The family has been an important social institution in all cultures, responsible for socializing children with the behaviors, knowledge, and skills they will need to get along in the world. Prior to the Industrial Revolution in the late eighteenth century, families formed into small related groups to meet basic needs, a process known as collectivism. After the Industrial Revolution, people moved away from their extended families into the cities to seek work. Socialization became a responsibility of institutions outside the family. Individualism became more important than collectivism in contemporary society, yet family-based care remains important. The purposes of the family are to socialize children and to serve the needs of individual family members.

Theoretical models for working with families include structural-functional, family stress, family development, and family systems theory. According to Structural-Functional Theory, families meet the needs of individual members by assigning roles and responsibilities to each family member. The family process is the way a family is organized to address functional needs. Family structure is the base for assessment, including family form (traditional or nontraditional), the extended family (the previous generation), and the nuclear family (who belongs in the family).

The family form varies. A nuclear dyad is defined as a married heterosexual couple without children, either by choice or situation. Blended families are nontraditional forms in which children live with one birth parent and one stepparent. Other nontraditional family forms are single adults living alone, single adults living communally, cohabitating heterosexual couples, and cohabitating homosexual couples. A useful way to assess the family’s structure is the genogram, a graphic representation of the family form. No matter the family form, families have several functions: affection, socialization, conjugal/reproductive, family coping, economic, basic needs, and health promotion.

Each family also has a family role structure, in which formal and informal roles (provider, housekeeper, childcare provider, socializer, sexual partner, therapist, recreation organizer, and kinship member) are assigned. Role competence requires individual understanding of the role. Roles are often defined by gender. Role conflict occurs when the expectations for one role are incompatible with those of another role. Role overload is a form of role stress/strain that occurs when a family member lacks the time, resources, or energy to perform a role. Role transition is the process of changing role assignment for developmental, situational, or illness-related reasons, a potential stressor for any family. Situational role transitions are changes that are made in roles when families experience the addition or loss of a family member, or during a family member’s illness.

The value system learned during the socialization process influences the family’s functioning. Strong family values promote health but incongruence in values between the family and the surrounding community can lead to family conflict. Values affect access to health care and cooperation with health care providers.

The power structure of the family is also important. Power is the ability to control, influence or change another person’s behavior. Chaotic family power is the absence of a power structure within a family, resulting in poorly delineated leadership and values and unpredictable socialization of children. Symmetrical (egalitarian) family power is power shared between family members, which promotes the independence and competence of children but should nevertheless be guided by an adult. Complementary family power is power in which a clear adult leader is present. When the leader is coercive or abusive to other members of the family, domestic violence intervention may result.

Health behaviors and decisions arise out of the family. The three forms of health decision making within families are bargaining, coercion, and de facto. A healthy family protects and supports its members in stressful situations, facilitating health. Family development theory states that families move linearly and predictably through developmental stages, the family life cycle, and meeting certain stresses that affect health during developmental transitions. The usefulness of this theory is questioned in nontraditional families.

Family systems theory defines the family system as a goal-directed unit, made up of interacting parts, distinct from the surrounding environment, and requiring input from the surrounding environment for stability. The family system is holistic, in other words, greater than the sum of its parts.

Social support is the provision for people in one’s social network, thereby buffering the client against life stressors. A social network includes all the people and agencies that provide emotional or substantive help for a family. Social isolation is a deficit in integration with the rest of the family or community. Social support can be perceived or actual. Social support is affected when there is negative support (individuals in a social network are conflicted) and mental health issues have affected relationships within a social network. Socioeconomic status also affects the level and quality of social support.

Nursing interventions to enhance social support include client and family education, involving the client and family in the multidisciplinary plan of care, suggesting supportive behaviors, and assisting family members in identifying resources.