家 族 看 護 学 研 究 第 10 巻 第 l 号2004 年
〔 原 著 〕
AJ apan- U. S.  Compari son of Fami l y Funct i ons f rom the Perspecti ve of Mot hers Utilizing “Fami l y Houses" 
一－Cross-Cul tural Research Usi ng the Feet ham Fami l y Functi oni ng Sur vey-
Naohi r o Hohashi 11 Chi kako Koyama2)  
Abstract 
Fami l y functi ons in J apan and the U. S.  wer e compar ed by means of J apanese and Engl i sh 
versi ons of the FFFS ( Feet ham Fami l y Functi oni ng Survey)  ,  whose subj ects were J apanese 
and Ameri can mot hers usi ng “fami l y houses.  ” J apan showed significantly l ower suffi ci ency of 
fami l y functi oni ng in t wo of the 25 survey i tems ．“ Ti me wi th heal th professi onal s” and “Ti me 
you are ill. ” Thus it is necessaηr to i mprove the protecti ve and rest functi ons wi thi n J apanese 
families. 
Li kewi se,  when the survey resul ts for J apan and the U. S.  were compar ed in three areas of 
fami l y functi on,  J apan t ended to show a  l ower suffi ci ency of fami l y functi oni ng in “Rel ati onshi p 
bet ween fami l y and subsystem. ” Thi s can be attri buted to the characteri sti c of the J apanese 
fami l y to dr aw a  cl ear boundar y bet ween fami l y member s and others.  It is necessary to adj ust 
the rel ati onshi p bet ween the fami l y and the subsyst em ( acquai ntances,  relatives and peopl e 
such as nei ghbors wi th whom the fami l y has strong i nterrel ati onshi ps) in the context of cul tural  
background.  
The fami l y functi on scores and i mport ance scores di scl osed that the fami l y functi ons that 
requi red fami l y nursi ng i nterventi on in J apan were “Probl ems wi th chi l dren” and “Sati sfacti on 
wi th marri age" and in the U. S. ，“ Probl ems wi th chi l dren. ” In other words,  in bot h J apan and the 
U. S.  i nterventi on is necessary to relieve worri es over chi l dren in the hospi tal  and chi l dren left 
at home.  Al so,  wi th respect to “Sati sfacti on wi th marri age" in J apan,  assi stance in supporti ng 
sexual -l ove functi ons bet ween husbands and wi ves can be consi dered.  It is necessary to re-
conf i rm i mprovement s in the heal th care envi ronment  wi th emphasi s not onl y on si ck chi l dren 
but al so on fami l y life. 
As  descri bed above,  it was possi bl e for the medi cal  staff member s to reach a  deeper under 
standi ng of the J apanese fami l y agai nst the background of cul ture,  and to recei ve suggesti ons 
for consi deri ng fami l y nursi ng i nterventi on t hrough cross-cul tural  research.  
Key words :  Fami l y House,  Fami l y Functi oni ng,  FFFS,  J apan U. S.  Compari son 
11Child and Family Health Nursing, Faculty of Health Sci-
巴nces, Kobe Uni v巴rsity School  of Medi ci ne "Ward No. 2, Kobe University Hospital 
22 家 族 看 護 学 研 究 第 10 巻 第 l 号2004 年
I. Introducti on 
In bot h J apan and the U. S.  chi l dren wi th 
chroni c illness are often brought  to hospi tal s in 
urban centers for state-of-the-art heal th care. 
But  admi ssi on to or regul ar outpati ent treat-
ment  at such a  hospi tal  pl aces a  heavy financial, 
mental ,  and physi cal  burden on the fami l y who 
live far f rom an urban center.1121 However,  the 
Ne w Syst em Regardi ng Al l ocati on of Nurses 
(Mi ni stry of Heal th,  Labor and Wel fare)  in pri n-
ciple prohi bi ts the fami l y f rom accompanyi ng 
the pati ent on a  round- the- cl ock basi s and,  
therefore,  presentl y there is barel y any space or 
facilities for families in the wards. 31 
In recent years,  in order to ease the burden 
on fami l i es，“ fami l y houses" have been exten-
sively constructed. 11 A “fami l y house，’＇l ocated 
near a  hospital,  provi des sick chi l dren and their 
families i nexpensi ve accommodat i ons wher e 
they can find repose.  Moment um for the “fami l y 
house" came f rom the Ronal d McDonal d House 
(hereafter RMH)  ,  whi ch was establ i shed in the 
U. S.  in 1974.  Ot her RMHs  fol l owed in succes-
sion. Thei r operati on depends upon assi stance 
f rom an organi zati on of unpai d volunteers.4151 
Meanwhi l e,  in J apan,  the first “fami l y house，” 
Esaka House,  was establ i shed by vol unteers in 
1988.  J apan’s  first R MH was finally establ i shed 
in 2001.  The comparati vel y hi gh constructi on 
costs in J apan and the fact that vol unteer activi-
ties have not taken root in J apanese society61 
have del ayed the establ i shment of “fami l y 
houses. ” But  the 1998 suppl ement ary budget  of 
the f ormer Mi ni stry of Heal th and Wel f are pro-
vi ded for the devel opment  of 32 accommodat i on 
facilities for families of chi l dren wi th chroni c 
diseases.11 
A “fami l y house" is expected to suppl y,  in par-
ti cu恒久 resi dence,economi c,  protecti ve,  and 
rest functi ons to the family. However,  the func-
ti ons of families usi ng “fami l y houses" have 
never been the subj ect of research.  There are 
several  scal es for eval uati ng fami l y functi ons.  
One is the FFFS ( Feet ham Fami l y Functi oni ng 
Survey)  ,  devel oped by Feet ham and others in 
the U. S.  It was devel oped by nurses,  whi ch is its 
salient feature,  and is frequentl y used in fami l y 
nursi ng research.  71 Moreover,  a  J apanese ver-
sion, FFFS J apanese Language Versi on I, has 
been devel oped,  provi di ng a  basi s for compari -
son of fami l y functi oni ng in J apan and in the 
U.S.81 J apan' s “fami l y house，＇’ i ntroduced on the 
model  of RMH,  must  satisfy needs parti cul ar to 
the J apanese peopl e,  such as the need for men-
tal heal th care.11 In this way  cultural back-
ground must  al so be taken into consi derati on 
when deal i ng wi th the i ssue of fami l y nursi ng.  
Thus this study compares J apanese and U. S.  
fami l y functi ons f rom the perspecti ve of J apa-
nese and Ameri can mot hers who have used 
“fami l y houses" and RMHs.  The purposes are to 
anal yze the i mperfecti ons and i nsuffi ci enci es of 
functi ons of the J apanese fami l y and to identify 
areas wher e fami l y heal th nursi ng is necessary.  
II. Sampl es and Met hods 
1  .  Sampl es and met hods of survey 
In J apan,  an expl anati on of the survey was 
mai l ed to the heads of the 32 accommodat i on 
facilities for families of chi l dren wi th chroni c 
di seases in Sept ember 2002.  The 12 facilities 
agreei ng to parti ci pate became the subj ects of 
the study.  In Oct ober 2002,  a  questi onnai re 
家族看護学研究第 10 巻 第 1 号2004 年23 
and rel ated materi al s wri tten in J apanese were 
mai l ed to 7  5  mot hers (limited to those wi th hos-
pitalized chi l dren 18 years of age or younger)  at 
the 12 facilities. 
In Oct ober 2002,  an expl anati on of the survey 
was  mai l ed to the heads of 32 RMHs  sel ected at 
r andom f rom 145 facilities in the U. S.  that have 
been in operati on as of August,  2002.  The four 
facilities agreei ng to parti ci pate became the 
subj ects of the study.  In November  2002,  a  
questi onnai re and rel ated materi al s wri tten in 
Engl i sh wer e mai l ed to 84 mot hers (limited to 
those wi th hospi tal i zed chi l dren 18 years of age 
or younger)  at the four facilities. 
The package sent to the mot hers contai ned a  
letter of request,  a  coveri ng letter, the FFFS 
sheet,  a  self admi ni stered questi onnai re con-
cerni ng fami l y attributes, a  smal l  t oken of grati-
tude,  and a  return envel ope for the questi on-
naire. In the questi onnai re concerni ng fami l y 
attributes,  i tems pertai ni ng to sick chi l dren and 
their fami l i es and to the “fami l y house" wer e cre-
ated on the basi s of previ ous research.1121 The 
operati onal  defi ni ti on of a  fami l y was a  group of 
t wo or mor e peopl e shari ng bonds and mutual l y 
recogni zi ng one anot her as family. Al so,  the 
t erm husband i ncl uded a  partner perf ormi ng 
the rol e of husband,  i rrespecti ve of actual  mari -
tal status. The coveri ng letter to the mot hers ex-
pl ai ned the purpose and met hods of the study,  
that parti ci pati on was by their own volition, and 
that thei r confi denti al i ty woul d be protected.  It 
asked t hem to respond onl y if they consent ed to 
these issues. 
2. Structure of FFFS and Eval uati on Met hod 
of Fami l y Functi ons 
The FFFS is a  sel f-admi ni stered 2  7-i tem ques-
ti onnai re that obj ecti vel y eval uates the suffi-
ci ency of fami l y functioning.7181 Twenty-fi ve 
i tems consi st of mul ti pl e-choi ce questi ons.  
There are seven possi bl e responses,  f rom 1  Oit-
tle) to 7  ( much)  on the Li kert scale. Fr om these 
responses the d  score [the fami l y functi oni ng 
score (a hi gh score i ndi cates the i nsuffi ci ency of 
fami l y functi ons) J  and the c  score [the i mpor-
tance score (a hi gh score means the i tem is be-
l i eved i mportant) J  are cal cul ated.  Accordi ngl y,  
an i tem wi th both hi gh d  scores and hi gh c  
scores i ndi cates nursi ng i nterventi on was nec-
essary7181. Furt hermore,  fami l y functi ons can be 
classified broadl y into three areas ：“ Rel ati on-
shi p bet ween fami l y and the i ndi vi dual " (  10 
i tems）；“ Rel ati onshi p bet ween fami l y and the 
subsyst em" (8 i tems) ,  and “Rel ati onshi p bet-
ween fami l y and soci ety" (6 i tems). These three 
areas account  for 24 i tems al together.  ( One of 
the 25 i tems was i ndependent  of the areas. ) The 
total of the d  scores of i tems in an area was the 
area’s  d  score.81 
Al so,  t wo of the i tems were open- ended ques-
ti ons .“ What  is most  difficult for you now？” 
and “What  is most  hel pful  for you now？” 
3. Dat a tabul ati on and met hod of anal ysi s 
SPSS 11. 0 for Wi ndows was used for statisti-
cal anal ysi s. Whe n unanswered i tems were dis-
covered in the questi onnai re,  onl y these were 
excl uded f rom analysis. 
Ill. Resul ts 
1. Response to the questi onnai res 
In J apan 35 mot hers (46. 7 % response)  re-
t urned the questi onnai res by November  15, 
2002.  In the U. S.  39 mot hers ( 46. 4% response)  
returned the questi onnai res by December  20,  
2002.  
2 4  家 族 看 護 学 研 究 第 10 巻 第 1号2 0 0 4 年
Tabl e 1. Attri butes of Fami l i es Uti l i zi ng “Fami l y Houses”  
J apan (n =  35) U.S. (n =  39) 
I t em %  Average 士 S D (range) %  Average ±  S D (range) 
Parent age Mot her * 34.2 ±  5.4 yrs (25 ～ 49 yrs) 30.3 ±  7.2 yrs (18 ～ 44 yrs) Fat her* 36.5 ±  6. 7  yrs (25 ～ 51 yrs) 31.8 ±  7.6 yrs (17 ～ 47 yrs) Number  of househol d member s 4.3 ±  1.3 persons (2 ～ 7  persons) 4.2 土 1.2 persons (3 ～ 7  persons) Presence of fami l y member s Father 96.7 94.7 Sibling(s) 73.3 71.1 Grandparents *  *  23.3 。
Rel ati ves 6.7 2.6 Mot her empl oyed/at  home *  Empl oyed 32.3 63.2 At  home 67.7 36.8 Age of sick child 5.3 ±  4.3 yrs (O～ 17 yrs) 3.6 ±  5.4 yrs (O～ 17 yrs) Gender of sick child Mal e 50.0 62.9 Femal e 50.0 37.1 Ti me f rom home to hospitalキ＊＊225.5 ±  17 4.1 mi n (  60 ～ 840 mi n)  110.2 ±  74.0 mi n (45 ～ 480 mi n)  Ti me f rom “fami l y house” to hospital *  *  16.0 ±  22.6 mi n (1 ～ 90 mi n)  3.4 士 1.7 mi n (1 ～ 7.5 mi n)  Durati on of child hospitalization this ti me *  78.6 ±  95.1 days (1 ～ 360 days) 29.9 ±  43.6 days (O～ 150 days) Lengt h of stay in “fami l y house" this ti me ＊キ60.6 ±  77.1 days (1 ～ 240 days) 20.1 ±  31.9 days (1 ～ 150 days) 
*. p  <  0.05. ＊キ p <  0.01, *  *  *  p  <  0.001 ( compari son bet ween J apan and U.S.) 
2. Attri butes associ ated wi th families 
Attri butes associ ated wi th fami l i es were 
shown in Tabl e 1  .  In the J apanese- Ameri can 
compari son,  significant di fferences were ob-
served in age of mother,  age of father, presence 
or absence of grandparent s in the househol d,  
percentage of mot hers wi th j obs,  ti me requi red 
f rom home to hospital,  ti me requi red f rom “fam-
ily house" to hospital,  number  of days of child’s  
hospi tal i zati on,  and number  of days families use 
“fami l y house" ( one- way ANOV A or chi - squared 
test). 
The chi l dren’s  di seases (classified accordi ng 
to the 10th Revi si on of the Internati onal  Classi-
fication of Di seases)  were in J apan neopl asms 
(9 chi l dren,  30. 0%) ,  congeni tal  anomal i es (8, 
26.  7%) ,  geni touri nary syst em di seases (4, 
13. 3%) ,  di seases of eye and adnexa (3, 10. 0%)  
and other di seases (6, 20. 0%) .  The number  of 
valid responses was  30.  In the U. S. ,  on the 
other hand,  the di seases were ci rcul atory sys-
t em di seases (8 chi l dren,  21. 1 %)  ,  certai n con-
di ti ons ori gi nati ng in the peri natal  peri od (8, 
21. 1 %)  ,  neopl asms (7, 18. 4%) ,  respi ratory 
di seases (5, 13. 2%) ,  endocri ne,  nutri ti onal  and 
metabol i c di seases (3, 7  . 9%)  and other di seases 
(11, 29. 0%) .  El even other chi l dren had differ-
ent di seases.  There were 38 valid responses,  
and mul ti pl e responses.  
3. d  scores and c  scores in the FFFS 
Tabl e 2  shows d  scores and c  scores by item. 
In the J apan- Ameri can compari son d  scores for 
2  of the 25 i tems show significant di fferences.  
J apan had significantly hi gher scores in “Ti me 
wi th heal th professi onal s" and “Ti me you are ill ”  
( Mann- Whi t ney U  test). As  well, there were sig-
nificant di fferences bet ween J apan and the U. S.  
i nc scores for 15 of the 25 i tems ;  in all 15 i tems 
the Ameri can scores were significantly hi gher 
( Mann- Whi t ney U  test). Tabl e 3  ranks the top 
five i tems in t erms of d  and c  scores,  respec-
tively. 
Whe n J apanese and Ameri can d  scores for the 
three areas are compared (Tabl e 4),  J apan 
tends to have hi gher scores in “Rel ati onshi p be-
t ween fami l y and subsyst em" ( Mann- Whi t ney U  
test). 
4. Responses to the open- ended questi ons in 
家 族 看 護 学 研 究 第 10 巻 第 l 号2 0 0 4 年
Tabl e 2. Aver age Scores on F F F S  I t ems 
Con tens of Likert-scale questi ons d  score c  score Average± S D Average 土 S D
1. Di scuss concerns or probl ems wi th fri ends (  Il) 0.8 ±  0.9 キ＊0.8 ±  1.2 5.8 ±  1.5 2. Di scuss concerns or probl ems wi th relatives (  Il) 0.7 ±  1.1 5.6 ±  1.4 ] * 0.6 ±  1.0 6.4 ±  1.1 3. Ti me spent wi th spouse (  I  )  2.4 ±  2.2 ＊＊ 1.6 士 1.66.6 ±  1.1 4. Di scuss concerns or probl ems wi th spouse (  I  )  0.8 ±  1.0 6.0 ±  1.5 0.9 土 1.46.5 ±  1.3 5. Ti me spent wi th nei ghbors 1.2 ±  1.3 3.6 ±  1.4 0.9 ±  1.2 3.2 ±  2.1 6. Ti me for leisure or recreati on (  I  )  1.6 ±  1.5 4.8 ±  1.5 1.7 ±  1.3 4.7 ±  1.7 7. Hel p f rom spouse (  I  )  1.2 土 1.4＊＊ 1.2 ±  1.5 6.4 ±  0.9 8. Hel p f rom relatives (  Il) 0.9 ±  1.4 5.6 士 1.20.9 ±  1.5 5.2 ±  2.1 9. Ti me wi th heal th professi onal s (  Il) 1.6 ±  1.9 ]* 0.7 ±  1.4 6.3 ±  1.2 *  10. Hel p f rom fri ends (  Il) 1.1 ±  1.3 3.2 ±  1.7 Jι 0.8 ±  1.3 4.1 ±  2.2 11. Probl ems wi th chi l dren (  Il) 2.7 土 2.16.5 ±  1.0 2.0 ±  2.0 6.6 ±  0.8 12. Ti me wi th chi l dren (  I  )  1.5 ±  1.7 6.5 ±  0.9 ]* 1.0 ±  1.4 6.8 ±  0.5 13. Ti me chi l dren mi ss school  (III) 1.7 ±  1.9 5.5 ±  2.0 2.0 ±  2.3 6.1 ±  1.6 14. Di sagreement s wi th spouse ( I )  1.5 ±  1.5 5.4 ±  1.9 ] * 1.7 ±  1.8 6.3 ±  1.5 15. Ti me you are ill (III) 1.4 ±  1.6 「i 本5.1 ±  2.1 0.8 ±  1.4 5.5 土 2.316. Ti me spent on housework (  I  )  1.6 ±  1.5 ＊＊ 1.3 ±  1.4 邑0 ±  1.4 17. Ti me you mi ss wor k (i ncl udi ng housework)  （皿）1.8 ±  1.8 5.2 士 1.72.2 ±  2.2 5.7 ±  1.8 18. Ti me spouse mi sses wor k (i ncl udi ng housework)  (III) 1.5 土 1.74.9 土 1.81.7 ±  2.3 5.3 ±  2.3 19. Emoti onal  support f rom fri ends (  Il) 1.0 ±  1.3 ＊キキ0.8 土 1.56.2 ±  1.6 20. Emoti onal  support f rom relatives (  Il) 0.8 ±  1.5 5.7 ±  1.4 J  *  0.8 ±  1.3 6.3 ±  1.3 21. Emoti onal  support f rom spouse (  I  )  1.5 ±  1.9 J ム＊＊ 0.8 ±  1.3 6.9 ±  0.3 22. Ti me wor k routi ne is di srupted （皿）1.5 ±  1.9 J ム＊キ2.5 土 2.25.3 ±  2.1 23. Ti me spouse’s  wor k routi ne is di srupted (III) 1.1 ±  1.4 ＊＊ 1.4 ±  2.1 5.3 ±  2.0 24. Satisfaction wi th marri age (  I  )  1.7 ±  2.0 ＊＊ 1.4 ±  1.9 6.9 ±  0.3 25. Satisfaction wi th sexual  relations (  I  )  1.3 士 1.7＊＊＊ 1.3 ±  1.9 5.8 ±  1.9 
Upper  fi gures: J apanese mot hers (35), Lower  fi gures:  Ameri can mot hers (39) 
I  :  Rel ati onshi p bet ween fami l y and i ndi vi dual  (10 items),  Il :  Rel ati onshi p bet ween fami l y and subsyst em (8 items),  III .  Rel ati onshi p bet ween fami l y and society (6 i tems) 
ム： p く 0.1, *: p く 0.05, *  *  p  <  0.01，キ＊キp <  0.001 
the FFFS 
Responses to open- ended questi ons were 
classified by context and the top five were listed 
(Tabl e 5). 
2 6  家 族 看 護 学 研 究 第 10 巻 第 l 号2004 年
Tabl e 3. T op 5  Scores of F F F S  I t ems 
I t em (J apanese mothers)  
d  score (family functi on score) Probl ems wi th chi l dren Ti me spent wi th spouse Ti me you mi ss wor k (i ncl udi ng housework)  Satisfaction wi th marri age Ti me chi l dren mi ss school  
c  score ( i mportance score) Ti me wi th chi l dren Probl ems wi th chi l dren Emoti onal  support f rom spouse Di scuss ccncerns or probl ems wi th spouse Satisfaction wi th marri age 
Average± S D 
2.7 ±  2.1 2.4 ±  2.2 1.8 土 1.81.7 ±  2.0 1.7 ±  1.9 
6.5 ±  0.9 6.5 ±  1.0 
6.3 ±  1.1 6.0 ±  1.5 6.0 ±  1.3 
J apanese mot hers (35), Ameri can mot hers (39) 
Tabl e 4. Compar i son of J apan U.S. Fami l y Funct i ons 
Based on Thr ee Ar eas of t he F F F S  
Areas of relationships 
Rel ati onshi p bet ween fami l y and individual 
Rel ati onshi p bet ween fami l y and subsyst em 
Rel ati onshi p bet ween fami l y and society 
d  score Average 土 S D
15.3 ±  8.6 13.2 ±  9.6 9β士 6.0 「！ム7.3 ±  6.8 _ J  9.4 ±  6.0 9.9 ±  8.8 
Upper  fi gures:  J apanese mot hers (35), Lower  fi gures Ameri can mot hers (39) 
ム. p  <  0.1 
IV. Di scussi ons 
1. A  compari son of J apanese and Ameri can 
fami l i es usi ng “fami l y houses" 
Whe n the rate of three-generati on fami l i es is 
consi dered,  the fami l y composi ti on si gni fi cantl y 
differs bet ween J apan and the U. S. ,  wi th 23. 3% 
of J apanese househol ds i ncl udi ng a  grandpar-
ent, as opposed to 0 % in the U. S.  ( Tabl e 1). 
Al so,  the fi gure for worki ng mot hers was  signifi-
cantl y hi gher in the U. S. ,  at 63. 2%,  as opposed 
to 32. 3% in J apan.  In this way  the di fferences in 
attri butes of J apanese and Ameri can fami l i es 
became clear, and it is t hought  that a  deeper 
underst andi ng of the J apanese fami l y deri ved 
f rom the assessment  of cul tural  features will 
l ead to suggesti ons for fami l y nursi ng i nterverト
I t em ( Ameri can mothers)  
Ti me wor k routi ne is di srupted Ti me you mi ss wor k (i ncl udi ng housework)  Probl ems wi th chi l dren Ti me chi l dren mi ss school  Ti me spouse mi sses wor k (i ncl udi ng housework)  
Satisfaction wi th marri age Emoti onal  support f rom spouse Ti me wi th chi l dren Ti me spent wi th spouse Probl ems wi th chi l dren 
tion for the J apanese family. 
Average± S D 
2.5 ±  2.2 2.2 士 2.22.0 ±  2.0 2.0 ±  2.3 1.7 ±  2.3 
6.9 土 0.36.9 ±  0.3 6.8 ±  0.5 6.6 ±  1.1 6.6 ±  0.8 
Whe n the number  of days of the chi l d’s  hos pi-
talization and the number  of days the fami l y 
uses the “fami l y house" are consi dered (Tabl e 
1) ,  it is seen that bot h fi gures are significantly 
hi gher for J apan,  and it can be sai d that the ex-
i stence of the “fami l y house" is cl osel y rel ated to 
resi dence functi on of the family. As  for the chi!-
dren’s  di seases,  neopl asms wer e top in J apan 
( 30. 0%) ,  but ranked thi rd in the U. S.  ( 16. 7%) .  
For  exampl e,  in the U. S.  hospi tal i zati on duri ng 
the i nci pi ent stage of l eukemi a is 7  to 10 days,  
far shorter t han in J apan.  Because subsequent  
treatment takes pl ace at home in the U.S.,91 
mot hers ma y  be likely to use a “fami l y house" for 
a  smal l er number  of days.  
Among  the top five responses，“ What  is most  
difficult for you now？”（Tabl e 5) ,  fi nanci al  bur-
den was  cited the most  in J apan (8 out of 26) .  
Stayi ng at an i nexpensi ve “fami l y house，’＇and 
t hereby savi ng on accommodat i ons and trans-
portati on,  reduces the fi nanci al  burden.  How-
ever,  even if the l odgi ng expense is l ow,  ex-
t ended hospi tal i zati on of a  chi l d is t hought  to be 
a  great burden.  u  Moreover,  because many of 
the users of “fami l y houses" are young parents 
( Tabl e 1) wi thout a  solid livelihood,  the fi nan-
家 族 看 護 学 研 究 第 10 巻 第 1 号2 0 0 4 年2 7  
Tabl e 5. T op 5  Responses to F F F S  Open ended Quest i ons 
J apanese mot hers Ameri can mot hers 
What  is most  difficult for you now? ( J apanese mot hers [26]. Ameri can mot hers [39]) Fi nanci al  burden 8  (30.8) Chi l d’s  illness 11 (28.2) Uncertai nty of future 6  (23.1) Separati on 仕o mfami l y 8  (2且5)No ti me to spend wi th other chi l dren 5  (19.2) Own  heal th probl ems 6  (15.4) Fami l y and own heal th probl ems 5  (19.2) No ti me to spend wi th other chi l dren 6  (15.4) Anxi eti es and w町 ries ever child’s  i l l ness/treatment 4  (15.4) Workl oad (i ncl udi ng home chores) 5  (12.8) Ot her (9 i tems) 15 (57.7) Ot her (12 i tems) 20 (51.3) 
What  is most  helpful for you now? (J ap叩 ese mot hers [26]. Ameri can mot hers [39]) Presence and support by family, relatives and acquai ntances 18 (69.2) Availability of fami l y house 19 (54.3) As日stan田 wi th housework and child raising 6  (23.1) Presence and support by family, relatives and acquai ntances 14 (40.0) Exchanges wi th other “fami l y house" users 5  (19.2) Support  by medi cal  staff 8  (22.9) Chi l dren’s  happi ness and growt h 4  (15.4) Exchanges wi th other “fami l y house” users 5  (14.3) Fi nanci al  assi stance 4  (15.4) Bei ng together wi th the sick child 3  (  8.6) Ot her (9 i tems) 15 (57.7) Ot her (12 i tems) 2日（57.1)
No.  persons ( %) ,  mul ti pl e responses gi ven 
cial burden may  i mpact upon their living condi -
tions. 11 Currentl y the average l ength of stay at a  
hospi tal  in J apan is 4. 2 ti mes l onger t han in the 
U. S.  101 Because ref orm of the J apanese medi cal  
syst em is l eadi ng to shorter hospi tal  stays,  the 
burden on the fami l y ari si ng f rom its living away 
f rom home is expected to gr ow lighter. 
In J apan a  trip f rom home to the hospi tal  takes 
225. 5 mi nut es ( 110. 2 mi nut es in the U. S. ),  but 
use of a “fami l y house" reduces the ti me to 16. 0  
mi nut es (3. 4 mi nut es in the U. S. )  (Tabl e 1). It is 
t hought  that use of the “fami l y house" is a  great 
relief for fami l i es because it al l ows t hem to se-
cure ti me wi th chi l dren and provi des a  pl ace 
f rom whi ch they can qui ckl y reach the hospi tal  
in case of an emergency.  The top five responses 
to the i tem “What  is most  hel pful  for you now？” 
( Tabl e 5) i ncl uded “Exchanges wi th other ' fam-
ily house'  users” in bot h J apan and the U. S.  (3rd 
pl ace in J apan,  4t h pl ace in the U. S. ) .  The “f am-
ily house" can be expect ed to consti tute a  pl ace 
of peer support  wher e families in si mi l ar ci rcum-
stances exchange i nformati on and provi de mu-
tual assi stance.  11 
However,  it takes a  significantly l onger ti me 
f rom a “fami l y house" to a  hospi tal  in J apan t han 
it does in the U. S.  In J apan the l ongest ti me was 
90 mi nutes.  Because a “fami l y house" cannot  
carry out its functi on unl ess it is cl ose to a  hos-
pital,41111 it will be necessary to reexami ne the lo-
cati ons of J apan’s “fami l y houses. ”  
2. A  J apanese- Ameri can compari son of fami l y 
functi oni ng by 25 i tems and 3  areas 
A n  exami nati on of the d  scores by i ndi vi dual  
i tems (Tabl e 2) shows that J apan has signifi-
cantl y l ower suffi ci ency of fami l y functi oni ng in 
“Ti me wi th heal th professi onal s" and “Ti me you 
are ill. ” It is necessary to suffice the protecti ve 
and rest functi ons wi thi n the J apanese family. In 
the U. S. ,  pati ent advocacy has become preva-
lent, and hospi tal  pati ents can al ways avail 
themsel ves of counsel i ng.  In J apan,  however,  
the physi ci an and pati ent have tradi ti onal l y had 
a  vertical rel ati onshi p. It is thought one reason 
for such a  rel ati onshi p is the absence of the 
fami l y doctor system.121 Moreover,  at Ameri can 
RMHs ,  the hospi tal  staffers al so serve in the 
rol e of advisers131 and there is a  wel l - devel oped 
syst em of consul tati on wi th heal thcare work-
ers.111 凶In contrast,  onl y 10. 3% of J apanese 
“fami l y houses" have establ i shed counsel i ng 
rooms,  and professi onal  assi stance f rom 
28 家族看護学研究第 10 巻 第 I 号2004 年
nurses,  heal thcare workers and others capabl e 
of provi di ng counsel11151 shoul d be offered. 
In onl y t wo of the 25 i tems significant differ-
ences were observed i nd scores bet ween J apan 
and the U. S. ,  but c  scores for 15 of the 25 i tems 
di ffered significantly. There was a  wi der di spar-
ity bet ween J apan and the U. S.  in i tems eval u-
ated as i mportant,  whi ch establ i shes the fact 
that J apanese and Ameri can families mai ntai n 
di fferent val ues.  Tabl e 3, whi ch lists the top five 
i tems in d  scores and c  scores,  shows that “Ti me 
wi th chi l dren" ranked among the top five in c  
scores Ost  in J apan,  3rd in the U. S. ),  di scl osi ng 
that bot h J apanese and Ameri can mot hers val ue 
ti me spent wi th their chi l dren. On  the other 
hand,  this i tem was not i ncl uded among the top 
five d  scores for ei ther J apanese or Ameri can 
mothers.  Thi s can be thought to reflect the fact 
that fami l y functi on was sufficient in that mot h-
ers coul d spend ti me wi th chi l dren in hospi tal s 
neart he “fami l y houses" they were usi ng.  How-
ever，“ Probl ems wi th chi l dren" was ranked 
among the top five i tems in d  scores (1st in Ja-
pan,  3rd in the U. S. ),  whi ch i ndi cates that wor-
ries over chi l dren persi sted. In response to the 
questi on “What  is most  difficult for you now？” 
the l ack of ti me wi th chi l dren other t han the si ck 
chi l d was among the top five responses in bot h 
J apan and the U. S.  (3rd in J apan,  4t h in the 
U. S. ) ( Tabl e 5) .  Thus i nterventi on to relieve 
anxi ety wi th respect to chi l dren in the hospi tal  
and chi l dren left at home is necessary.  161 
Items that ranked among the top five in bot h d  
scores and c  scores (Tabl e 3) were “Probl ems 
wi th chi l dren" and “Sati sfacti on wi th marri age" 
in J apan and “Probl ems wi th chi l dren" in the 
U. S.  Those i tems wi th bot h hi gh d  scores and 
hi gh c  scores suggest nursi ng i nterventi on is 
necessary.  As  for i nterventi on in the J apanese 
fami l y wi th respect to “Probl ems wi th chi!-
dren，” consi derati on of mothers'  difficulties calls 
for rel i evi ng anxi eti es and worri es over the sick 
child and assuri ng ti me wi th other chi l dren (Ta-
ble 5) .  It is necessary to pay personal  attenti on 
that satisfies each fami l y’s  needs by,  for exam-
ple, creati ng an envi ronment  in whi ch the 
mot her can wi th peace of mi nd return home to 
spend even a  short ti me wi th the rest of her fam-
ily. 171 It is concei vabl e that in addi ti on to the en-
hanced support f rom medi cal  social workers 
and other specialists, 11 as ment i oned earlier, 
nurses coul d assist mot hers f rom di stance to 
prevent t hem f rom feel i ng i sol ated and establ i sh 
wi th t hem trusti ng rel ati onshi ps in whi ch they 
coul d freely consul t about  their chi l dren’s  con-
dition or prognosi s.  181 As  well, nurses are ex-
pect ed to demonst rat e a  sympatheti c attitude 
t oward mothers,  191 to provi de t hem wi th accu-
rate i nformati on at appropri ate ti mes and to 
gi ve sati sfactory expl anati ons.181 Al so,  it is 
thought “Sati sfacti on wi th marri age" ranked 
among the top five in bot h scores because l ead明
i ng t wo lives meant  less ti me wi th one’ S  spouse,  
causi ng a  decl i ne in the sexual -l ove functi ons.  
Because it has been shown that havi ng a  child 
wi th a  chroni c di sease can l ead to fami l y prob-
l ems and di vorce,  201211 it is desi rabl e that the 
heal th care envi ronment  be i mproved not onl y 
for the si ck child but al so wi th an emphasi s on 
fami l y life. A  bi g functi on of the RMHs  in the 
U. S.  is to provi de a  pl ace resembl i ng the home 
wher e the sick child and fami l y can gather.221 It 
is thought that spendi ng ti me together and shar-
i ng vari ous probl ems among fami l y member s is 
an effective met hod of support  for families. For 
exampl e,  it is concei vabl e that nurses coul d give 
家 族 看 護 学 研 究 第 10 巻 第 l 号2004 年29 
consi derati ons to enabl i ng mot hers to be in 
cl ose t ouch wi th their di stant husbands,  en-
courage paternal  visits to promot e ti me when 
parents can talk and arrange sl eepovers at a  
“fami l y house" when conveni ent for fathers.181 
Whe n fami l y functi ons are exami ned in each 
of the three areas (Tabl e 4)  ,  it is seen that the 
suffi ci ency of fami l y functi on of“Rel ati onshi p 
bet ween fami l y and subsyst em" tends to be 
l ower in J apan.  Al so,  a  previ ous study231of J apa-
nese mot hers who have heal thy chi l dren attend-
i ng nursery school  shows that the average d  
scores in the FFFSwer e 14. 8±9. 8 in “Rel ati on-
shi p bet ween fami l y and i ndi vi dual ，”8. 4士5. 3 in 
“Rel ati onshi p bet ween fami l y and subsyst em" 
and 8. 9士6. 0 in “Rel ati onshi p bet ween fami l y 
and society. ” Al t hough it is not an exact com-
pari son,  because of the di fferent ranges in chi!-
dren'  s  ages,  if compar ed wi th the resul ts of this 
study (Tabl e 4) ,  d  scores show the greatest dif-
ference in “Rel ati onshi p bet ween fami l y and 
subsyst em" and reveal  that the fami l y functi on-
i ng of this area in this study was l ower t han that 
in a  previ ous study.  The subsyst em consi sts of 
peopl e wi th whom the fami l y has strong interre-
l ati onshi ps,  such as acquai ntances,  relatives 
and neighbors.81241 J apanese have a  speci al  con-
cept cal l ed “uchi -soto”（i nsi de vs. outsi de) .  251 
The family, whi ch erects a  solid boundary be-
t ween itself and others,  has weak rel ati onshi ps 
wi th the subsystem,  and is hesi tant to recei ve its 
support.  It has been poi nted out that in J apan 
an unfortunate feature of social support  for 
mot hers wi th babi es is that nei ghbors provi de 
the least help. 261 In consi derati on of this deepl y 
rooted cul tural  background,  it is necessary to 
try to i mprove the level of fami l y functi oni ng 
t hrough adj ustment of the fami l y- subsystem re-
l ati onshi p. 
V ‘Concl usi on 
The functi oni ng of J apanese and Ameri can 
fami l i es usi ng “fami l y houses" was compared.  
Amongst  FFFS items,  J apan had significantly 
l ower suffi ci ency of fami l y functi ons in “Ti me 
wi th heal th professi onal s" and 
ill. ” Whe n exami ned by area,  J apan t ended to 
have l ower suffi ci ency of fami l y functi on in “Re-
l ati onshi p bet ween fami l y and subsystem. ” Fur-
thermore,  i tems for whi ch nursi ng i nterventi on 
is necessary i ncl uded “Probl ems wi th chi!-
dren" and “Sati sfacti on wi th marri age" in J apan 
and “Probl ems wi th chi l dren" in the U. S.  In this 
way,  the features of the functi ons of J apanese 
and Ameri can families usi ng “fami l y houses" 
have been establ i shed,  and because of the 
deeper underst andi ng of the J apanese fami l y 
f rom a  cul tural  vi ewpoi nt,  fami l y nursi ng inter-
venti on for the J apanese fami l y shoul d be pro-
vi ded.  
Acknowl edgment s 
The 巴xcepti onal support  of Dr.  Yasumi  Uchi da of the J apan 
Foundat i on of Cardi ovascul ar Research duri ng this st udy is 
hereby grateful l y acknowl edged.  The study was  f ound巴d in 
part by Grant-i n Ai d for Scientific R 巴search ( B)  (2), 
#  15390670 ( granted to Naohi ro Hohashi )  ,  f rom J apan So-
ci 巴ty for Promot i on of Sci ence ( J SPS)  
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家 族 看 護 学 研 究 第 10 巻 第 l 号2004 年
ファミリーハウスを利用する母親からみた家族機能の日米比較- Feet ham家族機能調査を用いたクロスカルチヤー研究
法 橋 尚 宏I），小山智住子21
II 神戸大学医学部保健学科小児・家族看護学
21神戸大学医学部附属病院第二病棟
キーワード・ファミリーハウス，家族機能， FFFS，日米比較
ファミリーハウスを利用している日米の母親を対象として， FFFS ( Feet ham Fami l y Functi oni ng Survey）の日本語版と英語版を用いて家族機能を比較した.25 項目別にみた家族機能得点の日米比較では，「医療機関にかかったり，健康相談を受けること j と f体調が悪いとき」の家族機能充足度が日本のほうが有意に低く，日本の家族に対しては保護機能と休息機能の充足が望まれる．また， 3 分野別にみた家族機能得点の日米比較では，「家族とサブシステムとの関係j の家族機能充足度が日本のほうが低い傾向がみられた．これは 3 家族員とそれ以外の人々の聞に明確な一線があるという日本の家族の特徴と関係していると考えられ，文化背景を考慮しながら家族とサブシステム（知人や身内，近所の人のように家族との相互関係が強い人々）との関係を調整していくことが必要で、あろう．家族機能得点と重要度得点からの評価により，家族看護介入が必要である家族機能の項目は，日本では「子どもに関する心配事」と「結婚生活に対する満足感J ，アメリカ合衆国では「子どもに関する心配事j であった．すなわち，日米ともに入院中の病児と自宅に残している子どもに対する心配を軽減する介入が必要で、ある また，日本の「結婚生活に対する満足感J については，夫婦聞の性愛機能への支援が考えられ，病児のみならず家族の生活をも重視した医療環境の整備の再確認が必要である．このように，文化背景から日本の家族をより深く理解することが可能で、あり，クロスカルチャー研究により家族看護介入を考えてし、く示唆を得ることができた．