The effectiveness of a dialogical family guidance intervention regarding child treatment response in families with a child with neurodevelopmental disorders

BACKGROUND

Children with neurodevelopmental disorders (NDD) can have emotional and behavioral symptoms affecting not only the child, but the whole family. Since family members have a strong impact on each other, studies highlight the need to offer effective family interventions to strengthen the wellbeing of the family. The aim of the current study is to clarify whether there is a difference between parents` opinions regarding their child`s emotional and behavioral condition immediately after Dialogical Family Guidance (DFG) has ended and after a three and six month follow-up.

METHOD

Fifty families with a child with NDD were randomized into two groups. Group 1 received DFG with an immediate starting point, and Group 2 received DFG after a three-month waiting period. Parent experiences of treatment response regarding their children`s emotional and behavioral symptoms were estimated before and after DFG using the parent version of the Strengths and Difficulties Questionnaire (SDQ-p) at baseline, and after three and six months. Additionally, comparisons between boys and girls, and the age of the child were analyzed.

RESULTS

The total difficulties score between Group 1 and Group 2 showed no difference immediately after DFG, or after three months. Regarding subdomains boys had more peer problems than girls, and at baseline, children between 3 and 6 years appeared to have more conduct problems than children between 7 and 13 years. Subdomain prosocial behavior increased statistically significantly during the study period in Group 1. Other SDQ-p subdomains remained constant in both groups between baseline and three and six month follow-up.

CONCLUSIONS

The result does not show any differences between parents` opinions regarding their child immediately after or three months after DFG regarding SDQ-p total difficulties scores in either group. The difference between younger and older children regarding conduct problems at baseline, and the difference between boys and girls regarding peer problems is worth paying attention to in the clinical setting. Because of the small sample, it is not possible to draw relevant conclusions regarding the intervention`s effect regarding the child`s mental health dimensions, gender, or age. Nevertheless, Dialogical family Guidance represents one intervention that can be used.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04892992 (retrospectively registered May 18th 2021).

Consequences of Unexplained Experiences in the Context of Bereavement - Qualitative Analysis

Unexplained experiences are common among bereaved people and are a natural part of grieving, but their consequences may affect their coping with grief. However, professionals lack awareness of these unexplained experiences, which may lead to an unnecessary pathologising of the experiences and a lack of opportunity for the bereaved to process their experiences in a safe environment. The study involved an inductive content analysis of 408 narratives of the consequences of unexplained experiences shared by 181 bereaved individuals. The consequences of the unexplained experiences were: (1) Experiencing after-effects which may alleviate or aggravate wellbeing, as well as be life-affecting; (2) consequences related to sharing or concealing the experiences, and the reactions of others to recounting the experience; (3) documenting the experience through videography, photography and keeping mementos. In conclusion, these experiences have consequences to bereaved which needs to be taken account in support interventions aimed at bereaved individuals.

Experiences of Help from the Perspective of Parents Whose Adolescent Is Harming Themselves or Has Died by Suicide

Adolescent self-harm or suicide are emotionally difficult for parents, thus also parents need help. This qualitative descriptive study aimed to produce knowledge on the experiences of help received by Finnish parents (n = 23) whose adolescent is harming themselves or has died by suicide. The parents received diverse help for themselves, and for their self-harming adolescent or the deceased adolescent's sibling. Parents described negative experiences, but also factors that promoted their experience of help. There are many barriers to help related to the parents themselves, the adolescent, or to the social support system. Professional help should be easier to obtain and be based on the parents' individual expectations.

Factors helping pregnant multiparas cope with fear of birth: A qualitative study

OBJECTIVE

This study describes factors helping pregnant multiparas cope with their fear of birth and aims to contribute insight into measures that could be taken to support and develop care for multiparas with fear of birth.

METHODS

Purposive sampling was used for collecting data from closed discussion forums. An electronic questionnaire included structured background questions and qualitative open-ended questions related to the factors multiparas had found helped them cope with their fear of birth. After excluding respondents in early pregnancy (n = 20), the data consisted of answers from 78 pregnant multiparas from Finland. The data were analysed using inductive content analysis.

RESULTS

The factors helping pregnant multiparas to cope with their fear of birth included obtaining information, planning ahead, receiving empathic support, dealing with emotions in different ways, and focusing on the positive.

CONCLUSIONS

The support multiparas receive for their fear of birth from healthcare providers is insufficient and the quality and content of care varies widely. As a result, multiparas have been left to personally take responsibility for coping with their fear.

IMPLICATIONS FOR PRACTICE

The care for treating fear of birth in multiparas needs to be improved. This requires a critical evaluation of the maternity system, policies, and competence of healthcare professionals who work with pregnant people.

Functioning Changes in Varying Ways After Retirement: A Scoping Review

The association between retirement and functioning remains still poorly known. This scoping review examines physical, social, cognitive, and mental functioning after retirement, describes the changes in them, determines the different aspects that affect functioning, and documents the main characteristics of the phenomenon. We systematically scoped the relevant studies on functioning after retirement using CINAHL, MEDLINE, Medic, and PubMed databases. This scoping review included both qualitative and quantitative studies. The studies were analysed with inductive content analysis. After retirement, functioning was found to decline but also improve, and additionally, inequalities in functioning emerged. Functioning after retirement changed in ways which were: declining functioning, improving functioning, and inequalities in functioning. Only a few qualitative studies were found. This scoping review shows that functioning after retirement changes in varying ways. The results show that more qualitative research is needed to help us gain a more profound understanding on, for example, individuals' motives to improve leisure, physical, and social activities after retirement, which are likely to contribute to changes in functioning. Additionally, further longitudinal studies would offer knowledge about the long-term effects of retirement on the different dimensions of functioning.

Older individuals' perceptions of a good death: A systematic literature review

The purpose of this literature review was to describe older individuals' perceptions of a good death. A systematic data search of CINAHL, Medline, PsycINFO, ASSIA, and Medic databases from 2010 to 2020, supplemented with a manual search, resulted in 16 studies that met the inclusion criteria. Study quality was assessed using the JBI critical appraisal criteria. Data were analyzed by inductive content analysis. The core elements of older individuals' perceptions of a good death were a dignified moment of death, factors that enhance the desire to live, an active agency in adapting to death, and equal interpersonal relationships.

Experiences of Help From the Perspective of Finnish People Who Self-Harmed During Adolescence

Adolescent self-harm is a widespread phenomenon, and a significant problem worldwide. This study describes the experiences of help from the perspective of Finnish people who have suffered self-harm during adolescence. Data were collected from 27 participants as essays and interviews. Participants included both females and males with different backgrounds and treatment experiences. The data were analysed using inductive content analysis. Participants described having received help from other people in informal and formal ways, and they had both positive and negative experiences of help. The results show that several barriers exist for self-harming adolescents to access help, thus improvement in this area are necessary.

A qualitative study of the factors that help the coping of infertile women

Aim

The study describes the factors that help the coping of infertile women.

Design

A qualitative study.

Methods

Purposive sampling was used in gathering the data from the Finnish Infertility Associations closed discussion forum on Facebook. An electronic questionnaire included structured background questions and a qualitative open‐ended question related to the factors that help coping. In total, 101 women participated voluntarily in the study. The participants had at least a 1‐year personal experience of infertility. The data was analysed using inductive content analysis.

Results

The factors that helped the coping of infertile women were personal resources such as mental well‐being and having good abilities to deal with the issue. Also, a well‐functioning relationship and getting help contributed to coping. Coping was also positively influenced by the ability to adapt to a childless life, which included having comforting thoughts, doing things that brought relief and orientating thinking towards the future.

Dialogical Family Guidance (dfg)-Development and implementation of an intervention for families with a child with neurodevelopmental disorders

Aim

To describe the development and implementation of a Dialogical Family Guidance (DFG) intervention, aimed at families with a child with neurodevelopmental disorders (NDD).

Design

The DFG components are presented and the content of a DFG training course. Professionals' experiences after the DFG training were evaluated.

Methods

Dialogical Family Guidance development phases and implementation process are examined. The Revised Standards for Quality Improvement Reporting Excellence checklist (SQUIRE 2.0) was used to provide a framework for reporting new knowledge.

Results

The DFG training course seemed to increase possibilities of a more independent role as a nurse to deliver the DFG family intervention. The project showed that the use of dialogue can be difficult for some professionals. Analysis of the questionnaire completed after DFG training reported a high level of satisfaction. DFG training offered a new approach to deliver knowledge and understanding to families using dialogue, including tailored psychoeducation and emotional and practical guidance.

The relationship satisfaction of parents to children with congenital heart disease

The purpose of the research is to describe the marital satisfaction of parents with a child with congenital heart disease, and the factors associated with it. The data were collected using an electronic questionnaire from applicable parents (n = 104) via the website of the Finnish Association for Heart Children and Adults and a closed Facebook forum where such parents are members. Marital satisfaction was measured using the ENRICH Marital Satisfaction (EMS) scale. The data were analysed using statistical methods. The variables were described by frequencies, percentages, and dispersion measures (Md = median, Q₁= lower quartile, Q₃ = upper quartile). Associations between the background variables and relationship satisfaction were examined using Mann-Whitney U test and Kruskall-Wallis test. Most of the surveyed parents were quite satisfied with their relationships. Parental factors associated with marital satisfaction were the gender of the parent, current health situation, support received from the spouse, problems with the spouse, and remarkable changes in economic situation during last year. The age of the child with a congenital heart disease was a factor associated with marital satisfaction. The interaction skills of the parents must continue to be supported and strengthened, because good interpersonal skills increase marital satisfaction and help resolve the conflicts that may arise in a relationship.

Health, functionality, and social support in families with a child with a neurodevelopmental disorder - a pilot study

Introduction: Several studies have reported that having a child with a neurodevelopmental disorder (NDD) increases parental stress and that parental psychosocial functioning influences child`s development and behavior. It is unclear how parents of children with NDD experience family functionality, family health and receive support and if there are differences between experiences of mothers and fathers. Methods: Families with children referred to a neurocognitive unit were invited to the study. A modified version of the FAmily Functionality, HEalth, and Social support (FAFHES) questionnaire was used. Open-ended questions were also included. Results: Parents rated their social support lower than their family functionality and family health. Family functionality correlated positively with family health. No significant differences were found between mothers' and fathers' experiences. A three-months test-retest using the FAFHES showed no significant change in ratings of family functionality, family health, and social support. Conclusions: Family functionality was connected to family health in families with a child with NDD. Mothers and fathers experienced their family health, family functionality, and received social support in similar ways.

The dynamics of spousal relationships after the loss of a child among bereaved Malay parents

The purpose of this study is to explore the dynamics of the relationship between bereaved parents after the loss of their child. Literature has attempted to understand how coping mechanisms related to gender characteristics, communication, and intimacy influence the spousal relationship after the loss of a child. However, this area is scarcely explored in a Malaysian context. This qualitative study involved 11 bereaved parents. These parents had lost their children due to accidents (n = 9) and homicide (n = 2). Open-ended questions that focused on the patterns of the spousal relationship were administered to the parents. The data were analysed using thematic analysis. Some of the main themes found were that constructive communication and intimacy are interrelated in helping bereaved parents to cope better. Nonverbal intimacy is helpful. Avoidance or limited communication and intimacy are influenced by religion and cultural beliefs. The bereavement responses influenced the spousal relationship, causing it to become stronger, weaker, or causing the parents to act like nothing had happened. This study helps us to understand the effects of the loss of a child on the spousal relationship of the bereaved parents. This study makes recommendations related to the adjustment and maintenance of a healthy spousal relationship after the loss of a child.

Homicide in the western family and background factors of a perpetrator

AIMS

Familicide is a multiple-victim homicide incident in which the killer's spouse and one or more children are slain. A systematic review was conducted to reveal the background factors of western homicide perpetrators.

METHODS

The systematic search was performed in the Arto, Medic, Cinahl, Medline, EBSCOhost Academic Search Premier and Social Services abstracts databases. The keywords were familicide, family homicide, familicide-suicide, filicide-suicide, extended suicide, child, murder, family, filicide and infanticide. The searches revealed 4139 references from the databases. The references were filtered and 32 peer-reviewed research articles revealed in years 2004-2014 were selected as data. The articles were analysed using inductive content analysis, by finding all possible background factors related to homicide.

RESULTS

The factors were described as percentages of the range. The background factors of familicide perpetrators were categorised as follows: perpetrators who had committed homicide of a child and intimate partner and possibly committed suicide; a father had who killed a child; a mother who had killed a child; a father who had committed a filicide-suicide; and a mother who had committed a filicide-suicide.

CONCLUSIONS

Psychological instability, violence and crime were found in all these categories of familicides. Perpetrators who had committed a suicide in addition to the familicide had more often been diagnosed with depression, but they sought treatment for mental health problems less often and had violence and self-destructiveness less often in their background than in other familicide categories. Social and healthcare professionals should be more sensitive to emerging family problems and be prepared for intervention.

Parental relationship satisfaction after the death of a child

This study describes Finnish parents' (n = 461) parental relationship satisfaction and examines factors associated with relationship satisfaction after the death of a child in the family. This reported study is part of a broader investigation concerning parents' experiences after the death of a child. Most respondents were very (36%) or quite satisfied (49%) with their current relationship. Lower relationship satisfaction scores were reported by older respondents, people with poorer subjective health and people who had other living children. Causes of death other than stillbirth, need for marriage counselling and moderate or poor marital relationship of the respondents' own parents in childhood were also related to lower relationship satisfaction.

Evaluating a bereavement follow-up intervention for grieving mothers after the death of a child

AIM

The aim of this study was to produce information about parental grief intervention and its impacts on maternal grief.

BACKGROUND

The grief after death of a child is a lifelong process. Social support is often stated as the most important factor in coping after the death of a child.

DESIGN

A single measure post-test control group design was used to evaluate whether there are differences in the grief reactions between the mothers in the intervention program (n = 83) and the mothers in the control group (n = 53).

METHOD

The data were collected by using a questionnaire which included background variables and Hogan Grief Reactions Checklist 6 months after the child's death. The data were analysed by statistical methods.

RESULTS

There were no significant differences in the grief reactions between the intervention group and the control group. However, greater support from the healthcare professionals was associated with stronger personal growth. The mothers' age, self-perceived health status and the age of deceased child were associated with the grief reactions. This study emphasises the importance of social support to grieving mothers.

CONCLUSION

Health care professionals are in an important role when considering support for grieving mothers; the given support may relieve the mothers' grief reactions.

Negative Changes in a Couple’s Relationship After a Child’s Death

The purpose of this study was to describe negative changes in parents’ relationships following the death of their child. A request to join the study was presented to members of grief associations through email and websites. Additionally, data were gathered through closed internet-groups where parents who had experienced the death of their child were logged in (e.g. in Facebook). The study participants were mothers (n = 321) and fathers (n = 36) whose child had died. The data were analysed using inductive qualitative content analysis. As negative changes in their relationship following the death of their child, parents reported the following: problems caused by failing mental health, problems due to changes in identity, increased difficulty of emotional communication, and decreased sexual intimacy. In addition, decreased sense of togetherness, behaviour that damages the relationship, everyday life straining the relationship, and emotions straining the relationship. It is concluded that a child’s death brings many kinds of negative changes to the parents’ relationship. The changes manifest as problems in the parents’ interaction, their behaviour, and their emotional life. The results can be utilized in supporting the relationships of grieving parents, developing different kinds of support interventions, and in nursing education.

Validity and reliability of breastfeeding advice and coping with breastfeeding instruments

PURPOSE

To pilot two instruments: Breastfeeding Advice and Coping with Breastfeeding in NICU settings.

DESIGN

Psychometric testing of the Breastfeeding Advice and Coping with Breastfeeding instruments.

SAMPLE

Mothers (N = 47) with singleton or twin preterm (≤36 + 6 gestation weeks) infant(s) (N = 55) at discharge collected from seven NICUs in Finland.

MAIN OUTCOME VARIABLES

The validity and reliability of two instruments: Breastfeeding Advice measuring the quality of breastfeeding counseling and Coping with Breastfeeding measuring the mothers' experienced ability to cope with breastfeeding issues.

RESULTS

Infants' mean gestation age was 32.5 weeks at birth. The items of the instruments were supported by previous studies, demonstrating content validity. There was a significant correlation (r = .72, p < .001) between Breastfeeding Advice and Coping with Breastfeeding, indicating constructor validity. Evidence for predictive validity was not found. Good reliability for internal consistency of the Breastfeeding Advice (Cronbach's α = .86) and Coping with Breastfeeding (Cronbach's α = .85) was found.

Peer Supporters' Experiences of a Bereavement Follow-up Intervention for Grieving Parents

The aim of this study was to describe the experiences of peer supporters of a bereavement intervention for grieving parents and how the program should be developed further. The intervention included: a support package for grieving parents, peer supporters' contact, and healthcare personnel's contact with parents. The sample included 16 peer supporters. Data were collected via open-format questionnaires and telephone interviews and analyzed by content analysis. Peer supporters perceived the intervention and its viability as mostly good. Parents' willingness to receive support and peer supporters' good resources were important for the follow-up contact. However, the peer sup-porters' resources were insufficient to meet parents' unexpected needs. Continuous training and systematic supervision of peer supporters is needed. Study results suggest that support interventions aimed at grieving families need a greater number of male supporters, as fathers hope to receive more support from their male counterparts. Inter-organizational cooperation in supporting parents is important and must be further developed.

Evaluating a bereavement follow-up intervention for grieving fathers and their experiences of support after the death of a child--a pilot study

This article describes a study designed to evaluate the effectiveness of an intervention program for bereaved fathers and their experiences of it in a sample of intervention (n = 62) and control (n = 41) fathers. Data were collected by 3 scales: the Hogan Grief Reactions Checklist, a scale for measuring received social support, and a scale for measuring fathers' experiences of the intervention program. Assessment at 6 months after leaving the hospital showed that intervention fathers reported lower grief reaction scores and stronger personal growth. Intervention fathers reported the most emotional support from both health care personnel and peer supporters. The support received was perceived as helpful in coping, and fathers rated the intervention favorably. The findings support the continuation of the intervention.

Fathers' experience of social support after the death of a child

The aims of this study were to describe fathers' social networks and their experience of social support after the death of a child. The sample consisted of 8 fathers who had lost a child under the age of 3. The data were collected with open-ended questions and interviews. Data analysis used qualitative content analysis. The fathers' social support networks varied over time and between fathers. The support networks included either just the spouse or the spouse and other people. Social relationships broke down and new relationships formed in their place. The fathers experienced social isolation but also deliberately isolated themselves from human relationships. The support the fathers received was felt to be both positive and negative. Peer support was only positive. Support from professionals was reported to be important but was also criticized. In particular better family care, informal support, and systematic support after leaving the hospital were expected.

Fathers' grief after the death of a child

The purpose of this study was to describe fathers' grief and the changes the death of a child has brought to fathers' lives. Participants included eight fathers who had lost a child. The data were collected using a questionnaire with open-ended questions and by interviews. Content analysis was used as a means of data analysis. The grief of the fathers manifested itself individually and dynamically and also in various anticipatory feelings and in physical, social, and behavioural reactions. The death of the child brought both positive and negative changes to the fathers' lives. Mental health nurses should be aware that depression and other mental illness, as well as unemployment and financial problems, were reported by some of the study participants.