Family structural theory
The Form and Function of the Family
Introduction
The family has an important place in the health promotion paradigm. The roles family members play in providing care to a loved one are crucial to the health and well being of the family system. In order to adequately assist families in achieving health, it is important for the nurse to assess the family as a whole as well as its individual members.
Family Evaluation
When providing care, nurses evaluate families within three domains. First, families are viewed in relation to caring for the individual, with the family as a support system for the person needing care. The perspectives and information provided by the family is important in clinical decision making. Ejaz, Straker, Fox, and Swami (2003) posited that assessing family members’ views on the quality of care provided gives a human face to care, which complements research obtained by statistical measures. Secondly, the family is considered the client, and care is aimed at all members collectively. Lastly, the family is viewed as a system within the community.
Family Function
Family members are the first influence on a person’s view of health. What people are familiar with seeing and experiencing at home is, typically, what they will continue to carry out on their own. Families function as support systems for one another; they assist with providing basic human needs and help younger members learn to socialize with one another and with the world around them. Therefore, families define both acceptable and unacceptable values and behavior.
Family Structural Theory
Salvador Minuchin designed family structural theory through his work with families in crisis. The basis for his theory is that a family is an open social and cultural system that reacts and adapts to the demands placed on it through what is known as transactional patterns of behavior. These transactional patterns define how family members interact and create patterns that demonstrate when, how, and with whom they relate (Vetere, 2001).
Many of the concepts of this theory are familiar and include family rules and roles, family organization, stabilization, boundaries, subsystems, and change. The nurse uses this theory to assess the family in the here and now. Furthermore, this information assists the nurse in planning for family health promotion education and/or behavior changes needed (Vetere, 2001).
Family Developmental Theory
Nursing practice has a foundation of using developmental theory to assist patients through every stage of life. Duvall built upon the theoretical framework of Erikson in his eight stages of psychosocial development. Duvall also created eight stages in her family development theory. Stage one begins with the family as a married couple with no children. Stage two includes childbearing families with children up to 30 months of age. Stage three represents families with preschool children. Stage four is made up of those with school-aged children, 6 through 13 years old. Families with teenagers are at stage five, and those families assisting their young adults out into the world are at stage six. Stage seven is empty nest couples, and stage eight represents old age, from retirement to death (University of North Texas, n.d.).
In addition, Duvall’s theory utilizes a set of eight tasks that families move through in each stage (University of North Texas, n.d.). The successful completion of the task depends on building upon the previous developmental stage. Adaptation and new responsibilities come with each developmental stage and the tasks associated with it. The nurse uses this theory to analyze the family’s progress to anticipate opportunity for health promotion and intervention.
Systems Theory
With systems theory, the family is viewed as a whole unit through which the action of each member influences the others. Within this theory, it is assumed that the family unit is greater than the sum of its members. Nurses familiar with systems theory view the individual client as a functioning and contributing member of a larger family system whereby each member influences the other. Essentially, the nurse must focus attention of the family as a whole instead of only the individual. When there is a change in health status of any individual person, the entire family must adapt.
Gordon’s Functional Health Patterns
Gordon’s functional health patterns are founded on 11 principles that are incorporated within the nursing process. They serve as a framework for clinical assessment and can be applied to the individual, family, and community. Through this framework, data is collected and assessed, allowing for the application of nursing diagnoses and interventions that encompass a holistic view of the client. There are 11 patterns, and within each pattern there are four focal areas.
When used together, the 11 functional health patterns can formulate the basis for a comprehensive nursing assessment and allow for identification of actual or potential health concerns. These functional health patterns will promote holistic nursing care through the evaluation of many physical, social, environmental, and spiritual domains. In order to facilitate effective nursing interventions, it is necessary for the nurse to implement critical thinking skills. This allows for the adequate and accurate assessment of clients based on the data and cues provided by the client.
Provided below is a listing of Gordon’s (1994) functional health patterns (FHPs).

Pattern of Health Perception and Health Management
Nutritional − Metabolic Pattern
Pattern of Elimination
Pattern of Activity and Exercise
Cognitive − Perceptual Pattern
Pattern of Sleep and Rest
Pattern of Self Perception and Self Concept
Role − Relationship Pattern
Sexuality − Reproductive Pattern
Pattern of Coping and Stress Tolerance
Pattern of Values and Beliefs

Conclusion
Whether caring for individuals or for entire families, nurses must be cognizant of developmental and system theories that apply to family units. Having an understanding of the family as an integrated, living system provides the nurse with the tools needed to promote healthy living. In addition, recognizing the vital role that families play in ensuring the health and well being of children and family members of all developmental ages poises the nurse to promote a healthy community.
References
Ejaz, F., Straker, J., & Swami, S. (2003). Developing a satisfaction survey for families of Ohio’s nursing home residents. The Gerontologists, 43(4), 447-458.
Gordon, M. (1994). Nursing diagnosis: Process and application(3rd ed.). St. Louis: Mosby.
University of North Texas. (n.d.). Center for parent education. Retrieved November 30, 2007, from http://www.unt.edu/cpe/module2/thrybase.htm
Vetere, A. (2001). Structural family therapy. Child Psychology and Psychiatry Review, 6(3), 133-139.