BiWei Dong

Elizabeth Hopewell
Sarah Kline
Robyn Simmons
Julie Wellborn
 Theory Overview
 An individual family’s experience of stress, crises, and
subsequent adaptation is an ongoing and dynamic
process.
 The process of adaptation is affected by the family’s
response to a stressful event, their available resources,
and presence or absence of effective coping strategies.
 Adaptation exists on a continuum from positive
adaptation (bonadaptation) to maladaptation,
resulting in increased or decreased family functioning.
 Development of the theory
 The original family stress theory was developed by
Reuben Hill (1949), who studied families’ responses to
war, war separation, and eventual reunion after WWII.
 The ABCX Model detailed how the three factors (the
ABC components) of a stressor event, the family’s
perception of that stressor, and the family’s existing
resources interacted to predict the likelihood of a crisis
(X) occurring.
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.
 Theory originally based on longitudinal research
involving families in which a father/husband was a POW
or MIA during the Vietnam war.
 Families facing a stressor event experience phases of
adjustment and adaptation, exemplified by a range of
processes in which the variables interact.
 An Inductive Research Approach
 Example of a “bottom-up” approach
 Specific observations regarding the families involved
in the study led to the identification of patterns and
regularities, resulting in broader theoretical
statements and hypotheses.
 These hypotheses have been tested extensively in
subsequent studies (in various disciplines), leading to
the validation of the theory.
 Later Developments
 The FAAR (Family Adjustment and Adaptation
Response) Model (1988) emphasizes adaptation as the
key outcome
 More recent models incorporates additional variables
(i.e. community relationships) to explain how families
function in periods of tranquility as well as stress.
 New emphasis on resiliency
 Current Nursing Research
 Current nursing research uses this model extensively
to study family adaptation while dealing with chronic
and life threatening illness.
 Example: LoBiondo-Woods 2004 work on examining
the relationship of family stress, severity of the
stressor, uncertainty, coping, and family adaptation
from the pretransplantation to the posttransplantation
phase of liver transplantation in children.
 Explicit Assumptions
1. Families over the course of life face hardships and
changes as a natural and predictable aspect of family
life.

1. 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.
3. 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.

3. 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.
5. 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.

McCubbin, M.A., McCubbin, H. I. (1996). Resiliency in families: A conceptual model

of family adjustment and adaption in response to stress and crises. In Family
assessment: Resiliency, coping and adaptation (p. 14). Madison: University of
Wisconsin Press.
 Implicit Assumptions
 Families like to live an orderly and balanced life and
are willing to cope with stress.
 The family variables are existent prior to their
connections to each other and they can be clearly
distinguished
 World View
 Model grew out of a systems theory/holism approach
 Holism focuses on alleviating problems within a
system by emphasizing on the system as a whole and
understanding that member parts ultimately aggregate
to create that whole.
 Assumptions:
 all phenomena can be viewed as a web of relationships
among elements, or a system.
 all systems have common patterns and behaviors that
can be understood and used to develop greater insight
into the behavior of complex phenomena.
Systems theory and the Double ABCX Model

 The family is viewed as the “system”, where experiences

of one family member affect the experiences of other
family members.
 Family systems theory and the Double ABCX model
highlights the integral influence of the family system
on each individual member's development and vice-
versa
 Systems theory (and the Double ABCX model)
recognize interactions of the parts are not "static" and
constant but "dynamic" processes.
Relevant Metaparadigm Elements
 Person (family): viewed as encountering hardships and changes
as an inevitable part of family over the lifecycle

 Environment (within the family system): viewed as an open

system and a component of the larger community and society.
Families benefit from and contribute to the network of
relationships and resources in the community.

 Health: family resiliency or the ability of the family to respond

to and eventually adapt to the situations and crises encountered

 Nursing: the role of nursing is to not only promote family

members’ health, but also to support and enhance family
strengths, to assist families in maintaining linkages with
community supports, and to aid families in arriving at a realistic
expectation of what the best “fit” for them in their situation.
 Concepts: ABCX Components
Stressor (A)

 Life event or transition impacting the family unit that

has the potential for changing the family social system.
 Defined as distinct from stress.
 Can occur in any aspect of the family’s life- roles,
functions, goals
 Examples include chronic illness in children, cancer,
and elder care
Existing Resources (B)

 All families have some level of resources.

 Concept of existing resources is the family’s use of
community and intrafamilial systems. i.e. SES, parents
education
 May be adequate or inadequate depending on the
nature of the stressor event or family’s level of
functioning
Perception of the Stressor (C)

 Defined by Hill (1958) and McCubbin and Patterson

(1983) as the meaning the family assigns to the crisis
event and the total circumstances that lead to the
crisis.
 In lay terms: how well does the family define the
problem, grasp the problem and understand the
situation?
 Crisis (X)

 Defined as the “demand for change”.

 Continuous variable that reflects the sum of the
family’s disorganization, turmoil, disruption which is
triggered by an event.
 In the model- crisis is regarded as the family’s inability
to retain stability.
 If the family is able to meet the demands of the
stressor than the crisis may be averted.
ABCX Component Interactions
Stressor (A) → interacts with resources (B) → family’s
perception of stressor/how stressor defined (C) →
produces the crisis (X).
Concepts: Double ABCX Components
Pile-up (Aa Factor)

 The effect of managing changes, strains, and stressors

over the time continuum.
 These stressor “pile-up” and accumulate affecting each
member.
Existing and New Resources (bB)

 Allow the family to adapt and meet demands and

needs by potentially adding expanded resources.
 Existing resources = usual mechanisms of support +
New expanded resources → new resources
strengthened or developed in response to the crisis or
as a result of the pile-up of stressors.
 A family in the face of crisis will call on existing
resources in order to prevent an event from creating
further crisis.
Family Perception of the Stressor (cC)

 The way the family views, defines, and the significance

given to the stressor.
 The family that aims at understanding the meaning of
the crisis can help the other members manage and
cope, utilize/develop resources= adaptation.
 The family’s perception of the crisis is key and is the
central factor to it’s coping.
Adaptation (xX)

 Realized when there is a balance between levels.

 The family has accommodated, compromised, worked
together and defined/recognized the meaning in the crisis.
 Considered at the individual family member level, unit,
and community level.
 Adaptation exists as a continuum from bonadaptation to
maladaptation.
 Bonadaptation is positive= family has achieved balance=
utilization of resources, coping mechanisms, accepts and
understands crisis.
 Maladaptation is negative= typified by family imbalance
 A Disscussion of Clarity
 The theory reads easily (parsimonious).
 Major concepts are operationally defined, and are
presented clearly, and consistent throughout the
theory (semantic clarity/consistency).
 Relationships between the concepts can be easily
presented visually/graphically (structural).
 Causes and consequences are carefully separated.
 Multiple applications are available in the literature .
 Serves to further clarify the major concepts and
relationships between variables.
 Provides both content and construct validity.
Congruence: Is the theory internally consistent?
 Theory makes logical sense.
 Variables have been operationally defined with reliable
instruments.
 Some concepts may be too limited in definition.
 Crisis event is too narrow; concept of a situation may be more
accurate.
 The number of concepts can be cumbersome with
extensions of the model.
 Clarity and congruence can be diminished with extensions
 Example: Individual resources are interchangeable with family
resources, even though they are conceptualized separately.
 Researchers must identify whether they are testing part of
the model or the total model.
 Researchers must identify and define which variables they
are testing.
 A True Middle Range Theory!
 Theory of Family Stress and Adaptation meets the
qualifications of a Middle Range theory:

 Moderately abstract, i.e., stressor, perception, etc.

 Organized within the limited scope of families adaptation
to stress
 Limited number of variables, which are testable in a direct
manner
 Strong relationship with research and practice in various
disciplines, directly applicable to nursing actions/practice
 Putting Theory into Practice
 Current nursing research focuses on family
adaptation to chronic illness.
 Requires nurses to understand the stages of illness
and how families respond to the illness process
 Theory assumptions help to guide practice that
recognizes family needs beyond a one-time event
A Sample Nursing Plan:
 An established relationship of trust is inherent
 Assess what aspects of the disease and family dynamics
present the most stress
 Assess and plan for coping strategies
 Develop both a short- and long- term plan for individuals
and family
 Physical and psychological parameters
 Incorporate the unique strengths and vulnerabilities of
each individual family member
Areas for further testing:
 Current concept variables have been tested repeatedly
with validated instruments
 Family Inventory of Life Events & Changes (FILE) used to
measure pile-up (reliability = .78)
 Coping Health Inventory for Parents (CHIP) used to measure
coping (reliability = .89)

 Prediction models need to be tested to determine

which variables of the model and in what order best
explain family adaptation in applied situations
Areas for further testing (cont.):
 Ethnicity and cultural components
 Intervention studies that foster adaptation and
adjustment
 The use of instruments (i.e. FILE) in increasingly
complex family structures
 Current reliability and validity testing focuses on
“traditional” family roles of mother and father
Future Developments (?)
 Increasing number of “stressors” faced by families
 Increasing prevalence of chronic disease
 Increasing complexity of family structure
 Although the model in its entirety can be
cumbersome, the elements can easily be broken down
and applied to an almost infinite combination of
factors.
 References
 Hill, R. (1949). Families under stress: Adjustments to the crises of war, separation,
and reunion. New York: Harper

 Lavee, Y., McCubbin, H., & Patterson J. (1985). The double ABCX modelof family
stress and adaptation: An empirical test by analysis of structural equations
and latent variables. Journal of Marriage and the Family. 42(4): 811-825.

 LoBiondo-Wood, G., Williams, L., Kouzekanani, K., & McGhee, C. (2000). Family
adaptation to a child’s transplantation: Pretransplant phase. Progress in
Transplantation. 10. 81-87.

 McCubbin, H.I., & Patterson, J. M. (1983). The family stress process: The double
ABCX model of adjustment and adaptation. Marriage and Family Review,
6(7), 7-37
 References (continued)
 McCubbin, M.A., McCubbin, H. I. (1989). Familis coping with illness: The
Resiliency Model of Family Stress and Adaptation. In C. Danielson, B.
Hamel-Bissel, & P. Winstead-Fry (Eds.). Families, health, and illness:
Perspectives on coping and intervention. St. Louis: Mosby.

 McCubbin, M.A., McCubbin, H. I. (1993). Family coping with health crises: The
Resiliency Model of Family Stress and Adaptation. In C. Danielson, B.
Hamel-Bissel, & P. Winstead-Fry (Eds.). Families, health, and illness . New
York: Mosby.

 Patterson, J.M. (1988). Families experiencing stress. The family adjustment and
adaptation response model. Family Systems Medicine, 7(4), 428-442.
 References (continued)
 Van Sell, S. L. & I. A. Kalofissudis. Formulating Nursing Theory. Retrieved
October 25, 2008 from http://www.nursing.gr/theory/theory.html.