4.2 Family Structures, Cultural Practices, Roles, and Functions

Family Structures

In the United States, a family was traditionally defined as a heterosexual male married to a heterosexual female who raised their children together in one household. According to the U.S. Census Bureau, family is now defined as a group of two or more people (one of whom is the householder) related by birth, marriage, or adoption and residing together.[1] See Figure 4.1[2] for an image of a traditional family.

Image showing a simulated family silhouetted against a sunset background
Figure 4.1 Traditional Family

As societal and cultural norms continue to evolve, a variety of modern family structures are considered a family. Table 4.2 describes examples of many modern family structures.

Table 4.2 Examples of Modern Family Structures[3]

Family Structure Description
Dual-parent  Two parents raise children. Parents may be the children’s biological mother and father who are married or unmarried, adoptive parents, or same-sex caregivers.
Single-parent  One parent (male or female) raises children by choice or due to other circumstances. For example, a single parent may choose to parent without a partner, or they become a single parent due to loss of their partner through death or divorce. An additional scenario of a single-parent household is when families immigrate or move across the U.S. and both parents cannot relocate at the same time.
Grandparents, other relatives, or unrelated family members raising children In some circumstances, biological parents are not able to care for their children for a variety of reasons, such as incarceration or loss of custody due to neglect, abuse, or untreated substance use disorder. Children may be raised by relatives, such as grandparents or extended family members or by unrelated people who have assumed caregiver roles.
Teen parents Teens raising their children may elect to do so as a single parent, with a partner, or with the help of their families. Teens who become pregnant while still in high school may participate in supportive programs where they can return to school and have access to parenting classes and childcare.
Adoptive families Adoptive parents legally take a child into their family and raise them as their own because of infertility issues or because they prefer adoption. Adoption may be open or closed. Open adoption ranges from simply knowing the identities of the birth parent(s) to having a continued relationship with the birth parents as the child grows up. Closed adoption means the family does not have access to information about the birth parent(s) nor do birth parents have access to information about the adoptive family or child.
Resource families (formerly known as foster families) Resource families refer to child placement in temporary, licensed care due to extenuating circumstances involving their family of origin. Adults who provide care must be trained and follow strict protocols to provide the support, stability, and care these vulnerable children require. The intent of this care is to reunite children with their family of origin whenever possible. However, when it is not possible to achieve this goal, the children are placed for adoption.
Biracial/Multiracial families Parents are from two or more different races.
Families with multi-religious/faith/spirituality beliefs Parents have different religious, faith, or spirituality beliefs. They may choose to raise their children according to one religious/faith/spirituality belief or both.
Children with  incarcerated parent(s) One or both parents are incarcerated. The family’s structure, roles, and functions change when the incarcerated parent is away from home and again when the parent returns home.

Read more information about the impact of incarcerated parents on children on the National Institute of Justice web page.
Transgender parents  A transgender parent is a parent who identifies as a different gender from their biological gender. A transgender parent may transition to a different gender prior to or after having a child.

View a supplementary Vimeo video[4] on care considerations for children of LGBTQIA families: Considerations for Children of LGBTQIA+ Families.
Blended families A blended family consists of two or more parents who become partners and bring children from previous relationship(s) into the family. In some cases, they also have a child together.
Families formed through reproductive technology Infertility treatments allow a female to become pregnant and give birth to a child who may or may not be a biological child of one or both parents. Infertility treatments allow parents to use their own eggs or sperm, or donated eggs, sperm, or fertilized embryos. Another possibility is the use of a gestational carrier, also called surrogate mother, who is a woman who is impregnated through in vitro fertilization and delivers a child for a couple or individual. A legal contract is required for intended parents and their gestational carrier before medical treatment begins.[5]
First-time older parents Older parents in their 40’s, 50’s and older may have children for several reasons. For example, they may have chosen to first establish their career(s) and/or financial security, or they may have experienced infertility resulting in a delay in starting a family. In other cases, women may experience an unplanned pregnancy during perimenopause when they thought they could not conceive.
Families who experience housing insecurity Some children are raised in families that do not have a stable home or are homeless. Families may experience housing insecurity due to the parents’ loss of a job or steady income, bankruptcy, or other issues. They may be living in a car, hotel, homeless shelter, or multiple dwellings with friends and extended family. Family members experiencing housing insecurity or homelessness often do not share this status with others due to the shame and embarrassment that results from social stigma.
Families with children who have developmental delays and disabilities A child or multiple children in a family may have developmental delays and/or disabilities. These conditions often place a burden on families because of the extra responsibilities, time, and money required for care.
Families raising children in a new culture and/or English is not their primary language Families who immigrate may have children who were born in their country of origin or in the United States. Family members may not use English as their primary language, resulting in language barriers in health care and educational settings. Children may be more proficient at using the English language due to attending school and may serve as interpreters for the family. The impact of duality of cultures can create pride, shame, cohesiveness, and/or conflict within the family.

Individuals are influenced by their current family structure, as well as the family structure they grew up in as a child. Family of orientation is a term used to describe the family in which a person grew up as a child. Family of procreation is the term used for the family that adults form through marriage.[6]

Family Cultural Practices

Families share cultural traits from their cultural group and also have their own unique family culture. Culture is defined as the shared values, norms, symbols, language, objects, and way of life that are passed on from one generation to the next. Culture also impacts values and beliefs related to family, such as views on optimal family size, contraception, roles of family members, discipline, child upbringing, and value placed on elders and children.[7] Furthermore, the success of a couple’s marriage can be impacted by how well each spouse merges the culture from their family of orientation into the culture of their family of procreation.[8]

Nurses recognize the impact of family culture on a client’s health and wellness. They provide nonjudgmental nursing care and psychosocial support to clients and their family members. One of the American Nurses Association (ANA) Standards of Professional Practice in Nursing: Scope and Standards of Practice is “Respectful and Equitable Practice.” This standard is defined as “practicing with cultural humility and inclusiveness.”[9] Cultural humility is defined by the ANA as a “humble and respectful attitude toward individuals of other cultures that pushes one to challenge their own cultural biases, realize one cannot know everything about other cultures, and approach learning about other cultures as a lifelong goal and process.” Inclusiveness refers to treating everyone fairly and equally.[10]

The ANA describes the art of nursing as “unconditionally accepting the humanity of others, respecting their need for dignity and worth, while providing compassionate, comforting care.”[11] To provide respectful and equitable care while performing the art of nursing, it is important to begin by identifying one’s implicit biases. Implicit bias is a negative attitude, of which one is not consciously aware, about specific social group(s). Implicit bias is shaped by a person’s experiences and learned associations. A nurse’s perceptions and behaviors can be influenced by their implicit bias, even if they are unaware they hold such biases.[12] Consider your implicit bias about diverse family structures using the reflection questions in the following box.

Reflection Questions[13]

Consider your thoughts and feelings when reading about family structures described in Table 4.2.

  • What does the term family mean to you? Whom do you think of when you define family?
  • Is your family of orientation structure and/or family of procreation structure described in Table 4.2?
  • When reading about types of family structures, did you experience any immediate thoughts, feelings, judgments, or assumptions about people from families whose structures are different from your own family?
  • How could implicit bias affect the nursing care you provide to clients from diverse family structures?
  • What have you learned from this reflection that you will take into consideration during your nursing practice?

Family Roles

Family roles are recurrent patterns of behavior by which family members fulfill family functions and needs. Examples of family roles include parent, son, daughter, sibling, grandparent, and grandchild. See Figure 4.2[14] for an image of family roles. Cultural, societal, and legal expectations exist for how those family roles should be fulfilled. For example, parents are expected to teach, discipline, and provide for their children’s needs, and children are expected to cooperate and respect their parents. As family members age, they may take on additional roles, such as becoming a spouse, parent, or grandparent. A person’s family role is always expanding or changing.[15] However, the ability of a person to perform their family role may be impacted due to chronic illness or disease.[16]

Image of showing five people standing together, implying a family group
Figure 4.2 Family Roles of Parents, Sons, Daughter and Siblings

The decision-maker is influenced by the family’s cultural and religious beliefs regarding who makes decisions and heads the household. For example, in many traditional families in the United States, the father is the decision-maker and the head of the household. In other families, the mother or an elder may make decisions impacting the family members. Sometimes the decision-maker changes with the type of decision such as health care or car maintenance.

Other informal roles in the family may include peace-maker and tradition-holder. The peace-maker keeps the peace in the family by helping family members come to agreements. The tradition-holder keeps family traditions like decorating for holidays or celebrating birthdays, which adds to family cohesiveness.[17],[18],[19],[20],[21]

When family dysfunction occurs, some family members may cope by adopting unhealthy roles. The family often passes these patterns of dysfunction and unhealthy roles from one generation to the next. Common unhealthy roles include the following[22],[23],[24],[25],[26],[27],[28],[29]

  • The golden child: The golden child receives attention from external sources for doing good things and learns their worth is based on their achievements. In adulthood, this role often manifests as perfectionism and a low sense of self. It is common for people who assume this role to become obsessively attached to others as they learn to obtain their value and worth from external sources.
  • The hero: The hero tries to prove to the rest of the world that their family is normal. The family may value a family member’s role with beliefs such as, “If Jim is a football star, then our family can’t be that bad.” In adulthood, people who have assumed the hero role are drawn to achievement and success and are prone to perfectionism and being overworked.
  • The mascot: The mascot diffuses conflict in the family with humor and other methods of deflection. They are able to draw attention toward themselves and away from situations that could become volatile. The child mascot may be popular with friends but hides negative feelings with humor. Many well-known comedians and actors are self-proclaimed mascots.
  • The identified patient: The identified patient, also called the scapegoat or black sheep, is the family member who is identified as the family’s “reason” for having problems. Family members and others label this person as bad, blaming them for everything that goes wrong in the family. Scapegoats can grow up with a feeling of being inherently bad and may choose self-destructive behaviors or become addicted to substances. However, clinicians know that true family issues run deeper than one person.
  • The invisible child: The child’s needs are ignored when another family member has a medical condition requiring most of the parent’s time and energy.
  • The lost child: The lost child is a family member trying to survive unnoticed because getting noticed often means getting in trouble or being abused. They are quiet and tend to withdraw from conflict as they lock feelings away and turn inward because they do not feel safe. The lost child functions on their own without much attention or care from the family and often becomes introverted. In adulthood, a person who assumed this role may maintain a feeling of being lost and unseen, often having feelings of low self-esteem or self-worth and struggling in making decisions.
  • The enabler or caretaker: The enabler maintains the appearance of normalcy within the family by ignoring or tolerating problematic behavior of a family member. The enabler may provide assistance, make excuses, or not establish boundaries with a family member with problematic behavior. The enabler’s goal is to feel self-worth by being needed. Instead, enabling does not actually help but prevents the person with problematic behavior from realizing the negative effects of their behaviors.[30] In adulthood, the enabler may continue trying to fix others and has an overall sense of responsibility for the problems of others.
  • The parentified child: This person takes on the role of a caregiver in the absence of a healthy caregiver. In adulthood, this person is frequently drawn to dysfunctional relationships and emotionally unavailable partners. They often struggle with setting boundaries and base their self-worth on their partner’s (or others’) approval.

Family Functions

Why do people live together as families rather than independently as individuals? The primary reason people live together as families is because families can offer many types of support. The term family functions refers to tasks that support and sustain family members. Families fulfill many functions, including economic support, emotional support, socialization, control of sexuality and reproduction, and ascribed status.[31]

Families provide economic support to family members with essentials like food, clothing, shelter, and education. They can also provide emotional support and intimacy. Intimacy refers to the social, emotional, spiritual, intellectual, and physical trust that is mutually shared among family members that makes them feel loved and secure. Intimacy in family relationships can provide a strong buffer against ongoing stressors experienced outside of the home.[32] See Figure 4.3[33] for an image of a family providing emotional support to one another.

Image showing a family huddled together in a group hug
Figure 4.3 Family Providing Emotional Support

A third function of families is socialization of children. Socialization is the process by which individuals learn characteristics of their cultural group’s norms, values, attitudes, and behaviors. Children are born like blank slates, and family members are their first teachers. Families teach children hygiene skills, good manners, work ethic, eating patterns, sleeping patterns, study habits, and parenting skills. In addition to learning these skills, children also learn cultural and societal roles. They learn how to interact with others in a culturally appropriate manner by experimenting with family interactions. For example, when a child treats a family member in a certain way, they learn from that person’s response whether or not to repeat that behavior. Families also teach their members culturally appropriate displays of emotions. This helps children regulate their emotions and behave appropriately in their cultural group. However, children may also learn ineffective or unhealthy behaviors from their families, which can cause future health problems.[34]

A fourth function of families is control of sexuality and reproduction.[35] Researchers propose that monogamous marriage has been favored by cultural evolution because of its group-beneficial effects. Monogamy reduces crime rates and improves child investment and economic productivity. It also reduces intrahousehold conflict, leading to lower rates of child neglect, abuse, accidental death, and homicide.[36]

Finally, families provide ascribed status. Ascribed status is present at birth and includes cultural, religious, and economic status within the cultural group. In modern U.S. society, achieved status (status that comes as a result of one’s efforts) is more important than ascribed status, but the degree of achievement a person attains can be impacted by the level of support they receive from their family.[37]

  1. United States Census Bureau. (2023, November 3). Subject definitions. https://www.census.gov/programs-surveys/cps/technical-documentation/subject-definitions.html ↵
  2. ”family-730320_1920.jpg” by Alexa from Pixabay is licensed under CC0 ↵
  3. Children, Families, Schools, and Communities by ROTEL is licensed under CC BY-NC-SA 4.0 ↵
  4. Nat'l LGBTQIA+ Health Education. (2024, April 17). Care Considerations for Children of LGBTQIA+ Families. [Video]. Vimeo. All rights reserved. https://vimeo.com/935920627 ↵
  5. Yale Medicine. (n.d.). Surrogacy. https://www.yalemedicine.org/conditions/gestational-surrogacy ↵
  6. Sociology of Family by donnagiuliani is licensed under CC BY-NC-SA 4.0 ↵
  7. This work is a derivative of Nursing Fundamentals by Open RN and is licensed under CC BY 4.0 ↵
  8. Sociology of Family by donnagiuliani is licensed under CC BY-NC-SA 4.0 ↵
  9. American Nurses Association. (2021). Nursing: Scope and standards of practice. ↵
  10. American Nurses Association. (2021). Nursing: Scope and standards of practice. ↵
  11. American Nurses Association. (2021). Nursing: Scope and standards of practice. ↵
  12. American Psychological Association. (n.d.). Implicit bias. https://www.apa.org/topics/implicit-bias ↵
  13. Children, Families, Schools, and Communities by ROTEL is licensed under CC BY-NC-SA 4.0 ↵
  14. ”family-557122_1920.jpg” by Kris from Pixabay is licensed under CC0 ↵
  15. Peterson, R., & Green, S. (2009, May 1). Families first - keys to successful family functioning: Family roles. Virginia Cooperative Extension. http://hdl.handle.net/10919/48301 ↵
  16. Introduction to Social Work: A Look Across the Profession by Langford & Keaton is licensed under CC BY-NC 4.0 ↵
  17. James, R. (2017, October 13). Dysfunctional family roles. [Video]. YouTube. https://www.youtube.com/watch?v=jvmrV1FB4l0 ↵
  18. Heffernan, B. (2023, May 28). Dysfunctional family roles. [Video]. YouTube. https://www.youtube.com/watch?v=wvnlDJ1O3OQ ↵
  19. Stallworth, A. W. (n.d.). Dysfunctional family roles worksheet. Worksheet Zone. https://worksheetzone.org/dysfunctional-family-roles-printable-interactive-63aa616a92a53364d56bc304 ↵
  20. James, L. (n.d.). Dysfunctional family roles chart worksheet. Worksheet Zone. https://worksheetzone.org/dysfunctional-family-roles-chart-printable-interactive-6515c3971ed00b43e118fbd5 ↵
  21. James, L. (n.d.). Dysfunctional family roles chart worksheet. Worksheet Zone. https://worksheetzone.org/dysfunctional-family-roles-chart-printable-interactive-6515c3971ed00b43e118fbd5 ↵
  22. Introduction to Social Work: A Look Across the Profession by Langford & Keaton is licensed under CC BY-NC 4.0 ↵
  23. Gillis, K. (2023, March 23). 8 common dysfunctional family roles. Psychology Today. https://www.psychologytoday.com/us/blog/invisible-bruises/202303/8-common-dysfunctional-family-roles ↵
  24. andle.net/10919/48301 Raypole, C. (2019, June 27). What is an enabler? 11 ways to recognize one. Healthline. https://www.healthline.com/health/enabler ↵
  25. James, R. (2017, October 13). Dysfunctional family roles. [Video]. YouTube. https://www.youtube.com/watch?v=jvmrV1FB4l0 ↵
  26. Heffernan, B. (2023, May 28). Dysfunctional family roles. [Video]. YouTube. https://www.youtube.com/watch?v=wvnlDJ1O3OQ ↵
  27. Stallworth, A. W. (n.d.). Dysfunctional family roles worksheet. Worksheet Zone. https://worksheetzone.org/dysfunctional-family-roles-printable-interactive-63aa616a92a53364d56bc304 ↵
  28. James, L. (n.d.). Dysfunctional family roles chart worksheet. Worksheet Zone. https://worksheetzone.org/dysfunctional-family-roles-chart-printable-interactive-6515c3971ed00b43e118fbd5 ↵
  29. James, L. (n.d.). Dysfunctional family roles chart worksheet. Worksheet Zone. https://worksheetzone.org/dysfunctional-family-roles-chart-printable-interactive-6515c3971ed00b43e118fbd5 ↵
  30. Raypole, C. (2019, June 27). What is an enabler? 11 ways to recognize one. Healthline. https://www.healthline.com/health/enabler ↵
  31. Sociology of Family by donnagiuliani is licensed under CC BY-NC-SA 4.0 ↵
  32. Sociology of Family by donnagiuliani is licensed under CC BY-NC-SA 4.0 ↵
  33. ”family-7257182_1920.jpg” by Alisa Dyson from Pixabay is licensed under CC0 ↵
  34. Sociology of Family by donnagiuliani is licensed under CC BY-NC-SA 4.0 ↵
  35. Sociology of Family by donnagiuliani is licensed under CC BY-NC-SA 4.0 ↵
  36. Henrich, J., Boyd, R., & Richerson, P.J. (2012). The puzzle of monogamous marriage. Philosophical Transactions of the Royal Society of London, 367(1589), 657-669. https://doi.org/10.1098%2Frstb.2011.0290 ↵
  37. Sociology of Family by donnagiuliani is licensed under CC BY-NC-SA 4.0 ↵
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