Roles, Relationships, and Social Support Chapter 44

Roles, Relationships, and Social Support

Chapter 44

44-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Historical Trends of the Family as a Social Institution

The family has been recognized as a social institution that exists in some form in all cultures and societies.



The Family In Agrarian Time• Members of small groups worked together

and roles were clearly defined.• Genetic linkage was the inevitable outcome,

laying the foundation for the development of modern conjugal families.

• Family groups collected into small towns, increasing the complexity of society and social relationships.



The Family In Agrarian Time• Dependence on the family and related small

groups for basic needs led to the development of collectivism.

• Collectivism was characterized by shared values and norms of behavior.



Post-Industrial Revolution• People moved away from their extended

families on farms and in small towns to factory jobs in the cities.

• Over time, socialization of children was increasingly delegated to institutions outside of the family.

• Individual values began to gain favor over those of the original family unit.



Individualism• The predominate cultural type in the United

States and many other industrialized countries

• Formation of nuclear families in urban settings



The Purposes of Family• A social institution to socialize children.• A family serves the needs of the individual

family members.


Structural-Functional Theory

The family functions to serve the needs of its members.

Individual behavior is based on norms and values learned within the family.



Family Function• Affective function• Socialization• Conjugal/reproductive function• Family coping function• Economic function• Basic needs function• Health promotion function



Family Structure• Multi-generational extended family• Nuclear family• Blended families• Single adults living alone• Single adults living communally• Cohabiting heterosexual couples• Cohabiting homosexual couples



Family Structure• The genogram is a graphic representation of

the family form.


Genogram


Family Role Structure

Formal Roles Informal Roles



Formal Roles for Family• Contemporary families assign roles in a

variety of ways.• Societal sanctions exist when adult family

members fail to ensure a minimal degree of family functioning.



Position in the Family• Socioculturally constructed• Share social expectations for role

performance• In nontraditional families, dysfunction in the

family process can occur and is related to unclear consensus about assigning responsibilities.



Role of Children in Family• Limited by developmental stage, societal

sanction, and law• In most developed nations, law prohibits

children from entering the work force outside of family enterprises.

• In developing countries, children may be assigned into servitude or sent out to pedal food or wares.



Performance of Roles in Family• Role competency requires individuals to

understand their roles.• Role performance depends on established

norms for how roles should be enacted.



Performance of Roles in Family• Gender


Performance of Roles in Family

Role Disorders• Role Stress• Role Strain• Role Conflict• Role Overload



Role Transition• Situational role transitions are changes that

are made in role when families experience the addition or loss of a family member.

• Role transition related to illness can be temporary or long term, requiring flexibility, or changes in role assignment and role expectations.


Values and Their Effect on Family Function

A family’s functioning is strongly influenced by the values system learned during the socialization process.

Value incongruence with the surrounding community can lead to conflict within the family.


Communication Patterns in the Family

Native language patterns are related to the primary language learned and spoken as a child.

Clear and open communication among family members is a strong determinant of how the family performs in any of its functions.


Communication Patterns in the Family

Culturally sanctioned communication prepares children to communicate with elders and to live in a civilized society.


Power Structure

Power is the ability to control, influence, or change another person’s behavior.

Power is related to resources. In most families, parents and other

competent adults control the resources.


Power Structure

Family Power• Chaotic power• Symmetrical power• Complementary power


Decision Making about Health Behaviors

Often decided within the power structure of the family.

Many health decisions are made by the family prior to accessing the health care system.


Decision Making about Health Behaviors

Bargaining Coercion De-facto


Theories that Explain Family Processes

Family Development Theory• Human families move linearly and

predictably through developmental stages in time.

• Developmental transitions are characterized by stress that must be managed.


Theories that Explain Family Processes

Family Systems Theory• Based on a very broad and abstract theory

known as General Systems Theory.- Systems are made up of interacting parts.- Systems are holistic and greater than the sum of

its parts.


Family-Based Social Support

Concept of Social Support Social Isolation Social Support from Others Conflict and Negative Social Support


Mental Health and Family-Based Social Support

Mental illness is a common response to overwhelming stressors related to major family transitions and health problems.

Management of the client’s mental health and that of the family requires a multidisciplinary approach.


Socioeconomic Status (SES) and Social Support

Social class is associated with inequities in accessing resources and power.

The health status and longevity of socially and culturally marginalized groups is less optimal than it is for members of more privileged classes.


Social Support and the Nursing Process

Assessment• Family structure• Patterns of communication• Power base• Family’s perception of family health• Evidence of family cohesiveness, including

emotional and instrumental social support


Nursing Diagnoses

Ineffective Family Coping: compromised/disabling/risk for

Altered Family Processes


Outcome Identification and Planning

Role expectations will be renegotiated. Open communication between family

members will be enhanced. Multidisciplinary sources of social support

will be identified and accessed.


Implementation

Provide information to the client and family regarding alteration in health state.

Encourage family members to verbalize their concerns.

Suggest supportive behaviors for family members.


Implementation

Assist family members in identifying social network resources.

Assist in role performance and support.


Evaluation

Affirmation by client of increased self-esteem, self-efficacy, and lessened symptomatology from the client.

Family members report adequate rest and nutrition.

Family is receiving assistance from a broader network of resources.


Evaluation

Observation by the nurse of beginning coping skills and calmer emotions.

There is evidence of improved communication between family members.

Family members display affective functioning in the form of nurturing interactions.

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Roles, Relationships, and Social Support Chapter 44