Tracing the Use of the Family Management Framework and Measure: A Scoping Review

Evaluating a Self- and Family Management Framework for Young Adult Survivors of Childhood Brain Tumors

This study evaluated adaptations to the revised Self- and Family Management Framework aimed at enhancing support for families of young adult survivors of childhood brain tumors (YAS). Baseline data from condition-focused caregivers of YAS (N = 53) examined correlations between the Framework's Facilitators and Barriers (individual/contextual/clinical factors), Processes (caregiver problem-solving), Proximal Outcomes (YAS self-management, caregiver family management), and Distal Outcomes (YAS/caregiver HRQOL). All aspects of family management were associated with YAS HRQOL; only Parent Mutuality was associated with caregiver HRQOL. Problem-solving was partially supported as a process linked to family management and caregiver HRQOL. Individual/contextual/clinical factors were not associated with problem-solving. Self-management was not associated with problem-solving or HRQOL. Interventions grounded in concepts of family management may improve YAS HRQOL and have future potential for family nursing practice. Further research is needed to understand the divergence between HRQOL findings, partial support for problem-solving, and lack of associations with individual/contextual/clinical factors, and self-management.

Chronic Illness and Disability: A Multisystemic Practice Model

Serious health conditions can severely strain family relationships. This article describes the Family Systems Illness (FSI) model to provide a guiding framework to help individuals, couples, and families navigate the changing landscape in the experience of illness and disability over time. This resilience-oriented practice approach distinguishes three dimensions of the illness experience and trajectory over time: (a) "psychosocial types" of health conditions, based on the pattern of onset, course, outcome, disability, and level of uncertainty; (b) major developmental phases in their evolution over time (initial crisis, chronic, terminal), facilitating longitudinal thinking about chronic conditions as an ongoing process with transitions and changing demands; (c) key family system variables, emphasizing: the interweaving of illness, individual, and family development; multigenerational themes and legacies related to illness and loss that influence coping and adaptation; family health belief systems (e.g., meaning-making, including influences of culture, ethnicity, spirituality, gender, and race), and the goodness of fit in the patient/family/health care provider relationship. The FSI model is intended for a broad spectrum of health conditions in children and adults, diverse health care professional disciplines, and clinical settings. Discussion includes timely, cost-effective applications in different clinical settings, including the use of prevention-oriented family consultations, psychosocial checkups, and brief and intensive interventions.

Health Care Models for Persons with Multiple Chronic Conditions from Populations that Experience Health Disparities: A Scoping Review

Almost half of U.S. adults have multiple chronic conditions (MCC), and the prevalence of MCC has significantly increased for racial and/or ethnic minority groups, especially among those aged 45-64 years. Yet, little is known about evidence-based health care models for managing MCC in these populations. The overall objective of this scoping review was to identify the breadth of literature testing health care delivery models or components of models to improve the management of MCC for populations that experience health disparities. The databases of CINAHL Plus, Embase, PubMed, and Scopus were searched for original articles from 2016 to 2023. Included studies had to assess a health care delivery model, intervention, approach, or strategy for improving the management of two or more chronic conditions among U.S. adults. Using Covidence, each record was independently assessed by two reviewers and relevant data about the study, health care model, population studied, and outcomes were extracted. Out of 9583 initially screened records, 17 met the inclusion criteria, of which 5 (29%) were randomized controlled trials. Most (82%) studies focused on the management of psychiatric and physical chronic conditions. The most cited care model was the Patient-Centered Medical Home (41%). Most studies (82%) were conducted within clinical settings: primary care (n = 9), specialty care (n = 4), and behavioral health (n = 2). All studies documented positive improvements in patient outcomes, including fourteen (82%) studies that measured outcomes related to service utilization and eleven (65%) studies that measured clinical outcomes. Four studies (24%) measured cost-related outcomes. While the Chronic Care Model was developed almost 30 years ago, the applicable evidence for MCC is sparse for populations experiencing health disparities. There is an opportunity for research to develop, adapt, integrate, and implement evidence-based health care models for MCC to improve clinically significant health outcomes that align with the patient goal needs.

An Integrative Review of the Use of the Individual and Family Self-Management Theory in Research

The extent of the application of the Individual and Family Self-Management Theory (IFSMT) in research has yet to be determined. The purpose of this analysis was to review the use of the IFSMT in published research and evaluate posited constructs and relationships. Dimensions and categories of the IFSMT and the interrelationships were generally supported in the 77 articles reviewed. A majority focused on self-management of chronic conditions in the adult population. More research on the strength, direction, and interaction of relationships is needed. Defining and exploring social constructs, including race, ethnicity, and gender, should be prioritized in future IFSMT research.

Fathers' Ongoing Journey When a Child in the Family Has a Chronic Condition: A Meta-Synthesis

This qualitative meta-synthesis was conducted with the aim to understand fathers' experiences and involvement when their child has a chronic condition within family context. Family nurse researchers from five countries identified 19 studies through a systematic search. Inclusion criteria were: (a) fathers as primary informant; (b) children (<19 years) with a chronic condition; (c) written in English, Spanish, French, or Portuguese. Data were synthesized using thematic analysis. Four themes reflected fathers' journey: "Juggling multiple roles" included protector, provider, and supporter; "Managing control" included relinquishing and regaining control; "Creating a new normal" addressed recovery; "Maintaining wellbeing" reflected multiple emotional responses and support found through partners, family, spirituality, and health care communities. Fathers desire to be involved in caring for their child with a chronic condition, yet involvement and experience are continually evolving due to various family needs. Health care providers should consider unconscious assumptions regarding fathers' role in child care and encourage fathers' involvement to facilitate family wellbeing.

Who, What, Where, and How? The State of Family Science in Pediatric Palliative Care

CONTEXT

Families are vital providers and recipients of pediatric palliative care (PPC) services. Understanding the scope and nature of evidence at the intersection of family science and PPC research is necessary to develop family-focused interventions that enhance child and family health.

OBJECTIVES

Explore and describe the family-level impact of pediatric serious illness.

METHODS

We conducted a librarian-assisted scoping review using Arskey and O'Malley's approach. We searched PubMed, Scopus, CINAHL, and EMBASE databases for empirical publications from 2016 to 2021 that focused on families navigating serious pediatric illness published in English. Two reviewers assessed eligibility, with discrepancies resolved by a third. We used Covidence and REDCap for data management and extraction.

RESULTS

We screened 10,983 abstracts; 309 abstracts were included in full text screening. The final group of 52 citations was analyzed by the entire team. Most research was conducted in Western Europe and North America. The perspectives of parents of children with cancer were most frequently described; voices of seriously ill youth and their siblings were less often presented. Most of the research was descriptive qualitative, followed by descriptive quantitative. Few studies were mixed methods, inferential, or interpretive. Studies most often described parent, youth, and family experience with illness and less often explored family processes and relationships. Irrespective of the approach (i.e., qualitative, quantitative), few studies focused on families as the analytic unit or used family-level analysis techniques. Study participants were usually from local dominant populations and less often from historically marginalized communities.

CONCLUSION

The robust, descriptive, and individual-level evidence describing family impact of serious pediatric illness provides a solid foundation for future research priorities. Stronger integration of family techniques and diverse family voices in pediatric palliative care research can clarify family processes, illuminate structural barriers, and inform interventions that are responsive to family needs. These steps will enhance the education, policy, and clinical provision of PPC to all who would benefit, thereby advancing health equity for children living with serious illness and their families.

Family management structural model for children with atopic dermatitis

PURPOSE

To construct a structural model of family management for children with atopic dermatitis.

DESIGN AND METHODS

In this cross-sectional study, data were collected using a structured questionnaire. Participants included primary caregivers of children aged 2-12 years who had received a medical diagnosis of atopic dermatitis and had been experiencing the condition for over three months. We used SPSS/WIN 26.0 to analyze the variables and AMOS 23.0 for structural equation modeling.

RESULTS

Family functioning resilience, social support, and family coping had significant direct effects on family management. Illness severity, illness duration, and family life difficulty indirectly influenced family management, demonstrating significant total effects. The severity and duration of atopic dermatitis, family life difficulty, family functioning resilience, social support, and family coping explained 78.9% of the model.

CONCLUSIONS

The final model was suitable for predicting family management for children with atopic dermatitis. By confirming mediating effects, this study contributes to enhancing family management through nursing interventions. These findings offer valuable insights for developing family-centered nursing strategies to improve family management for children with atopic dermatitis.

PRACTICE IMPLICATIONS

Nursing interventions targeting the alleviation of family management challenges and enhancement of family functioning resilience, social support, and family coping are pivotal for improving the well-being of children with atopic dermatitis. Furthermore, tailored intervention development must take into account not only the severity and illness duration of atopic dermatitis in children but also the characteristics of the family. Improving family nursing through such tailored interventions can help enhance children's health and quality of life.

Caregiver condition management and family functioning after pediatric cancer treatment: Moderation by race and ethnicity

OBJECTIVE

End of pediatric cancer treatment requires family adjustment. Caregivers who struggle to incorporate the child's condition into family life have poorer family outcomes. To better understand factors that contribute to successful transition off active childhood cancer treatment, we sought to examine caregiver perceived management ability of the youth's condition and family functioning as predictors of caregiver distress, evaluate family functioning as a mediator between perceived ability and distress, and explore race and ethnicity as a moderator between perceived ability and family functioning.

METHODS

Caregivers (N = 141) completed measures assessing family management (condition management ability; CMA), family functioning, and distress as part of a clinical education and screening program within 1 year of the end of treatment. Bias-corrected bootstrap regression analyses examined mediation and moderated mediation models with patient race and ethnicity as the moderator.

RESULTS

The overall mediation model was statistically significant for CMA→family functioning→distress. Race and ethnicity moderated the relationship between CMA and family functioning, but the full model was not significant. CMA was related to family functioning for caregivers of non-Hispanic white youth, but not caregivers of Hispanic youth. Family functioning was related to distress for all caregivers.

CONCLUSIONS

Family functioning serves as an initial intervention target to reduce caregiver distress. Caregiver perceived management ability of their child's condition is a meaningful predictor of family functioning and distress for caregivers of non-Hispanic white youth, yet CMA may be limited as a screener of family management patterns for diverse populations, and other family management dimension may be more applicable.

Adaptation at the Family Level in Families of Individuals With Down Syndrome: A Scoping Review

Down syndrome (DS) is a chromosomal disorder associated with intellectual and physical disabilities and has historically been viewed by health care providers through a negative lens when considering the effect the condition has on the individual, family, and community. The purpose of this scoping review was to provide an overview of recent research concerning adaptation in families of individuals with DS with a focus on family adaptation rather than individual or dyadic adaptation. Three literature indexes were searched from 2017 to 2022, with 41 articles included. Foci of the studies included strength/resilience, stress/coping, and negative/challenge. Thirteen studies reported using a family framework. Multiple methodological approaches and family measures were used in the studies and are outlined. Findings from this review show there has been a shift in focus when researching families of individuals with DS from a negative and challenging experience to one of strength and resilience.

A Center Experience with Common Data Elements in Chronic Illness Self-Management Research

In recent decades, the use of common data elements has expanded across the health disciplines. This has included growth within programs of research focused on self-management and family nursing. Family nursing and self-management science may be expanded with the increased use of common concepts, measures, and theoretical frameworks. This article describes the experience of exploring the use of common data elements and identifying shared concepts from the perspective of one National Institute of Nursing Research funded Exploratory Center in Self-Management. Guidance offered by the Individual and Family Self-Management Theory is discussed, and implications for family research are presented.

Experiences and needs of parents whose child has attempted suicide

PURPOSE

To explore the stress, experience, and unmet needs of parents whose child has attempted suicide.

METHODS

A 23-question survey and a 53-item Family Management Measurement questionnaire were distributed to the parents of children admitted to an acute care facility for a suicide attempt (SA). Quantitative data were analyzed using Statistical Analysis System. Responses to the open-ended questions were sorted, synthesized, and clustered into tentative categories.

RESULTS

Eleven parents enrolled, but only 10 completed the qualitative questions. Three themes emerged: feelings of helplessness, uncertainty, and life management difficulty. Parents rated their stress as moderate (6.6 out of 10). Internal consistency (Cronbach's alpha) was questionable (0.69); however, three of six subscales were good to excellent (0.81-0.95).

CONCLUSION

Families experience stress, feelings of hopelessness, and uncertainty after an SA. More research is needed to better understand and quantify parental experiences.

Perceptions of Weight Management: Interviews with Adolescents with Severe Obesity and Their Mothers

Background: Adolescence is a challenging time for families, which is intensified when managing a chronic health condition. In adolescents with severe obesity, little is known about how adolescent/mother dyads approach management. Our study aims to (1) explore similarities/differences in adolescent/mother dyads' perceptions of weight management behaviors and (2) describe their experiences with successes and challenges related to weight management. Methods: This was a qualitative descriptive analysis of interviews from 21 adolescent/mother dyads. Conventional content analysis was used to identify themes characterizing dyads' weight management efforts. Results: Two patterns of perceptions were identified across the dyads specific to weight management behaviors: collaborative (dyads agreed) and conflicting (dyads disagreed). Weight management themes with collaborative perceptions were food preferences; food and emotion; the adolescent is active; exercise is not enjoyable; the family is active together; and stopping medications. Weight management themes with conflicting perceptions were responsibility for initiating and maintaining exercise, motivation and willingness to exercise, and responsibility for medications. Dyads had collaborative pattern responses on perceptions of success and challenges. Themes related to successes were weight loss and supportive relationships. Themes related to challenges were inconsistent daily routines and schedules, and unsupportive relationships. Conclusions: Dyads responded with collaborative or conflicting perceptions to weight management behaviors and with collaborative responses to success and challenges. Sustaining healthy habits was difficult from the perspectives of dyads. For youth with severe obesity, providing care that recognizes and addressees issues youth and their families experience may require improved and innovative interventions.

Current status and influential factors for family health management during quarantine: A latent category analysis

OBJECTIVE

We aimed to explore factors affecting family health management during home quarantine as well as the effects of variations in family health management (FHM) on individuals' health status.

METHODS

Using stratified random sampling, 618 families in Wuhan as well as cities within its surrounding provinces were recruited and surveyed online. Latent class variables were extracted from four modules: disinfection, space layout, physical exercise, and food reserves. The analysis was conducted using the poLCA package in R software (v.4.1.0). Chi-squared tests, Fisher's exact tests, and non-parametric Kruskal-Wallis tests were used to compare groups as appropriate.

RESULTS

We found an overall questionnaire reliability of 0.77 and a total omega of 0.92, indicating that the survey results were credible. The Bayesian information criterion and Akaike information criterion were used to identified four latent class variables, namely latent non-family health management (18.9%) and latent low, medium, and advanced FHM (30.93%, 29.49%, and 20.59%, respectively). Gender, household income level, body mass index, the presence of a nearby community hospital, and self-rated health status showed statistically significant differences with respect to latent FHM. Moreover, we found a statistically significant difference in emotional reactions when comparing latent advanced and low to mid-level latent FHM. Compared with latent non-family health managers, we detected statistically significant differences in individual energy levels between potential family health managers at latent low and medium levels. Additionally, we found statistically significant differences in individual energy levels between latent advanced and low level family health managers.

CONCLUSIONS

We found that multiple factors, including gender, household income, and body mass index, were correlated with latent FHM during home quarantine. We conclude that FHM can meaningfully improve individuals' health. Thus, increasing social support for individuals can improve FHM as well as individuals' health during home quarantine.

Caregivers' perspectives on the contextual influences within family management for ethnically diverse children with ADHD

PURPOSE

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting over 9% of children in the United States. Family caregivers are often responsible for the management of their child's ADHD. Contextual influences, such as healthcare providers, systems, and resources, are factors contributing to the ease or difficulty of family management. The purpose of this article is to qualitatively describe the major contextual influences that impact family management for ethnically diverse children with ADHD.

DESIGN AND METHODS

This analysis is part of a mixed methods study using a concurrent nested design (QUAL + quant) to understand the phenomenon of family management from a contextual and socioecological perspective. In this analysis, cross-sectional data from caregivers of children with ADHD (N = 50) within a large northeastern city in the United States were collected, analyzed, and interpreted in the qualitative descriptive tradition. Semistructured interviews were conducted with participants to understand the contextual influences within family management. Conventional content analysis resulted in the emergence of barrier and facilitator domains and subdomains.

RESULTS

Caregivers were predominantly female (98%) and between 24 and 61 years with a mean age of 37.54 (SD = 1.18). Caregivers identified their children as Black or African American (56%), White (26%), Multi-Racial (16%), Hispanic or Latinx (8%), and Asian (2%). Contextual influences within family management emerged as barrier or facilitator domains. Barrier domains included: (1) family, (2) healthcare systems, (3) educational systems, (4) stigma, and (5) financial, insurance, and policy issues. Facilitator domains included: (1) family and community, (2) healthcare providers, and (3) educational providers. Subdomains within each domain are expanded in the article.

PRACTICE IMPLICATIONS

Specialists in pediatric nursing should consider contextual influences within family management for ethnically diverse children with ADHD. As healthcare providers, it is important to recognize system-level barriers or facilitators for caregivers and their children and find creative ways to overcome obstacles and leverage strengths within families, communities, and care systems. Another important area for pediatric specialists to consider is understanding how stigma impacts children with ADHD. Policy-level engagement and advocacy should maximize the political will of nurses, families, and educators to create change within communities.

Ability of management of families of children with chronic conditions for care at home

ABSTRACT: Objective to analyze the relationship between families' living context and their management skills in caring for children with chronic health conditions. Method a mixed, convergent parallel study, with the Family Management Style as the theoretical framework. Participants were family members of children with chronic conditions egressing from a Neonatal Intensive Care Unit in Southeastern Brazil. For the collection of quantitative data, the instrument Family Management Measure and a questionnaire of socio-demographic characterization were used. Quantitative data were analyzed using the Stata 15 statistical program. Qualitative data were produced by means of semi-structured interviews and submitted to the Directed Content Analysis. Results the families presented a positive average score in the Management Ability scale, having greater ease to meet the care needs of the child with chronic condition at home. Favorable social and economic conditions contributed to the family's ability to care for the child with chronic health condition. Conclusions and implications for practice it was concluded that there is a relationship between the context of life of the families and the ability to manage the child in chronic condition. Being able to count on a partner or other family members can improve the management skills of these families.

Habilidade de manejo de famílias de crianças com condições crônicas para o cuidado no domicílio

RESUMO: Objetivo analisar a relação entre o contexto de vida das famílias e a sua habilidade de manejo no cuidado às crianças em condições crônicas de saúde. Método estudo misto, do tipo paralelo convergente, tendo o Estilo de Manejo Familiar como quadro teórico. Participaram familiares de crianças com condições crônicas egressas de Unidade de Terapia Intensiva Neonatal do Sudeste do Brasil. Para a coleta de dados quantitativos, foram utilizados o instrumento Medida de Manejo Familiar e um questionário de caracterização sociodemográfica. Os dados quantitativos foram analisados por meio do programa estatístico Stata 15. Os dados qualitativos foram produzidos por meio de entrevista semiestruturada e submetidos à Análise de Conteúdo Dirigida. Resultados as famílias apresentaram um escore médio positivo na escala Habilidade de Manejo, possuindo maior facilidade para atender às necessidades de cuidado do filho com condição crônica no domicílio. Condições sociais e econômicas favoráveis contribuíram para a capacidade da família em cuidar da criança com condição crônica de saúde. Conclusões e implicações para a prática concluiu-se que há relação entre o contexto de vida das famílias e a habilidade de manejo da criança em condição crônica. Poder contar com o companheiro ou com outros membros da família pode melhorar a habilidade de manejo dessas famílias.