with community supports, and to assist families in arriving at a reasonable expectation for them in their situation (McCubbin & McCubbin, 1989 as cited in Beckett, 2000) The concept of theory is talked about factors that influence to adaptation family such as: pile up of demand (stressors); resources; family appraisal as the way family view

stressor or problems in family, problem solving and coping; family typology; family adaptation is outcome of familys endeavor to deal with stressor. Proposition of each concept is relational because it describe every factor that should identify to assess family stress and lead to family adaptation II. Evaluation Resiliency Model of Family Stress that developed by McCubbin and McCubbin (1983) is influenced and developed from Hills Model of Family Stress Model. Sociologists McCubbin and Patterson (1983) developed the Double ABCX Model, which added postcrisis variables (e.g. coping mechanisms) to explain how families recover from crisis and achieve adaptation over time. After that Double ABCX Model develop to be Resiliency Model. The theory is clearly explained and consistent all over the theory; the theory also parsimonious because it clearly described and concisely. Testability and measurement of resiliency model of family stress has developed for each element such as: instrument to measure family stressor: Family inventory of Life Events and Changes (FILE) by McCubbin and McCubbin (1993); Resources: Family Inventory of Resource for Management (FIRM) by McCubbin, Comeau, & Harkins, 1987) and Family strength by Olsen, Larsen, & McCubbin, 1985; Family Typology: The Family Hardiness Index by McCubbin, McCubbin, & thompson, 1987 This model can used in many cases related to family area, such as: family with chronic illness, mental illness, disabilities, elderly with end of life situation and the others situation.

CHAPTER IV CONCLUSION I. Application of Model The resiliency model is a good tool for assessing families in crisis and planning nursing care in order to facilitate the family ' s successful to attain adaptation. Muratta in 1994 has applied The Resiliency Model to low-income female head of household, predominantly African American innercity family, another example, the research findings about utilization of resiliency model apply to caring for the family of a head injury client (Chen & Wang, 2004). Another research conducted by Franklin (2003) use adaptation phase of the Resiliency Model of Family Stress, Adjustment, Adaptation and the Relational Processes of Balance and Harmony (McCubbin & McCubbin, 1996) in African American caregivers who manage chronically ill elderly In conclusion, Resiliency Model of Family Stress, Adjustment, and Adaptation is broadly used in family nursing practice to deal with family problems. It guide as a framework to help nursing practitioner provide nursing care for family from assessing the problems using all component of models until evaluating the result of nursing intervention based on model utilization. This model is purposed to guide nurse to identify factors related to stressor and balancing the factors of family that lead to resiliency process to promote the adaptation of family.

II.

Student Research Interest Student interested to find the correlation of factors within family that influence to

adaptation family with mental illness. Mental illness prevalence is increased around the world (WHO & World Mental Health Survey, 2009 as cited in Kessler et al, 2009). Mental Illness prevalence in Indonesia is 4.6 % and dominated in Jakarta with prevalence 20.3 % (Basic Health Research (RISKESDAS), 2007). After having hospitalization, client with mental illness would come back to live in the family and community. Family as caregiver for mental illness patient is considered as vulnerable population. This vulnerability could affect to family stress and the way family lived their life. Resiliency model talked about the component that influence family adaptation after faced family stressor associated with mental illness. Student be able to assess the family stressor use Family Inventory of Life Events and Changes (FILE) that developed by McCubbin, Patterson, and Wilson (1981); identify family strength and capabilities as resources of family used Family Inventory of Resources for Management (FIRM), which developed by McCubbin, Comeau, & Harkins (1987); Family appraisal, problem solving and coping, and family adaptation. All components will lead to family adaptation as outcome of family effort to control all factors related to stress within family.

References Basic Health Reasearch (RISKESDAS). (2007). Report of Basic Health Reseach 2007. Retrieved from http://www.docstoc.com/Docs/DownloadFile.ashx?docId=19707850&key=&pass= Chen, W., & Wang, W. (2004). The application of the resiliency model to caring for the family of a head injury client [Chinese]. Journal Of Nursing, 51(4), 107-112. Franklin, C. (2003). The effects of resiliency on adaptation of African-American caregivers of chronically ill elderly. Louisiana State University Health Sciences Center School of Nursing; 2003. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed February 20, 2013. Friedman, M., M., Bowden, V., R., & Jones, E., G. (2003). Family nursing: research, theory, and practice. New Jersey: Prentice Hall Hsiao C ; Van Riper M. (2009). Individual and family adaptation in Taiwanese families of individuals with severe and persistent mental illness (SPMI). Research in Nursing & Health, 32 (3): 307-20. (54 ref) Kessler, S. C., Gasiola, S.B., Alonso, J. (2009). The global burden of mental disorders: An update from the WHO World Mental Health (WMH) Surveys. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039289/ Robinson, D., L. (1999). Family stress theory: Implication for family health. In A. Wagner & B. Alexander (Eds.). Reading in family nursing (pp 434-445). Philadelphia: Lippincot Rungreangkulkij,S., & Gilliss, C., L. (2000). Conceptual approaches to studying family caregiving for persons with severe mental illness. Retrieved from http://www.sagepub.com/pricefamchnge4e/study/articles/08/Rungreangkulkij_Gilliss.pdf Schneider, T. (2010). The effects of sex differences and cohabitation status on parental stress in parents of children diagnosed with autism. Walden University). ProQuest Dissertations and Theses, , 141. Retrieved from http://search.proquest.com/docview/305226772?accountid=48250. (305226772). Beckett, S. (2000). Family theory as a framework for assessment. Retrieved from http://jan.ucc.nau.edu/~nur350-c/class/2_family/theory/lesson2-1-3.html