Stress, Coping, and Resilience
RNAO Best Practice Guideline 2002
Supporting and strengthening families through expected and unexpected life events
Nurse-family empowering partnership
Assess family need
Sustain a caring environment
Identify resources and support
Educate and provide information
Change in family is constant – change in family experiences, family unit, and external forces ranging from mild to
Family stress – “pressure or tension in the family system – a disturbance in the steady state of the family” (Boss,
2002 p. 16)
Physiological stress – research of Cannon 1929 and Seyle 1976
o Fight or flight – activation of sympathetic nervous system, elevated BP and HR, increased adrenaline and
cortisol hormones in response to a stressor – actual or perceived threat to body.
o Health of individual family members may be related to the level of family stress or change in family system.
o Research on caregivers of family members with disabilities or chronic or terminal illness suggests that the
health of caregivers is often negatively affected by lack of social support and high stress levels.
o Prolonged stress is associated with asthma, ulcers, infections, cancer, heart disease and alterations in the
Social stress – actual or perceived threats in relationships – at work, conflicts at school, or interactions within society
Stress and Coping – Transactional Relationship
Psychological stress – a particular relationship between individual – environment that is appraised by the person as
taxing or exceeding his or her resources and endangering his or her well-being (Lazarus & Folkman, 1984)
Coping - A person’s cognitive and behavioral efforts to manage (reduce, minimize, master or tolerate) the demands
of the individual-environment interaction that is appraised to be taxing or exceeding the person’s resources.
Cognitive theory of psychological stress and coping is transactional – person and the environment are viewed as
being in a dynamic mutually reciprocal bidirectional relationship.
Lazarus emphasizes that the physical responses of the body are the same – cognitive processes and physical stress
initiate the fight or flight response in the body.
Family conflict and stressors may influence the psychological health of individual members and result in depression,
anger, violence or abuse.
Family meaning and perception of the situation is a key determinant in how the family adapts to stressful event or
Coping with Stressful Events – Transactional Model of Stress and Coping
Cognitive appraisal - the person evaluates whether he or she has anything at stake in this encounter - harm or
benefit to self-esteem, is health at risk?
o A range of personality characteristics including values, commitments, goals and beliefs about oneself and
the world help to define the stakes that the person identifies as having relevance to well-being in specific
o Cognitive primary appraisal – evaluating the significance of a stressor or threatening event.
o Cognitive secondary appraisal – evaluating the controllability of the stressor and a person’s coping
The person evaluates what if anything can be done to overcome or prevent harm or improve the
prospects for benefit – evaluate coping options, changing the situation, seeking more information,
accepting it, holding back from overreacting.
o Reappraisal – based on new information.
Coping efforts – actual strategies that are used – problem management and emotional regulation.
o Outcomes of coping – emotional well being, functional status, healthy behaviour
Families that consistently perceive and define events and their situation as threatening and dangerous rather than
challenging will be crisis prone.
Functional families see events as understandable and manageable – idea of coherence.
o Two major functions - dealing with problems that is causing the distress (problem-focused coping) and
regulating emotions (emotion-focused coping).
o Problem-focused coping – aggressive, interpersonal efforts and rational, deliberate thinking and problem-
o Emotion-focused coping – distancing, self-controlling, seeking social support, escape-avoidance, accepting
responsibility, and positive reappraisal.
o Over a variety of stressful events, the type of coping varied depending on what was at stake, what the
coping options were.
Signs and Symptoms of Family Stress
Changes in family rules, rituals, and chores
Roller-coaster like emotional climate
Changes in togetherness and cohesion
Ineffective coping can have serious consequences
Changes in family communication/conflict
Changes in family decision-making and leadership
Negative impact on: person/family health, moral/beliefs, and disrupt social functioning
FILE inventory assessment tool (McCubbin & Patterson 1983) and Classification of Family Stressor Events and
Situations Internal and External Stressors (Boss, 2002)
Internal coping strategies
o Family alliance, sharing, role flexibility
o Normalizing, problem-solving, communication, conflict resolution
External coping strategies
o Social support-informal, community
o Blame, guilt, threats, denial
o Drugs, neglect, abuse
Family Communication and Conflict Resolution
Conflict is a routine part of normal family interaction (Simmel) and functions to maintain family communication
and interactions - allows the release of pent-up feelings of hostility, and helps resolve different perspectives (way of
achieving some kind of unity).
Close intimate family relationships are likely to contain both + and - / love and hate emotions because all of one’s
personality is engaged in family.
Family members may hide their differences and disagreements in an effort to protect the relationship – absence of
conflict may be an indicator of stress, strain, insecurity.
Supporting and strengthening families through expected and unexpected life events. Change in family is constant change in family experiences, family unit, and external forces ranging from mild to dramatic. Family stress pressure or tension in the family system a disturbance in the steady state of the family (boss, Social stress actual or perceived threats in relationships at work, conflicts at school, or interactions within society. Psychological stress a particular relationship between individual environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being (lazarus & folkman, 1984) Coping - a person"s cognitive and behavioral efforts to manage (reduce, minimize, master or tolerate) the demands of the individual-environment interaction that is appraised to be taxing or exceeding the person"s resources. Cognitive theory of psychological stress and coping is transactional person and the environment are viewed as being in a dynamic mutually reciprocal bidirectional relationship.