An understanding of the family/clan structure is critical to the care of Hmong American elders.

Clan Names

Hmong Americans are organized into an 18-clan structure; all members of a clan recognize that they are related by a common ancestor.

Clan names include the following:

Some families add a grandfather’s name to clearly identify their clan lineage. For example, the last name Saykaothao indicates that their grandfather was Say Kao Thao and the last name Mouanoutoua indicates their grandfather was Nou Toua Moua.

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Role of Family in the Clan Structure

The family is a subcomponent of the clan structure. To support the clan structure and to receive the support of the clan, the Hmong are concentrated in geographic locations throughout the country, with the largest being in the St. Paul/Minneapolis area of Minnesota.
(See Figure 1)

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Important for Nurses

Knowledge of the Hmong family /clan structure can help prepare and assist nurses in understanding and appreciating the family dynamics that Hmong elders may bring with them into the clinical setting. The family can influence the decisions that are made during every stage of diagnosis and treatment. Furthermore, since each clan has its own history, there are specific taboos that are distinctive to each clan.

For example, members of the Vang clan are prohibited from eating fruit or even having fruit on the table during a meal, while members of the Yang clan are not allowed to consume the liver and heart of an animal. It is traditionally believed that if these rules are violated, bad fortune, often in the form of illness, will follow. Elders often retain these traditional beliefs.

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Marriage Practices

Membership into a clan is acquired through birth or marriage and it is a social category as well as a spiritual designation, since the ancestral spirits watch over their family members. Hmong practice exogamy, meaning that marriage partners must be chosen from outside of their birth clan.

However, there are certain clans that are considered to have diverged from a common ancestor and therefore, they may not intermarry. This includes

• Fang and Vang
• Her and Hang
• Kue and Thao clans

In addition to social repercussions, it is believed that biological implications would follow when endogamy is practiced. Upon marriage a woman leaves her clan and family and joins her husband’s clan and family; although many Hmong women in the U.S. keep their birth clan name as their last name, they are considered part of their husband’s clan.

Sides of the Family

There are two sides of the family:

1. kwv tij (father or husband’s side)
2. neej tsa (mother or wife’s side)

Traditionally, the father’s side was primarily responsible for actions and decisions in the family and the mother’s side was available for emotional support, but not financial support or to take responsibility for their daughter and her children. Contemporary roles between the two sides are changing, as more daughters and sons-in-law help the wife’s parents, but the main responsibility still resides with the husband’s family. (For more information refer to the section on Decision Making and Disclosure.)

Role of the Individual

The actions of individuals affect the reputation of the extended family. By tradition, the Hmong maintain strong family bonds that are based on interdependence rather than independence. As a result, it is expected that elders will rely on the extended family for assistance, and that younger family members will put other family members and the family unit before their personal desires. Adult children, in general, identify the importance of providing care to the aging parents in reciprocation for the care that was given to them as children (Gerdner, 2007; Gerdner, Tripp-Reimer, & Yang, 2008).

Living Arrangements

Multiple generations frequently choose to live in the same household for reasons of social and financial support. In this way families do not have to depend on outsiders for the care of family members (i.e., elders and children).

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