The family is regarded as one of the most important institutions in society; it sits at the centre of both personal and political spheres of life. For individuals, a family can be a ‘haven in a heartless world’ (Lasch 1995: 6), while others may experience their family as a source of conflict or distress. The myth of the family as either the panacea for all social ills, or the cause of them, permeates through social policy, the models used by health and social care professionals, and the lives of ordinary people (Jones 2002). Therefore, key to understanding the concept of family is to appreciate that it is an ideological concept (see Chapter 4). Ideologies about the family shape care provision (which of course includes nursing care), because they shape policy-makers beliefs about what the family is and what it should and should not do. This chapter will consider the development of the contemporary family and its role and function in relation to health and illness.

Wright and Leahy offer advice on how to ‘avoid or sidestep errors’ (2005: 91) in family nursing practice to enable nurses to work with more confidence and competence. The aim of this chapter is to provide nurses with a sound overview of the sociology of the family that may then be applied to practice with a sense of confidence.

For nurses, who need to respond thoughtfully and reflexively to people in their care, Nicholson (1999: 77) offers an insightful reminder that:

This means understanding differing perspectives on the family and appreciating the wide range of family forms experienced by those in our care. Silva & Smart (1999) emphasize the importance of attending to individual perceptions of family life, rather than simply accepting top-down definitions. Within sociology, the consideration of the individual subjective meanings of family follows what classical sociologist Max Weber described as the need for sociologists to achieve a ‘subjective understanding of the action of the component individuals’ (Weber 1968: 15). Weber believed that sociologists should be concerned with more than offering an explanation of the social world, what he termed Erklären, but should seek to achieve understanding or Verstehen (we discuss Weber’s major ideas in Chapter 4). By accepting this understanding of sociological enquiry, nurses can go on to explore the variety of family arrangements that may more accurately represent the diverse ways that people live in contemporary British society.

Definitions of what a family is, and what it should be, have been debated within political and social discourse for some time. For sociologists, an understanding of what is meant by the term ‘family’ is essential. Yet it is one of the most intractable issues to be faced within the study of the family. Numerous attempts have been made to define the family in a way that adequately encompasses the diverse family forms that exist, as can be seen in sociology texts which look at the family (Allen 2001, Bernardes 1997, Featherstone 2004 and Silva 1999). This has led some, for example Gubrium & Holstein (1990), to argue for the rejection of the term ‘family’ altogether and replace it with ‘household’. However, this can be problematic in a number of ways. First, within sociology as well as in everyday life, the terms often merge into one. However, there is an essential distinction to be made between the two (Allen & Crow 2001). A household generally refers to a social group, which usually share domestic activities such as eating some meals together, sleeping in the same dwelling, and normally sharing a common domestic budget (Anderson 1994 and Giddens 2001). Such households may include those who share a kinship link, but there is a growing trend towards single person households and individuals who share a dwelling for economic and situational reasons, such as students.

According to data from the Office for National Statistics (2005), in 2005 there were 7 million people living alone in Britain, which is nearly four times as many as in 1961 (Allen & Crow 2001). Among older people, women over the age of 75 are more likely to live alone than older men to a ratio of 3:5 (Office for National Statistics 2005). Widowhood is a common experience for older women which, not surprisingly, increases statistically with age. Interestingly, a trend in cohabitation among older adults has been noted, with the 2001 Census revealing that 5% of men and 4% of women aged between 50–59 lived with a non-marital partner (Office for Population Census and Surveys 2001b). Overall, there continues to be a growing trend in single family households, and as a result, the average household size has decreased from 3.1 to 2.4 during this same time period. In spite of this trend, the majority of people in Britain live in a family household: in 2004, 8 out of 10 people lived in a family household compared to 9 out of 10 in 1961 (Office for National Statistics 2005).

According to the 2001 Census, families headed by a person of non-White ethnic background were more likely to have a larger household with dependent children than their White counterparts. For example, almost four out of five Bangladeshi families in Britain had dependent children living at home with them, compared with almost two out of five White families. Bangladeshi and Pakistani families tend to be larger than families from any other ethnic group with 40% having three or more dependent children compared with 28% for Black African families; 20% for Indian families and 17% for White families (Office for Population Census and Surveys 2001b). Nurses should be mindful of the diversity of family forms and family practices, within a range of ethnically diverse groups. By thinking sociologically, nurses can avoid stereotyping ethnic groups and be wary of making assumptions about families.

From a sociological perspective, Allen & Crow (2001) add that for clarity it is essential to make a conceptual separation between the two terms ‘family’ and ‘household’ despite any overlap. Furthermore, it is essential to appreciate the perspective of the individuals who may see themselves as living within a family, as opposed to a household, which is especially important for nurses who endeavour to build a trusting rapport with those for whom they provide care.

Giddens (2001) suggests that it is more meaningful to talk of families rather than the family: a term that better represents the diversity of family forms. This apparently slight but significant conceptual move also avoids the problem of idealizing one family form over another, most notably the ‘nuclear family’.

It is useful at this point to offer a brief review of the historical development of the family. This further challenges the notion of the ubiquity of the nuclear family. Silva and Smart (1999: 4) suggest in their work that ‘there is both continuity and diversity in family life at the end of the twentieth century’. So, does a look at the past reveal a more consistent picture of family life? Reviews of the historical contributions to the sociological understanding of the British family uncover a range of explanations and perspectives on the growth and development of the family.

First, there appears to be consensus on the view that the effects of the economic expansion of industrial towns resulted in population shifts from rural to urban settings. This meant that the traditional extended families, which consisted of a number of people living together (or very close by) in one household all bound by kinship ties and roles such as grandparent, uncle and aunt, brothers and sisters with their spouses and children, were replaced by the economically more mobile nuclear family. Thus the economic and social support of the extended family was being replaced by a smaller family form (the nuclear family), seen by many social commentators as a better ‘fit’ with advancing industrialization and urban living.

Within sociology, the influential American sociologist Talcott Parsons, saw the modern nuclear family as functional to a developing capitalist society. Parsons described nuclear families as ‘factories which produce human personalities’ (Parsons 1955:16). He described the following functions of the modern nuclear family:

Parsonian functionalism dominated sociological thought about the family throughout the 1950s and 1960s, and thus the extended family and wider kinship roles were largely rendered invisible and ‘assumed to have withered away with the rise of modern industrial society’ (Twigg & Atkin 1994: 2). However, the now famous study of kinship in the East End of London by Young and Wilmot (1957) served to challenge this position, as it revealed a picture of intergenerational support within families, most significantly delivered by women. Further challenges came from a burgeoning feminist sociology, which challenged the Parsonian assumption that the contemporary nuclear family functioned in the interests of all its members drawing attention in particular to its negative impact on women.

The historical development of British family life cannot be seen as a smooth, linear process, not least because of the presence of ethnically diverse family forms. Within such families, the influence of other traditional or religious practices will go some way in shaping their family life, such as the principles of Islam which place importance and emphasis on family obligations (Hylton 1995). The evidence considered here shows what Simpson (1998) describes as a decline in significance of the nuclear family, and a growth in ‘unclear families’. Whatever form family life takes, it is important to note that nurses should approach with sensitivity, any discussion with people in their care of the experience of family life, and be aware that there are those ‘who feel excluded from or damaged by particular families’ (Featherstone 2004: 25) or experiences. For example individuals may be damaged by abuse or domestic violence and this can have lasting negative effects on health.