FAMILY

Family is a group of people affiliated by consanguinity, affinity or co-residence.

Although the concept of consanguinity originally referred to relations by "blood",
anthropologists have argued that one must understand the idea of "blood" metaphorically and
that many societies understand family through other concepts rather than through genetic
distance.

Family Types

The different types of families occur in a wide variety of settings, and their specific
functions and meanings depend largely on their relationship to other social institutions.
Sociologists have a special interest in the function and status of these forms in stratified
(especially capitalist) societies.

The term "extended family" is also common, especially in the United States and Europe.
This term has two distinct meanings. First, it serves as a synonym of "consanguinal family".
Second, in societies dominated by the conjugal family, it refers to kindred (an egocentric
network of relatives that extends beyond the domestic group) who do not belong to the conjugal
family.

These types refer to ideal or normative structures found in particular societies. Any
society will exhibit some variation in the actual composition and conception of families. Much
sociological, historical and anthropological research dedicates itself to the understanding of this
variation, and of changes in the family form over time. Thus, some speak of the bourgeois
family, a family structure arising out of 16th-century and 17th-century European households, in
which the family centers on a marriage between a man and woman, with strictly-defined gender-
roles. The man typically has responsibility for income and support, the woman for home and
family matters.

According to the work of scholars Max Weber, Alan Macfarlane, Steven Ozment, Jack
Goody and Peter Laslett, the huge transformation that led to modern marriage in Western
democracies was "fueled by the religio-cultural value system provided by elements of Judaism,
early Christianity, Roman Catholic canon law and the Protestant Reformation".[17]

Nuclear family

The term "nuclear family" is commonly used, especially in the United States and Europe,
to refer to conjugal families. Sociologists distinguish between conjugal families (relatively
independent of the kindred of the parents and of other families in general) and nuclear families
(which maintain relatively close ties with their kindred).

A conjugal family includes only the husband, the wife, and unmarried children who are
not of age. The most common form of this family is regularly referred to in sociology as a
nuclear family.

The nuclear family is considered the "traditional" family. The nuclear family consists of
a mother, father, and the children. The two-parent, nuclear family has become less prevalent, and
alternative family forms have become more common. These include homosexual relationships,
single-parent households, and adopting individuals.

A matrilocal family consists of a mother and her children. Generally, these children are
her biological offspring, although adoption of children is a practice in nearly every society. This
kind of family is common where women have the resources to rear their children by themselves,
or where men are more mobile than women.

Single-parent

A single-parent (also termed lone parent or sole parent) is a parent who cares for one or
more children without the assistance of the other biological parent. Single-parent homes are
increasing more and more as married couples divorce, or as unexpected pre-marital pregnancies
occur. The percentage of single-parent households has doubled in the last three decades, but that
percentage tripled between 1900 and 1950. The sense of marriage as a "permanent" institution
has been weakened, allowing individuals to consider leaving marriages more readily then they
may have in the past.
 However, in the western society the single parent family has been growing more accepted
and has begun to truly make an impact on culture. The majority of single parent families are
more commonly single mother families than single father. These families face many difficult
issues besides the fact that they have to raise their children on their own, but also have to deal
with issues related to low income. Many single parents struggle with low incomes and find it
hard to cope with other issues that they face including rent, child care, and other necessities
required in maintaining a healthy and safe home.

Extended family

The extended family consists of grandparents, aunts, uncles, and cousins. In some
circumstances, the extended family comes to live either with or in place of a member of the
nuclear family. An example includes elderly parents who move in with their children due to old
age. This places large demands on the caregivers, particularly the female relatives who choose to
perform these duties for their extended family.

A consanguineal family consists of a parent and his or her children, and other people.

Members of the extended family use descriptive kinship terms:

 Mother: a female parent

 Father: a male parent

 Son: a male child of the parent(s)

 Daughter: a female child of the parent(s)

 Brother: a male child of the same parent(s)

 Sister: a female child of the same parent(s)

 Grandfather: father of a father or mother

 Grandmother: mother of a mother or father

 Cousin: two people that share the same Grandparent(s)

 Such systems generally assume that the mother's husband has also served as the biological
father. In some families, a woman may have children with more than one man or a man may
have children with more than one woman. The system refers to a child who shares only one
parent with another child as a "half-brother" or "half-sister." For children who do not share
biological or adoptive parents in common, English-speakers use the term "stepbrother" or
"stepsister" to refer to their new relationship with each other when one of their biological parents
marries one of the other child's biological parents.

Any person (other than the biological parent of a child) who marries the parent of that child
becomes the "stepparent" of the child, either the "stepmother" or "stepfather." The same terms
generally apply to children adopted into a family as to children born into the family.

Typically, societies with conjugal families also favor neolocal residence; thus upon marriage
a person separates from the nuclear family of their childhood (family of orientation) and forms a
new nuclear family (family of procreation).

When additional generations intervene (in other words, when one's collateral relatives belong
to the same generation as one's grandparents or grandchildren), the prefixes "great-" or "grand-"
modifies these terms. And as with grandparents and grandchildren, as more generations intervene
the prefix becomes "great grand", adding an additional "great" for each additional generation.

Cousins of an older generation (in other words, one's parents' first cousins), though
technically first cousins once removed, often get classified with "aunts" and "uncles".

Similarly, a person may refer to close friends of one's parents as "aunt" or "uncle", or may
refer to close friends as "brother" or "sister", using the practice of fictive kinship.

English-speakers mark relationships by marriage (except for wife/husband) with the tag "-in-
law". The mother and father of one's spouse become one's mother-in-law and father-in-law; the
female spouse of one's child becomes one's daughter-in-law and the male spouse of one's child
becomes one's son-in-law. The term "Sister-in-law" refers to three essentially different
relationships, either the wife of one's sibling, or the sister of one's spouse, or, in some uses, the
wife of one's spouse's sibling. "Brother-in-law" expresses a similar ambiguity. No special terms
exist for the rest of one's spouse's family.

The terms "half-brother" and "half-sister" indicate siblings who share only one biological or
adoptive parent.

I. PRIMARY FUNCTIONS.

One of the primary functions of the family is to produce and reproduce persons—
biologically and socially. Thus, one's experience of one's family shifts over time. From the
perspective of children, the family is a family of orientation: the family serves to locate children
socially and plays a major role in their enculturation and socialization. From the point of view of
the parent(s), the family is a family of procreation, the goal of which is to produce and
enculturate and socialize children. However, producing children is not the only function of the
family; in societies with a sexual division of labor, marriage, and the resulting relationship
between two people, is necessary for the formation of an economically productive household.

II. OTHER FUNCTIONS

Economic functions
Anthropologists have often supposed that the family in a traditional society forms the
primary economic unit. This economic role has gradually diminished in modern times, and in
societies like the United States it has become much smaller — except in certain sectors such as
agriculture and in a few upper class families. In China the family as an economic unit still plays
a strong role in the countryside. However, the relations between the economic role of the family,
its socio-economic mode of production and cultural values remain highly complex.

Political functions

On the other hand family structures or its internal relationships may affect both state and
religious institutions. J.F. del Giorgio in The Oldest Europeans points out that the high status of
women among the descendants of the post-glacial Paleolithic European population was coherent
with the fierce love of freedom of pre-Indo-European tribes. He believes that the extraordinary
respect for women in those families meant that children raised in such atmospheres tended to
distrust strong, authoritarian leaders. According to del Giorgio, European democracies have their
roots in those ancient ancestors.

Family Values

Family Values, it can be described as a set of beliefs or morals that help provide for
family unity and social interaction as well as providing for a societal view for childhood
development. These beliefs have encompassed such topics as the roles of marriage, divorce,
childbearing, gender roles, and sexual activity and have shaped not only the family's interaction
with society, but also legislative policy.

What exactly makes up a strong family that possesses good family values? A family that
sustains its members — that supports and nourishes the members throughout the span of that
family. A strong family unit creates a safe, positive and supportive place for all members to
thrive. They are able to utilize resources and to live together in a fairly healthy manner.

The adults in a strong family set the tone. They are good role models that lead by
example. They reach out to friends and community and teach their children the importance of
doing the same -- and that becomes part of who the children are. They work together to solve
problems, and they pass their skills on to the next generation. Some important elements of a
strong family system are family cohesion, family flexibility and family communication.

Cohesion- In families cohesion would be defined as the feeling of being loved, of belonging to
the group and being nurtured by it. Although closeness is good in a family unit, there must be a
balance between being together and being separate. A person must be able to develop their
individuality, while being supported and confident within the family. A few things that bring a
family together are the commitment of other family members, and the spending of time together.

Flexibility- There must be a structure in a family or it will become chaotic and will not be a
peaceful setting for a family. Conversely, there must be flexibility or the family becomes rigid
and the authority figures become resented. We could compare a successful family to a
democracy. There are leaders, but the whole group is involved in the decision making process.
Although the leaders are in charge all members develop the ability to cope with stress, and at
times lead. While the family works to avoid stressful situations they work together to solve
problems, without blaming, criticizing and finding fault with each other. Families that tend to
have a strong spiritual base seem to have a sense of well-being that facilitates this working
together in times of stress.

Communication- Ever hear the saying, “What we have here is a failure to communicate?” A
lack of communication can rip a family apart and destroy them. Things that facilitate
communication are the things mentioned so far -- family closeness, flexibility, time spent
together, spirituality. All members must feel a freedom within the group to express themselves
freely.

Another very important factor is the relationship between the “head” couple. In a family
that is parented by a happily married couple, people are able to express themselves more freely.
What they might say isn’t filtered through the problems of the “guardians.” A happy marriage
seems to set the tone in the house. It spills over from the family to the community and a healthy
family will be reaching out to help others. They do not tend to isolate themselves from the rest of
the world.

A very important thing for families to teach their children is how to make good decisions.
If they have watched their parents making well thought out decisions over the years, they will
tend to be good decision makers themselves.

A healthy, happy family benefits our whole society. Among the children of strong
families their is less crime, less divorce and less emotional problems. They tend to go on and
have strong, healthy families of their own, having learned from their folk’s example.
Family Coping

• Continual demands force families to adapt in order to survive

• Without effective family coping processes, affective, social, economic & health care
functions cannot be achieved.

• Nurses can assist families to adapt.

• Goal: to strengthen & encourage adaptive responses & reduce stressors on family.

• An active process where the family utilizes existing family resources and develops new
behaviors and resources to strengthen the family unit and reduce the impact of stressful
life events. (McCubbin, 1979).

• A family crisis results when current resource and adaptive strategies are not effective in
handling the stressors.

Family adaptation

• Involves restructuring of family patterns of functioning.

• “the process in which families engage in direct responses to the extensive demands of a
stressor, and realize that systemic changes are needed within the family unit, to restore
functional stability and improve family satisfaction and wellbeing” McCubbin &
McCubbin (1993, p.57).

Stressors & Their Impact

• Most widely used tool to assess life changes in families is Family Inventory of Life
Events & Changes (FILE).

Families with higher scores have been found to have lower family functioning and poorer
health (McCubbin & Patterson, 1991).
 • Five most stressful life events are:

(1) a child member dies

(2) parent or spouse dies

(3) spouse/parent separated or divorced

(4) physical or sexual abuse in the home

(5) member becomes physically disabled or chronically

Family Coping Strategies

• Are stressor specific (e.g. cognitive strategy of “accepting the situation” may be helpful
to those who have lost a job, but not to couples coping with infertility).
• Most harmful coping behaviors: suppressing emotions; taking out feelings on others; not
sharing extent of stressor with others; denying, avoiding, or running away from problems.

• Internal Strategies (from within the family)

(1) Relationship

(2) Cognitive

(3) Communication

• External Strategies (outside supports & resources)

(1) Community links

(2) Social Support systems

(3) Spiritual

Internal Strategies

1. Relationship Strategies

Family Group Reliance (cohesiveness)

• Some families cope by becoming more reliant on their own resources
• “Pulling together to weather the storm”

• Establishment of greater structure (more rigid routines) to increase control in their lives

• Closing of family boundaries

Greater Sharing Together

• Sharing of feelings and thoughts

• Strengthening of family cohesion

• Very high cohesion = enmeshed

• Very low cohesion= disengaged

• Level of cohesion influenced by culture

• Family rituals helpful (e.g. shiva)

Role Flexibility

• Ability of mates to change or share roles when needed is important

• Flexible roles associated with better functioning

2. Cognitive Strategies

Normalizing

• Acknowledging a chronic condition, but defining family life as normal

• View the social effects of having a member with a chronic condition as `minimal’

• Families who coped this way do better than those with focus on sick member

Reframing & Passive Appraisal

• Positive outlook & maintaining hope key to resiliency

• Influenced by family beliefs
• Beliefs shape how families experience and interpret their environment

• Religious beliefs play important role

• Passive acceptance of situation helpful to some families, especially where situation

inevitable.

Joint Problem Solving

• Family able to discuss a problem, seek logical solutions, & reach consensus on what to
do
• Collaborative problem-solving approach

Gaining Information & Knowledge

• Increases sense of control and fear of unknown

• Provision of information a major nursing intervention

• Assisting family to use Internet effectively to gain accurate information important

nursing role

Being Open & Honest

• Good communication vital during periods of stress or crisis

• Communication must be direct, clear, open, & honest

3. Communication Strategies

Use of Humor

• Humor & laughter invaluable in coping & can bolster immune system
 External Family Coping Strategies

1. Maintaining Active Links with Community

• Continuing long-term associations with clubs, organizations & community groups

2. Social Support Strategies

• In addition to extended family & network of health care professionals, there are
neighbors, employers, classmates, teachers, & cultural or recreational groups as potential
supports
• Many people don’t seek needed external supports for variety of reasons

3. Spiritual Strategies

• Spiritual or religious beliefs often at core of a family’s ability to cope

Dysfunctional Coping Strategies

• Can temporarily reduce stress, but do not solve the problem and have long-term
deleterious effects.

(1) Denial of Family Problems

(2) Family Dissolution & Addictions

(3) Family Violence

(1) Denial of Family Problems

• Scapegoating reduces tension in family at expense of one member

• Scapegoat becomes focus of family’s problems, hiding the real problem but results in
state of equilibrium

• Scapegoat begins to take on the assigned role & internalizes it

 • Triangulation – used to reduce tension in a dyad by focusing on a third member

• Emotional distancing – creation of a façade of cohesiveness; affective communications

very limited

• Extreme authoritarianism /submissiveness to achieve family equilibrium

(2) Family Dissolution & Addictions

(3) Family Violence /abuse

Family Communication Patterns

Communication patterns in families refer to repeated interaction styles and behaviors. A

single family member's communication behaviors over time can be patterned, but family
communication scholars tend to focus on patterns among family members. Family relationships
are typically involuntary and long-lasting (Vangelisti 1993). One usually cannot choose one's
siblings, for instance, and sibling relationships – even strained ones – commonly endure for most
of one's lifetime. The involuntary and lengthy nature of family relations provides myriad
opportunities for various communication patterns to emerge.The meaning of any particular
interaction between family members is informed by previously established communication
patterns, sometimes even patterns involving previous generations (Vangelisti 1993). Such family
communication patterns are so central to family life that some scholars state that the very nature
of family relationships is constituted by the ongoing pattern of exchanges (Rogers & Escudero
2004).Although there is widespread agreement that patterns are important in families, the notion
of a pattern can have many different meanings. One reason that conceptualizations of patterns
vary is that patterns develop over different temporal periods

The family communication environment teaches the child how to approach the world. For
example, a family where open communication is stressed and ideas are readily shared may
convey to the child that his/her ideas are valuable and should normally be shared with others,
even with those outside of the family. In turn, that child may perceive others views as potentially
valuable. A family where hierarchy is stressed and parents make most of the decisions may
convey to the child that authority figures make rules which ultimately must be followed. The
child may then value the interpretations and ideas of other authority figures. The two dimensions
described reflect those measured by the Family Communication Patterns Inventory (McLeod &
Chaffee, 1972).

Instrumental and Affective Communication

Communication can be divided into two different areas: instrumental and affective.
Instrumental communication is the exchange of factual information that enables individuals to
fulfill common family functions (e.g., telling a child that he/she will be picked up from school at
a specific time and location). Affective communication is the way individual family members
share their emotions with one another (e.g., sadness, anger, joy).

Some families function extremely well with instrumental communication, yet have great
difficulty with affective communication. Healthy families are able to communicate well in both
areas.

Affective communication refers to how individual family members share their emotions
with one another.

Clear vs. Masked and Direct vs. Indirect Communication

Communication can be clear or masked and direct or indirect (Epstein, Bishop, Ryan,
Miller, & Keitner, 1993). Clear communication occurs when messages are spoken plainly and
the content is easily understood by other family members. Masked communication occurs when
the message is muddied or vague.

Communication is direct if the person spoken to is the person for whom the message is
intended. In contrast, communication is indirect if the message is not directed to the person for
whom it is intended.
 Four Styles of Communication

Epstein et al. (1993) have identified the following four styles of communication.

1. Clear and Direct Communication

Clear and direct communication is the most healthy form of communication and occurs when
the message is stated plainly and directly to the appropriate family member. An example of
this style of communication is when a father, disappointed about his son failing to complete
his chore, states, "Son, I'm disappointed that you forgot to take out the trash today without
my having to remind you."

2. Clear and Indirect Communication

In this second style of communication, the message is clear, but it is not directed to the
person for whom it is intended. Using the previous example, the father might say, "It's
disappointing when people forget to complete their chores." In this message the son may not
know that his father is referring to him.

3. Masked and Direct Communication

Masked and direct communication occurs when the content of the message is unclear, but
directed to the appropriate family member. The father in our example may say something
like, "Son, people just don't work as hard as they used to."

4. Masked and Indirect Communication

Masked and indirect communication occurs when both the message and intended recipient
are unclear. In unhealthy family relationships, communication tends to be very masked and
indirect. An example of this type of communication might be the father stating, "The youth of
today are very lazy."
Keys to Building Effective Family Communication

There are many things that families can do to become more effective communicators and in turn
to improve the quality of their relationships. Families can improve their communication skills by
following some suggestions for building effective family communication.
← Communicate Frequently

One of the most difficult challenges facing families today is finding time to spend
together. According to a recent Wall Street Journal survey, 40% of the respondents stated
that lack of time was a greater problem for them than lack of money (Graham & Crossan,
1996).

With our busy schedules, it is difficult to find sufficient time to spend with one another in
meaningful conversation. It is extremely important for families to make time to
communicate. Talk in the car; turn the TV off and eat dinner together; schedule informal
or formal family meetings to talk about important issues that affect your family; and talk
to your children at bedtime. There are many creative ways to make time to communicate
with other family members.

← Communicate Clearly and Directly

Healthy families communicate their thoughts and feelings in a clear and direct manner.
This is especially important when attempting to resolve problems that arise between
family members (e.g., spouse, parent-child). Indirect and vague communication will not
only fail to resolve problems, but will also contribute to a lack of intimacy and emotional
bonding between family members.

← Be An Active Listener

An essential aspect of effective communication is listening to what others are saying.

Being an active listener involves trying your best to understand the point of view of the
other person. Whether you are listening to a spouse or a child, it is important to pay close
attention to their verbal and non-verbal messages. As an active listener, you must
 acknowledge and respect the other person's perspective. For example, when listening to a
spouse or child, you should nod your head or say, "I understand," which conveys to the
other person that you care about what he or she has to say. Another aspect of active
listening is seeking clarification if you do not understand the other family member. This
can be done by simply asking, "What did you mean when you said..?" or "Did I
understand you correctly?"

Active listening involves acknowledging and respecting the other person's point of view.

← In order for effective communication to take place within families, individual family
members must be open and honest with one another. This openness and honesty will set
the stage for trusting relationships. Without trust, families cannot build strong
relationships. Parents, especially, are responsible for providing a safe environment that
allows family members to openly express their thoughts and feelings.
← Think About the Person With Whom You Are Communicating

Not all family members communicate in the same manner or at the same level. This is
especially true of young children. When communicating with young children, it is
important for adults to listen carefully to what the children are saying without making
unwarranted assumptions. It is also important to take into consideration the ages and
maturity levels of children. Parents cannot communicate with children in the same way
that they communicate with their spouse because the child may not be old enough to
understand.

← Pay Attention to Non-Verbal Messages

In addition to carefully listening to what is being said, effective communicators also pay
close attention to the non-verbal behaviors of other family members. For example, a
spouse or child may say something verbally, but their facial expressions or body language
may be telling you something completely different. In cases such as these, it is important
to find out how the person is really feeling.

← Be Positive
 While it is often necessary to address problems between family members, or to deal with
negative situations, effective communication is primarily positive. Marital and family
researchers have discovered that unhappy family relationships are often the result of
negative communication patterns (e.g., criticism, contempt, defensiveness). In fact, John
Gottman and his colleagues have found that satisfied married couples had five positive
interactions to everyone negative interaction (Gottman, 1994). Couples who are very
dissatisfied with their relationships typically engage in more negative interactions than
positive. It is very important for family members to verbally compliment and encourage
one another.

VITAL FAMILY FUNCTIONS

"Procreation is a function of the family, and, in a healthy, Biblically oriented and

governed family system, this function is preceded by an important fact that conditions
birth. The parents marry because there is a bond of faith and love between them, a
resolution to maintain for life a covenant under God. As a result, a heredity of faith and a
unity in terms of it is established as a prior condition of birth, so that a child born into
such a family has an inheritance that cannot be duplicated. The Biblical family cannot be
rivaled by man’s science or imagination as the institution for the procreation and rearing
of children.

"The family is man’s first and basic school…

"The family is also the first government in the life of the child, with the father as the
God-ordained head of the household and his government under God as the child’s basic
government…

"A basic function of the family is motivation and guidance. The child is provided with
the best kind of guidance, because the family is most interested in him, and the child is, in
the Christian family, given the highest kind of motivation for his own future and present
 development…

"The family also has a major economic function. The father provides for his family, not
for strangers….The family as an economic unit has an excellent division of labor plan,
whereby certain duties are required of the father, others of the mother, and still others of
the children. There are mutual rights and duties, all of which are discharged with a
greater degree of success and efficiency, despite all the problems, than in any other
institution. The family, moreover, can withstand and survive more shock than any other
institution – economic disasters, personal disagreements, social catastrophes, and the
like…

THEORETICAL APPROACHES IN FAMILY NURSING

FAMILY THERAPY

There are many different theoretical approaches to family therapy, and many diverse
groupings of people that might make up a family therapy session. A couple without children
might easily enter couples counseling or family therapy in order to learn how to cope with their
differences and deal with communication problems, or many other reasons. Such therapy could
also occur with adult siblings and parents, foster children and foster parents, or family units of
several generations. Therapists in such a setting may work with the various members of the
family all together in session, and sometimes work with one or two individuals for a session or
two.

Although you can find different types of approaches to this form of therapy, one focus is
observing how people with family ties relate to each other, and what these interactions say about
the health of these relationships. Focus may rest on teaching family members to understand
behaviors that tend to hurt relationships, and sometimes on specifically teaching skills like active
listening that may help heal communications between family members.
 Therapists may address individual members of the family if they appear to be suffering
from severe mental health issues that without treatment continue to threaten the potential for
good relationships within the family system. Thus a person in a family with alcoholism or
untreated major depression might be referred to another therapist who could give that person
more individual time to cope with and overcome these conditions. Typically, the therapist
providing family therapy is not focused on one member of the family. He or she is focused on
the whole family, and must not give the appearance of favoring one person over the rest of the
family members. This can be a hard balance to strike, but a necessary one so that each person in
the family feels supported in the therapeutic setting.

Family therapy is offered by licensed therapists, like licensed clinical social workers
(LCSWs), marriage and family therapists (MFTs, formerly classed as MFCCs) and
psychologists. Unlike individual psychotherapy, which might continue for a number of years,
there is often an endpoint and goals in sight for each family. Sessions required to help learn skills
to improve family dynamics can range anywhere from five to twenty over the course of several
months. Once goals have been reached, family members may exit therapy, decide to pursue
additional goals, or may take a break and re-enter therapy at a later point if the family again
seems to need assistance.

Structural Functional Perspective

 Meeting psychological needs

 Socializing children

 Producing new members

 Coping, maintaining order & stability

 Providing & allocating resources

 Providing food clothing, & shelter

System Model

 Complex of elements in mutual interaction

  Part of larger suprasystem & composed of many subsystems

 Whole is the sum of its parts

 Change in one member affects all members

 Able to create a balance between change & stability

Developmental Theory

 Accounts for change over time

 Families are long lived groups

 May have a middle class bias