The Form and Function of the Family
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.
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 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
Calgary Family Assessment Model
Lorraine Wright and Maureen Leahey (1994) developed a model for nurses to assess families
within three specific aspects: structure, function and development. Internal and external forces
affect the structure of the family. The nurse needs to gather enough information to get a more
complete picture of these forces. Function of the family would include communication styles
and how members interact with each other. Societal influence and life changes complete the
developmental picture of the family. Nurses can assess these aspects through conversing with
the patient and observing interactions among the family members.
Calgary Family Intervention Model
Wright and Leahey (1994) also developed the Calgary family intervention model to provide a
basis for the nurse to assess interventions for the family based on strengths and resiliency.
Previous interventions by the nurse tended to focus on dysfunction and shortcomings of the
patient and the family. A more positive connotation can be the focus when strengths are
emphasized and resiliency patterns are utilized. The nurse can assist the family in prioritizing
these specific aspects that help in dealing with illness.
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.
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
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.
Ejaz, F., Straker, J., & Swami, S. (2003). Developing a satisfaction survey for families of Ohio's
nursing home residents. The Gerontologists, 43, 447-458.
Gordon, M. (1994). Nursing diagnosis: Process and application (3rd ed.). St. Louis, MO: Mosby.
University of North Texas. (n.d.). Center for parent education. Retrieved from
Vetere, A. (2001). Structural family therapy. Child Psychology and Psychiatry Review, 6(3), 133139.
Wright, L. M., & Leahey, M. (1994). Calgary family intervention model: One way to think about
change. Journal of Marital and Family Therapy, 20, 381. Retrieved from
Wright, L. M., Leahey, M. (2012). Nurses and families: A guide to family assessment and
intervention (6th ed.). F. A. Davis Company, Philadelphia, PA.
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