Family structure and style

The family is the basic unit of society. When a family member becomes ill, the entire family is affected. The concept of „family“ is more than people who are biologically related. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines the family as „the person or persons who plays a significant role in the individual’s life, including persons not legally related to the individual.“ When viewed in this broader context, a „family“ might include two people of the same or different sexes living together with or without sexual attachment, single-parent families, remarried families with children and stepchildren, and many other family forms. What these examples of families have in common a strong sense of connection and kinship, whether it consists of a biological or a psychological basis.

The family comprises the social context in which illness occurs. The happiness and health of each person in the family depends, to a large extent, on the nature of his or her interaction with other members in the family unit. How a family functions influences the health of its members as well as how an individual reacts to illness. The family is also the social network from which the patient derives some of his or her own identity, with which the patient has strong psychological bonds, and in which each individual has a specific role. Not all families function the same way, nor do all families have the same structure or style. The health professional can help assess family style and structure by talking with the patient and family and by observing their interactions. Observe whom the patient talks about most, who in the family visits the patient, and what the patient’s reaction is when visiting with specific family members. By talking with both the patient and family members, you can learn what sources of stress family members were experiencing before the illness and how the current illness is affecting family function.

Families have identifiable life stages, during which time specific tasks are the focus of family life. The timing of illness of a family member and the family’s ability to respond depend, on part, on the family’s life stage. Table 8 shows life stages and examples of family tasks.

Table 8

Family Life Stages and Family Tasks

Stage Tasks
Early married life Establish a satisfying marriage
Child bearing family (children at birth to 30 months) Adjust to parenthood; encourage development of infants
Pre-school family (2.5 to 5 years) Nurture children in growth promoting ways
School aged family (5-13 years) Socialize and educate children
Family with teen-agers (13-20 years) Balance freedom with responsibility as teens mature
Launching family Release young adults; maintain supportive home base
Middle-aged parents Rekindle and rebuild the marriage relationship
Aging family Adjust to retirement and death of a spouse
Source: Mc Kelvey, J., & Borgersen, M. (1990). „Family development and the use of diabetes groups: Experience with a model approach“. Patient Education and Counseling, 16(1),61-67

It is important for health care professionals to realize that not all families will be able to meet our expectations for involvement and support. Because of the stage the family is in, family members may have conflicting obligations. For example, the children of an elderly patient may have child obligations of their own, may live in another state, and may not be in a position to help the patient carry out health care treatment recommendations. Unfortunately, not all patients get the support and encouragement they need from their families, and not all families have the emotional stability to cope with long-term illness. If the relationship between family members was previously strained or dysfunctional, the additional stress of illness may cause even more problems.

Information about family function, stress, transition, and expectations can be invaluable in developing a teaching plan that will be most effective for both the patient and family. You will be more effective with patient teaching if you’re able to identify the family’s predominant lifestyle and find ways to sustain and incorporate recommendations into it rather than trying to impose a different pattern. For example, some families exhibit a high degree of structure, while others exhibit little structure, appearing to be in a constant state of chaos.

A family’s attitude and support, or lack of it, has a far greater impact on the degree to which patients follow health advice than information presented by health care professionals. For example, although a young mother may wish to breast-feed, if her husband is concerned about her figure and other family members consider breast-feeding to be out of date, it’s unlikely that the mother will receive the support she needs. The nurse can intervene in this type of situation by including the husband and family members early in the teaching process to gain their understanding and support. The family may also influence the individual’s beliefs about the severity of various illnesses and the benefits and costs of treatment. If family members fail to realize why a certain medicine is ordered to treat a specific disease or fail to see the effects of treatment, their attitudes may be a direct barrier to patient compliance.

Impact of illness on the family