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.