Role changes during illness and hospitalization

In a periode of crisis, such as that by the serious illness of a family member,

the family structure is modified, the extent of modification depending on what degree
the sick member is able to carry out his or her usual family roles and the centrality of
the family roles or tasks that are vacated. The roles taken on by the mother are, as
discussed previously, a good example of the centrality of a members roles, the
family often enters a state of disequilibrium in which role and power relationships are
altered until new homeostatis is a achieved (Fife, 1985; Hill, 1958).
Shared, balanced role functions often become impossible to maintain in
couples when one partner become disabled. Negotiation of revised roles is often
needed to prevent role strain and confusion (Rolland, 1994). In a study of the effects
of a critical care illness on family members reported changes in family roles and
increased responsibilities as the result of critical care hospitalization.
There are two basic types of role changes that occur due to the loss or
incapacitation of a family member. First, the remaining family members have enough
inner and outer resources that they are able to take on the basic and necessary role
obligations and tasks that the sick family member is unable to assumethis is the
functional way the situation is managed. Second, they lack the needed inner and
outer resources, and as a consequence, certain basic and necessary roles in the
family are not performed or are performed unsatisfactorily. In other words, the
adequatelyfunctioning family can either flexibly modify family roles to meet the
demands of the situation or may call in resources and assistence from the outside to
fill the vacuum. In dysfunctional families, however, this does not happen.
Because of the role changes necessitated due to the loss or incapacitation of
a family member, role conflicts and role strain are often present, especially during the
stage of family disequilibrium immediately following the loss or incapacitation, when
family structure is in the transitional period. Either interrole or intrarole conflicts may
exist, as the family members are forced to accept new roles and have had little
opportunity to learn these roles or to rearrange all their other role responsibilities.
Role strain/stress is often the outcome. The family members burdened with the
esqusition of new roles may often feel woried, anxious, and guilty because of
feelings that they are not doing a competent job in their new roles or that with these

added

responsibilities,

their

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complex

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excessively

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unmanageable.
In a recent review of family nursing research regarding the impact of illnes on
families with member experiencing ischemic heart deaese, causes frequently
reported stress that was related to the need to assume additional household roles
and health monitoring responsibilities. Marital conflict receive to role reversal and
attempts of the healthy spouse to monitor noncompliance were also consistenly
reported.
Once a family has achieved a new equilibrium in response to a sick members
inability to perform his or her roles adequately, a similiar reintegration must take
place when that member resumes his or her ild place in the fsmily unit.
Understandably, having once gone through the process of adapting. The other
members may well be reluctant to again resuffles family roles and tasks, despite
the recovery or reentry of the lost member. This reluctance is seen even in the
most well-functioning families, because the process of reintegrating a family member
entails the diffulties and problems that are part of a disorganization before a new (in
this case, renewed) balance is achieved.
Assesment of family role structure
Families must respond to changes throughout their life cyclesometimes due
to normal developmental trantitions and sometimes due to situational families face.
Stressors/example require family role changes. If family members do not have the
requisite knowledge, skills or emotional readness for adjusting to the needed role
changes, then numerous types of role problems may result. One important role of
the family nurse in this regard is to assist famlies to identify role transitions so that
information about the new (anticipatory guidance) is provided to prevent or
ameliorate role problems.
An assesment of family roles primary focuses on the characteristics of the
formal and informal role structure, coupled with a consideration of how socioculture,
situational, and historical factors effect family role structure. There are four broad
areas for the assesment of the family role structure: the formal role structure, the
informal role structure and types of relationships, role models, and variables affecting

role structure. Each family members potition and roles are described by adressing
the following questions.
1. Formal Role Structure
What formal positions and roles do each of the family members fulfill? Describe

how each family member carries out his or her formal

Are these roles acceptable and consistent with the family members and

familys expectations? In other words, are there any role conflicts present?
How competenly do members perceive they perform their respective roles?
Is there flexibility in roles when needed?

2. Informal Role Structure

What informal or covert roles exist in the family, who plays them, anf how
frequently or consistently are they enacted? Are members of the family covertly
playing roles different from those that their position in the family demands that

they play?
What purpose do the identified covert or informal roles serve?
Are any of these informal roles dysfucntional to the family or family members in

the long run?

What is the impact on the person(s) who play this (these) role(s)?

3. Role Models
Who were (or are) the models that influenced family members in their early life,
who gave feelings and values about, for example, growth, new experiences,

roles, and communication techniques?

Who specifically acted as role model for the mates in their roles as parents, and

as marital partners, and what were they like?

If the informal roles are dysfunctional in the family, who enacted these roles in
previous generations?

4. Variables Affecting Role Structrue

Social class influences. How does social class background influences the

formal and informal role structure in the family?

Ethnic/cultural influences. How is the familys role structure influenced by the

familys ethnic and religious background?

Developmental or life cycle influences. Are the present role behaviors of family
members developmentally appropriate?

Situational event, including health and illness changes. How have healt
problems affected family roles? What reallocation of role and tasks have
occurred? How have the family members who have had to assume new roles
adjusted? Is there evidence od role stress and/or role conflict as a result of
these role shifts? How has the family member with the healt problem reacted to
her or his change or loss of a role(s)?

Summary
Individuals live their lives enmeshed in a network of family right and obligations
called role relations. Adequate role functioning is crucial for the invidual and for

the family as it is through the performance of family functions are fulfilled.

Role behavior, role performance, and role enactment are all interchangeable term
that denote what a person actually does within a position in response to role

expextations.
Role sharing refers to participation of two or more people in the same roles even

though they hold different positions.

Role taking refers to family members ability to imagine themselves in the role of a
counterpart, or role partner, and thereby better understand how they should

behave in their own roles.

Role compementary refers to the functional adequacy of roles based on the match
between the performnances and the expectations of parters in a relationship. A
role is always paired with a reciprocal role of another person. One can never look

at a role in isolation.
Role stress occurs when a social structure creates very difficult, conflicting, or

impossible demands for occupants of positions within that social structure.

Role difficult occurs when the occupant of a position perceives that he or she is
confronted with incompatible expectations. The source of the incompatibility may

be due to changes in expectations within the actor, others, or the environment.

Formal roles are explicit roles and informal roles are implicit roles within families.
Informal roles are played to meet the emotional needs of inviduals and/or to
maintain the fsmilys equilibrium. An invidual family member plays many roles in a

family, both informal and formal, with some of these roles being shared.
Major factors influencing the formal and informal family role structure include
social class, family role, cultural/ethnic background, family developmental (life
cycle) stage, role models, and situational events such as health alterations of
family members.

Eight basic roles making up the husbandfather and wife mother social
positions are the provider role, the housekeeper role, the recreational role, the
kinship role (maintaning relationships with paternal and maternal families), the
therapeutic role (meeting the affective needs of spouse (or intimate adult partner),

and the sexual role.

As women have moved from the home into the workplace in recent decades, their
roles have changed, and correspondingly, their role parteners behavior has
changed. There is much more flexibility and variation in mens and womens roles

in families now than in decades past.

Grandparenthood is a heterogeneous experience, with wide variation in bow
grandparent role is enacted. The historical context, age, ethnicity, social class,
and gender tend to produce sihnificant differences in grandparentss role
enactment.