After reading this chapter, the nurse will be able to:
Describe how cultural behavior is acquired in a social setting.
Define selected terms unique to the concept of social organization, such as culture-bound, ethnocentrism, homogeneity, bicultural, biracial, ethnicity, race, ethnic people of color, minority, and stereotyping.
Describe significant social organization groups.
Define family groups, including nuclear, nuclear dyad, extended, alternative, blended, single parent, and special forms of family groups.
List at least two primary goals inherent in the American culture in regard to the family as a unit.
Describe the significant influence that religion may have on the way individuals relate to health care practitioners.
Cultural behavior, or how one acts in certain situations, is socially acquired, not genetically inherited. Patterns of cultural behavior are learned through a process called enculturation (also referred to as socialization ), which involves acquiring knowledge and internalizing values. Most people achieve competence in their own culture through enculturation. Children learn to behave culturally by watching adults and making inferences about the rules for behavior ( ; ). Patterns of cultural behavior are important to the nurse because they provide explanations for behavior related to life events. Life events that are significant transculturally include birth, death, puberty, childbearing, childrearing, illness, and disease. Children learn certain beliefs, values, and attitudes about these life events, and the learned behavior that results persists throughout the entire life span unless necessity or forced adaptation compels them to learn different ways. Patterns of cultural behavior are also apparent in rituals. Some commonly observed rituals include weddings, funerals, and special holiday meals ( ). It is important for the nurse to recognize the value of social organizations and their relationship to physiological and psychological growth and maturation.
Culture as a Totality
Most anthropologists believe that to understand culture and the meaning assigned to culture-specific behavior, one must view culture in the total social context. The concept of holism requires that human behavior not be isolated from the context in which it occurs. Therefore, culture must be viewed and analyzed as a totality—a functional, integrated whole whose parts are interrelated and yet interdependent. The components of culture, such as politics, economics, religion, kinship, and health systems, perform separate functions but nevertheless mesh to form an operating whole. Culture is more than the sum of its parts ( ; ).
As children grow and learn a specific culture, they are to some extent imprisoned without knowing it. Some anthropologists have referred to this existence as “culture-bound.” In this context the term culture-bound describes a person living within a certain reality that is considered “the reality.” Most people have learned ways to interpret their world based on enculturation. Thus, although certain interpretations are understandable and persuasive to persons brought up to share the same frame of reference, other people may not share these interpretations and therefore may make little sense out of the context. , who has traveled extensively around the United States, notes that connecting across racial lines is among the most difficult things on earth. In a perceptive work, A Country of Strangers, he notes, “Even as we look upon each other like strangers from afar, we are trapped in each other’s imaginations.” In Liberal Racism, suggests that rather than trying to overcome racism and create a color-blind world, individuals should fight for equality on nonracial terms. In fact, in polls most Americans agree that people should be judged for themselves, not for their race ( ).
Nurses are also culturally bound within the profession because they are likely to bring a unique scientific approach—the nursing process—to determining and resolving health problems. Many nurses are likely to consider the nursing process the best and only means of meeting the needs of all clients, regardless of their cultural heritage. However, clients may view this modern scientific approach differently, believing that the nursing process meets their needs in some ways but not in others. The nursing process may not consider alternative health services, such as folk remedies, holistic health care, and spiritual interventions. In these cultures, medicine is often practiced in unscientific ways, according to the Western viewpoint. Therefore, desirable outcomes for treatment may occur independently of medical and health care interventions.
Traditionally, American nurses have been socialized to believe that modern Western medicine is the answer to all humanity’s health needs. Most illnesses have been attributed to a biological cause ( ). More recently, Americans have been moving toward a more harmonious relationship with nature in which there is a growing sensitivity to the environment. Traditional attitudes toward disease are being reassessed. Today, more attention is given to the concept of the individual as an organic whole. Nurses are beginning to study and assess options outside of Western medicine that have been used by other cultures, such as Zen meditation, a Buddhist practice ( ), or tai chi, an exercise treatment used in China for hundreds of years to reduce chronic pain in older adults ( ). Many nursing leaders in America are calling for a change in nursing paradigms from scientific to holistic ( ; ; ).
The nurse should appreciate that some illnesses are uniquely found in a given cultural group. Culture-bound syndromes is a term that refers to “diseases” that seem to be specific to a single culture or a group of related cultures. Culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for a pattern of sets of experiences ( ). In some cases the “illness” may be linked to a category in the Diagnostic and Statistical Manual of Mental Disorders (APA, 2014) but have symptoms, a course, and social responses that are influenced by local cultural factors. Examples are amok, a mental or emotional affliction known in the Philippines that causes one to become a killer, and susto, an ailment widely associated with Spanish-speaking groups in which the soul is believed to leave the body as a result of a frightening event ( ).
For the most part, people look at the world from their own particular cultural viewpoint. Ethnocentrism is the perception that one’s own way is best. Even in the nursing profession, there is a tendency to lean toward ethnocentrism. Nurses must remain cognizant of the fact that their ways are not necessarily the best and that other people’s ideas are not “ignorant” or “inferior.” Nurses must remember that the ideas of laypersons may be valid for them and, more importantly, will influence their health care behavior and consequently their health status. In contrast to the term ethnocentrism is the word ethnic, which relates to large groups of people classed according to common traits or customs. In populations throughout the world, people are bound by common ties, elements, life patterns, and basic beliefs germane to their particular country of origin.
In general, the medical paradigm used in Western culture views health, illness, and dying as biophysical realities. However, the meaning a nurse places on life can affect relationships with clients. For example, a nurse’s belief that there is no relationship between illness and evil may conflict with a client’s belief that illness is a punishment from God or the work of spirits ( ; ; ). On one hand, some Puerto Ricans believe that sickness and suffering are a result of one’s evil deeds; on the other hand, many Ugandans believe that an infant’s illness or death is the result of a neighbor’s curse ( ).
It is also important for the nurse to be aware of treatment practices clients may present that do not appear in Western medicine and may seem shocking. For example, female genital cutting, which may range from a ceremonial pricking of the genitalia to the removal of the clitoris, occurs in 28 African countries with prevalence rates estimated at 50% ( ). Yet another concept that the nurse should appreciate is that moral definitions of an illness may arise from particular historical, social, or medical circumstances that are different in each society. For example, in some societies leprosy is common and considered just another debilitating illness, which many families tolerate. In other societies leprosy has been stigmatized, and lepers are quickly divorced, are pushed out of their homes, and end up as beggars ( ).
It is difficult to find a homogeneous culture in the United States. If a homogeneous culture did exist, all individuals would share the same attitudes, interests, and goals—a phenomenon referred to as ethnic collectivity. People who are reared in ethnic collectivity share a bond that includes common origins, a sense of identity, and a shared standard for behavior. These values are often acquired from experiences that are perceived to be cultural norms and determine the thoughts and behaviors of individual members ( ; ). The ultimate consequences of enculturation are carried over to health care and become an important influence on activities relative to health and illness behaviors. In the American culture there is a tendency to speak of culture as if it included a set of values shared by everyone. However, even within an ethnic collectivity, intraethnic variations occur and are obvious in health behaviors. For example, intraethnic variations are seen in the concept of mental illness ( ; ; ), in cultural definitions of health and illness, in skepticism about medical care and consequently the use or lack of use of health care services ( ; ), and in the willingness of the individual to assume a dependent role when ill ( ). Since there may not be obvious clues (e.g., language, physical appearance, clothing) to alert the nurse to intraethnic variations, it is essential to be alert to the presence of differences and to be sensitive in interactions with the client when nurse–client variations become evident ( ).
The term bicultural is used to describe a person who crosses two cultures, lifestyles, and sets of values. Some children of African-American, Hispanic, Asian, and American Indian heritage are socialized to be bicultural—that is, to acquire skills to function in both a minority and a majority culture ( ; ).
Ethnicity is frequently and perhaps erroneously used to mean “race,” but the term ethnicity includes more than the biological identification. Ethnicity in its broadest sense refers to groups whose members share a common social and cultural heritage passed on to each successive generation. The most important characteristic of ethnicity is that members of an ethnic group feel a sense of identity.
Efforts to precisely delineate the term race have been made by many scientists ( ). The AAPA suggests that race, in a pure sense of genetically homogeneous populations, does not exist in any human species today. also proposes that the biological concept previously held to be the “one drop rule” is dated and as such is no longer tenable in today’s society. Nonetheless, many biological scientists suggest that while socioeconomic status may have a more profound effect on health status, race is a viable term that merits attention. Thus, in contrast to the term ethnicity is the term race, which is related to biology. Members of a particular race share distinguishing physical features, such as skin color, bone structure, or blood group. Ethnic and racial groups can and do overlap because in many cases the biological and cultural similarities reinforce one another ( ). A more precise definition of race is a breeding population that primarily mates within itself ( ). There are very few races that still mate largely within the group, but some pure-blooded lineages are found in certain parts of the world, such as some of the descendants of West Africans who live along the Georgia and South Carolina seacoasts in the United States. These people have protected their lineage because they have refused to intermarry. These individuals are known as the Gullah people ; they have not only their own lineage but also their own distinct dialect of English ( ). It is important for the nurse to remember that regardless of race, all people have a cultural heritage that makes them ethnic. It is also important to appreciate that race has an interrelational effect with family structure and income that can influence health and academic and professional achievement ( ).
As views of racial and ethnic identities have changed over time, so have official categories and measurement procedures. The U.S. government weighed in on the question of race as far back as 1790, beginning the arduous process of classifying people into racial categories. Nonetheless, the categories and the method of measuring race or ethnicity have changed dramatically in the intervening decades since the first census was taken in concert with the political and economic forces that have evolutionarily defined this nation. With early censuses, the census takers simply answered the race question based on their perception of the individual. These early censuses were at the very least racially insensitive in that slave status was used as a proxy for a racial category. Even so, at that time, the only race options available for selection include “free White persons,” “slaves,” or all other “free persons” ( ; . As the census continued to evolve, the necessity for more specificity in racial categories became clear for those of mixed African-American and White descent, such as mulatto, quadroon, and octoroon. Beginning in the late 1800s, Asian groups were listed on the census for the first time. Those groups included Chinese, Japanese, and Filipinos ( ). In 1870, other Asian groups were added and included Korean, Vietnamese, and Asian Indian. Likewise, in 1870, American Indians for the first time were included as a separate group. Similarly, counting and measuring the Hispanic population has varied over time. Census takers began by identifying who was Hispanic by looking for a Spanish surname, the use of the Spanish language in the home, and the birthplace of the respondent or parents to indicate Hispanic ethnicity ( ). Over time, this crude way of measurement and counting any racial or ethnic group would prove to be obsolete.
By 1970, racial classification on the census changed from the census taker’s identification to self-identification. Yet, while this was a fairly significant change, it had a relatively minor impact on the count of racial and ethnic groups in the 1970 census compared with the 1960 census. Nonetheless, this change was the catalyst that would spur even greater changes in the census count in subsequent years ( ). The Office on Management and Budget (OMB) announced new standards for federal data on race and ethnicity in 1997 ( ). The Census Bureau, taking its cues from the OMB standards, recategorized racial categories to include, for the first time in 2000, five suggested categories, including White, Black/African-American, American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander. The Census Bureau also added a sixth category, “some other race.” The Native Hawaiian/other Pacific Islander category was separated from the Asian category for the first time. A significant change—another first since the census started—allowed respondents to choose more than one racial category.
When an individual crosses two racial and cultural groups, the individual is considered “biracial.” To be both biracial and bicultural often creates an almost insurmountable dilemma for an individual. Physical attributes such as color, shape of eyes, or hair may have a profound influence on others’ acceptance of the “biracial” individual. One problem associated with biracialism is the inability of the individual to identify or find acceptance in any one of the biologically related racial groups ( ). It is the total exclusion and the sense of not belonging to either of the racial or cultural groups that often create the dilemma. For example, an African-American who is an “octoroon,” a person with one eighth African-American blood, may have difficulty being accepted as African-American because of the lightness of the skin. Conversely, this same individual might be ostracized by some Whites because of the “blackness of the blood lineage.” Although interracial marriages are on the rise, issues of discrimination still occur. Golf champion Tiger Woods revealed in 1997 that in spite of his national stature, his mixed-race origin of White, Black, Indian, and Asian was sometimes met with hostility ( ). This probably is also true for Barack Obama, the first Black president elected in the United States in 2008, who is also of mixed racial heritage. Cose suggests that even in the emerging U.S. mestizo future, if the Latin American experience is a guide, people who are whiter will still have the advantage. Even in Brazil, where racial mixing is sometimes celebrated, status and privilege are still related to lighter skin. For some people of color, there is a perception that White America believes that color is the difference that makes the differences ( ).
A minority can consist of a particular racial, religious, or occupational group that constitutes less than a numerical majority of the population. With use of this definition for the term minority, it is obvious that all types of people can belong to various kinds of minorities ( ). Often a group is designated minority because of its lack of power, assumed inferior traits, or supposedly undesirable characteristics. In any society, cultural groups can be arranged in a hierarchical power structure. Dominant groups are considered to be powerful, whereas those in minority groups are considered inferior and lacking in power.
The term minority is not synonymous with numbers. In the United States, people of color (African-Americans, Latin Americans, Asian Americans) are considered minorities. However, when the population of the world is considered in its aggregate, it is obvious that people of color are in the majority.
Gender is another example of how the term minority is used erroneously. Females in the United States are a larger numerical percentage (50.9%) than males (49.1%) but are considered to be in the minority because of their underrepresentation in high-level managerial positions in the workplace ( ).
The significance of the term minority cannot be overemphasized. The central defining characteristic of any minority group, according to , p. 6), is its “experience with various disadvantages at the hands of another social group.”
The term ethnic minority is often used because it is less offensive to people of color than other terms. Supposedly it takes into account ethnicity, race, and the relative status of the groups of persons included in the category. Were it not for the use of the word minority, perhaps this terminology would be less culturally offensive to some groups of people (that is, ethnic people of color). According to , use of the term people of color might be the preferable option, particularly in situations where sensitivity to racial preferences needs to be heightened. It is estimated that by the year 2050 about half of the total American population will be nonwhite, thus eliminating the meaning of the term ethnic minority ( ; ).
Stereotyping is the assumption that all people in a similar cultural, racial, or ethnic group are alike and share the same values and beliefs. For example, stereotyping occurs when an African-American nurse is assigned to care for an African-American client simply because of ethnicity and race. It is stereotypical when the assumption is made that all African-Americans are alike and therefore the African-American nurse is more likely to be more sensitive to the needs of the African-American client. Race and ethnicity do not, in and of themselves, make persons “resident experts” on the belief and value systems of other persons. Whether stereotyping is engaged in as a result of scientifically proved, research-based data or because of past associations and experiences, stereotyping can ultimately lead to faulty data gathering and wrong interpretations.
Role of Gender and Cultural Significance
In traditional Chinese society, women have held subordinate roles to men, a belief that dates back to the first millennium b . c . ( ). Traditional Chinese believe that the universe developed from two complementary opposites: yin (Cantonese, yam ), the female, and yang (Cantonese, yeung ), the male. For some traditional Chinese Americans, the yin represents the dark, cold, wet, passive, weak, feminine aspect of humankind. In stark contrast, the yang represents the bright, hot, dry, active, strong, masculine aspect of humankind ( ). In traditional societies, there are written and unwritten roles that dictate the behavior of girls and women ( ). Although some countries in North America are highly evolved technologically, traditional beliefs about the role of women in society still persist throughout many regions of America. noted that discrimination exists for women in the workplace because women are viewed as having a higher absentee rate than their male counterparts. For many women, discrimination creates a barrier to entrance into the workplace and, even more important, places a “glass ceiling” on advancement that their male counterparts need not overcome ( ).
According to a U.S. General Accountability Office study in 2000 ( ; ), salaries of women and men in managerial jobs were even farther apart in 2000 than in 1995 in 7 of the 10 industries that employ the most women in the United States. By 2008, this disparity apparently had not ended. For example, in 2008, women who were full-time wage and salary workers had median weekly earnings of $638, or about 80% of the $798 median for their male counterparts ( ).
In 1995, female managers in entertainment earned 83 cents for every dollar earned by a male manager; by 2000, female managers in the industry earned only 62 cents. By 2008, the range of pay in the category now called Leisure and Hospitality ranged from the lower limits to 78 cents to 83 cents of their male counterparts ( ). Although women have tended to be an oppressed group in the workplace, numerous studies have indicated efforts by industries to implement policies and procedures to prevent discrimination on the basis of sex. For example, women may have access to benefits such as child care leave, alternative working arrangements, child care arrangements, special brief leaves to deal with family problems, and free prenatal classes ( ). Because breastfeeding reduces the incidence and severity of diarrhea, ear infections, allergies, and sudden infant death syndrome and lessens the risk of ovarian and breast cancer in mothers, programs that allow mothers to do so can result in significant savings for companies in medical claims ( ).
In some cultures, nursing is a low-status occupation. For example, in Saudi Arabia and Kuwait, care for the sick is carried out by health care providers hired from abroad for the purpose of caring for the bodily needs of the sick ( ). Clients or physicians from a culture where nurses are in the lower class may have difficulty accepting the nurse as being in a role of authority and as having expertise. In many parts of the world, female purity and modesty are major values, and disregard of these values can cause distress. For example, female purity is especially important in the Middle East and Muslim countries. In some cultures it is preferable to assign nurses of the same gender as care providers ( ). If the nurse is female and the client is male and is from a cultural group where touch is permitted only between members of the same sex and where direct eye contact is avoided, special modifications in care may be needed ( ; ).
Role of Disability and Culture
Today, almost exclusively, more attention has been directed toward a definition of culture that includes groups of people by such characteristics of race/ethnicity, religion, and cultural heritage. In addition, the same is true for the term health disparities. Statistical data now suggest that other population data, not just race and ethnicity, should now be used to define cultures of people, including those living with health disparities. Disabled people, for example, can now be considered a cultural group that lives with a number of health disparities. A person with a long-lasting condition or disability can be described as suffering from a health disparity. In 2009, 41.2 million individuals in the United States had disabilities ( ). reported a two to three times greater likelihood that individuals with disabilities would suffer from each of 16 secondary conditions, including falls or other injuries, respiratory infections, asthma, sleep problems, chronic pain, and periods of depression. Individuals with disabilities are also at higher risk for preventable physical, mental, or social disorders that may result from the initial disabling condition. Individuals with disabilities are more likely to report that their health is poor or fair (44.8%) than are individuals without disabilities (9.4%) ( ). These individuals are less likely to be involved in physical activity and more likely to smoke and be overweight ( . Negative social and economic circumstances are also more likely among individuals with disabilities, including decreased participation in social relationships, decreased employment, and decreased income for those employed ( . Thus, it is important to assess the individual with a disability by using the six phenomena of the Giger and Davidhizar model to determine the specific difficulties that this culturally unique individual may experience ( ) ( Figure 4-1 ).
Social Organization Groups as Systems
Social organizations are structured in a variety of groups, including family, religious, ethnic, racial, tribal, kinship, clan, and other special interest groups. Groups are dependent on particular persons and are more affected by changes in members than are other systems. In most groups, except for racial and ethnic groups, members may come and go. Thus, the formation and the disintegration of groups are more likely to occur during the members’ lifetimes than are the formation and the disintegration of other systems.
According to general systems theory, social organization groups are characterized by a steady state and a sense of balance or equilibrium that is maintained even as the group changes. Most groups form, grow, and reach a state of maturity. Social organization groups begin with a variety of elements that include individuals with unique personalities, needs, ideas, potentials, and limits. In the course of development of the group, a pattern of behavior and a set of norms, beliefs, and values evolve. As the group strives toward maturity, parts become differentiated, and each member assumes special functions.
One group of paramount concern for the nurse when working transculturally is the family. In fact, as the family goes, so goes the health care system. Nevertheless, a consensus about the definition of the word family does not exist. offers 21 definitions of family. In terms of the U.S. Census, the term family households is defined as “people who occupy a housing unit” ( ). It is estimated that in 2010, there were 77,538,296 family households and 39,177,996 nonfamily households, representing 66.4% and 33.6% of all U.S. households, respectively. Married couples maintained 48.4% of all families, whereas women with no husband maintained 13.1% ( ).
Regardless of cultural background or the nature of the family, the family is the basic unit of society in the United States. From a sociological perspective, family may be defined as a social unit that interacts with a larger society. The discipline of economics may define family in terms of how it works together to meet material needs. From a psychological perspective, family may be defined as a basic unit for personality development and the development of subgroup relationships, such as parent–child relationships. Still another definition is offered from a biological perspective, which conceptualizes the family as a unit with the biological function of perpetuating the species. However, even while families deliver most health care and at one time being in a family was expected, today not being in a family is both common and accepted and has profound implications for health care delivery ( ).
Types of Family Structures
Traditional Nuclear Family.
According to Virginia , the traditional nuclear family consists of one man and one woman of the same race, religion, and age who are of sound mind and body and who marry during their early or middle twenties, are faithful to the other for life, have and raise their own children, retire, and finally die. This definition appears narrow; however, it has maintained popularity over the years and is still seen by many persons as the most desirable family form. Today a more current definition of the nuclear family allows for more variation: a family of two generations formed by a married woman and man with their children by birth or adoption ( ). Within this particular family form, as within all identified family forms, the assigned roles and functions performed by each member vary. One common family structure has the father working outside the home and the mother working at home taking care of the children and household tasks. However, today the traditional nuclear family often finds both mother and father working outside the home. Thus, childrearing and childcare may be shared by both parents as well as by others outside the family, such as a day care center.
The most common type of household, married-couple families, changed from 55% to 51.65% of all households from 1990 to 2012. In the United States in 2010, there were 120,768,000 married-couple families with the spouse present, representing 43% of all families in all races, with an additional 4% of households headed by males and 12% of households headed by females with no spouse present ( ; ). The number of married-couple households varies by state, with the highest number in Utah and Idaho and in the west-central section of the country, which corresponds with the 2010 census ( ). A total of 44% of married-couple families have children under age 18 in their home. The average size of the nation’s households declined from 2.63 persons in 1990 to 2.57 persons in 2012. In 2004, first marriage occurred at age 25.8 years for women and 27.4 years for men. An increasing and less stigmatized trend today is for adult children to live at home. In 2004, 2.72 million males and 1.56 million females between the ages of 25 and 34 were still living at home. This is approximately double the number in 1970 ( ). Certain ethnic groups, including Asians, African-Americans, and Hispanics, are more likely to stay home longer and are less likely to move far away.
The median age of the U.S. population in 2012 was 37.2 years, the highest it has ever been, up from 32.9 years in 1990. As the median age rose, so did the age of first marriage. The average age at first marriage in 2010 was 26.8 for men and 25.1 for women, and it has been creeping upward ( ). As the population continues to age, relatively fewer families will have children—a projected 39% in 2012, down from 50% in 1994. Among families with children, a lower proportion includes two married parents—49.3%, significantly down from 74% in 1994. It is estimated that fewer than 14% of American children living today are growing up in two-parent nuclear families ( ). While the number of children in a family is decreasing, increasing numbers of married and unmarried Americans are seeking children to adopt. In 1998, a survey of American women found just 200,000 considering adoption; in 2000, by contrast, 500,000 wanted to adopt a child. Because fewer children are available in the United States, there has been a concomitant sharp increase in foreign adoptions, with 18,441 in 2000 ( ).
Interestingly, although the nuclear family is on the decline, immigration laws still lean toward “family preference.” In the interest of keeping families together, U.S. policy allows an unlimited number of visas to certain relatives of U.S. citizens and of permanent resident aliens. Thus, an illiterate laborer with no skills but with a parent in the United States has a better chance of immigration than a graduate school–educated foreigner with no family or employer in the United States. In 1995, about 68% of immigrants came to the United States through the family preference, and about 10% of them came as adult siblings. People born in Mexico, which sends more legal immigrants—18%—to the United States than does any other country, have responded to family preference in particularly high numbers, and they are more likely to use ties to extended family members than any other group. The result is a family-based immigrant population that, for Mexicans and Central Americans at least, is skewed toward unskilled labor ( ).
The second most common type of household, consisting of people living alone, rose from 28.15% in 2000 to 30% of all households in 2012 ( ).
Nuclear Dyad Family.
The nuclear dyad family consists of one generation and is made up of a married couple without children. In the United States, 56.5 million people (19.4% of the population) report that they live in a household with only a spouse ( ). There are numerous reasons why a family may remain childless: the family may have chosen not to have children, they may not be able to have children or to adopt them, or the children may have died. Unlike their parents, couples who married in the United States in 2002 were more likely to delay having children ( ). In some cultures this family form is considered a beginning point for the formation of the family. However, in other cultures the nuclear dyad family is considered a part of the mainstream of the social organization of the family.
The extended family is multigenerational and includes all relatives by birth, marriage, or adoption. The family group includes grandparents, aunts, uncles, nieces, nephews, cousins, brothers, sisters, and in-laws. In today’s society there is a tendency for children to leave the homes and communities of their parents, which has resulted in a separation of the nuclear family from the extended family. As longevity in America increases, increasing numbers of people are elderly. In 2010, 22.9% of Americans were over age 65 ( ). Concomitantly, the number of multigenerational or extended family households is increasing. In 2019, more than 24 million (23.4%) households included individuals 65 years of age and older. The elderly are increasingly living alone. More than 9 million (9.2%) persons 65 years of age and older were in nonfamily households ( ).
Grandparents who are taking care of grandchildren are a growing family group. With increasing numbers of parents dying of acquired immunodeficiency syndrome (AIDS) and single parents who are not interested in child care, grandparents are finding themselves in the role of primary caregiver ( ). An estimated 7.8 million of America’s children live with at least one grandparent; this figure represents a 64% increase since 1991 when only 4.7 million children reportedly lived with a grandparent. Among children living with a grandparent, 76% also were living with at least one parent in 2009, which was not statistically different from the 77% who lived with at least one parent in 1991 ( ).
The alternative family consists of adults of a single generation or a combination of adults and children who live together without the social sanction of marriage. The alternative family is often either a communal arrangement—composed of roommates who might be either homosexual or heterosexual—or a love relationship between a man and a woman. Unmarried partners form 5.5 million households in the United States, including 5 million of the opposite sex and 600,000 of the same sex. These unmarried-partner households made up 8.9% of all households in 2010, an increase from 4% in 1990 and 2% in 1980 ( ).
The single-parent family consists of two generations and is made up of a mother or a father and children by birth or adoption. The reasons for a single-parent family include electing to be a single parent, divorce, death, separation, or abandonment. The prevalence of the single-parent family is increasing because of such factors as divorce and the acceptability of being a single parent. In 2010, families maintained by women with no husband present edged up to 13.1%, for a total of 15.2 million. Among female-headed households, 15,250,349 or 13.1% of all households had children under age 18 years ( ). Between 2005 and 2013, 44.3 children per 1000 were born to unmarried women 15 to 44 years of age, compared with 3.8% in 1940 ( ). This is a 7% increase in these births; however, the median age of the unmarried mothers is in the late twenties, they may be divorced or never married, and 40% are living with a man who may be the father of one or more of the children ( ). More than half of the youngsters born in the 1990s are predicted to spend at least part of their childhood in a single-parent home. Single fathers account for 2.7 million households, representing little variation since 1994 ( ).
Reconstituted or Blended Family.
The reconstituted or blended family is formed by “put-together parts” of previously existing families with the intention of forming a new nuclear family ( ). The blended family, like the traditional nuclear family, is two-generational. However, the blended family differs in form and may consist of a single person who marries a person with children or of a man and a woman, both of whom have children, who marry. This family form may also yield biological children; thus, there may be children who are “yours,” “mine,” and “ours” in the family. The blended family can become very complicated because of the composition of family members, which may include stepbrothers, stepsisters, stepparents, and stepgrandparents. Unipolar blended and bipolar blended describe whether one or both parents bring stepchildren to a marriage. If one parent’s children do not live with the family, the family is a secondary-step, bipolar family. If one parent brings children from two previous marriages, the term double-step family is used ( ). Nearly 25% of all minor children live in a stepfamily ( ).
Special Forms of Families: Communal Families and Gay Families.
In some cultures, an even wider array of family forms occurs, particularly if ideas about marriage and the requirement that the nuclear family is essential to family definition are disregarded. These groups function as families and therefore must be recognized. These special forms of families may be either unigenerational or multigenerational. Two or more adults constitute these special family forms, and they may or may not be of the same sex.
A commune is a group of people that intertwines husband–wife, parent–child, and brother–sister types of relationships of individuals who have elected to live together in one household or in closely adjoining structures. Family members in a commune must express a feeling of commitment to others in the group. Assigned family roles as well as responsibilities are divided among the members of the group. Generally there are specific rules and expectations for each member of the group. A commune may be formed when people have a common goal, such as a religious, philosophical, or political goal, or a common need, such as an economic, social, or physical need. Examples of communes include Israeli kibbutzim, religious cults, retirement homes for the elderly, and households where couples share resources.
Some gay households consist of two persons and generally function as a nuclear dyad. Other gay households may consist of more members, such as a commune. Today, perhaps as a result of the gay rights movement, homosexual couples have openly taken up residence together. In 1999, many members of society rejected this particular family form, as indicated in a survey by the Washington Post, Harvard University, and the in which 53% of respondents stated they believed sexual relationships between two adults of the same sex were always wrong. By 2015, this prevailing attitude had switched occurring to data from a Pew Poll whereas now 55% of Americans) support same-sex marriage, compared with 39% who oppose it.
To combat discrimination against gays and lesbians, legislation regarding the workplace, marriage, and adoption is increasingly being enacted at the state and federal level. In 1996, Congress passed a bill dubbed the “Defense of Marriage Act,” which prohibited federal benefits for spouses in same-sex marriages and guaranteed that no state shall be required to legally recognize same-sex unions. In June of 2015, the Supreme Court of the United States, writing in a decision in the case of Obergefell v. Hodges, upheld the principle that marriage is a fundamental right that all couples are entitled to under the Fourteenth Amendment of the Constitution, which provides for equal protection to all citizens under the law ( ). In 1997, a New Jersey gay couple was allowed to jointly adopt a child, as New Jersey became the first state to explicitly allow lesbian and gay couples to adopt children jointly, just as married couples do. As gay and lesbian baby boomers enter their golden years, the estimated current number of 1 to 3 million gay and lesbian seniors is expected to skyrocket. Gay retirement communities are being developed from Boston to Palm Springs to offer retirees the opportunity to be part of a like-minded community that stands against discrimination ( ). Young gays are disclosing their sexual orientation earlier. Whereas in 1997 there were approximately 100 gay–straight alliances (clubs for gays and gay-friendly kids) on U.S. high school campuses, today there are nearly 3000 ( ). The nursing literature is increasingly addressing variations in sexual orientation and encouraging nurses to come to terms with their own feelings about homosexuality and to practice unconditional acceptance of the individual regardless of sexual orientation ( ).
Characteristics of a Family System
According to general systems theory, a system is a group of interrelated parts or units that form a whole. When general systems theory is applied to the family, the individual family members are those units that make up the identifiable family system. These parts or units act as one or more subsystems within the larger system. Within the family system, the subsystems refer to the ways in which the members align themselves with one another. For example, in the family system, the parents may be one subsystem and the children another subsystem. At the same time, males and females of the family system may be two other subsystems. A subsystem may consist of any number of members who are linked by some common factor. Within the family system, membership in a particular subsystem may be determined by generational considerations, sexual identity, areas of interest, or a specifically designated function. Individual family members may belong to several different subsystems. Family members also belong to external systems, such as the community system, the school system, and career systems. Subsystems may be constructed to ensure that important functions within the family system are carried out to maintain the overall family structure.
studied the family as a living open system and thus viewed family nursing as an emerging conceptual framework for nursing care. Nurses have cared for families for years; however, it is only recently that nurses have begun to study the family as a whole ( ; ).
Family as a Behavioral System.
The family is conceptualized as a behavioral system with unique properties inherent to the system. A close interrelationship exists between the psychosocial functioning of the family as a group and the emotional adaptation of individual family members. A distinguishable link exists between disorders of family living and disorders of family members. This link can best be understood in the context of systems theory. Systems theory is an orientation whereby people are recognized and defined by who they are in the context of their relationship with family, friends, and the society in which they live. Family systems theories were developed in the 1950s on both the East and West coasts of the United States. On the West Coast, a group of people that included Jackson, Haley, and their associates in Palo Alto, California, explored the notions of communication theory and homeostasis applied to the family with a schizophrenic member ( ; ). On the East Coast, in Washington, DC, conceptualized a family systems theory based on a biological systems model. In Philadelphia, used a systems model in his research with families with psychosomatic disorders.
and explored both disturbed families and healthy families from a systems perspective. A system is a whole that consists of more than the sum of its parts; a system can be divided into subsystems, but the subsystems are not representative pieces of the whole. To study the family from a cultural perspective, one must understand the basic characteristics of a family system and of a living system. Today in nursing, the family nursing process is the same whether the focus is on the family as the client or the family as the environment. Therefore, the nursing process used in family nursing is the same as that used with individuals, that is, assessment, nursing diagnosis, planning, intervention, and evaluation. According to , the only distinguishable difference is that both the individual and the family receive care simultaneously. There are some inherent underlying assumptions germane to the family approach to the nursing process, including the beliefs that all individuals must be viewed within their family context, that families have an effect on individuals, and that individuals have an effect on families. As nursing becomes more involved in the delivery of care in the community, it is imperative to strengthen nursing expertise in the delivery of care to the entire family ( ).
All systems have basic units that make functioning possible. Within the structure of the family system, the basic interdependent units are the individual family members. As in any open system, change within one family member affects the entire family system. For example, when one family member becomes physically or emotionally ill, the entire family system is changed in some way. Additional alterations in the family system occur because of the changing composition of family membership as a result of events such as birth, divorce, death, hospitalization, leaving home for college, or marriage. All these variables, whether positive or negative, may bring about disruption and disequilibrium in the family system. All family systems have dynamic characteristics that must be used when disruption or disequilibrium occurs if the family system is to be permitted to return to equilibrium as matter, energy, and information are exchanged ( ).
The number of adults who are unmarried (never married, widowed, or divorced) is dramatically increasing in the United States. Between 2000 and 2009, the number of young adults between 25 and 34 years who were married dropped precipitously by 10% from 55% to 45%. It is interesting to note that during that same period, the percent of adults in the same cohort who were never married dramatically increased from 34% to 46%. These data indicate a dramatic reversal between individuals who have been married and those who have not and for the first time those who have not exceed those who have ( ; ). In 2012, widowed persons represented 13.8 million (2.3% of males and 10.3% of females) of the population while divorced individuals represented 21.5 million (8.8% of males and 11.5% of females) of the population ( ).
As with all open systems, an internal and external environment controls the direction of growth of the family system. The internal environment involves the social and physical factors within the family boundaries, the quality of which is reflected by such factors as (1) marital relationship, (2) location of power, (3) closeness of family members, (4) communication, (5) problem-solving abilities, (6) free expression of feelings, (7) ability to deal with loss, (8) family values, (9) degree of intimacy, and (10) autonomy of family members. Within the family system, the external environment is the social and physical world outside the family, such as church, neighbors, extended family, school, friends, work, health care system, political system, and recreation.
Within the family system, the “boundary” is the imaginary line or area of demarcation that keeps the family system separate and unique from its external environment. As with all open systems, energy, in the form of information, material goods, and feeling states, passes among family members and the external environment. Openness and closeness in a family system are governed by the degree of information or energy that is exchanged and the nature of the boundaries. Information coming into the family system provides the family with information about the environment and about family functioning. If the family accepts the information, it may be used to formulate and respond to the environment, assist the family in coping with disequilibrium, or rejuvenate the family. Energy coming into the family can also be stored until needed. Finally, energy or information coming into the family can be rejected or ignored ( ).
As with all open systems, the amount of energy or information that enters and leaves the system must be balanced within certain limits to maintain a steady state of functioning or homeostasis if proper adaptation of the system is to occur. Any system can become dysfunctional if the system is allowed to become too open or too closed. No truly closed systems exist, except in a theoretical sense. On the other hand, if a family system were totally open, the family system would probably lose its identity as a system separate from other systems to which family members belong. Therefore, the family members might suffer from alienation, rootlessness, and a lack of belonging. The opposite extreme, a theoretically closed family system, would have very rigid boundaries, and family members would become enmeshed, fixed, and unable to move out, grow, or change.
Communication within the Family System
The verbal and nonverbal interaction among family members is communication. Factors that contribute to the family members’ patterns of communication include (1) the pattern of members in acknowledging each other’s verbal and nonverbal messages, (2) the degree of responsibility each member takes for expressing individual feelings, thoughts, and reactions in a constructive way, (3) the extent to which the family encourages a clear exchange of words, (4) the extent to which family members are allowed to talk for themselves, and (5) the patterns of spontaneous talking. Bonding among family members results from the forms of communication patterns that exist.
Roles in the Family
Family member roles are patterns of wants, goals, beliefs, feelings, attitudes, and actions that family members have for themselves and others in the family. Roles are both assigned and acquired, and they specify what individuals do in the family. Although they are usually dependent on social class and cultural norms, roles are dynamic and change in response to factors both within the family and without. Roles are reciprocal and complement roles taken by other family members. Family equilibrium is dependent on how well roles in the family are balanced and reciprocated ( ; ).
The way in which a family member assumes a particular role is influenced by various factors, including temperament, height, weight, gender, birth order, age, and health status. Certain roles, however, depend solely on the sex of the family member. Females can be sister, daughter, wife, mother, or girlfriend, whereas males can be brother, son, father, husband, or boyfriend. Other roles, such as breadwinner, childrearer, homemaker, cook, handyman, and gardener, are performance roles and depend on the person’s ability to perform a certain task. In contrast to performance roles are emotional roles, such as leader, nurturer, scapegoat, caretaker, jester, arbitrator, or martyr, which may be adopted at certain times as a means of adjusting to the demands of a family system, to an extended family crisis such as a long-term family illness, or to long-term family conflict. The functions of emotional roles are to reduce conflict among family members and to promote temporary adaptation among family members. However, consistent use of emotional roles may impair adaptation, thus hindering the growth of the family. An example is when one family member, perhaps the oldest child, assumes the role of family caretaker, supporting other members and arbitrating disputes. The role may take on negative characteristics in this instance because the family caretaker may appear outwardly strong and capable but inwardly have unrealistic feelings, such as “I can’t fail” or “I can’t be weak.” In this emotional role, this person may function under pressure to be perfect but at the same time have feelings of self-doubt and fear. It is important for the nurse to remember that roles have a significant effect on individual adjustment. Role function is influenced by the values of social groups to which the individual belongs. For example, in an international study by , Finnish Lutheran women placed less value on bearing and rearing children than other groups studied (American Mormons and Canadian Orthodox Jews).
To understand family organization, the nurse must remember that structuring of both functions and goals must be addressed. It is also important for the nurse to remember that most families are dynamic, endlessly adaptable, and continuously evolving in both structure and function. The functional ability of a family depends in part on the individual needs and wants of the members. If the nurse is unable to assist family members in meeting needs within the family structure, pain may be felt and confusion may exist. The nurse must keep in mind that, in the American culture, families are expected to be self-perpetuating and at the same time be the primary system for the transfer of social values and norms.
In the American culture, two primary goals are inherent in the family: (1) the encouragement and nurturance of each individual and (2) the production of autonomous, healthy children ( ). Marital partners are expected to be supportive and protective of each other. Both the husband and the wife are expected to share a sense of meaning and emotional closeness within the boundaries of their relationship, thus fostering the goal of personality development. In families in which supportive relationships do not exist, the achievement of the first goal (the encouragement and nurturance of each individual) is not attainable. The second goal of the family includes encouraging children to develop their own identity and individuality by allowing them to develop ideals, feelings, and life directions. At the same time, children are encouraged to sense both similarities to and differences from others and to be able to initiate activities based on this information ( ). Factors that must be addressed to determine the degree to which the family will accomplish these two primary goals include the patterns of relationships and adaptive mechanisms that are present. There are many reasons why some families fail to accomplish these two primary goals, including psychiatric disturbance of family members, incomplete maturation of children, and disintegration of the family system. When the family uses adaptive mechanisms, internal equilibrium may result. These adaptive mechanisms are dependent on (1) the level of communication skills within the family, (2) the individual contributions of each family member to the family welfare, (3) the mutual respect and love within the family, (4) the types, kinds, and amounts of stressors encountered, (5) the response pattern to stressors encountered in the internal and external environment, and (6) the support or resources available and the opportunity to participate in support systems ( ; ). For example, a family that has an alcoholic father may not be able to accomplish goals because this problem may result in psychiatric disturbances in the wife and children, and ultimately the family system may disintegrate. The reasons for the disintegration of this family include not only the individual psychiatric disturbances but also accompanying difficulties, such as incomplete maturation of children and adult members, financial instability, inability to adapt successfully to stressors, and, more important, the inability of each family member to perceive the family unit as caring and loving ( ).
Levels of Functioning.
Four levels of family functioning that have been identified form a continuum in increasingly abstract levels ( Box 4-1 ): (1) family functions and activities, (2) intrafamilial interactions, (3) interpersonal relationships, and (4) the family system ( ).
Level I: Family functions and activities
Level II: Intrafamilial interactions
Level III: Interpersonal relationships
Level IV: The family system
Level I deals with family affairs and functions. Included in this level are tangible, pragmatic activities that are observable or easily identified; more important, these are things that family members are most comfortable discussing. Four categories of family functioning have been identified in Level I:
Activities of family living. Families are expected to provide physical safety and economic resources. Included in this category is the ability of family members to obtain such necessities as food, clothing, shelter, and health care.
Ability of the family members to assist one another. Included in this category is the family’s ability to assist other members in developing emotionally and intellectually and at the same time attaining a personal as well as a family identity.
Reproduction, socialization, and release of children. Included in this category are functioning goals that allow the family to become closely aligned, thereby allowing the transmission of subcultural roles and values.
Integration between the family, its culture, and society. Included in this category is the ability of the family to use external environmental resources for support and feedback.
Level II deals with communication and various interactions between family members, including what is said, how it is said, patterns of communication over time, the ability of each family member to communicate, and the quality of communication skills. Also included in this level is the transfer of information from family member to family member.
Level III deals with the way family members interact in relationships that occur within the family constellation. The dimensions of closeness and power and the degree of empathy, support, and commitment among family members are important. How the family functions in regard to decision making and problem solving is included in this level.
Level IV deals with the concepts of the family system, as well as how the family functions as a system. Level IV is the most abstract level of family functioning. It encompasses the concepts of wholeness, openness or closedness, homeostasis, and rules.
To understand the family from a cultural perspective, it is essential that the nurse recognize that family relationships are stronger among some ethnic or cultural groups than among others. However, the importance of socioeconomic class cannot be overlooked. According to , a pattern of strong family relationships exists, particularly among poor people who have few resources and must rely on the support of the family kinship network to meet physical and emotional needs. Middle- or upper-class people often have resources that extend beyond the extended family and are therefore able to avail themselves of physical and emotional support within the community. It is often believed that when people do not have money or other available resources for recreation and social activities in the community, they tend to spend more time together and depend on the family group for recreational and social outlets.
Regardless of socioeconomic class, families must organize and structure themselves. Structure refers to the organization of the family and includes the type of family, such as nuclear or extended. The value system of the family dictates the roles assigned in the family, communication patterns within the family, and power distribution within the family ( ; ). The basic beliefs about humankind, nature, the supernatural (fate), time, and family relationships constitute a family’s value system. Value systems are often clustered by socioeconomic status or ethnic groups. For example, families from lower socioeconomic groups tend to have a present-time orientation and view themselves as being subjugated by the environment or the supernatural (fate). Often the family relationships are disrupted by desertion of a spouse or by the early emancipation of the children because of severe economic difficulties. These families have been able to survive and adapt by taking in children of other extended family members; for example, a grandmother may provide direct assistance by raising her son’s or daughter’s children. In these families, power is usually authoritarian or not exerted at all.
Middle- and upper-class families in the United States for the most part espouse the Protestant work ethic values, which dictate the importance of working and planning for the future. These values encompass the belief that although humanity is somewhat evil, behavior is changeable by hard work. In the middle- and upper-class family structure, financial stability and success are viewed as rewards for hard work. Within these classes, family relationships center on the nuclear family, socialization occurs with work-related or neighborhood friends, and power may be more egalitarian than in the lower-class family. Power tends to become more male dominated as the economic level of a family rises. Middle- and upper-class families often see themselves as able to control or have mastery over their environment ( ).
When typical White American families are compared with Asian American families, some differences can generally be noted. The typical White American family defines itself by the present generation, is fiscally independent, has the core relationship as husband–wife, emphasizes happiness of the individual, and is more feeling oriented. In contrast, the Asian family is defined by past, present, and future generations; feels economic obligations to kin; has parent–child as the core relationship; emphasizes the welfare of the family; and is more task oriented ( ). The Asian client’s explanatory model of illness is greatly influenced by the family ( ), and the discussion of illness is related to a sense of obligation to the family ( ).
The nurse must keep in mind that these statements on structure and organization of a family by class are broad generalizations of social class values and in themselves cannot account for cultural differences. For example, many ethnic groups, such as the Newfoundland Inuit family, regardless of socioeconomic status, place great importance on extended family relationships rather than on the individualism valued by White, Protestant, middle-class Americans. A family with a good income but with a time orientation in the present, such as that commonly found among persons in the lower socioeconomic class, may fail to recognize the importance of saving money and thus may always struggle financially. To understand whether a family system organizes itself around a family unit, such as the extended family, or tends to be a more individualistic system, such as the nuclear family, the nurse must assess the family as a group. The American family is composed of diverse multicultural populations and is defined by three criteria: kinship, function, and location.
In the first criterion, kinship, there are three dyads that imply the existence of or location for the individual within the family structure: husband–father, wife–mother, or child–sibling. There are several conventional forms of family structures that are composed of these positions, including the nuclear family and the stem family. The nuclear family, which was discussed earlier, may consist of a husband, a wife, and their nonadult children and is based on all three dyads, with their marital, parental, and sibling elements. Whereas the nuclear family is restricted to a depth of two generations, the stem family encompasses three generations: grandparents, parents, and children.
The second criterion, function, describes the purpose, goals, and philosophy of the family organization. Family function is defined as the expected action of an individual in a given role. In a description of family organization, the term function is used to depict family roles and the assigned tasks for those roles. Every family has unit functions that must be performed to maintain the integrity of the family unit and to meet the needs of the family. If individual family members’ needs and societal expectations are to be met, the functioning role of the family must be clearly delineated. In family systems with two or more individuals, the family members have unit functional responsibilities related to their social positions. Depending on position within the family structure, an individual may function in a variety of roles, such as companion, decision maker, health motivator, or sexual partner. It is important for the nurse to remember that the maintenance of the family system is dependent on these various roles. Some cultural groups function in traditional ways in which the family is viewed as a holistic functioning unit. Other cultural groups may function as a disaggregate unit, meaning that the family does not function as a unit but that members function independently.
When the nurse is providing care, it is particularly important to assess who has the decision-making function in the family. For example, a decision about consent to treatment, receiving care or teaching, or whether to follow instructions may need to be made individually ( ). On the other hand, a client may not feel comfortable in making a health care decision without the spouse or family. In some situations the client may defer to the spouse for decision making ( ). In still other situations, another individual or group, such as a deacon or a church, may need to be involved. In a traditional Mexican family, the man is the decision maker. When a decision regarding health care is needed, a woman may defer any decision until her husband can arrive ( ). Consideration for families’ decision-making style is included in the recent additions to the standards of the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), which acknowledge the autonomy of the client and/or of the family in the health care decision-making process ( ). Decisions about who makes decisions regarding the end of life may also be culturally determined, although it can never be assumed that all members of the group will act the same or share the same beliefs. For example, among Asian and Pacific Island cultures, the interaction of Buddhism, Confucianism, and Christianity generally supports filial piety. While the family assumes the decision-making role, terminating treatment for a parent can influence the fate of the living and be equated with ancestor murder. Thus, many families will want to provide artificial feedings and hydration to the terminally ill and to demented patients not taking food and fluids orally since they feel that only God decides when it is time to die ( ).
Another family function that the nurse needs to examine is in relation to the family’s physical, affectional, and social properties ( ). Physical functions include providing food, clothing, and shelter; protecting against danger; and providing health care. Affectional functions include meeting emotional needs. Social functions include providing social togetherness, fostering self-esteem, and supporting creativity and initiative. Another approach to examining family functions views the family from a task-oriented perspective ( ). Tasks include socialization of children, strengthening competency of family members in relation to their adjustments within organizations, appropriate use of social organizations, providing an environment that fosters the development of identities and affectional behavior, and creating a satisfying, emotionally healthy environment essential to the family’s well-being. Adaptation is essential to the family’s ability to carry out functions and tasks and to meet the changing needs of society and other social systems, such as political and health–illness systems.
One of the most significant dimensions affecting childrearing practices in America today is managing children’s time with computers, TV, and video games. It is estimated that the average American child in 2002 spent an average of 4.5 hours a day at home in front of a screen, an increase of 30 minutes from the previous year. In 1999, the average American child grew up in a home with two TVs, two VCRs, three audiotape players, two CD players, one videogame player, and one computer, according to a Kaiser Family Foundation study; children had an increasingly sedentary lifestyle and increased exposure to violent and sexual images ( ). Parents are challenged to protect their children online using software packages such as Cyber Patrol, Net Nanny, and Cybersitter, but nothing is promoted as perfect, and children remain vulnerable to pornography and sex predators on the Internet ( ; ).
Family location is also a significant criterion for understanding the family. and discussed the variations that occurred among values of African-American families when families were evaluated in urban versus rural settings. Martin found that when families moved from rural to urban settings, there was an erosion of values emphasizing “mutual aid” and a contrasting increase in individualism, materialism, and secularism. When urban African-Americans are compared with their rural counterparts, it appears that urban African-Americans may view their counterparts as lacking the toughness and sophistication needed to make headway in a dominant urban culture. Despite the variations that occur with location changes, geographical separation does not mean a severing of kinship ties, according to Martin; rather, geographical separation may strengthen the emotional bonds among relatives. Today there is a tendency among African-Americans, whether urban or rural, toward a migration back home and getting back to their people. For some African-Americans there has been an increasing awareness that the urban centers have not met their hopes and aspirations. From the 1940s to the 1970s, there was a migration by some African-Americans away from the rural South. In the 1980s there was a trend toward migration of some African-Americans away from the urban North back to the urban South. For example, significant numbers of urban Northern African-Americans have migrated to such cities as Atlanta, Dallas, and Houston ( ).
According to many sociologists, religion is a social phenomenon ( ). Religious practices, therefore, are usually rooted in culture, and each culture typically has a set of beliefs that define health and the behaviors that prevent or treat illness ( ). However, many persons, particularly those with religious convictions, tend to think of religion in an entirely different way. For some people religion is seen in the context of a person’s communion with the supernatural, and religious experiences fall outside ordinary experiences, whereas other people view religion as an expression of an instinctual reaction to cosmic forces ( ). Another worldview of religion depicts it as an explicit set of messages from a deity. For the most part, all these beliefs tend to de-emphasize, ignore, and perhaps even reject the sociological dimensions of religion. Nevertheless, whether it is being considered in general, in regard to a particular religious family such as Christianity or Buddhism, or in regard to a very specific religious group, such as Baptists, religion is believed to interact with other social institutions and forces in society and to follow and illustrate sociological principles and laws. In other words, regardless of what religion is or is not, it is a social phenomenon and as such is in a continual reciprocal, interactive relationship with other social phenomena.
Regardless of its definition, be it theological or sociological, many different kinds of groups are based on religion. Generally, religious structures fall into two basic types: the church type and the withdrawal-group type. The church type of structure is broadly based and represents the normative spiritual values of a society that most people adhere to by virtue of their membership in the society, such as Hinduism in India or Catholicism in Spain. For the most part, membership in certain societies dictates the faith that the person should belong to if that person has not made a conscious, deliberate choice to adhere to something else. The church type of structure is generally a comprehensive system that allows for individual variations and in practice does not make extremely rigorous demands on its members. In the United States, the church type of structure is encompassed within numerous major denominations. This denominational structure is in sharp contrast with the church type of structure in other countries, such as India or Spain, where most of the people belong to one faith and one church. In some countries, particularly the United States, individual churches are often closely identified with an ethnic group rather than with a social class, and churches thrive, more or less, as a means of asserting ethnic identity. For example, the Black church, regardless of denominational faith, has become synonymous with the Black life experience. The Amish people, on the other hand, subscribe to one denominational belief; however, the belief is synonymous with the Amish life experience.
The second type of religious structure is the withdrawal group, which expresses the beliefs of those for whom personal commitment and experience are more important than the family and the community functions of religion ( ). Withdrawal groups meet the needs of those who believe that the majority’s faith or lack of faith is not for them. Persons involved in withdrawal groups define themselves by making a separate choice. These groups include the Amish or Jehovah’s Witnesses, which tend to represent a more intense or unbending commitment than that held by the average person adhering to a religion. These groups may be called sects . Groups that combine separation with syncretism and new ideas and that emphasize mystical experience are often referred to as cults . However, the word cult is often used in Western society with caution because it has acquired a negative connotation. In some religious groups, such as the Church of Jesus Christ of Latter-Day Saints (Mormons), Muslims, Jehovah’s Witnesses, Seventh-Day Adventists, Buddhists, or Hindus, as well as that of the Gypsy culture, the extended social organization of the religion is considered more important than membership in the individual family. It is essential to remember that while this view is held by some theological scholars ( ), many members of these religious groups do not necessarily share this belief. For example, in the Church of Jesus Christ of Latter-Day Saints (the Mormon Church), children are taught at a very young age that families are eternal. In this sense, the family is viewed as a stable, cohesive group bonded by love and as such is one of the most important units on earth today ( ).
As persons from different religions increasingly intermarry, it is becoming more common for parents not to share the same faith. The proportion of Jews who married Gentiles, around 10% for the first half of the century, according to the American Jewish Committee, doubled in 1960, doubled again by the early 1970s, and in the 1990s leveled off at just over 50%. Approximately one of three American Jews lives in an interfaith household ( ). Comparable figures are 21% for Catholics, 30% for Mormons, and 40% for Muslims. Thus, a new form of religious identification in America is developing that is analogous to a “mixed race.” However, although diversity is increasingly acceptable among American religions, observances inevitably involve some sectarianism. Even though raising children in two faiths promotes diversity, it is sometimes confusing for the children, who may feel that they are not as good as their all-Jewish or all-Christian cousins. Although attitudes toward intermarriage are becoming more liberal, for some it creates confusion over which holidays to celebrate and which church children should attend. On the other hand, intermarriage is not completely accepted in the United States. There are conservative sects, such as Old Colony Mennonites and Missouri Synod Lutherans, who are less tolerant of intermarriage and insist on born-again spouses ( ).
There are 215 distinct church traditions represented in the United States. Many of these groups represent the process of dividing and reuniting that has been a characteristic of religious life in America ( ; ). Data from the American Religious Identification Survey indicated that there were 228,182,000 persons in the United States in 2008 who considered themselves members of a church; this is up from 2000, when more than 152 million claimed membership ( ). The denomination with the largest membership is the Catholic Church, with 57,199,000 members, comprising 24% of the U.S. population; the Southern Baptist Convention has 16.2 million (all Baptists, including Southern Baptists, total 36,148,000), the United Methodist Church has 11,366,000, and the Church of God in Christ has 6.4 million. The Church of Jesus Christ of Latter-Day Saints ranks fifth, with a membership of 3,158,000, but is noted to have had a very brisk increase in membership since its origin in 1830. The Church of God in Christ, which has historically been the largest Black Pentecostal church, is now among the five largest denominations, indicative of the growth of Pentecostal churches ( ) ( Tables 4-1 and 4-2 ).