Assignment: Family Nursing Theories and Literature Review Paper ESSAY

Assignment: Family Nursing Theories and Literature Review Paper

Assignment: Family Nursing Theories and Literature Review Paper

A family issue that many western countries face is divorce. The decision is arrived at after years of pain and struggle to try and salvage the marriage. Divorce occurs in 30-50% of all marriages in the US and it causes much pain for the concerned partners and children (Levitt, 2015). In dealing with divorce a theory on can use is family stress theory because it examines why some families can handle stress while others disintegrate. The purpose of this paper is to discuss divorce and how to manage it and outline the family stress theory. The paper will also explain the strength and weakness of family stress theory, its application in nursing, and how it can be used to help the family handle divorce.

Divorce refers to the dissolution of a marriage. It is an unhappy event that is marked by disappointment as well as the loss of expectations and dreams. It entails many parental, emotional, legal, financial and practical aspects that call for a change in routines and responsibilities and destabilize the affected parties’ life. According to Levitt, (2015), divorce follows five transitional zones. It begins with blames and disillusionment of one party where couples blame each other for all the problems they have been facing. At this stage, the initiator presents with a negative self-image, stored anger, anxiety, vague feelings of dissatisfaction, low energy levels. Additionally, Murray, Seekoe and Peu, (2018) agree that the initiator has a masked feeling of depression, anger, fear blame, and stubborn behavior. The authors also state that the receiver develops a feeling of denial, lack of control, disbelief, shock, fear of unknown and divorce opposed helplessness.

The second stage of divorce is marked with an expression of dissatisfaction and mourning the loss. The parties present with a profound painful feeling of grief, hopelessness and meaningless torture of life (Hirschfeld & Wittenborn, 2016). The couples are sensitive to any comment, lose parenting role, find it hard to concentrate and have intense preoccupation. The couples then transition to the third stage full of anger and resentment. At this juncture, they feel betrayed and either angered by all women or all men. The initiator feels like the other partner wronged them and thus should suffer however, they face fears and uncertainty about their finance, future, and ability to find an understanding couple. Additionally, the couples also express relationship dissatisfaction, emotional roller-coaster feelings, and uncertainty.

The fourth stage is when the couple decides to be single and divorce. The parties feel the desire to be free from couple constraints, create more emotional distance and try new affair. They also try new activities, make their own decisions, improve their self-image, try new experiences of independence and return to their parental and work roles (Hirschfeld & Wittenborn, 2016).  The couple lastly transitions to the last stage where they get new beginnings and act on decisions. The stage has physical and emotional flare-ups separation, self-settle down and self-orientation. The parties have an increased need to be in control, make long term commitments and plans, create a fair agreement and accept the end of the marriage.

Managing Divorce

At every transition stage of divorce, a counselor is essential to help the couple handle the emotional and physical aspects of the process. According to Cohen at el, (2016), at the first stage, the counselor has to foster couple sense of control on the couple lives and neutralize the fear from the physical and emotional separation process. A counselor also has to support the short-term decisions made by the couple in response to physical separation and maintain structures of information gathering to develop better parenting skills and create a support system to handle the roller coaster couple feelings. At the second stage, the counselor should give the couple short term tasks and allow them to go through the grieving process. The therapist should also redirect the couple from their poor me attitude, make them accept the grief process and realize the divorce process through a structured information gathering. Hirschfeld and Wittenborn (2016).assert the need to help the couple establish a common foundation or constructive channel they can use to get a fair settlement for their benefit.

At the third stage, the therapist has to neutralize the couple’s anger and make sure that the energy is channeled towards constructive tasks. Additionally, the therapist has to enhance the couple’s ability to make decisions by offering them short term and long term problem-solving skills and putting them in reality testing. At the fourth stage, the ideal approach is to enhance the direct couple communication skills, increase the co-parenting cooperation skills, help them make long-term plans and recover relationship interaction. Cohen at el, (2016) recommends to appropriately select the time for mediation to ensure that the couple is in a relatively good emotional phase. In the last stage, the therapist has to emphasize on the future of the family rather than on the past. There is a need to create a smooth transition, encourage new life and help the couple to accept ending the marriage and starting a new bright life.

Family Stress Theory

The theory is borrowed from family science and it explores why some family systems can handle situational stressors or transitional event while others disintegrate and deteriorates (Figley & McCubbin, 2016). The theory outlines concepts like person, environment, health, and nursing.  According to the theory the person or the family has to encounter hardships and changes as part of the lifecycle. The family also come up with strengths and capabilities to empower individual members and protect the family unit from a major disruption that occurs during change or transition. The family is defined as the nuclear, extended or clan. The environment is seen as an open system and a part of the larger society that provides benefits to the family and contributes to the network of relationship and resources.  The environment requires harmony to keep the balance between individual, family, and community (Figley & McCubbin, 2016). Health is defined as the resiliency of a family after facing a crisis and the ability to adapt to situations. Resilience helps the family to get balance and harmony. Lastly, the theory sees nursing as the ability to promote the recovery of family members from illness and perform maximally without specific health limitations. It also means the support offered to a family that enhances its strengths, maintain its link with community support and help them arrive at a realistic appraisal of what fits in a given situation.

Description and Analysis

The theory postulates two models namely the double ABCX model and the Family Adjustment and Adaptation Response (FAAR) Model. The Double ABCX model was developed to handle the inadequacies seen in various studies that research on family stress.  It emphasizes that family stress is a dynamic process of adjustment (Murry, Butler‐Barnes, Mayo‐Gamble & Inniss‐Thompson, 2018).  The model has four factors that define the way a family copes with stress. The first one is the pile-up of stressors (A) which is followed by the family efforts to get new resources (C). The third factor is changing the definition of the situation(C) while the last one is the results of coping strategies. The model has been embedded into the family adjustment and adaptation response as a way of portraying family adjustment.

The Double ABCX Model thus define family stress as an imbalance of demands and capabilities.  Nevertheless, the impact of the demand is influenced by the way the family defines the imbalance where a positive definition results in eustress while a negative definition leads to distress (Figley & McCubbin, 2016). Stress may not overpower a family if they can use resources and definition to resist change but when a family is unable to balance the demands and capabilities, a crisis (X) occurs. When the crises develop the family has to develop coping strategies to help in adaptation since new rules, roles and pattern of communication are developed.

The second part of theory sets in which is family stress and coping theory. It is explained using the Family Adjustment and Adaptation Response (FAAR) Model whose emphasis is the link between family stress theory and family resilience perspective. It also has four central constructs which are the efforts to balance family demands using family capabilities and supported by family meanings to

arrive at a level of family adaptation or adjustment (Lin, Lo, Lui & Wong, 2016).  According to the model, family demands are ongoing family strains, normative and non-normative stressors, and daily hassles. Family capabilities are coping behaviors and tangible and psychosocial resources. Demands and capabilities are either from individual family members, family unit or community contexts. To outline this, individual demand would a disabling condition in a child, a family demand would be marital conflict due to the management of the child’s condition and community stigma on the child disability will be a community level demand. Capabilities at the three levels that would help handle the demands above are good health and education services, family cohesiveness and parent education.

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An analysis of the theory reveals that it defines and explores the periodic, acuter stressors that are seen in families. If the stressors are frequent and when a family or an individual fails to get the support of significant relationships, the result is an increased residue of insecurity that manifests as personal and family crises including emotional, relational and physical trauma (Figley & McCubbin, 2016).  The family crises seen are divorce, child abuse, accidents, chronic substance abuse, episodes of domestic violence and diseases due to weakened immune systems. The theory purports that maintenance or disruption of the daily routine is what affects the sense of security. Examples of the routines are repetitious environmental stimuli, rituals, habits, and schedules. However, a lack of consistent behavior patterns and erratic personal activities can be buffered using protective factors like social relationships and perceptions. The positive factors are what families use to cope despite the presence of chronic and acute stressors.

Strengths of Family Stress Theory

The strength of the family stress theory can be seen from its development. It was introduced in the late 1940s by Professor Reuben Hill after the Great Depression and the observations used were derived both from families who survived the economic challenges and those who did not. The theorist thus was able to explain the way some families can adapt and survive when faced with stressors while other families face a crisis (Kaakinen, Coehlo, Steele & Robinson, 2018). The framework set has assisted in the creation of better family stress models like the resiliency model and has been used as the basis for clinical practice and crisis intervention. The theory also clearly describes the need to have social relationships and positive perceptions to help in buffering the family from a crisis. The models offered by family stress theory define stress, establish family resources, and explore the family perception of the stressor as well as the crisis. The theory is easily used by nurses to establish variables in any stressful event as well as the capability of the family to adapt to stress. It can be used to help families create goals and plan for strategies to resolve their issue, offer the family interventions to handle their stressor event, enhance their coping abilities and improve the family strength when dealing with a stressful event (Walsh, 2016).

The Weakness of the Family Stress Theory

A weakness prevalent in the family stress theory is the circularity of concepts. It is hard to distinguish stressors from the family response to the stressors especially when a stressor is a traumatic event and the reactions involved are interpersonal conflict and highly charged emotional responses (Kaakinen, Coehlo, Steele & Robinson, 2018). A circularity problem is also evident in how the families define demand-capability imbalance. As outlined above a positive definition of a situation results in eustress and distress if a negative approach is used. The conclusion that arises is that if the stressor causes growth it is no longer a stressor because the family system can resist change. In the theory, the definition of the situation can arise from either an individual or the family thus a question that arises is how family incorporate, modify or change the definition offered by an individual. The theory does not clearly explain how individuals, families, and communities influence each other since it does not describe how an individual participates in the adjustment and adaptation process. It is also not clear how a family member can convince the family unit to change as well as how the family seeks out external resources.

Application of Family Stress Theory to Nursing

In nursing, the theory is used to help families develop feasible ways of handling stressful events. Research indicates that the theory has been instrumental in coming up with innovative family care plans that guides families on reducing or avoiding stress levels (Sullivan, 2015). Additionally, it is applicable in family-focused research where it generates coping behaviors for culturally diverse families in stressful situations. The theory is easy to use and as well as translate into intervention and therapy and thus nurses can explain to patients on adaptation, family coherence, family resilience, and family adaptation. To be particular, the theory is essential in family nursing practice in that it acts as a starting point to begin interventions, treatment and other diagnoses (Sullivan, 2015). It offers nurses the intrinsic and extrinsic information to provide better care, services, and outreach to families.

Applicable Case

As outlined above, marital disruption is a cause of stress among families. To be precise divorce is a key issue that leads to separation and it creates a stressful period for both the children and parents. The affected parties react in anger, sense of failure and conflicting loyalties. Nevertheless, research suggests that divorce is less harmful to children compared to an unhappy, conflict-ridden marriage (Cohen et al., 2016). Divorce has two phases, pre-divorce and post-divorce. In predivorce, children experience emotional trauma from the heated arguments and fighting between parents. The process also exposes a child to a single-parent family which creates conflicting loyalties.  Children also exhibit reactions like denial, depression, regression, and guilt. The post-divorce on the other hand makes children fear that the left parent will leave also and they may face guilt when dealing with colleagues in school and neighborhood. For the parents, they may feel anxious, depressed, rejected and angry. Research indicates that the affected parties have strong fantasy relationships with the lost person (Cohen et al., 2016).

An example is a case between John and Jane who were married for seven years. They had a son and initially separated and both moved out of the marital home. They started renting apartments and had an informal parenting agreement. John was in home security and earned a good figure while Jane was working part-time and was almost becoming a registered nurse. The couple eventually decided to divorce and their assets were divided amongst them and the court offered them a joint decision-making authority in the child welfare as well as residential responsibility. After divorce, John lost his job and had to work part-time while Jane now works full time and was a nurse practitioner. John feels that he should be given residential responsibility sine the son currently spends most of his time with him.

Addressing Divorce Using the Theory

According to the family stress theory, pressure comes from within and without the family system. The family, therefore, has to constantly transform its position in response to the stress as a way of growing and continuing the family system (Hirschfeld & Wittenborn, 2016). Inability to adapt to the stress results in the breakdown and eventual separation and divorce. The unhandled stress causes a dysfunctional transactional pattern between family members and impacts the family negatively. It is then critical to treat the entire family system to help the family create a functional transactional pattern, resolve their stress and avoid the occurrence of separation and divorce.  However, once the divorce has occurred the family stress theory can be used to assist families to understand that it is a transactional process in the evolution of a family life cycle (Meadows et al., 2016). The theory postulates that stress arising from divorce is linked to internal family pressure and there is a need to come up with new family rules. One should also create new subsystems lines of differentiation since the family system no longer consists of parents and children but has one parent and children. According to the theory, the family breakdown that results in divorce and separation can be prevented and treated when one help the families adapt and accommodate to extramarital forces. In case a breakdown does not occur the model offers strategies to help parents and children make a successful transition by reforming new structured, roles and rules within the family systems (Cohen et al., 2016).

There is a need to help the disrupted families cope with divorce. The families need a coping mechanism to gain resilience and deal with the psychological and emotional effects of divorce. For instance, the best way to help them is through psycho-educational groups which offer social support and enhances the coping skills (Cohen et al., 2016). An example is child-centered programs that try to alleviate the negative feelings, misconceptions, and problems that occur during divorce. The programs use techniques like role-playing, storytelling, drawing, social problem-solving exercises, audio-visual materials, and bibliotherapy among others. Additionally one can use multi-stage treatment model to deal with conflict and the new model family system. The model begins with individual insight-oriented psychotherapy, it is followed by a parent-child session then a conjoint therapy with ex-spouses to establish a prenatal coalition and family therapy to handle co-parental issues and triangulation. Lastly one can employ filial therapy to enhance the relationship between family members. The therapy assumes that an enhanced relationship between ex-spouses and children assist the affected parties to cope with the transition of divorce and enhance the skills needed to tackle stressors that accompany divorce (Cohen et al., 2016).

Conclusion

A prevalent family issue is a divorce and it results in disappointment and loss of expectations and dreams. It follows five stages namely blames and disillusionment of one party, expression of dissatisfaction and mourning the loss, anger, and resentment, decision to be single and divorce and lastly new beginnings and acting on decisions. All through the transition, there is a need to have a counselor to help the couple deal with the emotional and physical aspects of the process. A theory that aligns with a transitional issue like divorce is the family stress theory. The theory postulates that some family systems can handle situational stressors or transitional events while others disintegrate and deteriorates. It has concepts like a person, environment health and nursing. It also offers models like the ABCX and FAAR.   ABCX model defines family stress as an imbalance between demands and capabilities and it has four factors namely the pile-up of stressors, efforts to get new resources, redefining the situation and coping strategies. In case a crisis occurs the family has to develop new rules, roles, and patterns. The FAAR model outlines how a family becomes resilient and adapt to stress. It also has four constructs namely efforts to balance family demands, family capabilities, family meanings, and family adaptation or adjustment.

The theory has its strengths in that it defines stress, defines family resources and explore the family perception of the stressors. It has also been used for crisis intervention and clinical practice. However, it portrays a circularity of concepts which makes it hard to differentiate stressor from family response to the stressors. The theory is applicable in nursing especially in developing family care plans that handle stress levels as well as acting as a basis for interventions, treatment, and diagnoses. An applicable scenario is the one dealing with family disruption due to divorce.  To address the issue, there is a need to handle dysfunctional transactional pattern between family members as a way of avoiding separation and divorce. Otherwise, once divorce occurs the ideal approach is to help the family understand divorce through techniques like psycho-educational groups, multi-stage treatment model and filial therapy.

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