An ethnographic study of families who used hospice services was conducted to identify how families defined and practiced family health during a time of family transition. Eight families (N = 29) who recently experienced the death of a family member participated in three interviews. Key findings were: (a) family health is a complex construct with dynamic intergenerational linked patterns, (b) mothers continue to have roles related to family health when children are adults, (c) household context influences family health, and (d) health routines changed during caregiving and loss. Hospice care was a valued family health support during caregiving and following death. Family members deconstructed, reconstructed, and established some new health routines during the terminal phase and bereavement. Future family research should consider transgenerational influences, mothers’ roles related to the health of adult children, contextual influences most predictive of family health, and interventions most supportive of families during change and transition.
Get full access to this article
View all access options for this article.
References
1.
Allen, J.
, Becker, D., & Swank, R. (1991). Impact of spouse concordance of psychological adjustment on functional status after coronary bypass surgery. Journal of Nursing Quality Assurance, 5(2), 69-74.
2.
Antonovsky, A.
, & Souriani, T. (1988). Family sense of coherence and family adaptation. Journal of Marriage and the Family, 50, 79-92.
3.
Artinian, N.
(1989). Family member perceptions of a cardiac surgery event. Focus on Critical Care, 16(4), 301-308.
4.
Backett, K.
(1992). The construction of health knowledge in middle class families. Health Education Research, 7(4), 497-507.
5.
Belsky, J.
, Spanier, G., & Rovine, M. (1983). Stability and change in marriage across the transition to parenthood. Journal of Marriage and the Family, 45, 553-556.
6.
Berman, P.
, Kendall, C., & Bhattacharyya, K. (1994). The household production of health: Integrating social science perspectives on micro-level health determinants. Social Science & Medicine, 38(2), 205-215.
7.
Blecke, J.
(1990). Exploration of children’s health and self-care behavior within a family context through qualitative research. Family Relations, 39, 284-291.
8.
Bottorff, J.
, Steele, R., Davies, B., Garossino, C., Porterfield, P., & Shaw, M. (1998). Striving for balance: Palliative care patients’ experiences of making everyday choices. Journal of Palliative Care, 14(1), 7-17.
9.
Bowlby, J.
(1980). Loss: Sadness and depression. New York: Basic Books.
10.
Campbell, T. L.
(1986). Family’s impact on health: A critical review. Family Systems Medicine, 4(2-3), 135-191.
11.
Cowan, P.
(1991). Individual and family life transitions: A proposal for a new definition. In P. A. Cowan & M. Hetherington (Eds.), Family transitions (pp. 3-30). Hillsdale, NJ: Lawrence Erlbaum.
12.
Davies, B.
, & Oberle, K. (1990). Dimensions of the supportive role of the nurse in palliative care. Oncology Nursing Forum, 17(1), 87-94.
13.
Davies, B.
, Reimer, J., & Martens, N. (1994). Family functioning and its implications for palliative care. Journal of Palliative Care, 10(1), 29-36.
14.
Denham, S. A. (1997). An ethnographic study of family health in Appalachian microsystems. Unpublished doctoral dissertation, University of Alabama at Birmingham.
15.
Doherty, W.
, & Campbell, T. (1988). Families and health. Newbury Park, CA: Sage.
16.
Ducharme, F.
(1995). Longitudinal change in conjugal support and coping behaviors of elderly marital partners. Journal of Family Nursing, 1(3), 281-302.
17.
Duffy, M. E.
(1988). Health promotion in the family: Current findings and directives for nursing research. Journal of Advanced Nursing, 13, 109-117.
18.
Gilliss, C.
(1984). Reducing family stress during and after coronary artery bypass surgery. Nursing Clinics of North America, 19(1), 103-111.
19.
Gilliss, C.
, Neuhaus, J., & Hauck, W. (1990). Improving family functioning after cardiac surgery: A randomized trial. Heart & Lung, 19(6), 648-653.
20.
Gilliss, C. L.
(1991). Family nursing research, theory and practice. Image, 23, 19-22.
21.
Grant, J.
, & Bean, C. (1992). Self-identified needs of informal caregivers of head-injured adults. Family & Community Health, 15, 41-48.
22.
Grant, J.
, & Davis, L. (1997). Living with loss: The stroke family caregiver. Journal of Family Nursing, 3(1), 36-56.
23.
Grey, M.
(1993). Stressors and children’s health. Journal of Pediatric Nursing, 8(2), 85-91.
24.
Harrington, V.
, Lackey, N., & Gates, M. (1996). Needs of caregivers of clinic and hospice cancer patients. Cancer Nursing, 19(2), 118-125.
25.
Hileman, J.
, & Lackey, N. (1990). Self-identified needs of patients with cancer at home and their caregivers: A descriptive study. Oncology Nursing Forum, 17(6), 907-913.
26.
Hilgenberg, C.
, Liddy, K., Standerfer, J., & Schraeder, C. (1992). Changes in family patterns six months after myocardial infarction. Journal of Cardiovascular Nursing, 6(2), 46-56.
27.
Kelly, R. B.
, Zyzanski, S. J., & Alemagno, S. A. (1991). Prediction of motivation and behavior change following health promotion: Role of health beliefs, social support, and self-efficacy. Social Science & Medicine, 32(3), 311-320.
28.
Keltner, B.
, & Ramey, S. L. (1992). The family. Current Opinion in Psychiatry, 5, 638-644.
29.
Keltner, B.
, & Ramey, S. L. (1993). Family issues. Current Opinion in Psychiatry, 6(5), 629-634.
30.
Kilpatrick, M.
, Kristjanson, L., Tataryn, D., & Fraser, V. (1998). Information needs of husbands with breast cancer. Oncology Nursing Forum, 25(9), 1595-1601.
31.
Krishnasamy, M.
(1996a). Social support and the patient with cancer: A consideration of the literature. Journal of Advanced Nursing, 23, 757-782.
32.
Krishnasamy, M.
(1996b). What do cancer patients identify as supportive and unsupportive behavior of nurses? A pilot study. European Journal of Cancer Care, 5(2), 103-110.
33.
Kristjanson, L.
, Leis, A., Koop, P., & Mueller, B. (1997). Family members’ care expectations, care perceptions, and satisfaction with advanced care: Results of a multi-site pilot study. Journal of Palliative Care, 13(4), 5-13.
34.
Kristjanson, L.
, Sloan, J., Dudgeon, D., & Adaskin, E. (1996). Family member’s perceptions of palliative care: Predictors of family functioning and family member’s health. Journal of Palliative Care, 12(4), 10-20.
35.
Kristjanson, M.
, & Ashcroft, T. (1994). The family’s cancer journey: A literature review. Cancer Nursing, 17(1), 1-17.
36.
Lau, R. R.
, Quadrel, M. J., & Hartman, K. A. (1990). Development and change of young adults’ preventive health beliefs and behavior: Influence from parents and peers. Journal of Health and Social Behavior, 31, 240-259.
37.
LeMasters, E.
(1957). Parenthood as crisis. Marriage and Family Living, 19, 352-355.
38.
Lupri, E.
, & Friederes, J. (1981). The quality of marriage and the passage of time: Marital satisfaction over the family life cycle. Canadian Journal of Sociology, 6, 283-305.
39.
Martens, N.
, & Davies, B. (1990). The work of patients and spouses in managing advanced cancer at home. Hospice Journal: Physical, Psychosocial, and Pastoral Care of the Dying, 6(2), 55-73.
40.
Martinson, I.
, McClowry, S., Davies, B., & Kuhlenkamp, E. (1994). Changes over time: A study of family bereavement following childhood cancer. Journal of Palliative Care, 10(1), 19-25.
41.
McHale, S.
, & Huston, T. (1985). The effect of the transition to parenthood on the marriage relationship: A longitudinal study. Journal of Family Issues, 6, 409-433.
42.
McLeod, J. D.
, & Shanahan, M. J. (1993). Poverty, parenting, and children’s mental health. American Sociological Review, 58, 351-366.
43.
McRae, M.
(1991). Holding death at bay: The experience of the spouses of patients undergoing cardiovascular surgery. Canadian Journal of Cardiovascular Surgery, 2(2), 14-20.
44.
Mercer, R.
, Nichols, E., & Doyle, G. (1988). Transitions over the life cycle: A comparison of mothers and non-mothers. Nursing Research, 37, 144-150.
45.
Moser, D.
, Dracup, K., & Marsden, C. (1993). Needs of recovering cardiac patients and their spouses: Compared reviews. International Journal of Nursing Studies, 30(2), 105-114.
46.
Nelson, M. A.
(1994). Economic impoverishment as a health risk: Methodologic and conceptual issues. Advances in Nursing Science, 16(3), 1-12.
47.
Orzeck, S.
, & Staniloff, H. (1987). Comparison of patients’ and spouses’ needs during the posthospital convalescence phase of a myocardial infarction. Journal of Cardio-pulmonary Rehabilitation, 7(2), 59-67.
48.
Patterson, J. M.
(1990). Family and health research in the 1980s: A family scientist perspective. Family Systems Medicine, 8(4), 421-434.
49.
Pearlin, L.
, Lieberman, M., Managhan, E., & Mullen, J. (1981). The stress process. Journal of Health and Social Behavior, 22, 337-356.
50.
Periard, M.
, & Ames, B. (1993). Lifestyle changes and coping patterns among caregivers of stroke victims. Public Health Nursing, 10, 252-256.
51.
Rando, T. A.
(1984). Grief, dying, and death: Clinical interventions for caregivers. Champaign, IL: Research.
52.
Rando, T. A.
(Ed.). (1986). Parental loss of a child. Champaign, IL: Research Press.
53.
Rando, T. A.
(1993). Treatment of complicated mourning. Champaign, IL: Research Press.
54.
Ransom, D. C.
(1986). Research on the family in health, illness and care—State of the art. Family Systems Medicine, 4(2-3), 329-335.
55.
Raudonis, B.
, & Kirschling, J. (1996). Family caregiver’s perspective on hospice nursing care. Journal of Palliative Care, 12(2), 14-19.
56.
Schumacher, K.
, & Meleis, A. (1994). Transitions: A central concept in nursing. Image: Journal of Nursing Scholarship, 26, 119-127.
57.
Selder, F.
(1989). Life transition theory: The resolution of uncertainty. Nursing & Health Care, 10(8), 437-451.
58.
Skaff, M.
, & Pearlin, L. (1992). Caregiving: Role engulfment and the loss of self. The Gerontologist, 32, 656-664.
59.
Smith, G.
, Smith, M., & Toseland, R. (1991). Problems identified by family caregivers in counseling. The Gerontologist, 31, 15-22.
60.
Spradley, J. P.
(1979). The ethnographic interview. New York: Holt, Rinehart and Winston.
61.
Spradley, J. P.
(1980). Participant observation. Fort Worth, TX: Harcourt Brace Jovanovich.
62.
Tapp, D.
(1995). Impact of ischemic heart disease: Family nursing research, 1984-1993. Journal of Family Nursing, 1(1), 79-104.
63.
Thomas, R. B.
(1990). A foundation for clinical family assessment. Children’s Health Care, 19(4), 244-250.
64.
Tomlinson, P.
(1996). Marital relationship change in the transition to parenthood: A reexamination as interpreted through transition theory. Journal of Family Nursing, 2(3), 286-305.
65.
Van Riper, M.
, & Selder, F. (1989). Parental responses to a child with Downs Syndrome. Loss, Grief and Care: A Journal of Professional Practice, 3(3-4), 59-76.
66.
White, L.
, & Booth, A. (1985). The transition to parenthood and marital quality. Journal of Family Issues, 6, 435-449.
67.
Wingate, A.
, & Lackey, N. (1989). A description of the needs of noninstitutionalized cancer patients and their primary caregivers. Cancer Nursing, 12(4), 216-225.
68.
Wise, P. H.
, & Lowe, J. A. (1992). Noise or fugue: Seeking the logic of child health indicators. Mental Retardation, 30(6), 323-329.
69.
Worden, J. W.
(1982). Grief counseling and grief therapy: A handbook for the mental health practitioner. New York: Springer.
70.
Yin, R. K.
(1994). Case study research: Design and methods (2nd ed.). Thousand Oaks, CA: Sage.
