Family Stress and Adaptation Middle Range Theory

Afza.Malik GDA

Adaptation Middle Range Theory 

Family Stress and Adaptation Middle Range Theory

What is Family Stress and Adaptation,Five Assumptions,Concepts About Theory ,Uses of  Middle Range Theory ,Model and Variable of Theory,Areas of Research

What is Family Stress and Adaptation

    Family Stress and Adaptation theory is derived from a framework known as the Double ABCX Model of family adaptation (McCubbin, HI, & Patterson, 1982). This middle-range theory, which has its roots in sociology, developed over decades beginning with the study of family response to war following World War II (LoBiondo-Wood, 2003). 

    The original theory included the concepts of stress or event, family existing resources, and family perception of the stressor contributing to a crisis; additions to the theory over time included postcrisis variables, such as pile-up, coping, and adaptation; Most recently the model has been configured to include resilience (LoBiondo-Wood). 

    "All of these conceptualizations add important pieces to the puzzle of what the family is and how it functions and adapts in periods of tranquility as well as upheaval" (LoBiondo-Wood, p. 93). 

Five Assumptions 

    LoBiondo-Wood notes five underpinning assumptions which address: 

(1) hardships as natural aspects of family life

(2) basic family strengths that protect the family unit and foster growth when families are faced with change

(3) basic and unique competencies to protect the family unit and foster recovery in the face of unexpected stress

(4) connection with communities to give and receive resources during stress and crisis

(5) work to restore order and harmony when families are faced with crises demanding change

    The assumptions and concepts of this theory make it applicable to nursing, when nurses are seeking a structure for guiding practice and research focused on family stress and adaptation.

Concepts About Theory 

    The key concepts of the middle range theory of family stress and coping are stressor, existing resources, perception of the stressor, crisis, pile-up, existing and new resources, family perception of the stressor, coping and adaptation (LoBiondo Wood, 2003). 

    Stressors are family hardships; existing resources include intrafamilial and community sources of support; perception of the stressor is the meaning assigned to the hardship by the family; crisis is the demand for family change; pile-up is the effect experienced when change is confronted over time; existing and new resources refer to evolving opportunities for facing the hardship.

    Family perception of the stressor is the meaning assigned to the total experience of facing the hardship; coping is an active process of using resources; and adaptation is the outcome of this middle-range theory, suggesting that the family has accommodated (LoBiondo-Wood).

Uses of  Middle Range Theory 

    LoBiondo-Wood (2003) notes strengths and weaknesses of this middle-range theory. Central strengths are that the theory focuses on the family as a whole and has multiple instruments developed to address the concepts of the theory. 

    Family Stress and Adaptation theory is unique in this way because the instruments have been specifically created to measure the ideas of the theory and psycho metric data are available for the existing instruments. 

    From a negative perspective, the theory has a large number of concepts and sometimes the concepts are not well distinguished from each other (LoBiondo-Wood). 

    For instance, the reader may have noticed that in the listing and description of the concepts, perception of the stressor appears twice with little to distinguish one concept from the other. 

    Examination of the model indicates that the first appearance of "perception of the stressor" occurs precrisis while the second appearance, entitled "family perception of the stressor," occurs post-crisis. 

    This pre-to post-crisis view is another strength of the theory. Even though the pre-to post-crisis view contributes to complexity and a cumbersome structure, it provides a longitudinal perspective, enabling application to situations which are changing over time, as most health problems are. 

    "The model calls upon nurses not only to be able to understand the processes and stages of the illness, but also how families respond to the illness trajectory" (LoBiondo-Wood, p. 106).

Model and Variable of Theory

    In spite of this strength of providing a longitudinal perspective, when the theory is used for research, the researcher often selects specific variables from the model rather than using the whole model (LoBiondo-Wood, 2003). 

    LoBiondo-Wood (2003) and colleagues have used the model to study children undergoing liver transplantation, employing the Family Inventory of Life Events & Changes (FILE) to address pile-up; the Family Inventory of Resource Management (FIRM) to address existing and new resources.

    The Coping Health Inventory for Parents (CHIP) to address coping; the Family Coping Coherence Index (FCCI) to address perception of the stressor; and the Family Adaptation Device (FAD) to address adaptation. 

    It is apparent from this list of instruments which operationalize theory concepts that the theory of Family Stress and Adaptation is very amenable to use by researchers. The theory has provided a wealth of instruments for testing family response to chronic illness. 

    The model, extensions, and conceptual distinctions may seem cumbersome, but when the model is broken down and the elements that are consistent with a problem are outlined, the measurement and testing of hypotheses can be accomplished. (LoBiondo-Wood, p. 107)

Areas of Research

    In spite of years of research and continued development of the Family Stress and Adaptation theory, LoBiondo-Wood (2003) has identified several areas for continued study, such as examination of the fit of ethnicity and culture and consideration of new definitions of family, where Parents may be same gender individuals or individuals from two generations who come together to coparent a child. 

    The middle-range theory of Family Stress and Adaptation is a valuable structure for guiding nursing research and practice and it could be an asset to undergraduate and graduate students learning to care for families in crisis. 

    Furthermore, nursing research could effectively contribute to the areas in need of further development, making this middle-range theory even more relevant for the sociocultural context of today's families.

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