The Family Structural Theory
The Family Structural Theory provides a method in which a nurse is able to identify how family members interact with one another to establish a baseline. These interactions create patterns of behavior that the nurse is able to focus on when assessing how, why, and under what circumstances family members behave in their assumed roles, how they are organized as a family, what their established boundaries are, and how they are able to adapt when faced with change, illness, or crisis. If these family interactions are failing to yield positive outcomes, the nurse can use the Family Structural Theory to facilitate improvement in family functioning (Minuchin, & Fishman, 2004).
Once actual and potential problems are identified in a dysfunctional family, a specific care plan, including family health promotion education, and strategies for initiating and maintaining behavior change can be developed. Family members should start by trying to solve their individual problems, one at a time, then begin the work of tackling the family’s problems, one step at a time. The nurse should educate, and reassure the family that change will occur gradually, with each member first changing a single behavior of their own. Once these baby-steps start to produce positive outcomes, the family’s rules and organizational structure, or lack thereof, would need to be changed to gain functional order from dysfunction (Minuchin, & Fishman, 2004).
An example of the Family Structural Theory at work is the successful treatment of those diagnosed, and suffering from the disease of Anorexia Nervosa. In 1978, Salvador Minuchin was a contributing author of Psychosomatic Families: Anorexia Nervosa in Context. Through the use of the Family Structural Theory, caregivers were able to identify causes, which were shown to often originate within the family itself, and design effective interventions to help change the behavior of those individuals with Anorexia Nervosa, and the behavior of their families, to facilitate lasting success over the disease (Minuchin, Rosman, & Baker, 1978).
From personal experience, this nurse can think of one family in particular where the Family Structural Theory helped provide a working model to facilitate the restoration of some level of function to a dysfunctional family. The patient was a 13 year-old female, seen in the pediatric emergency department for dyspnea, and fever. Upon entering the room, the first thing that jumped out at me was the red color of a Marlboro cigarette box in the girl’s front pocket of her jean-jacket.
After starting her Albuterol/Atrovent nebulizer treatment, and communicating with radiology the approximate time that she would be ready for her X ray, I asked the adult with her, the maternal grandmother of the patient, who bought her the cigarettes. She laughed and told me that she did not know. Upon exiting the room, I spoke to the doctor who advised me that they were frequent-flyers who were already in the system. After the diagnosis of pneumonia was made, and it was time for me to provide patient education and discharge, including family health promotion education. I took the opportunity to tell a story of a COPD patient that I had in the hospital about ten years ago. I asked my 13 year-old patient how many times she took a breath in one minute. Then I told her to multiply that 84 by 60 minutes in one hour. Then I told her to multiply that number by 24 hours in one day.
Then I told her to multiply that number by 365 days in one year. Then I told her to multiply that number by the 20 years this woman had been suffering from COPD. I told my 13 year-old patient to imagine having to struggle for each of those breaths, every second, of every day, not being able to breathe, or to eat, or to drink, or to speak a full sentence, or to sleep, or to have one moment of comfort, and how there were not enough pillows for this woman to be able to sit up enough to get comfortable; she had about 12 pillows behind her back trying to get in a position where she could breathe; nothing helped. She was not able to breathe in oxygen, or exhale carbon dioxide, and was essentially suffocating to death. Neither of them said a word as the 13 year old cried quietly.
That was in 2009; she is 17 years-old now. I see her and her grandmother from time to time, when the girl is brought in to the emergency department; they are one of the many families who utilize the emergency department for their primary care needs. The last time I saw the girl, she told me that she did not smoke again after that day when I spoke to her about my COPD patient. She added that no one ever spoke to her like that, and that no one ever cared if she smoked or not, because everyone in her family smoked. Since 2009, she told me that her grandmother does not smoke anymore either. Being an emergency department nurse, I am with family’s for a short period of time, but I can still use the Family Structural Theory to identify areas of dysfunction, and at least try to change one single thing. It is my hope that with one single change, and the provision of follow-up care, a snowball effect will be set in motion to start the transition from dysfunctional behavior to functional behavior.