Group 4 By: Delly Arfa Karina Megasari Tita Septi Sukardin

Family Stress Theory

Begin with Hills Model in 1949: Three element that cause crisis, i.e family issues (stressor), family resources, point of view about the issues Especially related to health care situation because of the effluent illness that lead into stress family event (Artinian, 1994 in Fridman, 2003) Original based of work is nuclear family

Stressor
Its refer to the initiating or the precipitating agents that activate the stress process, are: Life events Environmental Economic Socioculture events Experience

Coping
Coping is a effort to solve the problem Family Coping Process which the family create the family empowerment, build the new behavior and find some family resources to determine the stressor

Hills Model (1949)

A : variable that stimulates to the event or stressor with its adversity B: variable refers to what do family have to cope with their problem, such as family resources. For example, religion, economic condition, social support, health, litheness of family, coping mechanism C: Variable that shows family point of view about their problems; family perception about stressor in one event. X: Variable that shows sum of family ineffectiveness or incapability to prevent changes that related to stressor events; X variable is a crisis

Variable A, B, and C combination influence the familys ability to prevent changes associated with stressor events.

Family Stressor (s) A

Coping Resources B

Preception of Stressor (s) C

Figure 1. Hills ABCX Model

Crisis X

Developmental of Theory
The Double ABCX Model Expand by Mc. Cubin & Patterson (1983a in Fridman 2003) They Develop Hills Theory about ABCX Model Mc. Cubbin & Patterson modify Hills ABCX components by adding post crisis concept

(Mc. Cubbin&Patterson, 1983 in Liehr &

Smith, 2008)

C: Perception

bB.Existing and New Resources

Bonadaptation

A: Stressor

X: Crisis

aA.Pile up

Coping

X. Adaptation

Mal adaptation

B: Resources

cC. Perception

Pre crisis

Postcrisis Time Figurre 1.2 Family Stress and Adaptation

Illustration Case
There is a family with autism child (6th years old). He is the older son of the family. The parents told nurse that they are not well informed about autism; they have heard that autism is being abnormal. They overhelmed by their childrens behaviour; they try to keep their family problem to environment. This family is come from good socioeconomic class. Family comes to clinic and ask to counsel the nurse about their child condition.

ABCX Model by Hill: Stressor in family A

Children with autism, environment opinion, shameful feeling,

B : Family Resources Good socioeconomic class C: Family Point of View At first, family do not want to accept their child condition, after that family want to improve their child condition to be more autonomous X: Crisis in Family Inadequate family knowledge to take care autism chiild

Double ABCX Model by Mc. Cubinn & Patterson (1983)

aA Factor: Family is adjust the stressor to be accumulative issues Family hidden their autism child from environment and did not do anything bB Factor: New resources in Family i.e: Self reliance from Family Family integration: improve communication pattern in family

Continued
cC Factor: Perception of stressor Family opinion about their problems and their new resources will minimize pshycological effect from the crisis. Family try to comprehend their situation having autism child, and get to know more about autism child > coping mechanism xX Factor: Family Adapt the situation Bonadaptation or maladaptation

Family stress strategies

Cognitive strategies
Normalizing Control the meaning of the problem by reframing and passive appraisal Joint problem solving Gaining of information and knowledge

Communication strategies
Being open and honest Use of humor and laughter

External family coping:

Community strategies : maintaining active linkages w/ the community Social support Spiritual strategies

Assumptions of the family stress model include (Artinian, 1994 in Fridman, 2003):
Unpredicted issues Issues that comes from inside families (internal

issues) Knowledge insufficiency about stressor affair Ambigous or unclear stressor events

Example of Nursing Care Plan

Create trust relationship with family Assess stressor in family Assess family resources Assess family point of view about their issues Assess family coping mechanism Develop short and long term care plan based on concept and theory

Conclusion

Family Stress Theory begin with Hills model (1949) that divided 3 components to lead crises, such as stressor, family resources, and family perception about issues/ stressor Hills Model has an ABCX Model Mc. Cubin and Peterson (1983) develop Family Stress Theory to be Double ABCX Model that added post-crisis concept. Nurse should understand about the concept and family stress theory when give family nursing services Need to develop short and long term care plan based on family stress theory

References

Fridman, M., Bowden, V., Jones, E. (2003). Family Research Nursing: Theory & Practice (5th Ed.). New Jersey: Pearson education Inc. Liehr, P., Smith, M . (2008) Middle Range Theory for Nursing (2nd ed.). Retrieved from http://books.google.co.id/books?id=BxrrFVwW4PgC&pg=PA225&dq=appl ication+of+family+stress+theory&hl=id&sa=X&ei=cwzUJa4NMXnrAfFsoCACw&ved=0CDYQ6AEwAw#v=onepage&q=applica tion%20of%20family%20stress%20theory&f=false (November, 24, 2012)