Health Care and Concept of Family
Family Theory and Research
Family
refers to any group whose members are related to one another through marriage,
birth, or adoption. E. Burgess’s (1926) description of a family as a unit of
interacting personalities is still relevant to how families are viewed today.
Because of the variety of family forms, theorists and researchers should
provide their own definitions of family.
Health Care Family
Nursing
has long been interested in families as the context for individual members and
has focused more recently on the family as a whole. Families have been a
component of studies of psychiatric illness, caregiving, violence, adaptation
to chronic illness in both children and adults, and cardiac conditions and
other acute illnesses.
Family transitions, including grieving, transition to
parenthood for adolescent mothers and married couples, and adaptation to
divorce, remarriage, and stepfamilies, have also been studied. Nurses have
published reports in major family journals as well as in nursing research and
specialty journals and the new Journal of Family Nursing.
Category or Types of Theories
Scholars
from various disciplines have studied families, using diverse approaches.
Theories presented here (except for stress theory) are based on descriptions
provided by Klein and White (1996).
The
central focus in exchange theory is on the individual and what motivates his or
her actions. Individuals are viewed as rational and self-interested, seeking to
maximize rewards and avoid costs.
Individuals compare their own situation to
others in the same circumstances and to others in different circumstances. In
exchange theory the family is viewed as a collection of individuals. The family
group is considered to be a source of rewards and costs for individual members.
Exchange theory could be used by nurse researchers to investigate the processes
of family negotiation and problem solving.
Like Exchange Theory and Conflict Theory Assumes
Like
exchange theory, conflict theory assumes that individuals are motivated by
self-interest. Individuals compete for scarce resources, which include
knowledge, skills, techniques, and materials. Resources provide a potential
base for the exercise of power.
Conflict within the family is seen as the
result of inequality of resources among individuals. Because conflict is both
endemic and inevitable, a primary focus in the study of families is how they
manage conflict.
Concepts
of symbolic interactionism include interaction patterns, meanings and
definitions, symbols, sense of self, and role expectations. Socialization is
the process by which individuals acquire the symbols, beliefs, and attitudes of
their culture.
Individuals construct a sense of self and meanings for events
and things through interactions with other people and with the environment.
Role involves each person’s adjusting behavior to what he or she thinks the
other person is going to do. Children and adults have particularly significant
interactions in the context of the family.
Likewise, roles that develop within
the family are a crucial component of the individual’s self-image.
Concept of Family in General
The
family as a whole is the focus of family systems theory. All parts of the system
are interconnected, and therefore, changes in one part of the system influence
all other parts of the system. Subsystems are smaller units of the system, such
as individuals and dyads.
Boundaries define who participates in the family and
who participates in each subsystem. Boundaries exist between family members,
between subsystems, and between the family system and the external environment.
The degree of permeability of boundaries (open or closed) refers to the extent
of impediments to the flow of information and energy.
A homeostatic system
dynamically maintains equilibrium by feedback and control.The
central concept in the ecological approach is adaptation. The child always
develops in the context of family-type relationships, and that development is
the outcome of the interaction of the person’s genetic environment with the
immediate family and eventually with components of the environment.
The
individual is embedded in four nested systems. The microsystem is the immediate
setting in which the person fulfills his or her roles, such as family, school,
or place of employment. The mesosystem refers to the interrelations between two
or more settings in which the developing person actively participates.
The
ecosystem consists of external settings that do not include the person as an
active participant but instead include systems (such as the legal system) that
affect the person’s immediate settings. Macrosystem refers to culture. Bishop
and Ingersoll (1989) used the ecological framework in their research on the
effects of marital conflict and family structure on self-concepts of children.
Family Development Theory
Family
development theory focuses on systematic changes experienced by families as
they move through stages of their life course. Family stage is an interval of
time in which the structure and interactions of role relationships in the
family are noticeably distinct from other periods of time.
Shifts from one
family stage to another are called transitions. Family development theory
emphasizes the dimensions of time and change. Using family development theory,
Mercer, Ferketich, De-Joseph, May, and Sollid (1988) investigated the effect of
stress on family functioning during pregnancy.
Double ABCX Model
The
double ABCX model is an extension of R. Hill’s (1958) original ABCX family
stress model, in which A refers to the stressor event and related hardships, B
refers to resources, and C to perception of A (McCubbin & Paterson, 1983).
The crisis, X (the amount of disruptiveness or disorganization), emerges from
the interaction of the event, resources, and perception of the event.
The
family’s accumulation of life events and added stressors over time (Aa, pileup
of demands) influences family adaptation both directly and indirectly through
Bb (adaptive resources) and Cc, which is the perception of X, Aa, and Bb. J.
Austin’s (1996) study of family adaptation to childhood epilepsy is based on a
modification of the double ABCX model.
Research
on families typically is an effort to test theoretical propositions or to
develop theory. Although family research reflects different theoretical
orientations, a common concern is the most appropriate unit of analysis. Is the
concept of interest a property of the individual, dyad, or the family as a
whole?
For example, can families as a whole or only individual members perceive?
Another recurring issue in family research is how to construct family variables
if discrepant reports are provided by different members of the same family.
As
family scholars address these problems, they can better explain the
complexities of family life and ultimately provide guidance for intervention.