In a period of crisis, such as that caused by the serious illness of a family member, the family structure is modified, the extent of modification depending on what degree the sick member is able to carry out his or her usual family roles and the centrality of the family roles or tasks that arc vacated. The roles taken on by the mother are, as discussed previously, a good example of the centrality of a member’s roles. When illness results in the vacancy of critical roles, the family often enters a state of disequilibrium in which role and power relationships are altered until new homeostasis is achieved (Fife, 1985; Hill, 1958).

Shared, balanced role functions often become impossible to maintain in couples when one partner becomes disabled. Negotiation of revised roles is often needed to prevent role straits and confusion (Rolland, 1994). III a study of the effects of a critical care illness on family members (Johnson et al., 1995), most family members reported changes in family roles and increased responsibilities as the result of critical care hospitalization.

There are two basic types of role changes that occur due to the loss or incapacitation of a family member. First, the remaining family members have enough inner and outer resources that they are able to take on the basic and necessary role obligations and tasks that the sick family member is unable to assume—this is the functional way the situation is managed. Second, they lack the needed inner and outer resources, and as a consequence, certain basic and necessary roles in the family are not performed or arc performed unsatisfactorily. In other words, the adequately functioning family can either flexibly modifies family roles to meet the demands of the situation or may call in resources and assistance from the outside to fill the vacuum. In dysfunctional families, however, this does not happen.

Because of the role changes necessitated due to the loss or incapacitation of a family member, role conflicts and role strain are often present, especially during the stage of faintly disequilibrium immediately following the loss or incapacitation, when family structure is in the transitional period. Either interrole or intrarole conflict may exist, as the family members are “forced” to accept new roles and have had little opportunity to learn these roles or to rearrange all their other role responsibilities. Role strain/stress is

often the outcome. The family members burdened wills the acquisition of new roles may often feel worried, anxious, and guilty because of feelings that they are not doing a competent job in their new roles or that with these added responsibilities, their role complex is excessively demanding and unmanageable.

In a recent review of family nursing research regarding the impact of illness on families with a member experiencing ischemic heart disease, spouses frequently reported stress that was related to the need to assume additional household rotes and health moni- toring responsibilities (Artinian, 1989; Gillis, 1984; Gilliss, Sparacino, Gortner, & Kenneth, 1985; Hilgenberg, Liddy, Standerfer, & Schraeder, 1992; McRae, 1991; Nyamathi, 1987b; Stanley & Frantz 1988; Tapp, 1995). Marital conflict related to role reversal and attempts of the healthy spouse to monitor noncompliance were also consistently reported (Gaplin & Sexton, 1988; Hilgenberg et al.; McRae; Michel & Muntaugh, 1987; Nyainathi, 1987a).

Once a family has achieved a new equilibrium in response to a sick member’s inability to perform his or her roles adequately, a similar reintegration must take place when that member resumes Ids or her old place it’s the family unit. Understandably, having once gone through the process of adapting, the other members may well be reluctant to again “reshuffle” family roles and tasks, despite dm recovery or reentry of the “lost” member. This reluctance is seen even in site mast we/I-functioning families, because the process of reintegrating a family member entails site difficulties and problems that are part of any disorganization before a new (in this case. renewed) balance is achieved.

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