altered parenting and the reconstituted family

Altered Parenting and the Reconstituted Family

GEORGIA GRlFFlTH WHITLEY, EdD, RN, and JUDITH M. KACHEL, EdD, RN

Reconstituted families are a high incidence phenomena in contemporary society. Because the family continues to be a focus for the delivery of nursing care, nurses must now address the special needs of individuals who are members of reconstituted families. Studies in this area provide important back- ground information regarding behavioral patterns in reconstituted families that can be used for assessment and intervention with these families. Through the use of focused assessment parameters, nurses can collect data that will indicate the special needs of members of reconstituted families. In general, nursing interventions with clients who are a part of a reconstituted family fall into two major categories: (a) developing positive parenting behaviors, and (b) protecting the development of the stepchild.

LITERATURE REVIEW by M a l l (1986) supported the contention that the family unit has been an early, A continuing, and ever-increasing focus of nursing

care. However, there is scant attention in the nursing literature to the phenomenon of reconstituted families. It is projected that by the year 2000, the number of single-parent families and reconstituted families will exceed the number of nuclear families. It is also estimated that one in every two children will live part of hidher childhood with a single parent or in a reconstituted family (Bryan, Ganong, Cole- man, & Bryan, 1985). It is critical, therefore, that nurses who work with childbearing families understand the needs of reconstituted families if they are to intervene effectively.

Crosbie-Bumett ( 1984) indicated that the relationship having centrality in the reconstituted family is that of the stepparent and stepchild. The quality of this relationship is vital to the success of the reconstituted family. Visher and Visher (1978) indicated that the most difficult adjustments occur in the stepmother-stepchild relationship. A factor that contributes to adjustment difficulties is the traditional societal view of women as warm and nurturant. This view may place pressure on both the stepmother and stepchild for

Reprint requests: Georgia Griffth Whitley. EdD, RN, Assistant Profes-

Accepted for publication October 9, 1990. sor, School of Nursing, Northern Illinois University, DeKalb. IL 601 15.

From Northern Illinois University, School of Nursing, DeKalb, Illinois; and Sf. Joseph College of Nursing,

Jolief, Illinois

instant warmth and love. If the feelings of love are not forthcoming, either the stepmother or stepchild may harbor concerns about the relationship. Feelings surrounding the stepmother-stepchild relationship thus make this a major area of adjustment and can greatly influence the success or failure of the reconstituted family.

Risk Factors

Nurses have emphasized the importance of parenting through the establishment of altered parenting as a nursing diagnosis. The potential for altered parenting occurs when the ability of the nurturing figure(s) to create an environment that promotes the optimal growth and development of the child is potentially compromised. Carpenito (1989) identified the stepparenting situation as a potential factor in altered parenting. Risk factors that may lead to the diagnosis of altered parenting in the reconstituted family are listed in Figure 1 . Parenting, including stepparenting , requires physical, social, and emotional resources. When the ability to function as a parent is compromised and resources are limited, the intervention of a health care professional may be required (Carpenito, 1989).

The complexities of relationships within the reconstituted family are demonstrated when illustrated diagrammatically (Fig. 2). Hrobsky (1977) noted that major reorganizations during the development of any family unit require the application of transitional processes to aid in adjustment among family members. When the family unit is involved in the establishment of a reconstituted family, a period of reorganization occurs. McGoldrick and Carter (1980) identified three steps in the formation of a reconstituted family. These steps include (a) entering the new relationship with recommitment to marriage and readiness to deal with com-

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73 ALTERED PARENTING AND THE RECONSTITUTED FAMILY WHITLEY AND KACHEL

Altered parenting related to: compromised ability of the nurturing figures to provide a

inadequate physical, social, and emotional resources; complexity of relationships within reconstituted families; unresolved grief related to loss of nuclear family; role transitions necessitated by the reconstituted family;

0 beliefs and expectations related to common myths (the wicked stepmother, the recreated nuclear family, and instant love); characteristics of reconstituted families (stepmother’s age and religion, stepchildren’s age, locale of residence, gender, length of remarriage, and birth of children into remarriage); and

membership in two family subsystems.

growth promoting environment;

affective issues related to guilt and loyalty conflicts and

FIG. I . Risk factors in the reconstituted family.

plexity and ambiguity; (b) planning the new marriage and family; and (c) the reconstitution of the family with restruc- turing of boundaries and realignment of roles. This transitional period is a time of considerable anxiety and relearning.

There is a prevalent myth that the transition to parenthood is a blissful, stable period (Hrobsky, 1977). This myth is accentuated in the reconstituted family by the myths of instant love and the widespread expectation that this family will be another happy nuclear family (Schulman, 1972). The stepparent role, however, has contradictory aspects of parent and nonparent (Engebretson, 1982), which may lead to role ambiguity and difficulty in the development of meaningful relationships. Nurses are in an opportune position to assess the psychosocial needs of clients during this period of role transition and to provide intervention appropriate to the needs of the individuals. Without this intervention, individuals may develop role insufficiency (Meleis, 1975); in the reconstituted family, this may be manifested as altered parenting.

A factor that influences the transition period for members of the reconstituted family is the extent of resolution of grief for the loss of the original nuclear family. Children tend to assume responsibility for the break-up of the marriage and to maintain hope for a reconciliation after the adults have resolved these issues and moved on to new roles and new relationships. Children need assistance in resolving their grief for the lost nuclear family before they can integrate into the new family structures.

Several research studies have delineated factors that influence stepmother/stepchild relationships in reconstituted families. Nadler (1977) concluded that a stepmother’s increased stress in relationships with her stepchild lies in her failure to find familial and societal support for her role and the affirmation of a favorable self-image. Stepmothers suffer from the stigma of the “wicked stepmother,’’ who is por-

trayed as evil and heartless (Fast & Cain, 1966). This myth denigrates the role of the stepmother.

Other research findings have begun to indicate variables that influence the stepmother’s adjustment in stepmother/ stepchild relationships. One study indicated that younger Protestant stepmothers (younger than 40 years of age) made better adjustments than older and/or Catholic stepmothers (Duberman, 1973). Further, stepmothers who have not had prior marriages have greater difficulty in adjusting to stepchildren (Duberman, 1973; Ambert, 1986; Kachel, 1989). In addition, stepmothers who have visiting stepchildren dem- onstrate increased difficulty in adjustment as compared with stepmothers with live-in stepchildren. Furstenberg & Span- ier (1984) concluded that stepmothers with live-in stepchildren felt they were part of a team with their husbands in raising the stepchildren and that this feeling facilitated their adjustment .

It also appears that stepmothering is easier with younger stepchildren (Babcox, 1979; Canfield, 1982), as well as in those reconstituted families that have been expanded through the birth of a new child into the existing family (Albrecht, 1979; Duberman, 1973; Weingarten, 1985). The finding of a positive influence of children from the new marriage has been countered by other researchers, who found that the birth of a new child increases difficulties in adjustment as stepparents further distinguish the parent and stepparent roles (Ambert, 1986; Crosbie-Burnett, 1984; Kachel, 1989).

The sex of the stepchild appears to be significant. A stepmother’s relationship with stepdaughters appears more problematic than with stepsons (Brand & Clingempeel, 1987; Canfield, 1982). Stepmothers with stepdaughters have greater difficulty in establishing positive relationships, per- haps because of increased loyalty conflicts for the child.

Wymore (1988) and Morgan (1981) further suggested that it takes up to 7 years for the reconstituted family to adjust. Clingempeel and Segal (1986) found that the longer stepdaughters lived in stepmother-biological father households, the more positively they perceived the stepmother-stepchild relationship. Further, this more positive relationship is cor- related with less frequent visits with the biological mother. Duberman (1973) found that excellent stepmother/stepchild relationships were reported more frequently as the socioeco- nomic level of the family increased.

Adjustments within the reconstituted family are influ- enced by many individual, familial, and societal factors. Nursing assessment and intervention with reconstituted families should be based on an understanding of the factors that influence successful relationships.

Assessment

While altered parenting may occur within any family structure, some families may be identified to be at higher risk for experiencing difficulties in parenting. Situations or con-

74 JCPN VOLUME 4 NUMBER 2 1991

A MALE

0 FEMALE - - MARRIAGE

# DIVORCE

I 6 I0 LO GI C AL P AR ENT-C HI L D RE L AT 10 N S H I P

~ - STEPPARENT-STEPCHILD RELATIONSHIP

n SIBLING RELATIONSHIP

* HALF-SIBLING RELATIONSHIP

STEPSIBLING RELATIONSHIP

FIG. 2. Diagram of the relationship patterns in the reconstituted family.

ditions of parents or children that intensify stress within the family unit increase the risk for altered parenting (McFarland &McFarlane, 1989). The problems in relationships that stem from stepparenting situations have been identified as contrib- uting or risk factors that may lead to the diagnosis of alteration in parenting (Carpenito, 1989). Thus, the presence of a reconstituted family that includes a stepchild-stepparent relationship may serve as a cue for the nurse to implement a focused assessment in this area.

If the nurse is operating within a nursing diagnosis framework, a logical prototype for assessment is that provided by the Unitary Person Framework. This conceptual framework was created by a subcommittee of the North American Nursing Diagnosis Association (NANDA) consisting of 14 nursing theorists charged with developing a conceptual framework for nursing diagnoses. Assessment tools (Guzzetta, Bunton, Pnnkey, Sherer, & Seifert, 1989) orga- nized around the nine human response patterns within the Unitary Person Framework offer guidelines that can accom- modate the stepchild-stepparent focus and include those tools with a developmental orientation. Altered parenting is subsumed under the human response pattern Relating. Spe- cific questions that ask for stepparent information and living/

visitation arrangements need to be included in assessment tools (Fig. 3). The nursing care, teaching, and discharge planning may involve two interrelated sets of family dynam- ics rather than merely one, as is usually assumed.

Another assessment framework appropriate for use within a nursing diagnosis orientation is that provided by Gordon (1987) in the Functional Health Patterns Model. Gordon identified 1 1 health patterns as an assessment focus and developed guidelines for the assessment of individuals, families, and communities within each of the 11 patterns. Assessment data pertinent to altered parenting are elicited in the Role-Relationship Pattern category. The guidelines for this category are broad and need to include more specificity if they are to elicit data relative to stepchild-stepparent and living/visitation situations.

Because altered parenting is an abstract nursing diagnosis that is inclusive and general, concrete assessment data are critical for planning nursing interventions. When dealing with the family structure that includes children and stepparents, assessment data must include multiple family constellations, living arrangements, financial responsibilities, and specific role and relationship patterns. These specific data will indicate whether the defining characteristics of this

ALTERED PARENTING AND THE RECONSTITUTED FAMILY WHITLEY AND KACHEL 75

Family ConsteUations/Role and Relationship Patterns Who are the significant family members in each family for

the child? What are the ages of these family members? (A diagram such as Figure 2 would facilitate examination of the family relationship.)

What roles do family members play in the child’s life? Who is the major caretaker for the child in each home

Who has legal custody of the child? What are the visitation arrangements? How long has it been since dissolution of child‘s family of

origin? How long have the child’s parent(s) been remarried? Living Arrangements

situation?

Where is the child‘s custodial home? What physical facilities are provided for the child in the

Where is the child’s noncustodial parent’s home? What physical facilities are provided for the child in the

custodial home?

noncustodial home? Financial Arrangements

What are the child-support arrangements? Are there adequate financial resources to provide for the

Is there adequate coverage for the child‘s preventive, child’s day to day needs?

treatment and rehabilitative health care needs?

FIG. 3. Nursing assessment of reconstituted families: family constella- tionhole and relationship patterns.

diagnosis are present and will, it is hoped, point to contrib- uting factors within the family constellation.

Interventions

When the diagnosis of Altered Parenting is derived by the nurse, it is important to use assessment data to identify specific outcomes and interventions that will assist the stepparent in achieving positive parenting. There are multiple settings in which the nurse may confront the needs of the reconstituted family. The nurse may be functioning in a primary care setting, including the school, or in an acute care setting with either childbearing or childrearing clients. These interactions may occur during the hospitalization of the stepchild or the stepmother or may relate to the birth of a new child in the family. Nursing care related to Altered Parenting should address two priority outcomes. First, the nurse should support the stepparent in the development of positive parenting behaviorshole. Also, the nurse may need to intervene to protect the stepchild’s optimal biopsychosocial development. With these two goals as a framework, specific interventions can be identified.

Developing Positive Parenting Behaviors

In assisting the stepparent to develop positive parenting behaviors, several intervention approaches may be incorpo- rated. These interventions focus on supporting the stepparent in the adjustment to parenting as well as on helping the

stepparent understand the process of family reconstitution. Stepparent support for positive parenting can be enhanced by providing knowledge concerning the characteristics of the process and the myths related to this process. Particularly, the myths of instant love, the recreated nuclear family, and the “wicked” stepmother should be discussed with the stepparent and responses to these myths evaluated.

The stepparent and other members of the reconstituted family can benefit from an understanding of the normalcy of the problems inherent in the reconstitution process. The stepparent must accept hidher own fears and those of the new spouse and children about reconstitution. Also, adjustment related to new roles, boundaries, and affective issues such as guilt, loyalty, conflicts, and unresolved past hurts must be examined. The reconstituted family should be informed that adjustment is an ongoing process that may take years to complete in such a complex situation; families should be supported in their positive behaviors that lead to successful linking of the old and new family. Reinforcement that this adjustment process is ongoing, particularly with the expan- sion of the family by the birth of a new child, is also helpful. Further, the stepparent may benefit from health teaching regarding the patterns of normal childhood, adolescent growth and development, effective communication, prob- lem-solving techniques, and strategies for positive parenting.

The development of parenting-role identity can be enhanced by assisting the stepparent in discussing options for parenting. Particularly, the stepparent may identify personal parenting limits and examine the parenting role, specifically related to discipline: (a) stepparents should discuss develop- mentally appropriate discipline measures and examine the process of relationship development, (b) stepparents need to examine how and when discipline becomes a significant part of their relationship with the stepchild, and (c) the couple needs to be encouraged to support one another in matters of discipline. The health professional can provide an environment in which the stepparent feels he/she can express emotions freely, examine responses, and be positively rein- forced for the development of positive parenting behaviors.

Nursing can have a direct effect on the promotion of positive parenting in reconstituted families through the development of health teaching programs, the promotion of reconstituted family support groups, and the development of a supportive attitude toward the reconstituted family in any health care setting. To this end, the health professional may find useful information from the Stepfamily Association of America (SFA). The SFA provides complete professional and consumer bibliographic references that can be used in the planning and delivery of health teaching.

Protecting the Development of the Stepchild The second goal related to Altered Parenting is to protect

the stepchild’s optimal biopsychosocial development. This

76 JCPN VOLUME 4 NUMBER 2 1991

goal is achieved by the above measures that assist the Summary stepparent in positive parenting, but goal achievement is also enhanced by other interventions. The children in a reconstituted family must also have information regarding the reconstitution process. In addition to helping the stepparent com- municate more effectively in the family situation, the nurse can assist the child in gaining insight into hisher new family life. The child should be allowed to examine fears regarding reconstitution and have the opportunity to accept the complexities and ambiguities of new roles and boundaries. The child needs the opportunity to discuss guilt, loyalty conflicts, and unresolved past hurts. Bibliotherapy can be a very useful tool for the child with reading ability. The SFA has references specifically identified for use with children. Exposure to the reconstituted family structure could even be part of normal health education, which would expose many students to this family form. With younger children, drawing and role playing can be useful tools. These tools can help the young chiid examine the new relationships in hidher life and feelings about these relationships.

In promoting the optimal development of the child, the reconstituted family may be helped to provide the child with a sense of security and responsibility in the new structure. Living arrangements, visitation patterns, and financial concerns are critical issues. It is important that the child has a designated space of his or her own in both households. Additionally, belongings such as toys, personal hygiene items, and basic clothing needs should be available in both homes. Visitation patterns need to be clearly defined and worked out as fully as possible for the optimal satisfaction of the child and both families. It is important that the child knows where he/she may expect to be at any given time. Courteous relationships between former spouses aid in the adjustment process for the child. Chores and responsibilities help the child function as a member of the household rather than merely as a guest.

Issues of child support and other financial concerns must be worked out through compromise and flexibility on the part of the adults in both households. These often are emotionally volatile issues that may require professional services in the form of negotiation. emotional support, and opportunities for the expression of feelings. In the event that hostilities do flare up between the biological parents, it is imperative that the child be reassured that these problems are not the child’s responsibility. Again, children assume guilt and may feel overwhelmed and threatened by angry exchanges on the part of the parents. Children need assistance in understanding that they are not responsible for parental conflicts and that they cannot control them.

Children’s safety in the reconstituted family should be a primary health concern. If the child’s safety is threatened, the nurse must be prepared to contact appropriate authorities. In a high-risk situation, appropriate referrals should be made to family counseling or other support groups.

The trend toward an even higher incidence of reconstituted families is clear, as is the continuing and increasing focus on the family in the delivery of nursing care. The stepparent- stepchild relationship has been identified as having priority in the success of the reconstituted family. Three myths that may need to be debunked by the nurse working with reconstituted families are the myth of instant love, the myth of the recreated nuclear family, and the “wicked stepmother” myth.

The stepparenting situation has been identified as a potential factor in the occurrence of the nursing diagnosis of altered parenting. Nursing assessment of individuals and families must be guided by specific questions regarding family constellations, living arrangements, financial responsibilities, and role and relationship patterns. This format offers a means to identify reconstituted families and provides direction for interventions. Nursing actions aimed at the facilitation of positive parenting include teaching about the reconstitution process, discussion of normal growth and developmental stages of families and individual members, exploration of changing role identities for both parents and children, and referrals to both lay and professional counseling services and support groups. In addition, nursing actions will encompass issues of safety and the nurturance of the children in reconstituted families. These children will also need to learn about the reconstitution process. Role playing, drawing, and bibliotherapy provide appropriate outlets for the expression of feelings by the children.

The changing and complex nature of family systems provides constant challenges to the nurses who interact within these systems. Nursing roles and functions must be constantly adapted and updated to articulate with the needs of the clients who move within the systems.

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