The family health system as an emerging paradigmatic view for nursing

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE PERSIAN VERSION OF THE FAMILY FUNCTIONING, HEALTH, AND SOCIAL SUPPORT QUESTIONNAIRE IN A SAMPLE OF HEART FAILURE PATIENTS AND THEIR FAMILY MEMBERS

Background and Purpose: Family functioning, family health, and social support have significant roles in the management of heart failure (HF). This study aimed to translate, adapt, and assess the validity and reliability of the Persian version of the Family Functioning, Family Health, and Social Support (FAFHES) questionnaire. Methods: FAFHES questionnaire was translated into Persian, and an expert panel assessed the cross-cultural adaptation. We examined the construct validity by confirmatory factor analysis and internal consistency by Cronbach's alpha coefficients among 576 participants. Results: The Persian FAFHES confirmed the three-factor structure in the social support and the five-factor structure in the family health scales. However, the family functioning scale yielded the three-factor structure versus the four-factor structure in the original scales. The Cronbach's alpha for the three scales varied from 0.85 to 0.94. Conclusions: The adapted FAFHES seems to be valid and reliable to measure family functioning, family health, and social support in families with HF.

Factors Associated with Quality of Care Among Dependent Older Persons in the Community

Introduction

Dependent older persons who are limited in their daily activities affect physical, mental, social ability needs help in the family and the community caregiving.

Objective

The study aimed to analyze the relationship between caregivers' characteristics and health conditions, social support, the burden of care, and the quality of respect for the dependent older persons.

Methods

The descriptive study design applies in using a Donabedian framework, including structure, process, and outcome with House's social support. The sample consists of 102 family caregivers currently caring older people with dependency in Bangkok, Thailand. Data were collected through questionnaires, semi-structured interviews, and care quality assessments through tested content validity from 3 health experts, which received a score of 0.97. Descriptive statistics and correlation coefficients were used to analyze the information and tested using Spearman's rank correlation; acceptable criteria were obtained before collecting the actual data.

Results

The results showed that they were statistically significantly related to social support and quality of care. When considering each aspect, social support was associated with the quality of physical and psychological care. Resource social support was to relate the quality of medical and financial aspects. Social support of acceptance and appreciation is associated with quality, environmental, physical, psychological, human rights, and economic elements; information social support was significantly related to information supervision quality.

Discussion

This study found that personal factors in age and comorbidity affect the burden of care in family caregivers. In addition, good social support will affect the quality of respect for the dependent older persons in psychological, medical, human rights, and financial dimensions. In particular, the appraisal support, incredible care, attentiveness, and dedication to care will result in a good quality of care in all areas except the quality of physical dimensions.

Measuring Family Members' Experiences of Integrating Chronic Illness Into Family Life: Preliminary Validity and Reliability of the Family Integration Experience Scale:Chronic Illness (FIES:CI)

Measures of family members' experiences of integrating chronic conditions (CC) or chronic illnesses (CI) into family life are needed to optimize family care. This article reports development and psychometric testing of the Family Integration Experience Scale: Chronic Illness (FIES:CI), a measure of family member perceptions of integrating CC or CI into evolving family life. Family Systems Nursing (FSN), the Reintegration Within Families in the Context of Chronic Illness Model, and measurement theory guided the study. Participants were those (N = 328) managing a CC or CI. Concurrent validity (r = +.629; p < .001) and discriminant validity, F(1, 155) = 7.09; p < .05, were demonstrated. Exploratory factor analysis revealed a two-dimensional model explaining 63.8% variance. Scale internal reliability was α = .70 and .785, and factor reliabilities were α = .798 (Factor 1) and α = .847 (Factor 2). Test-retest item and subscale correlations, while accounting for intra-family correlation, were acceptable. The FIES:CI contributes a valuable new measure of family integration in the context of CC or CI with preliminary validity and reliability as tested in these samples.

The parents', hospitalized child's, and health care providers' perceptions and experiences of family centered care within a pediatric critical care setting: a metasynthesis of qualitative research

The delivery of family centered care (FCC) occurs within varied pediatric care settings with a belief that this model of care meets the psychosocial, emotional, and physical needs of the hospitalized child and family. The aim of this review was to explore the attitudes, experiences, and implementation of FCC from many studies and to facilitate a wider and more thorough understanding of this practice from a diverse sample of parents, hospitalized children, and their health care providers within a pediatric critical care setting. A metasynthesis is an integration of qualitative research findings based on a systematic review of the literature. Thirty original research articles focusing on family-centered care experiences from the hospitalized child's, parents', and health care providers' perception published between 1998 and 2011 met the criteria for the review. Nine syntheses from 17 themes emerged from the synthesis of the literature: Prehospital, Entry into the Hospital, Journeying Through Unknown Waters, Information, Relationships, The hospital Environment, The Possibility of Death, Religion and Spirituality, and The Journey Home. The individual cultures of the critical care units helped create and reinforce the context of parental needs where satisfaction with communication, information, and relationships were interconnecting factors that helped maintain the positive or negative experiences for the parent, hospitalized child, and/or health care providers.

Development of the concentric sphere family environment model and companion tools for culturally congruent family assessment

The article presents development of a nursing model for holistically understanding the family environment that acts on family well-being as well as of tools based on this model to assess family well-being. These were constructed by using qualitative, quantitative, and literary approaches, such as the Delphi technique, a literature review, semistructured interviews with families, and ethnographic studies in Japan, Hong Kong, and the United States. In the "Concentric Sphere Family Environment Model," a three-dimensional logical space is formed by the three assessment axes of relationships (structural distance, functional distance, and temporal distance) and five systems (supra system, macro system, micro system, family internal environment system, and chrono system) located therein. The "Family Environment Assessment Index" comprises 37 items for assessing the family well-being, and for each of their specifications useful sample questions are provided to conduct the culturally congruent family assessment.

A family systems nursing intervention model for paediatric health crisis

AIM

This article discusses the development of a family systems nursing intervention for clinical use in health crisis.

BACKGROUND

Although studies in paediatric critical care provide evidence that family stress is an important clinical phenomenon, studies have demonstrated that few nurses have the requisite family intervention skills to provide family members with adequate support during crisis. In addition, few intervention studies that focus on provider-family relationships with the goal of reducing stress have been reported. This article contributes to the literature by redressing this lack. Data sources.  The literature search supporting this project spanned from 1980 to 2009 and included searches from classic nursing theory, family theory and relevant nursing research specific to the design of the intervention reported.

DISCUSSION

The goal of the intervention is to provide a theoretical and practical foundation for explicit action that enhances relationships with caregivers thereby supporting the integrity of the family and enhancing their coping abilities. The intervention, based on the Family Systems Model and the family's understandings of the situation, defines specific goals and desired outcomes to guide strategic actions. Discussion of the conceptual foundation, procedural development and an example of the protocol is provided. Implications for nursing.  The intervention is designed for nurses with limited knowledge in family theory to aid them to better help families dealing with stress.

CONCLUSION

The proposed intervention can be used to increase nurses' skills in family centred nursing care. Although designed for use in paediatric critical care, it can, with modifications, be used in other nursing specialty areas.

Strategies to teach family assessment and intervention through an online international curriculum

A Web-based certificate program for international health professionals to acquire understanding of family health and strategies to implement culturally sensitive health care of families is outlined. In four Web courses and a project, students progress interactively to apply culture, family, and interdisciplinary health system theories to assessments and clinical interventions with families in the interdisciplinary setting. Four online educational strategies to facilitate student success from the virtual classroom to actual clinical care are described: adjusting to the technology, communicating the learning progress openly, giving mutual feedback, and implementing evidence-based family care. Outcomes addressing student learning and skill enhancement, family interaction, and student and faculty experiences in the virtual learning environment are explored. Overall, students learned to work successfully with families in health care, experienced increasing comfort and competency in challenging situations, introduced family care in their work setting, and emerged as leaders while working in interdisciplinary teams.

Factors affecting the sense of burden felt by family members caring for patients with mental illness

The purpose of this study was to identify factors that affect the sense of burden felt by family members caring for patients with mental illness at home in Japan. This study was conducted by using the cross-sectional method, and a questionnaire was delivered to 30 patients and 30 family caregivers. A multiple regression analysis was conducted, with sense of burden as the dependent variable and variables showing a significant correlation in the univariate analysis as the independent variables. The results of the study revealed that patients' satisfaction with daily life and ability to perform tasks had a strong impact on the sense of burden felt by the caregivers. These results suggest that providing support that enhances the quality of life of the patients with mental illness may indirectly help reduce the sense of burden felt by family members caring for them.

[Family history of children with chronic kidney failure: data collection]

The systematization process of care has as its first step the nursing history. This study aims to present the experience of data collection for care planning involving families of children with Chronic Kidney Failure on peritoneal dialysis. Family Nursing was used as a theoretical reference framework. Data were collected by means of in-depth interviews, documentary analysis, field diary, genogram and ecomap. Study participants were four families. The authors discuss in-depth interviews, its limitations and advantages, the construction of the genogram and ecomap and ethical, legal and social implications. Finally, it is presented general considerations on how to apply these instruments in care delivery involving families of children with Chronic Kidney Failure on peritoneal dialysis.

Family identity: black-white interracial family health experience

The purpose of this interpretive descriptive study was to describe how eight Black-White couples with school-aged children constructed their interracial family identity through developmental transitions and interpreted race to their children. Within and across-case data analytic strategies were used to identify commonalities and variations in how Black men and White women in couple relationships formed their family identities over time. Coming together was the core theme described by the Black-White couples as they negotiated the process of forming a family identity. Four major tasks in the construction of interracial family identity emerged: (a) understanding and resolving family of origin chaos and turmoil, (b) transcending Black-White racial history, (c) articulating the interracial family's racial standpoint, and (d) explaining race to biracial children across the developmental stages. The findings guide family nurses in promoting family identity formation as a component of family health within the nurse-family partnership with Black-White mixed-race families.

Development of professional practice based on a family systems nursing framework: nurses' and families' experiences

The purpose of this evaluation project was to elicit nurses'and families' experiences about differences and changes for nurses and families and the family-nurse relationship when a family systems nursing approach was used to guide practice. Following nurses' involvement in an educational workshop, the evaluation examined changes in nurses'and families' experiences over an 8-week period of a child's hospitalization in a pediatric rehabilitation center. A total of 17 nurses and 13 parents participated in the project. Nurses and parents completed questionnaires and participated in semi-structured interviews and focus groups. Nurses completed journals reflecting on their interactions with families. Data were analyzed using descriptive statistics and content analysis. Findings indicate that a family systems nursing approach had a positive impact on how nurses viewed their nursing practice and their work with families, thereby enhancing family-nurse relationships. Such findings have relevance to clinical nursing practice, professional development, and evaluation research design.

Older Married Couples and Health Promotion: Joint Decision-Making Process for Long-Term Spouses

The purpose of this study was to explore communication patterns between long-term married couples to better understand the process by which later-life couples participate in health promotion. Forty community-residing couples married for 30 years or longer were asked to respond to open-ended questions and to participate in a decision-making activity. The majority of couples made health decisions jointly, with wives acting as the final deciders 54% of the time. Most couples used positive communication strategies during a structured scenario. Findings highlight the importance of expanding beyond traditional individual-focused models to include joint decision-making processes. Implications for future research and for nursing practice are discussed.

A double concern: Danish grandfathers’ experiences when a small grandchild is critically ill

This paper addresses grandfathers' lived experiences when a new-born or small grandchild is critically ill. Grandfathers are marginal in nursing research in spite of the fact that intensive care nursing has broadened its perspective from being patient-centred to include family-oriented care. A convenience sample of seven grandfathers was interviewed once. Using Van Manen's phenomenological methodology, the essence of the phenomenon was found to be "a double concern". Main themes in this essential theme were: "Being a father and a grandfather" and "being in the midst of life and death". Six sub-themes expanded and clarified the meaning of these themes. Overall the grandfathers experienced worry and loving concern for parents and grandchildren. In life-threatening situations grandfathers were scared and felt helpless; they were prepared to console and comfort; they always hoped for the best; and they felt like being in the inner circle if the health personnel included them when informing about the infant. Information and presence generally were of importance for the wellbeing of grandfathers. The findings constitute a systematic and thematic description of Danish grandfathers' experiences and therefore add to a family-oriented body of knowledge for intensive care nursing.

Family-nurse co-construction of meaning: a central phenomenon of family caring

The purpose of the study was to understand and interpret caring in the family health experience by exploring the interactional phenomenon of family-nurse co-construction of meaning in the paediatric intensive care unit (PICU). A hermeneutic phenomenological method within a framework of existentialism and symbolic interactionism was used in the investigation. The convenience sample for this study was four family-nurse dyads, that is four families of critically ill children (all with positive outcomes) and the four nurses assigned to their care who were participating in a larger study. Data were derived from semi-structured interviews regarding significant interactions throughout the child's illness and subsequent significant interactions of families with other nurses and nurses with other families. Trustworthiness of the study was addressed through the criteria of credibility, dependability, transferability and confirmability. Co-construction of meaning in the family health experience was found to have two dimensions: interdependent and independent. Both families and nurses described being like family as an essential component of the interdependent experience. Independent dimensions for families were journeying through troubled waters of learning the meaning of the illness event and sensing family comfort through the nurse's care. Independent dimensions described by nurses were journeying through troubled waters of learning to care for families and living with another's fear. The family-nurse interaction, the relational connection and the evolution of meanings that families and nurses construct, was affirmed as the major vehicle in the co-construction experience. Family caring is influenced by the existential meaning constructing, process-oriented, interactional nature of the family health experience. Caring in the family health experience is enhanced through actions the nurse performs on behalf of, and with, the family while understanding the family's unique situation. Caring enacted by nurses in participation with families holds abundant potential for enhancing the family health experience and honor the ethic of caring as central to nursing.

Family routines: a structural perspective for viewing family health

Although rituals are considered in the anthropological and sociological literature, less attention is given to associated biophysical and health perspectives. Three ethnographic studies were conducted to identify the ways family health was defined and practiced. Findings indicated that routines were an important aspect of family health. Families described routines linked to family health and discussed how they evolved, ways they were modified over time, and how families recreated them when stress and change were encountered. Findings indicated that routines provide a structural perspective for assessments, interventions, and outcome evaluations related to health and useful to nursing practice. This article explains some of what is known about family routines, describes the author's findings, and suggests implications for nursing.

Family members' experience of familial amyloidotic polyneuropathy disease--an infernal struggle and a fact of life

Familial amyloidotic polyneuropathy is a fatal, hereditary, systemic, progressive amyloidosis. No previous qualitative study of the family members' experience of the disease has been published. The purpose of this phenomenological study was to understand the lived experience of family members whose nearest and dearest suffered from familial amyloidotic polyneuropathy. In-depth interviews were conducted with six family members. The analysis of the data was inspired by Colaizzi's method. Two major theme categories, difficult to accept and forced to accept, emerged from the interviews. Implications for nursing practice, such as genetic counselling and support, are discussed.

Family nursing interventions: Mexican American early family formation

The purpose of this ethnographic study (based on Roy's adaptation model) with 23 Mexican American families was to assess the similarity of nursing interventions that enhance family processes of nurturing, support, and socialization. The investigator sought to assess the similarity of nursing interventions to existing ways families were nurtured, supported, and socialized and to inquire whether young parents would be receptive to nurses intervening in their families. Parents rated 20 ways of offering nursing interventions according to dimensions of similarity and acceptability and then offered explanatory comments.

Actual and ideal professional support for African American family members

The purposes of this study were to describe and compare, specifically, African American family members of critically ill adults' perceptions of the professional support they would like (ideal) to receive with the professional support they received (actual) from critical care nurses. The Professional Support Questionnaire for Critical Care Nurses Working With Family Members (PSQ) was administered by mail or telephone to 36 African American family members. The PSQ consists of three domains of support--information, comfort, and assurance. Paired t-test analyses indicated there were differences between the descriptions of professional nursing support expected (ideal) by family members and the professional support provided (actual) by critical care nurses. Although there was not an absence of professional nursing support, the degree and frequency to which African American family members wanted nurses to support them were not comparable to the support that nurses provided them.

Nurses' involvement in interdisciplinary team evaluations: incorporating the family perspective into child assessment

An expanded nursing role in interdisciplinary team evaluations of children with special needs would include seeking the family's perspective in a systematic yet sensitive way. Nursing's background in family and child health can offer valuable insight. This article reviews family nursing assessment categories, reframes them for use in assessing the family's perspective in relation to the child's health and educational needs, and presents a systematic integrated history and assessment format for gathering child and family data. This approach promotes family collaboration in understanding family, child health, and educational issues. The holistic understanding gained by the school nurse through this systematic process enhances insight in interdisciplinary team planning. The nursing written report with preliminary conclusions facilitates an organized presentation of data, setting the stage for family and interdisciplinary team mutual exploration of options and facilitating greater likelihood of successful outcomes.

Parental experience and meaning construction during a pediatric health crisis

This study explores parental lived experience following admission of their child to a pediatric intensive care unit. The interview data used were collected from 10 randomly chosen families from the Family Impact of Catastrophic Childhood Illness Project recruited during the early phase of critical care hospitalization of their child. A 3-stage contextual analysis procedure integrating interactional and contextual perspectives into Colaizz's phenomenological approach was used to reduce text data to thematic content. The analysis uncovered a multidimensional and holistic phenomenon consisting of four organizing concepts: initial boundary ambiguity, parents' coping patterns, family resources, and functioning of the family boundary. These results provide evidence of a collective family level perception of stress when experiencing the health crisis of a child and support further use of family stress perception as a family level phenomenon that represents family meaning construction during critical illness of a child.

The FAMTOOL family health assessment tool

The purpose of this study was to design and validate a family health assessment tool (FAMTOOL) based on a concept analysis of family and health. Preliminary testing of this instrument by a convenience sample of 80 adults resulted in an internal consistency coefficient of .90. A retest 2 weeks later produced a stability coefficient of .96. The FAMTOOL provides rehabilitation nurses with a quick, positive assessment instrument for helping patients and their family members assess their own family's health, compare responses with each other, and see strengths they might not have considered otherwise. As the family health system should be included in the initial assessment of everyone entering the healthcare system, the FAMTOOL may prove helpful to nurses in a wide variety of primary, secondary, and tertiary settings.

Advancing the role of clinical nurse specialist in rural family health research

For the clinical nurse specialist (CNS), perhaps the least implemented role is researcher. This is especially true of CNS research pertaining to rural family health. To be effective in this area the CNS must recognize the various definitions of rural, family, and family health. In addition, the impediments to CNS research in rural family health must be addressed. In this article, these issues are discussed, and the nurse-managed center is proposed as an ideal setting for conducting research into rural family health.

A model of nonparticipation in alcohol treatment programs

Why do the vast majority of those who suffer harm from drinking fail to obtain treatment? Based on a review of research literature and educational and treatment program materials, a model of nonparticipation in treatment is proposed whereby particular population groups are separated out according to whether or not they exhibit specified characteristics related to both harm from drinking and attitudes towards treatment. Eleven groups have been identified in the model, each of which has different reasons for failing to seek and/or obtain treatment. It is suggested that differing educational program messages should be sent to each group. While the model does not purport to be wholly inclusive of all nonparticipation, it offers a basis for addressing the variety of disparate groups that suffer harm from drinking but do not obtain treatment.

Older couples' decision making on health issues

The purpose of this qualitative study was to determine the process of spousal influence as it relates to health-promotion behaviors and the concept desire to change spousal health behaviors. Fifty-nine elderly couples in long-term marriages were recruited through three senior centers; participants were asked to respond to five open-ended questions. The majority of couples said that they made health decisions jointly; wives tended to be the primary deciders in the even that a health decision had to be made. Most people, but particularly wives, desired to change something about their spouses' health behavior; a variety of strategies were used in the attempt to change spousal behavior. Aging or illness in the self or spouse were identified as precipitants of increased desire to change the spouses' health behavior over time.

Life support decisions for children: what do parents value?

This investigation answered the question, What meaning do parents give to the decision to authorize or to withdraw or forgo authorization of life-sustaining treatment for a child? Using an exploratory design, the author interviewed 20 families who had faced this decision in the prior 6 to 12 months. From content analysis, parents' essential meaning was experienced through their sense of self, their being, and an ethic of responsibility. Parents' decisions reflected values regarding the eight key themes of life, pain and suffering, quality of life, not self, respect for person or best interest, family, faith and nature, and technology.

Concept analysis of family+health = a new definition of family health

In this article, the authors explore references to family and health in the nursing literature and compare them with their own perceptions to propose a new definition of family health. Focusing on connectedness, energy, and hope for the future, this definition and its conceptual model can help nurses care for families in the rehabilitation setting.

A family-focused perspective on chronic illness

The care of the chronically ill traditionally has focused on the individual who has the illness. Nursing has always emphasized including the family in care, but very few protocols dealing with chronic illness focus on the family as the unit of care. In this article, the author presents a new approach to the care of families affected by chronic illness, applying concepts of the family health system (Anderson & Tomlinson, 1992) to chronic illness. The protocol described, which includes nursing assessments and interventions, groups areas of family experience into five types of processes: interactive, developmental, coping integrity, and health processes. The protocol presented is an example of an innovative, holistic, family-focused perspective on the care of those with chronic illness.

Conceptual underpinnings of the family support movement

In communities across the nation, rapid expansion of programs seeking to promote healthy development of children by strengthening families has been taking place. These diverse programs are reshaping traditional approaches to families and children and are becoming important catalysts for change in human service delivery systems. Historically rooted in our culture and past initiatives, the family support movement is grounded in theories of the ecology of human development and social support. As popularity for these programs grows, preserving the underlying values and operating principles of family support is essential. Pediatric nurse practitioners can be strong advocates for these principles within their communities and health care settings.