Yearbook on Journal of the Japan Society of Nursing Research 2014

Role Transitions in Families Due to Health Issues: Married Couples’ Viewpoints
Sayuri Tanaka1), Yuko Tomari1)
Key Words :family roles
role transition
married couples
family development

I. Introduction

ABSTRACTThe present study involving the families of patients who developed health problems aimed to examine
their approaches to changing their family roles and adapting themselves, from the viewpoint of a couple.
The subjects were five patients with sequelae associated with cerebrovascular disorders or undergoinghemodialysis and five spouses. Semi-structured interviews with them were conducted during hospitalizationand following discharge. The familial roles were grouped into the following six categories: housework,
earning an income, nursing care/child-raising, liaison, and enshrining ancestors, and examined changes
in these roles over time. The results were as follows: 1) When patients with preschoolers or school-aged
children were hospitalized, the roles of housework and child-raising were shared by their parents. Whenpatients with adult offspring or in the young-elderly group were hospitalized, the roles of housework andhome nursing care were shared by the offspring of the patients. After patients were discharged, these roles
were played by a spouse or one family member alone in all cases. 2) When a family member had a healthproblem, it became difficult for the family to continue to earn an income. 3) When it became necessary fora family member to provide nursing care, the new role increased or decreased his/her role in providing
other family members with emotional support. 4) When patients with adult offspring or in the young-elderlygroup developed health problems, they shifted their roles and authority to their offspring.

by Hill and McCubbin.17) During a period of transition offamilial life stages or when the structure of a family haschanged, role transition occurs as coping behaviors performed
by family members.17) In the field of family sociology, studiesof role transition between husbands and wives have primarily
been conducted to identify factors contributing to husbands’
participation in housework and to discuss changes in theirlifestyles, such as retirement.18-21) Regarding parent-childrelationships, there have been studies of generational changes
associated with role and authority transitions as viewed byelderly parents.22, 23) In the field of nursing science, studies ofchanges in role awareness and coordination were conducted,
with an emphasis on the relationship between patients andcare providers.24, 25) When people develop a chronic disorder,
their families will be required to play a new role as nursing
care providers. No studies have been conducted to examine
the influences of these factors on family members from theviewpoint of role transition.
When people have developed health problems, they
will often be admitted to hospital for treatment and thendischarged home. The present study examined how thefamilies of patients changed their roles and adapted
themselves during this process, with a focus on couples - thecenter of families. The obtained results should be useful forclinical research on care and support approaches, taking into
consideration patients and all other family members and theirpost-discharge lives.

If a person has developed a health problem, this person andtheir family will be required to change their daily activities,
and the family environment and relationships will easilychange. As these changes are considered to cause further
problems, it is necessary to support patients and their families
in this period.
In order for health care professionals to provide thefamilies of patients with support or to identify the natureof necessary support activities, they are required to adopt
a viewpoint that allows them to understand the family of apatient as a whole.1) However, since nursing care provided
in clinical settings usually focuses on individual patients,
health care professionals have difficulty providing thefamilies of patients with support despite their recognition of
its importance. In the field of research on adult and elderly
nursing care, many more studies have focused on patients andprimary care providers than those emphasizing patients andtheir families,2-10) and these studies viewed family members
as background factors behind patients, considering family
structures and relationships as related factors.
In the field of family sociology, a variety of approaches forunderstanding the families of patients have been studied
and developed.11) Family development approaches, which
integrate many different concepts, including theories
of interactions and family life cycles,11-13) can be used tocomprehend internal processes that occur in families, changes
in their structures, and differences between generations. The
approach focusing on “roles” in particular helps researchers
view “patients and their families” as a unit, examine theirchanges in integrated and multidimensional manners,14) anddevelop more appropriate family intervention methods.
Within the framework of theories of family roles, changes
in relationships related to family roles, expectations, andskills are regarded as role transitions.15, 16) Research on shifts
in familial roles started to be conducted in the mid-1980s,
utilizing the framework of familial stress theories established

II. Study Methods

A qualitative and descriptive research method includingsemi-structured interviews was adopted.
1. Conceptual framework

1) Faculty of Nursing, Shiga University of Medical Science

Corresponding author. Tel.: +81 771 72 1181; Fax: +81 771 72 0326.
E-mail address: sayutana@meiji-u.ac.jp (S. Tanaka)

47

The present study aimed to examine changes in the lives offamilies of people who have developed health problems andtheir family roles, from the viewpoint of patients and theirspouses as a subsystem. In this study, the theory of roles
based on developmental theory was adopted as a conceptual
framework (Figure 1). Figure 1 suggests that health problems
affect role expectation and recognition: components of a role,

This paper was published at “the Japan Society of Nursing Research” Vol.25 No.5 in 2002.

Yearbook on Journal of the Japan Society of Nursing Research 2014

[Family roles]
Shared roles to be played by each member of a family
to maintain the group. The framework of the classification
was developed by reference to the following: Items from
Koyama’s28) Japanese version of the classification revised
based on the methods developed by P. G. Herbst and R.
Blood, the structure of group roles suggested by Morioka
and Mochizuki,13) items from the married-couple subsystemsuggested by Nye and Gecas,29) and the classification by
Kamiko;30) six role categories were extracted (Table 1).

Extended family

Role performance

Role expectationRole recognition

Family basically consisting of a couple

Table 1. Classification categories of family roles

1. Role of doing housework
2. Role of earning an income
3. Roles of providing the elderly and patients with nursing careand parenting
4. Roles of the alleviation of tension and emotional integration
5. Role, as a representative liaison, of helping family members
interact with their relatives, neighbors, and various organizationsin the community
6. Role of enshrining ancestors

Health problem

Figure 1. Role transition when a family member has
developed a health problem

and their changes influence role performance. In the process,the influenced role expectation affects role expectation andrecognition, which also interact with each other. Such a
process occurs between couples in particular, and also amongfamily members including elderly parents and their offspring(extended families).

Housework-related roles in the present study refer toactivities such as cooking, laundry, simple carpentry, andlocking up the house. The role of the acquisition of income
refers to the activity of earning income. The role of theprovision of nursing care for infants, elderly people, andpatients refers to daily-life support, including meals, toilet,
and bathing, to help the young, the elderly, and the infirm
live a normal life. Activities of taking consideration of thehealth conditions of other people were also included. Childraising in this study refers to parenting of high school-aged
or younger children. The roles of relaxation of tensions andemotional integration (emotional roles) refer to behaviors ofcaring, understanding, discussing, cherishing, and opening up
to and going out with others. The role of liaison represented
by helping family members interact with their relatives,
neighbors, and various organizations in the community refers
to interactions among relatives and PTA activities. Visiting
ancestors’ graves is defined as the role of enshrining theirsouls.

2. Operational definitions of terms

The present study adopted the following operational
definitions of terms:[Family]: A family consisting of a patient and his/her spouse isdefined as a conjugal family (husband and wife), and a family
consisting of a couple, their children, and their (elderly)
parents is defined as an extended family.

[Family development]
Changes in the structure of a family, or a group of people
who function in specific cultural and social systems, and theirrelationships over time. The present study adopted the theory
that the development of a family can be classified into sevenstages according to the number of family members and thelevel of development of the oldest child.26, 27)

3. Subjects[Role transition]
This study examined changes in family development fromthe viewpoint of the roles of family members, and interpreted
them as changes in the relationships among the roles withina family, role expectations of other family members, andabilities to play their roles.26)

The subjects were patients admitted to two hospitals in aprefecture who satisfied all of the following conditions andtheir spouses, namely, five couples:- Patients with cerebrovascular diseases whose physicalfunction was impaired or condition worsened so thatthey required dialysis treatment due to the most recent
hospitalization- Middle-aged to elderly males and females- Married people (regardless of the duration of marriage)- People scheduled to be discharged home
- People who were unlikely to be readmitted to hospital forthree to four months[Role performance]
Behaviors actually performed while taking into consideration social norms, recognitions based on circumstances, andexpectations from other people[Role expectation]
Expectation of the behaviors of other people according torecognition based on social norms and circumstances

4. Period of the survey[Role recognition]
Understanding of behaviors expected of oneself byother people, based on recognition of social norms andcircumstances

The survey was undertaken between April and October
1999. Interviews were conducted twice: during hospitalizationand two to three months after discharge, to examine changes
over time. The appointed time and place for the interview were
decided by taking into consideration the physical conditions
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This paper was published at “the Japan Society of Nursing Research” Vol.25 No.5 in 2002.

Yearbook on Journal of the Japan Society of Nursing Research 2014

and lives of patients and their families and prioritizing
their intentions. Interviews with husbands and wives wereconducted separately to encourage them to speak about theirspouses honestly.
To give due consideration to research ethics, we provided
patients and their spouses with oral and verbal explanations
when we asked them to participate in the survey. Before theyconsented to the study, it was explained to them that they
could withdraw from the interview at any time and that what
they said would be kept secret from their spouse.

There were two male (husbands) and three female (wives)
patients. The ages of the patients ranged between 39 and 61
years old; husbands were aged 39 to 63 years old and wives
29 to 61 years old. Regarding health problems, there were
three patients undergoing artificial hemodialysis due to renal
diseases and two patients with impaired physical functions
due to cerebrovascular disorders.

The question items were developed based on the category
structure of the Calgary Family Assessment Model,31) with thegoal of understanding families, and the Questionnaire Survey
for the Understanding of the Structure of Family Roles,22, 28)
with the goal of understanding “married-couple/parent-childsubsystems” (Table 2).

1) Examples of patients with preschoolers (in the childraising period) and school-aged children

2. Changes in family roles in each of the developmental stages
In this section, common items extracted from the data andrepresentative remarks of the subjects are presented.

5. Structure of the questionnaire (question items)a. When the wife was in good health, the husband helped her
with housework and parenting.

The husband took out the garbage, took the children out
and brought them home, played with the children, cleaned
the bathtub and rooms, took care of the garden and trees, andmanaged their land.
I often played with our children on holidays. Since my wife
(patient) was busy in the morning, I cleaned the bathroom
every day. I sometimes cleaned the rooms as well (husband
with school-aged children).

Table 2. Question itemsa) Attributes of the families of the subjects(1) Type of family(2) Age(3) Relationship to the patient(4) Employment status(5) Health condition (medical history/chronic disorders)(6) Living together with or separately from the patients(7) Driver's licenseb) Married couple subsystem (patients and their spouses)(1) Academic background(2) Form of the marriage(3) Most reliable person(4) Behaviors of the day (status of performed family roles)(5) Role recognition(6) Roles expected of the spouse(7) Stress experienced or not experiencedc) Parent-child system (Generations of patients' children andsenior parents)(1) Status of performed family roles(2) Role expectation and recognition(3) Stress experienced or not experiencedd) Social network
Relationships with relatives, neighbors, friends, and patients'
associations

b. When husbands or wives were hospitalized, their spouses
did the housework and parenting, and provided nursing care.

When husbands or wives were admitted to hospital, theirspouses did housework and provided child and nursing
care, in addition to earning an income. Specifically, the rolesof nursing care performed by them included preparation
for hospitalization, hospital visitation, the collection of
information on the health problem, listening to explanations
provided by physicians, and conveying them to the patient.
I am in charge of almost all of the housework. I listen to
explanations provided by the physician and convey themto my wife the following day. I always drop by the hospitalon my way home from work (husband with school-aged
children).
c. When husbands or wives were hospitalized, their mothers
helped with housework and child-raising.

6. Data analysis method

Data were coded and classified into “role performance”,“role expectation”, and “role recognition”. “Role performance”
was classified for each of the six family role categories. Dataobtained from three different periods: “prior to the onset ofthe disease (until the day before hospitalization)”, “duringhospitalization”, and “following discharge”, were classified to
examine changes over time and extract common items.

When the spouses of patients left home for work or hospital
visitation, their mothers prepared meals, took their children
to and from kindergarten, and took care of them.
When my husband was ill, our children were taken care of
by my mother-in-law three days a week and by my motheronce a week. My mother-in-law took care of our children ather home on weekends (wife in the child-raising period).

III. Results of the Studyd. When husbands or wives had become ill, their spouses
recognized that they would have to earn an income insteadand did so.

1. Summaries of case examples

Table 3 shows summaries of case examples of subjects
and their families. The subjects were classified into thefollowing family developmental stages: one couple in thechild-raising period, one couple with children at school, twocouples with adult offspring, and one young-elderly couple.

When husbands or wives had become ill, their spouses felt
anxious over their future, considering that they would have tocompensate for a decrease in the family income, and became
determined to work harder or do extra work.
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This paper was published at “the Japan Society of Nursing Research” Vol.25 No.5 in 2002.

In good health䕕Structure of the family

Dropout of a twoyear college

䕿

䕿

䕕

䕿 䕕
䕿

Husband䖂䕕䕕䕿

Husband/Parents

䕿
䕿

Wife

䕕

ᅇ

High school

RetiredSelf-employed

Dialysis due tochronic renal
disorders52

Husband (patient)

䕕

䕕

䕿

Eldest son

High school

Self-employed

Self-employed

In good health

52

Wife

Case A (a couple with adult offspring)

Dialysis due
to diabetic
nephropathy

53

Wife (patient)
Asthma from 10
years ago

63

Husband

䕿

䕕

None

High school

䕿

䖂

䕿

䕕

HusbandHigh school

Company employee Full-time housewife

This paper was published at “the Japan Society of Nursing Research” Vol.25 No.5 in 2002.

50

䕿

䕕

䕕

䕿

䕿

䖂

䕕

䕕

HusbandHigh school

Management ofimportant documents

The parents of the patient: They stayed They did housework when the patient was While his father was hospitalized, he was The patient expected her to do housework The eldest daughter (35): Full-time housewife
overnight at the patient's home once a not at home.
in charge of the family business.
and provide nursing care.
living about 30 minutes away by car from themonth.
couple's house.

Living separately The parents of the couple living about 90 The parents of the patient living in the The eldest son (28) living 20 minutes The second daughter (26) living in the The eldest son (37) living on the same
minutes away by car from their house.
neighborhood.
away by car from the couple's house:neighborhood.
premises: He and his parents agreed thatthey would not interfere with each other.

䕕

䕿

Wife

High school

Househusband

Full-time housewife

Occlusion of theleft middle cerebral
artery Left hemiplegia

61

Wife (patient)

Example of a couple in the young-elderly
periodCompany employee Company employee Company employee

High bloodpressure55

HusbandCase B (a couple with adult offspring)

The eldest (16) and second (11) sons: The second (26) and third (24) sons: The eldest daughter (28): Nurse. The
During their mother's hospitalization, they Company employees. During their father's patient did not expect her to do housework
took care of themselves.
hospitalization, they sometimes helped and provide nursing care.
their father attend hospital and did
housework.

䕕

䕕

Wife

Dropout of a college

Sideline business at
Company employee Full-time housewife
home

Dropout of a twoyear college

Dialysis due tochronic renal failure

46

Wife (patient)

Clerk in a hospital

In good health51

HusbandFull-time housewife Company employee

Persons living with the patient The eldest daughter (5) and son (3).

Family members of thehusband and wife from thecouple's perspective--------

Wife

Reliable family members

ᅇHigh school

Clerk

Academic background(following hospitalization)

Attendant

29

Cerebellar infarction
Right cerebellar
ataxia39

Job (prior to hospitalization)

Health condition

Age

Wife

Husband (patient)

An example of a couple in the child-raising An example of a couple with school-aged
periodchildren

Table 3. Summary of case examples

Yearbook on Journal of the Japan Society of Nursing Research 2014

Yearbook on Journal of the Japan Society of Nursing Research 2014 fter my husband became ill, I worried about our futureA
every day. I started doing extra work because my husband
might lose his job (wife in the child-raising period).

2) Examples of patients with adult offspring (a) (b) and in theyoung-elderly perioda. When the patient was in good health, her husband only
performed the role of earning an income.

e. After husbands were discharged, they became more
involved in housework.

The wife used to do all of the housework. The husband wascommitted to his work and enjoyed his hobbies all day longon days off and holidays.
I played with his friends after work and did not care about
my wife (patient) at all (husband in the young-elderly
period).

A husband (patient) washed the dishes after meals to
alleviate the physical fatigue of his wife and prevent her
condition from worsening. He felt sorry for his wife, andstarted doing what he could to help her: taking in the laundry
and cleaning the bath and other rooms, which were also
rehabilitation exercises for him.
I clean the windows of our house because I was told that it
would be a good rehabilitation exercise for my hands. Since
I rely too much on my wife, I apologize to her for this by
doing that. I may be trying to find what I can do (husband
in the child-raising period).

b. While patients were in hospital, their spouses did
housework and provided nursing care.

When their spouses were admitted to hospital, thehusbands and wives performed the roles of earning an
income, doing housework, and providing nursing care.
Specifically, the role of providing nursing care included
preparation for hospitalization, hospital visitation, thecollection of information on the health problem, listening to
explanations provided by physicians, and conveying them tothe patient.
I received explanations from the physician, and I conveyed
them to my wife (patient) several times. I visited thehospital in the morning and evening (twice a day), andalso performed housework (husband in the young-elderly
period).

f. Patients recognized that they could not continue to earn asmuch of an income and withdrew from or reduced their work
following discharge.

Since my husband was replaced by another person at work
due to his long-term hospitalization and impaired physicalfunctions, he changed his job to perform simpler tasks.
Although a wife (patient) wanted to continue her job andthe physician approved of this, she withdrew from work,
taking into consideration the burden of work, time constraint
due to treatment, and the wishes of her family.
A colleague who replaced me during my hospitalization
continues to work in that position. I could not resume myprevious work due to my impaired right hand and ear, andI changed my job to perform simpler tasks (husband in thechild-raising period).

c. When patients had developed health problems, they
expected their children to perform housework, earn an
income, and provide nursing care.

Patients and their spouses expected their sons to earn
an income and conduct household management, and theirdaughters to perform housework and provide nursing
care: the roles that had been performed by patients prior tohospitalization.
I can feel at ease because my second daughter, who
is married, comes to our house every evening to dohousework for my husband and eldest daughter while I
am in hospital (wife with adult offspring (b)).

g. After husbands or wives were discharged, their spouses
provided nursing care.

While patients were receiving care at home, theirspouses provided them with the following nursing care:health management for them, efforts to improve meals,
encouragement to perform self-care, psychological support,
and ensuring their safety.
I told my husband (patient) that he should also pay
attention to his condition because I cannot stay home all
day to take care of him, although I can cook when I am athome (wife with school-aged children).

d. When patients had developed health problems, theirchildren did the following tasks: housework, earning an
income, nursing care, liaison, and enshrining ancestors.

While a patient was hospitalized, her son was in chargeof the family business, interacted with relatives, andpaid respects to their ancestors’ grave. Her daughter did
housework and provided nursing care.
Since I had to stay with my wife (patient), my son
participated in a Buddhist memorial service and paid
respects to our ancestors’ grave during the Bon Festival
period (husband in the young-elderly period).

h. After a patient had been discharged, his wife wished that
her children would provide nursing care in the future.

The wife hopes that her children would become health care
professionals so that the patient (her husband) and she would
be able to receive care from them in the future.
I hope that my children will become health care
professionals. Although I do not want to ask my children
to help me with housework right now, I am expecting themto take me to hospital when I am older (wife with schoolaged children).

e. When patients developed health problems, they recognizedthat they had to give up or reduce their role of earning an
income, and retired from or reduced their work.

Patients retired or reduced their work for the following
reasons: long-term hospitalization, time constraint, impaired
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Yearbook on Journal of the Japan Society of Nursing Research 2014

physical functions, self-awareness of decreases in physicaland psychological strengths as well as abilities, to prevent
recurrence, and the wishes of family members. The spousesof patients retired or coordinated their work schedule.
As my husband has to attend hospital frequently, he works
at his company once a week, and does simple work at homeon other days (wife with adult offspring (a)).
I had to retire in order to provide nursing care and do all
housework because I live alone with my wife (husband in theyoung-elderly period).

b. Following discharge, patients could not adapt to theworkplace and felt helpless.

I was replaced by someone while I was in hospital, and I do
not think that the workplace needs me. I became frustrated
because I was not assigned to the tasks that I used to perform
prior to hospitalization. I also felt anxious about being fired
and helpless, thinking that there is nothing I can do.
Will I ever be able to work in the same manner as I used
to? Will the company continue to employ me under suchconditions? I may have to change my job (husband in thechild-raising period).

f. After patients were discharged, their spouses or only one
family member primarily performed housework and nursing
care.

c. Following discharge, my husband could not receive nursing
care support from our children.

The spouse of a patient or one family member performed
the following tasks as nursing care: housework/healthmanagement of patients, efforts to improve meals,
encouraging self-care, psychological support, helping thepatient attend hospital, and ensuring the safety of the patient.
Since my husband was discharged, I have been checking hiswater intake, measuring his blood pressure, and preparing
sodium-restricted meals (wife with adult offspring (a)).

My husband was expecting to receive rehabilitation
support from our daughter-in-law. However, he could notreceive any support at all and became frustrated with ourson and daughter-in-law.
I was expecting my daughter and wife to help me withrehabilitation at home. However, my son, who lives nextdoor, has been busy at work since I was discharged, andour grandson stays for only a short period of time. I wish
that my daughter-in-law could pay more careful attention
to me (husband in the young-elderly period).

3. Influences of role transition on emotional aspects
1) Positive effects

d. Following discharge, patients could not talk with theirspouses and became frustrated.

a. Following discharge, couples provided each other withemotional support more often.

Following discharge, patients wished to hold conversations
with their spouses. However, the spouses had no time
for these because they were tired from working, doinghousework, and child-raising, and patients became frustrated
with their reactions.
My husband leaves for work early in the morning. Whenhe comes home from work, he washes the dishes after
dinner, takes a bath, and falls asleep immediately. He isoften reluctant to hold a conversation with me even when
I talk to him. I wish to talk to him about our children andfuture (wife with school-aged children).

After patients were discharged, they talked, cared,
encouraged, and discussed with their spouses more often
because there was more time for them to spend together:
the role of earning an income was assumed by other family
members and patients were assisted by their spouses when
they attended hospital.
I did not care about my wife when she was in good healthor prior to her hospitalization. Now, I spend more time withher, providing nursing care, doing housework, and talking
with her (husband in the young-elderly period).

IV. Discussion2) Negative effects

a. Spouses and family members of patients felt stressed.

Family roles in each family developmental stage werediscussed.

The spouses of patients felt burdened because they had
to coordinate relationships between patients, who had been
deprived of their roles, and their children, who had becomein charge of them, and assume a new role involving the healthmanagement of patients. Since only one family member
provided nursing care and did housework in most cases, they
became stressed.
As my husband had not felt that his company needed him
following his discharge, I consulted with him about his job
to inspire him while being careful to keep him from feelingpressured. Our eldest son had to replace my husband onvery short notice, and had difficulty adapting to work. As amediator between my husband (patient) and son, I always
have to be careful. I also feel stressed conducting the healthmanagement of my husband (wife with adult offspring (a)).

1. Division and transition of family roles

Murata32) suggests that, to overcome the health problemsof a family member, namely, a family crisis, it is importantfor people to adapt flexibly to changes in their family roles
and lifestyles, and become able to receive external resources
and support in appropriate manners, separately from thecircumstances. In five cases presented in the present study,
family roles were shared by husbands and wives when afamily member had developed a health problem,26) and theroles previously played by patients and their spouses wereassumed by extended family members. Family roles suchas doing housework, child-raising, and nursing care could
be shared by two or more family members, and the role ofearning an income was often assumed by no-one or one
family member. The traditional idea regarding gender roles
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Yearbook on Journal of the Japan Society of Nursing Research 2014

that “Husbands work outside and wives do housework” isconsidered to be deep-rooted in Japan.33) To address thehealth problems of a family member, it is essential for thefamily to be able to share their roles and perform themregardless of their gender.
Impaired physical functions may reduce the scope ofdaily life activities and influence the division of roles. It isadvised to simplify the roles to be performed, and encourage
family members to share roles by utilizing social resources
and family networks. However, patients in the child-raising
period, whose ADL levels had been maintained to some extent,
were able to recognize housework as part of rehabilitationin their daily lives and perform it. In the above-mentioned
cases, role performance was facilitated based on the purposeof treatment and the roles of the spouses of patients, or heavy
burdens on them, were reduced. It is necessary to apply thesecases to clinical nursing settings.

3. Influences of role transition on emotional aspects

Japanese couples with preschoolers or younger children
tend to have fewer opportunities for communication.35, 36)
According to the results of the present study, after patientswith high school-aged or younger children were discharged
from hospital, they expected their spouses to communicate
with them more often or to perform emotional roles. This
family developmental stage is an important period for couples
to review their future direction, and they are faced with anumber of problems. To help patients and their families
address the occurrence of unexpected health problems, it isnecessary to encourage them to communicate with each othermore often. In the case of “couples with adult offspring” andthose in the young-elderly period whose spouses stopped
earning an income or worked less, they communicated witheach other more often following discharge than during or evenprior to the hospitalization period. Satisfaction with spouses
experienced by people in the elderly period significantly
correlated with the time couples spent on conversation andother activities.37) In some cases, a new role in the provisionof nursing care performed by husbands or wives due to thehealth problems of their partners improved their marital
relationship.
Since people in the young-elderly period had lived withthe belief that they and their married children should notinterfere with each other, the roles of providing nursing care
were not shared at all. The occurrence of health problems
highlighted their poor relationships. The study results suggestthat it is important for people to establish close relationships
with their children (including those in law) and emotionalbonds with them, rather than interfering with them.

2. Role transition

When patients with high school-aged or younger children
were hospitalized, their spouses primarily provided nursing
care, and the mothers of patients (grandmothers) helped themwith housework and child-raising. During hospitalization,
patients and their spouses received support from extended
family members, as viewed by them, who were living with or
separately from them. However, in all cases, the spouse of thepatient or one family member performed the roles, and someof them felt stressed. As the functions of a family continue toweaken, it has in recent years become increasingly difficult
for a network consisting of only family members to address
the above-mentioned problems due to the proliferation of
nuclear families, aging of the population, and decrease in thebirth rate. Since family members overburdened with various
roles often feel stressed after patients are discharged, it isnecessary to provide support while taking into consideration
the post-discharge lives of family members as nursing careproviders to alleviate their stress.34)
Family roles are closely associated with the authorityof family members.13) Previous studies suggested that, as
children start to assume some of the roles played by theirparents at an age of approximately 71 years or older, theauthority of the parents also shifts to their children.22) When
parents with adult offspring and those in the young-elderly
period developed health problems, some roles importantto families, including the acquisition of income, liaison, andenshrining ancestors, were assumed by their children (roletransition). When individuals who financially support theirfamilies, which empowers them, suddenly become unable
to perform their roles due to illness, with these roles being
assumed by their children, parent-child relationships tend toworsen until parents accept this new situation. A sense of loss
regarding a person’s roles often influences their perceived
significance of their existence and health awareness. It isnecessary to: encourage the families of patients to assume
new roles so that they can understand the significance of
their existence and reason for living, give consideration tothem by reducing their roles using a step-by-step approach,and implement intervention to inspire them to change theirvalues and view role transition as a positive change rather
than a negative one.

V. Conclusion

The present study involving the families of patients who
had developed health problems aimed to examine theirapproaches to change their family roles and adapt themselves,from the viewpoint of a couple, which is the core of a family,
as a subsystem. However, the number of subjects was small:
one couple in the child-raising period, one couple with schoolaged children, two couples with adult offspring, and one
young-elderly couple. The results were as follows:
1. When patients with preschoolers or school-aged children
were hospitalized, the roles regarding housework and childraising were shared by their parents. When patients had adultoffspring or were in the young-elderly group, these roles wereshared by their children. After patients were discharged, theseroles were played by their spouses or one family member.
2. When a family member had developed a health problem, it
became difficult for the family to continue to earn an income.
3. When it became necessary for a family member toprovide nursing care, this new role increased or decreased
this person’s role of providing other family members withemotional support.
4. When patients with adult offspring or in the young-elderlygroup had developed health problems, they shifted their roles
and authority to their children.
The results of the present study do not necessarily apply to
all disorders because all subjects were patients undergoing
dialysis treatment and with impaired physical functions, andthe number of subjects and their attributes were limited. It
53This paper was published at “the Japan Society of Nursing Research” Vol.25 No.5 in 2002.

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Acknowledgement

I would like to express my appreciation to the families ofthe patients for participating in the interview survey, and thestaff members of the hospital for providing introductions tothe subjects, despite their busy health care activities.
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