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The Meaning of the Family: Lived Experiences of Turkish Women Immigrants in Germany
Andrea Zielke-Nadkarni
Nurs Sci Q 2003 16: 169
DOI: 10.1177/0894318403251797
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10.1177/0894318403251797
International
Nursing
Science
Perspectives
Quarterly, 16:2, April 2003

ARTICLE

The Meaning of the Family: Lived Experiences

of Turkish Women Immigrants in Germany
Andrea Zielke-Nadkarni, RN; PhD
Professor of Nursing Education, University of Applied Sciences, Muenster, Germany
The basic premise underpinning this research is that the family plays a key role in understanding and providing adequate nursing care for an ill member. To understand the family, the view on what members are as a family and what
meanings are attributed to their various roles is of central importance for nurses. Since Turkish Muslim families
who live as migrants in Germany differ considerably in their own understanding of themselves in their German environment, qualitative research, based on Spradleys developmental research sequence method, was conducted with
nine Turkish women in order to learn about the meaning of family for them.

Iingly
n the last two decades families as caregivers have increasbeen the focus of nursing research (Fink, 1995; Fischer,
1986; Shyu, 2000). The results show that families take over
responsibility for most of the nursing care needed by their
members. In cases of long term care, however, this produces
great strain for the mostly women caregivers. Professional
caregivers need to be aware of the life situation, the views
held, and the care practices wanted by these families and their
individual members. Turkish migrant women in Germany
perceive themselves as different in many respects from their
German counterparts. They have different views on how a
family should operate and how an ill family member should
be attended. The aim of this research was therefore to offer an
analysis of the views on the family held by a sample of Turkish women.
Family structures are based on traditions that relate to social systems. This means that families who migrate may be
confronted with demands from a new society that can modify
their traditional concepts, structures, and functions, even
though a typical feature of families in transition is their fixation on the familiar. The narratives of the women interviewed
for this study, which is part of a larger project, showed the effect of their social environment on their personal understanding of the role of the family and its ensuing impact on health
issues. In fact, the informants did not consider themselves primarily as individuals, but as members of a family with specific roles attributed to each position.
Historical Background
In 1965, a contract between Turkey and Germany initiated
the flow of a work force of 2.1 million people from east to
west, the largest ethnic minority of a total of 7.2 million immigrants (Herbert, 1986). During the recession of the late 1960s
the German government sought to reduce the number of miNursing Science Quarterly, Vol. 16 No. 2, April 2003, 169-173
DOI: 10.1177/0894318403251797
2003 Sage Publications

grants, and finally stopped advertising abroad in 1973. Those

who immigrated before 1973 have been termed the first generation, their children and grandchildren the second and third
generations. As Muslims they represent a group with distinct
customs which differ from those of the predominantly Christian Germans. Although Turkish people have now lived in
Germany for 30 years their specific care needs have not been
adequately addressed (Schilder, 1998).
Literature Review
Research on Turkish immigrants focusing on their particular nursing care needs has been limited both within Germany
and internationally. In Germany, the specific needs of a growing number of elderly Turkish people have been analyzed
(Gtschenberger, 1993). Scheib (1996) examined the changes
in traditional family support due to structural changes that led
to an increasing demand on places in public homes for the elderly. The potential problems of a return to Turkey are discussed by Koch-Straube (1991). Arabian-Vogel (1998) suggests an internationalization of homes for the elderly to
counteract possible discrimination. At present, however, the
family is still the main source of help for elder Turkish people
living in Germany. Carrier (1999) found that social networks
vary according to age, family status, and gender. The networks
of elderly people, married couples, and women are more limited than are those of younger people, singles, and men.
A qualitative study by Grottian (1991) examined the views
on health and illness of Turkish migrant women in Germany.
The results showed that the women felt overtaxed with household chores, jobs, and children. In particular, the first generation suffered from the loss of their female network, which
caused them various psychosomatic illnesses. Schilder
(1998) interviewed nine nurses who worked with Turkish outpatients. They reported that the women they visited often did
not talk to them, because this was considered to be the mans
Keywords: family nursing, Spradley, Turkish women

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Nursing Science Quarterly, 16:2, April 2003

job by and the women nurses did not feel accepted. It is also
clear from this research that the nurses had little experience
with Muslim patients, and that there was a major communication gap due to language.
Zwaard (1992) carried out a content analysis of 15 essays
written by Dutch community health nurses. They described
the educational attainment and the relationship of the family
members within Turkish and Moroccan families, with the aim
of giving better support to these groups. Zwaards analysis revealed that in most essays the concepts ignorance, unequal
relationship of cultural differences, and uncertain residence
status were regarded as having an explanatory force for the
risks and problems faced by these families.
DeSantis (1997) developed a concept for an appropriate
ethnic mix in communities, based on the concepts of mutually
approaching stereotypes, solidarity, and mediating agents.
She regarded cultural brokerage between institutions and ethnic groups as the task of specially trained nurses. DeSantis
showed that the views on the situation of the migrants held by
the nurses whom she interviewed are similar to those held by
German nurses (Schilder, 1998).
Method
The qualitative study reported here drew on the interpretative paradigm of ethnography to explore the meanings the informants ascribe to being a family, and their attitudes toward
nursing care for a family member. Nine Turkish women (4
from the first generation and 5 from the second generation)
were interviewed in accordance with the ethnographic developmental research sequence method (Spradley, 1979). The
method is based on the recognition that qualitative research is
particularly apt for eliciting information regarding beliefs and
cultural attitudes (Field & Morse, 1991; Hammersley &
Atkinson, 1995). Semi-structured interviews were used to
elicit the informants account of reality. The emic dimension,
that is, the participants view (Spradley, 1979) of the phenomenon under study was explored, and explanations were given
from the informants points of view. Informants were chosen
with the help of Turkish doctors assistants with access to
women who care for a family member. Consent was obtained
before each interview. Interviews were conducted in Turkish
and in German. They were audiotaped and transcribed verbatim. Each informant had the right to refuse to participate or to
withdraw at any time from the study. The result was a thick
description (Geertz, 1987) of the informantsattitudes toward
family and the role of the sexes.
The meaning of family was investigated by comparing the
attitudes and experiences of the informants. All Turkish informants saw their identity as Turkish since they were brought
up within a Turkish framework. The first generation participants had between 0 and 5 years of formal education. The second-generation participants had between 5 and 11 years and
they came from a rural, working class, or lower middle class
background. All women had caregiving experiences.

Findings
Turkish Womens Concept of the Family
The phrase, as a family we have to stick together, summarizes the views of family and nursing care which are held
by the Turkish informants and which depended on the specific values, norms, and organization of daily life embedded
in their social network. They are clearly influenced by the
structures of the social system, the topical historical situation,
and socio-cultural factors. Gender specific roles have evolved
in traditional ways within marriage and determine the distribution of any labor in the household.
A decisive part in the life experience of both immigrant
generations is the separation from loved ones. In Turkey, the
first generation of women traditionally left their parents
home when they got married and moved in with their inlaws
who often lived far away, with few means of transport available. This meant that in some cases they did not see each other
again for years. Then, the husbands left for Germany. Finally
the women themselves followed their spouses and, in so doing, had to leave their families and neighbors a second time,
and often their children, which they viewed as their most
painful experience.
At the beginning of their lives in Germany the women often had no one to turn to, sometimes not even their husbands.
They were there without any knowledge of the German language, without a job or much education to rely on, and without their families. They were also used to rural life styles and
strict Muslim customs, and now found themselves alone in a
strange urban environment that did not welcome them unless
they were fortunate to live in a Turkish dominated suburb.
Mrs. L. related,
I was born in a village in Middle Anatolia. I had many sisters
and brothers. At fifteen I was engaged and married at sixteen
and immediately afterwards I came to Germany. It is true, I
came all the way from Turkey to this country, and my husband
did not come home at night. I sat waiting for him; often I was
ill and very homesick. When he got back early in the morning
he used to sleep till nine or ten the next day, and then he got up,
had breakfast and left again. I did not know where he was going, where he had been, and, because we are all a big family, I
was not allowed to ask.

The second generation experienced a separation from at

least one parent. They were often left for years to grow up
with relatives and then had to leave the relatives to go to Germanyfollowing their parents from whom they were estranged, since they saw them only once a year during a holiday. Mrs. F. explained,
When I was a year and a half old my parents left me with my
grandparents and emigrated to Germany with my two brothers. It was just when I needed my parents that they were not
around. I was never able to speak openly to them about this.
When they spent their holiday in Turkey with us, once a year,
they were like strangers to me. My grandparents did everything for me. Later there were problems in the family and I

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International Perspectives
was given to my aunt, my fathers sister, and I was strictly forbidden to see my grandparents again. At the age of 11, I came
to Germany. It was very hard, as I did not feel close to my parents. There was a coolness between us.

In spite of all this, the family was and is the primary source
of support due to the lack of social support from the Turkish
government and from an unwelcome target society into which
they moved. Research by Schuleri-Hartje (1994) confirmed
that Turkish families feel a greater closeness than German
families, a closeness that is linked to specific behavioral conventions. In this research, sticking together as a family was
found to be the key category in the interviews together with a
number of subcategories.
The most important subcategory, helping each other, links
sticking together to the reality of everyday life where support
is based on reciprocity. In order to be able to help when
needed, the family members must keep in touch. Keeping in
touch means visiting ones family regularly. Everybody is
welcome at any time while it is also expected that children
make regular contact with their parents. Among siblings contact is frequent, but not as strictly regulated. Permanent closeness is seen as the foundation of genuine care. Finally, sticking together as a family means that husband and wife should
not separate without very good reasons. The women in particular are asked to work on a stable relationship through compromises, respect for their husband, and quite pragmatically
through sharing money.
Mrs. E. stated,
In Turkish marriages money is not held separately, but shared.
If there is a divorce everything is arranged for in the Quran. It
is very important for me that all the money is shared and that
we are working for one cause. And then, this having affairs.
Well, in many German or non-Muslim relationships people
give up very quickly without saying Now, I want to compromise, I dont want to lose you, I dont want any social problems. If our people separate they will have to face social reactions like Why did you do that? And people talk behind
ones back. Who knows what happened? It means that people
think twice and often you find that it was good that they stayed
together and stuck with each other during that bad stretch.

Sticking together as a family, both strengthens the intra-familial connections and marks the family as different from the
Germans who are believed to care less for their families than
Turkish people do. This strong boundary between ones own
and German families is described in terms of specific contrast
categories. Warmth, philanthropy, and hospitality are values
Turkish women are proud of and find to be missing in the Germans. These feelings are openly and frequently demonstrated
by hugging and kissing children who are not ones own, for
example, by giving freely and by allowing ample time for frequent social contacts. The attributes connected with being
Turkish center on collective or shared things and feelings.
Mrs. E. quotes a Turkish saying which underlines this attitude: We say, the giving hand is better than the taking hand.
Another difference from the Germans is symbolised in a spe-

171

cial outlook on life. Mrs. F. told me, I want to bring my children up as I was brought up, and thats what we try to do. It
means a difference in faith.
This outlook on life is conveyed through ones upbringing
and faith. Within the authoritarian structure of the family the
concept of respect plays a key role and comprises showing respect for ones parents by accepting and tolerating their
wishes and decisions. However, the second generations respect for their parents has been undermined in part by its linguistic superiority in speaking German and by a more realistic appreciation of the social situation (John, 1987). Also,
Turkish fathers belong to a discriminated minority within a
society that no longer subscribes to the principle of paternal
authority to the same extent as the Turkish people. Parents
apart, respect is owed to older relatives and the husband who
may, for example, forbid his wife to work. Respect is also paid
to persons with a specific body of knowledge such as religious leaders, teachers, or medical doctors. In order to safeguard their Turkish outlook on life, members of the first generation often sought to marry their children to partners from
Turkey because they expected them to have had a traditional
upbringing. Mrs. H. related,
There were problems with my parents-in-law. Although they
live far away in Turkey they had a lot of influence. I was not
accepted because their son chose me and not they themselves
and because girls from Europe are indecent anyway and know
nothing about modesty and Turkish customs.

The traditional code of honor maintained by first generation Turks is linked to the terms honor (namus) and disgrace
(ayip). A loss of honor, for example, if the daughter is deflowered before marriage, means social disgrace for the whole
family (Schiffauer, 1980) and must therefore be restored.
Since honor and disgrace are core components of traditional
Turkish morality (zkara, 1988) the first generation sought to
see their daughters married before any trouble occurred.
Therefore, when Mrs. Bs daughter fell in love, it was only
logical in the eyes of her parents to marry her to a man they
chose. Before this could happen their daughter jumped out of
a high window and, due to the resulting trauma, is now permanently bedridden.
The second generation of women mostly met their husbands secretly before their marriage. The men then made use
of other contacts to propose to the girls parents. Now mothers
want their daughters to have more freedom than they themselves had, even though they still follow tradition. Mrs. F.
stated,
Virginity is very important for me, although I do not think that
my daughter should not have a boyfriend. But I want to meet
him. I dont want my child to go to a disco. I want her to live a
religious life, to be polite and helpful, to be disciplined, and to
show respect.

As regards their relationship with their husbands, the

women of the second generation consider themselves a lot

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Nursing Science Quarterly, 16:2, April 2003

more independent than their mothers. While Mrs. E.s mother

grew up in a patriarchal authoritarian tradition, Mrs. E. would
not tolerate unfaithfulness in her husband, gambling, or violence, all of which are still quite frequent in first generation
families, and in second generation families with low educational levels.
The identity of Turkish women is very heavily based on
their faith and its importance in everyday life. While the intensity and strictness of religious performance varies, the
principle values are regarded as binding. Mrs. F. said, We are
not very strict in our religious performance. We keep the
rules, but not all the time. After all, weve grown up in a modern world. Religion helps to strengthen that part of the identity that is connected to the country of origin and it provides
answers to the question of belonging. Mrs. E. held,
I have been suffering from identity problems. Where do I belong, there or here? Being married to a really religious man
has helped me see that I must be a model for my child. Now
that Im wearing a headscarf I can tell her to wear one as well
when she is seventeen or eighteen.

Maintaining a religious identity also raises the question of

self-representation within a Christian exclave. Different options of presenting ones Muslim identity, ranging from the
partially open to the partially hidden, are practiced according
to individual viewpoints. While Mrs. E. wears her headscarf
outside her home, her very religious mother seeks to stop her,
in order to save her from any disadvantages which may result
from orthodox clothing. Mrs. E., however, accepts the role of
a provocative outsider in German society, even though she is
uncomfortably aware of possible discriminatory reactions.
The Relationship Between Men and Women
Turkish women are expected to do everything in the marriage. Getting married is a duty for every Muslim. Being unmarried is seen as a blemish, as wasting ones life and being
sinful. The relationship between the sexes in Muslim families
is traditionally shaped by an attitude of respect and obedience
on the part of the wife toward her husband and by her being
tied to the house. The husband has decision-making powers
on all matters outside the home, while the wife decides on issues inside the home. Mrs. L. stated, My husband decides
everything. I have to ask him about everything even when I
want to leave the house. He then says yes or no.
A mans decisions are, however, influenced by the rest of
the family. Yet, migration changes those structures. Women
are working outside the home. They earn their own money
and thus, even the first generation experiences more independence than previous generations, although its extent depends on each individual family. Mrs. A. related,
Normally a man and wife decide together, but not in my family. I decide for myself. Maybe other families dont do it like
this, but I have always learned to decide everything by myself.
I think this is how it should be.

Similarly, Mrs. H. said, My husband is the father, the breadwinner, the head of the family, but I do not feel respect exclusively for him because then I would not feel as valuable myself. But, I am valuable too, and I respect myself.
Education for women and division of labor had little
meaning in the rural environment of the first generation. Furthermore, a womans working outside the home meant loss of
prestige for the husband. These days both wives and husbands
regard a proper education as very desirable for all of their
children.
In nursing situations, the division of labor within the family is a key issue for nurses cooperating with families in the
care of an ill relative. In this respect, migrant families have
their own rules. The women do household chores and look after the children and the ill. The traditional division of labor
where men go shopping, take the ill to the doctors, deal with
the authorities and with any matters outside the house is basically still maintained. The women, however, take over the
mens tasks some of the time on top of their own workload.
Mrs. B. shared, In my family the men help the women and I
have the say. For example, if I want to go out, my husband will
look after my daughter. This means that Mrs. B. gets help if
she wants to go out. While she is at home, however, which is
most of the time, she does the work.
All the women feel ill and are ill and overtaxed. Due to the
lack of speaking German and the lack of financial resources,
they do not have drivers licences. Sometimes the family does
not own a car, which means that the women do not just have to
look after their ill family member, they also have to do the
shopping for the whole family while relying on public transportation. Mrs. C. said, The men help when there are no
women to do the work. In the house the women do everything;
men earn a bit of money.
While first-generation husbands did not take over many
chores, the role concept held by the second-generation men
often included going shopping, cooking, cleaning, and looking after the children. The main responsibility for these tasks
however still rests with the women. Mrs. K. shared,
Its easier for the men. They go off to work for 8 hours. When
he is back, he sits down, watches TV and has his meal. Me, on
the other hand, I dont have just 8 hours. Sometimes I work 12
hours and then he says, What have you done all day?

Through their education the women aim at a greater involvement of their sons in the household. When Mrs. H.s son
was still well he had to do some chores. Mrs. H. explained,
We had a plan I made and he had his own area of duties, like
his room or sweeping the stairs before I wash them. He had to
take out the rubbish and sometimes hoover, help with the
washing up and with going shopping. It is important to teach a
boy early so that he does not become macho. Really, its the
mothers who bring them up and have to break this cycle.

Traditionally women used to have their network of neighbors and relatives who helped. In the course of migration,

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International Perspectives
needs changed. Today men are needed more in the home nowadays because the women have jobs and the families do not
live near each other. The men, however, favor the traditional
values which bring them relief at the expense of their wives.
As a result, the present infrastructure disadvantages women.
The women try to continue the mutual support, but due to the
living situation often find themselves left alone. Life in an urban environment means that the men spend more time at
home, that is, in the traditional realm of the women, which
limits everybodys space. This can lead to conflict and poses
questions about the division of labor which can no longer be
justified on the basis of the formerly valid criteria. All in all,
however, the family remains the key resource. Mrs. B. said,
When I need help my family is there. My brother helps me
with any bureaucratic or economic problems. With anything else my husband or my youngest daughter help. Yes, it
is mainly my family from whom I get help. Thus, sticking
together as a family on the basis of tradition on the one
hand, and adapting to modified life circumstances on the
other, show in the womens emotional divide between the
wish to live their traditions and the demands made by changed
circumstances.
Implications for Nursing Practice
Luker, Austin, Caress, and Hallett (2000) found that the
concept, knowing the patient, is of central importance for the
60 nurses they interviewed. This attitude is part of a philosophy called new nursing which entails a holistic approach, a
recognition of the patients individuality and uniqueness.
Knowing the patient results from continous contact between
nurse and carereceiver and from personal closeness. The
meanings attributed to family have a great impact on the effects of nursing care. Nurses who allow patients to share their
perspective can learn about roles in a family, and about the
tasks and competencies that go along with them. Nurses also
get to know the values and beliefs of the patient and the family, which may differ from their own and/or add new perspectives to it. Given that the nurse cannot know what kind of nursing care would be acceptable or rewarding to a particular
patient, dialoguing becomes a key element within the nursing
process, all the more in the care of a patient from a sociocultural background different from that of the nurse. The fact that
the family is seen as the main resource for help even when the
women interviewed are completely overtaxed with household
chores, job, and the ongoing need to care for a (chronically) ill
family member, points to an urgent need for a relationship
based on trust between them and the professional caregivers.
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