Psychometric Testing of the Experience of Integrating Chronic Illness into Family Life Questionnaire

Family members' experience of integrating chronic illnesses or chronic conditions into family life is valuable information for health care professionals, such as nurses, to understand, improve, and adjust the care provided to families of chronically ill patients. Furthermore, the assessment of the experience of integrating chronic illness into family life can support family nursing interventions and reduce suffering. This study aimed to adapt and psychometrically test a new Likert-type questionnaire on the experience of integrating pediatric chronic illness into family life (EICI-FLQ) in two European samples. A sample of 164 primary caregivers of children/adolescents with chronic illnesses/conditions in Iceland and another sample of 237 primary caregivers with children/adolescents with chronic illnesses/conditions in Portugal completed the online questionnaire. Exploratory factor analysis of the Icelandic sample yielded support for a one-factor solution with acceptable internal reliability (Cronbach's α = .866). Confirmatory factor analysis of the one-factor structure in the Portuguese sample indicated good model fit and similar internal reliability (Cronbach's α = .838). This instrument has good psychometric characteristics and is a promising tool for measuring the experience of integrating pediatric chronic illness into family life in clinical and research settings.

Educational and personal burnout and burnout regarding collaborating with fellow university nursing students during COVID-19 in 2020-2021

BACKGROUND

Knowledge is lacking about the effects of COVID-19 on nursing students' burnout symptoms. Burnout can lead to negative feelings and behaviours towards learning and poor mental health.

AIMS

To describe and compare nursing/midwifery students' burnout, explore differences and detect predictors at two time points through COVID-19.

METHODS

Students were offered participation in the spring semesters of 2020 and 2021 (N = 2046), during COVID-19. The response rate was 30-33%. By using reliable and valid instruments, the students' stress and burnout were analysed as well as the students' health and perceived support.

RESULTS

Symptoms of academic burnout were higher among 1st and 2nd year BSc students in 2021. On the contrary, 3rd and 4th year students had higher academic and personal burnout than graduate students as well as than 1st and 2nd year students. Regarding academic burnout, 47% of the variability was explained by educational level, support, stress and the interactional effect of stress and support. Collaborational burnout, predicted by the students' educational level and support, explained 7% of the variability in the outcome. Additionally, educational level, and stress, predicted 52% of the variability in personal burnout.

CONCLUSION

Educators or student counsellors need to facilitate effective learning practices and offer academic support, specifically during 3rd and 4th year to boost helpful coping strategies and handle uncertainty and stressors related to crises such as COVID-19.

Family Health of Patients With Heart Failure and Their Family Members Before and During the First COVID-19 Lockdown

Background: Family health plays a vital role in the self-care and lifestyle modifications in families living with heart failure. Objective: To investigate the family health of patients with heart failure and their family members before and during the first COVID-19 lockdown. Method: This was a cross-sectional study design. We included 34 participants before and 34 participants during the first COVID-19 lockdown. Independent t-tests were conducted for comparison of the mean scores of the family health and its dimensions. Results: There was no significant difference between the total score of family health during the first COVID-19 lockdown compared to before the first COVID-19 lockdown in patients and family members. However, the values and ill-being dimensions of family health in patients and ill-being dimension in family members were significantly decreased during the first COVID-19 lockdown. Conclusion: This study indicated the positive and negative impacts of COVID-19 lockdown on family health. Implications for Nursing: Our results may help nurses to identify vulnerable patients with a low level of family health to tailor the best support to them.

Nursing students' perception of family importance in nursing care during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

Little is known about nursing students' illness beliefs and attitudes towards the involvement of families in nursing care during the COVID-19 epidemic. Focusing on family nursing throughout an undergraduate nursing education is not only appropriate or critical but also essential for advancing family nursing practice.

OBJECTIVES

To evaluate the differences in undergraduate and graduate nursing students' perceptions of illness beliefs and their family nursing practice skills at the time of the COVID-19 pandemic.

DESIGN

A cross-sectional study.

SETTINGS

The Faculty of Nursing at the University of Iceland.

PARTICIPANTS

Of the nursing and midwifery students, 109 participated in 2020 from one university.

METHODS

Data was collected regarding illness beliefs and attitudes towards family involvement in nursing care, through questionnaires via the Red Cap software.

RESULTS

The main finding indicated that the graduate students reported more confidence or reassurance regarding their knowledge of the cause of an illness, control, effect, suffering and what is the most and the least helpful in coping with an illness/health disorder when compared to the undergraduate students (t-value = -2.50, p-value = 0.014). Additionally, graduate nursing students also reported higher positive attitudes towards family importance in nursing care than undergraduate students (t-value = -2.16, p-value = 0.033).

CONCLUSION

Even though the graduate students reported higher illness beliefs than undergraduate students, the undergraduate students reported a reasonably high or over medium high score, on the illness beliefs scale. University nursing educators need to be aware that nursing students' knowledge, skills and attitudes towards family nursing practice at the time of the COVID-19 pandemic shape clinical competence in family nursing within health care settings.

Nurses' attitudes towards family importance in nursing care across Europe

AIMS AND OBJECTIVE

To explore differences in nurses' attitudes regarding the importance of family in nursing care and factors associated with nurses' attitudes across 11 European countries.

BACKGROUND

Family involvement in healthcare has received attention in many European healthcare systems. Nurses have a unique opportunity to promote family involvement in healthcare; however, their attitudes and beliefs may facilitate or impede this practice.

DESIGN

A cross-sectional survey across European countries.

METHOD

A broad convenience sample of 8112 nurses across 11 European countries was recruited from October 2017 to December 2019. Data were collected using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire. We used the STROBE checklist to report the results.

RESULTS

There were significant differences in nurses' attitudes about families' importance in nursing care across Europe. Country was the factor with the strongest association with the total scores of the FINC-NA. Older age, higher level of education, increased years since graduation, having a strategy for the care of families in the workplace, and having experience of illness within one's own family were associated with a higher total FINC-NA score. Being male and working in a hospital or other clinical settings were associated with a lower total FINC-NA score.

CONCLUSION

Nurses' attitudes regarding the importance of family in nursing care vary across 11 European countries. This study highlights multiple factors associated with nurses' attitudes. Further research is necessary to gain a deeper understanding of the reasons for nurses' different attitudes and to develop a strong theoretical framework across Europe to support family involvement in patient care. The inclusion of family healthcare programs in the baccalaureate curriculum may improve nurses' attitudes.

RELEVANCE FOR CLINICAL PRACTICE

In clinical practice, the focus should be on identifying influencing factors on nurses' attitudes to enhance families' importance in nursing care across Europe.

Effectiveness of Nursing Interventions for Patients With Cancer and their Family Members: A Systematic Review

Cancer diagnosis poses enormous physical and psychosocial challenges for both the affected person and their families. This systematic review identifies the characteristics and effectiveness of nursing interventions offered to adult patients with cancer and their families. Five databases were searched, and 19 studies published from 2009 to 2020 were included. Interventions were categorized as follows: (a) interventions with supporting and cognitive components (n = 3), (b) interventions that included skills training for the caregiver (n = 3), (c) interventions to enhance care through managing symptoms (n = 8), (d) interventions focusing on the dyad or family-patient relationship (n = 4), and (e) interventions targeted to the patient's condition (n = 1). The results of this review offer an overview from which to carry out new studies and are useful for providing future directions within family nursing practice, taking into account the impact that the family has on the disease and the consequences the condition may bring to the whole family.

Effectiveness of a couple-based intervention on sexuality and intimacy among women in active cancer treatment: A quasi-experimental study

PURPOSE

To evaluate the effectiveness of a strenghts-oriented therapeutic conversation intervention on confidence about how illness beliefs affect sexuality and intimacy and on perceived relationship quality among women in active cancer treatment and their partners.

METHODS

A quasi-experimental single-group pre-post-follow-up design was used. Women in active cancer treatment and their intimate partners were randomly assigned to a nurse-managed couple-based intervention (experimental group, n = 30 couples) or wait-list (delayed intervention) control group (n = 27 couples) plus 4 additional couples who pilot tested feasibility of the intervention, prior to the RCT. However, baseline differences in demographic and clinical variables prevented comparisons between groups. Therefore, a repeated-one-group pre-post test setup was used, comparing women with cancer and their partners over three time points. The intervention consisted of three Couple-Strengths-Oriented Therapeutic Conversations (CO-SOTC) sessions. The participants also had access to web-based evidence-based educational information. Data were collected before intervention (T1, baseline), one to two weeks post-intervention (T2), and after a follow-up session at three months (T3). Data from 60 couples (N = 120) were analyzed.

RESULTS

Significant differences were observed, for both women and intimate partners, over time in more confidence about how illness beliefs affected sexuality and intimacy (T1 versus T2, and T1 versus T3), and increased overall quality of the relationship (T1 versus T2, and T1 versus T3). No differences were found between dyad members' scores on illness beliefs or relationship quality at any time point.

CONCLUSIONS

The CO-SOTC intervention was effective in supporting sexual adjustment among women in cancer treatment and their intimate partners.

TRIAL REGISTRATION NUMBER

NCT03936400 at clinicaltrials.gov.

Long-Term Effect of Receiving a Family Strengths-Oriented Intervention on Family Cancer Caregiver Stress, Anxiety, and Depression Symptoms: A Longitudinal Quasi-Experimental Study

The aim of this longitudinal study was to evaluate the long-term effects of providing a therapeutic conversation intervention, based on Family Systems Nursing, to family caregivers of a close relative with advanced cancer over the period before and during bereavement. To prevent adverse outcomes, caregivers need ongoing support that begins pre-loss and extends into the post-loss period. This study employed a one-group pre-test, post-test quasi-experimental design. Twenty-four caregivers participated in two intervention trials conducted over a 42-month period, receiving two intervention sessions pre-loss (Trial 1) and one intervention session post-loss (Trial 2). Significant decreases in anxiety and stress were noted over the three post-loss assessments. The final post-loss stress outcome was significantly lower than the first pre-loss score. For the depression score, there was not a significant change over time within the pre- or post-loss period. The findings provide evidence of decreasing anxiety and stress following the implementation of an extended family nursing intervention for bereaved family caregivers.

The Impact of Family Strengths Oriented Therapeutic Conversations on Parents of Children with a New Chronic Illness Diagnosis

A growing number of families with children are dealing with a new diagnosis of chronic illnesses or health problems that are demanding. Nurses are in a prime position to provide support and empowerment to these families. The aim of the study was to evaluate the benefits of two sessions of a Family Strengths Oriented Therapeutic Conversation (FAM-SOTC) intervention, offered by advanced practice nurses (APNs) to mothers (N = 31) of children and adolescents in Iceland with newly diagnosed chronic illnesses/disorders. Families of children with Juvenile Idiopathic Arthritis (JIA), epilepsy, Type 1 diabetes (T1DM), or with sleep disturbance with attention-deficit/hyperactivity disorder (ADHD), reported significantly higher family support, greater conviction about their illness beliefs, increased quality of life, and greater satisfaction with health care services after receiving two sessions of the FAM-SOTC intervention (Time 2) compared to before the intervention (Time 1). The findings emphasize the importance of the APN's role and family nursing expertise in supporting families of children with a new diagnosis of chronic illnesses or disorders who are in active treatment.

The better sleep better well-being programme: Educating and training community healthcare nurses in developing interventions for families of infants with moderate sleep problems: a pilot study

The main aim of this pilot study was to evaluate the benefit of the Better Sleep Better Well-being (BSBW) educational and training intervention programme regarding infants sleep problems for Community Health Care (CHC) nurses, on their perceptions on their family nursing practice skills and on their job demand, control and support. There were 6 CHC nurses who participated in the BSBW programme, and 26 nurses in the comparison group. The programme consisted of 4 sessions (8 hours per session) of lectures on the aetiology of infants sleep problems as well as on evidence-based and family relational practices and on 20 sessions of clinical cases, scenarios, discussions and reflections. The main finding indicated that the nurses in the intervention group reported significantly higher family nursing practices skills compared to the nurses in the comparison group. The findings are promising, since they offered additional resources to the CHC nurses, in their clinical practices.

Predictors of quality of life for families of children and adolescents with severe physical illnesses who are receiving hospital-based care

AIM

There is strong evidence regarding the impact of medical treatments on hospitalised children and their families after being diagnosed with a serious illness. Even though survival rates have increased for children and adolescents with illnesses such as cancer, kidney, liver and gastrointestinal diseases, lengthy medical procedures and symptom management may have an impact on the well-being and quality of life for families. Little is known, however, about promoting family quality of life in hospital-based paediatric settings. The main purpose of this study was to evaluate the predictors of quality of life (QOL) across physical health conditions among families of children and adolescents with cancer, kidney, liver and gastrointestinal diseases. Further, to evaluate the difference in perception on QOL among families of children with cancer compared to families of children with kidney, liver and gastrointestinal diseases.

METHOD

The study design was cross-sectional. Thirty-eight families of children with cancer, kidney, liver or gastrointestinal diseases participated at a University Hospital. Data were collected using valid and reliable instruments to measure the study variables from March 2015 to May 2016.

FINDINGS

The main result from the stepwise regression analysis indicated perceived family support and illness beliefs, significantly predicted quality of life of the family; approximately 41% of the variance in the families' perception of their quality of life was explained by the model.

CONCLUSIONS

The findings emphasise the importance of supporting and maintaining quality of life for families of children with physical illnesses.

RELEVANCE TO CLINICAL PRACTICE

Family level interventions within the healthcare system are needed for families of children with severe physical illnesses, since that can result in better outcomes for the child or adolescent and their family. Such an intervention would need to emphasise therapeutic conversations within a relational context, highlighting illness management, illness beliefs, and cognitive and emotional family support.

Drawing forward family strengths in short therapeutic conversations from a psychiatric nursing perspective

PURPOSE

The aim of the narrative is to describe the therapeutic process and experience from a psychiatric nursing perspective, in therapeutic communication, with a father and his son in acute psychiatry.

METHODS

In this case scenario, the Family Strength-Oriented Therapeutic Conversation Intervention (FAM-SOTC Intervention) was used.

FINDINGS

The FAM-SOTC Intervention was found to be beneficial for the father-son relationship.

PRACTICE IMPLICATION

It is encouraging for nurses in acute psychiatry to know that three short therapeutic conversations can make a difference within the family system. FAM-SOTC seemed to offer cognitive and emotional support to the father-and-son dyad.

Perception on family support and predictors' of satisfaction with the healthcare service among families of children and adolescents with serious mental illnesses who are in active psychiatric treatment

PROBLEM

Little is known about the factors related to satisfaction with healthcare services among families of children with serious mental illness who were in active psychiatry treatment.

METHODS

A cross-sectional study was conducted to explore perceived family support, illness beliefs, and families' satisfaction with healthcare services. Sixty-eight families of children with anxiety, depression, attention-deficit/hyperactivity disorder, eating disorders, and autism/Asperger's syndrome participated. Data were collected from March 2015 to December 2016.

FINDINGS

Illness beliefs and perceived family support explained 23% of the variance in family satisfaction with the healthcare service.

CONCLUSION

Family interventions need to specifically focus on the families' satisfaction with healthcare services and on utilizing the family support network, offering emotional support, and exploring illness beliefs.

The impact of implementing an educational intervention to enhance a family-oriented approach in specialised palliative home care: A quasi-experimental study

RATIONALE

Healthcare providers' beliefs, attitudes, experiences and knowledge, which guide the care they deliver, are the key factors influencing the quality of palliative care. Education and coaching innovation are needed to translate research outcomes and adopt evidence-based nursing care into practice.

OBJECTIVES

To evaluate the impact of an advanced educational and coaching programme in a family systems' nursing approach for palliative care nurses in a home-care setting.

METHODS

A quasi-experimental study using qualitative data from open-ended questions to augment the quantitative outcome study that included a single-group, pre- and post-test design. A total population sample of nurses was recruited from a specialised palliative home care unit at a university hospital. The study utilised two self-reported questionnaires.

RESULTS

There was a statistically significant increase in the nurses' critical appraisal of clinical nursing practice related to family nursing after participation in the educational programme than before. No statistical difference was found in items related to nurses' experience of the interaction and reciprocity in the nurse-family relationship after participation in the programme than compared to before or in nurses' cancer-related beliefs. However, there was an overall significant positive change found in attitudes towards families in the total score of the Family Practice Scale. Nurses were also more positive about the further development of their knowledge and skills in advanced family nursing evident in the qualitative data.

CONCLUSION

An advanced educational intervention programme was successful in improving the nurses' knowledge, skills, satisfaction and confidence in relation to applied family nursing approach within the context of caring for families affected by advanced/final stage cancer. However, further refinement of the implementation process is needed to enhance family care improvement and the nurses' professional development in advanced family nursing in specialised palliative care.

Psychometric testing of the Iceland Health Care Practitioner Illness Beliefs Questionnaire among school nurses

BACKGROUND

Beliefs have been found to have an effect on how people deal with illness. Therefore, knowing healthcare practitioners' beliefs about specific high frequency illnesses are vital when caring for vulnerable populations such as school-age children with chronic illnesses or disorders.

AIM

To psychometrically test the Iceland Health Care Practitioner Illness Beliefs Questionnaire for healthcare professionals who are working with families of school-age children with asthma and attention deficit/hyperactivity disorder.

DESIGN

The Iceland Health Care Practitioner Illness Beliefs Questionnaire is a 7-item Likert-type instrument with four additional open-ended questions that was developed from the Iceland Family Illness Belief Questionnaire. The questionnaire is designed to measure a provider's beliefs about their understanding of the meaning of the illness situation for families. The questionnaire was administered to 162 school nurses in Iceland and the state of Minnesota.

METHOD

Two condition-specific versions of the Iceland Health Care Practitioner Illness Beliefs Questionnaire were developed in this study: one to measure beliefs about families of children with asthma and one to measure beliefs about families of children with attention deficit hyperactivity disorder. Higher scores on the questionnaire indicate that healthcare professionals are more confident in their illness beliefs. After initial development, the questionnaire was translated into English. Participants completed the questionnaire using an online survey platform and parallel study procedures in both countries.

RESULTS

Based on exploratory factor analysis using principal component analysis, the Iceland Health Care Practitioner Illness Beliefs Questionnaire was found to have a one-factor solution with good construct validity (Cronbach's α = 0.91). Confirmatory factor analysis supported the one-factor solution (Cronbach's α = 0.91).

CONCLUSION

This instrument is a promising tool for measuring illness beliefs among healthcare practitioners in clinical and research settings.

The effectiveness of therapeutic conversation intervention for caregivers of adolescents with ADHD: a quasi-experimental design

WHAT IS KNOWN ON THE SUBJECT?: Caregivers of adolescents with ADHD experience major difficulties as care providers and are in need of guidance and support. Adolescents with ADHD may develop oppositional and criminal behaviour. More than 50 % have the symptoms in adulthood, and up to one-fourth with severe emotional or antisocial difficulties. There is a lack of evidence of caregivers' supporting intervention although caregiver groups have been found to contribute to better coping, decreased stress and improvements in ADHD symptoms. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Primary caregivers of adolescents with ADHD experienced better quality of life after the Therapeutic Conversation Intervention. The intervention contributed to better social functioning among secondary caregivers. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The content of the Therapeutic Conversation Intervention is significant and highlights the utility of a combination of group and private sessions for caregivers of people with ADHD. The intervention can influence how services for families are organized, such that a Therapeutic Conversation Intervention could be offered on a regular basis.

ABSTRACT

Introduction Caregivers of adolescents with Attention Deficit Hyperactivity Disorder are burdened with tasks and many suffer from distress. Adolescents with ADHD may develop antisocial behaviour and caregiver's group can empower caregiver's supporting role. Aim/Question To evaluate the effectiveness of a Therapeutic Conversation Intervention on caregivers of adolescents with ADHD regarding strengthening the supportive role. Method The study utilized a quasi-experimental design. The participants (n = 60) were caregivers of adolescents (13-17 years old) with ADHD. The intervention consisted in-group and parent sessions. The Calgary Family Model and the Family Illness Beliefs Model were used as theoretical frameworks. Results The study revealed significant differences in the improvement of quality of life; regarding primary caregiver (PC) worry, daily activities, family relationships and collaboration post-intervention, as well emotional functioning at both post-intervention and follow-up. Secondary caregiver (SC) social functioning was significantly improved at follow-up. Discussion The intervention proved to be beneficial to the caregivers and is filling a gap in much needed intervention. Implication for practice The results will expand health care professionals' knowledge of how to increase PC quality of life when supporting their adolescent with ADHD. This treatment information should improve service at health care centres/hospitals where adolescents with ADHD receive care.

Effectiveness of therapeutic conversation intervention among caregivers of people with eating disorders: quasi-experimental design

AIMS AND OBJECTIVES

The aim of this study was to evaluate the effectiveness of therapeutic conversation intervention in group and caregiver sessions on the supporting role of caregivers.

BACKGROUND

Caregivers of people with eating disorders are known to suffer major difficulties and are in great need of support. Unhelpful parental support strategies can delay the recovery of an individual with an eating disorder. Skill training interventions can equip parents with skills, guidance and techniques by helping them to be a support person and making them one of the most important links in the treatment process.

DESIGN

The therapeutic conversation intervention consisted of five group and caregiver sessions and three booster sessions. The Calgary Family Assessment and Calgary Family Intervention Models, the Illness Beliefs Model and the New Maudsley Method were used as theoretical frameworks. The content of the intervention consisted of work on difficult behaviours, feelings and helpful strategies. The participants (n = 58) included primary and secondary caregivers of 12- to 24-year-old patients with eating disorders. Eight caregivers dropped out of treatment.

METHODS

This study had a quasi-experimental design with one pre- and two post-test measures.

RESULTS

Between 90-96% of caregivers rated the therapeutic conversation intervention as supportive. Furthermore, the study revealed significant differences in caregiver emotional and cognitive support, illness beliefs, disruptive behaviour and quality of life, negative aspects of care giving demands and caregiver and patient behavioural difficulties after the intervention and/or at follow-up.

CONCLUSIONS

Therapeutic conversation intervention with caregivers in group and private sessions proved to be beneficial.

RELEVANCE TO CLINICAL PRACTICE

This outcome provides information for healthcare professionals on how they can help primary caregivers in their supporting role, which can, in turn, improve services in healthcare centres and psychiatric hospitals.

Surviving Childhood Cancer: Parents’ Perceptions of Their Child’s Health

The improving prognosis for children with cancer refocuses attention to long-term outcomes. The purpose of this study was to assess whether changes in mothers’ and fathers’ perception of caregiving demands and well-being over a 1-year time period predicted parents’ perception of their child’s health at 12 months and to evaluate if these variables predicted change in health perceptions over a period of 1 year. Twenty Icelandic families of children younger than 18 years with cancer participated in the study. The change in general well-being over the year significantly predicted parents’ perception of their child’s health at 12 months; for the mothers, the change in well-being also predicted the changes in their perception of their child’s health over the 1-year period. These findings suggest the importance of incorporating long-term health-related outcomes and measures to improve well-being among family members in future research and clinical practice, when caring for children and families surviving childhood cancer.

Development and Psychometric Testing of the Iceland-Family Illness Beliefs Questionnaire

Illness beliefs affect how individuals and families deal with illness. A valid and reliable instrument has not yet been developed to measure "illness beliefs" in family nursing research and clinical practice. This article describes the purpose, reliability, validity, and the potential clinical and research applications of a new instrument, the Iceland-Family Illness Beliefs Questionnaire (ICE-FIBQ). The ICE-FIBQ is a short, self-report measure of an individual's beliefs about illness. Drawing from an advanced nursing practice model called the Illness Beliefs Model, the instrument was developed to measure illness beliefs about (a) cause of illness, that is, etiology; (b) control of illness on family and control of family on illness; (c) effect of illness on the individual and family; (d) illness suffering; and (e) support received from health care professionals during illness. The instrument was tested on 139 family caregivers of adolescents/youth with an illness or a disorder. Exploratory factor analysis reduced the original questionnaire from eight to seven items with a one-factor solution (Cronbach's α = .780). Confirmatory factor analysis supported the one-factor solution (Cronbach's α = .789). Further research is needed to determine concurrent validity with other illness belief/illness perception scales and if the instrument is sensitive to capture change in illness beliefs following family nursing intervention.

The importance of family support in pediatrics and its impact on healthcare satisfaction

AIMS

To evaluate predictors of healthcare satisfaction for parents whose children received hospital-based healthcare services at the Children's hospital at Landspitali University Hospital.

METHODS

In this cross-sectional study, data on perceived family support, family quality of life, expressive family functioning, coping strategies and healthcare satisfaction were collected from 159 mothers and 60 fathers (N = 177 families) of children and adolescents from 2011 to 2012.

RESULTS

Logistic regression analysis revealed that, for mothers, 38.8% of the variance in satisfaction with healthcare services was predicted by perceived family support and their coping strategies, while for fathers, 59.9% of the variance of their satisfaction with healthcare service was predicted by perceived family support, family quality of life and whether the child had been hospitalised before.

DISCUSSION

Perceived family support was the one factor that was found to predict both the mothers' and the fathers' satisfaction with healthcare services. Knowing which factors predict satisfaction with health care among parents of hospitalised children with different chronic illnesses and health issues can inform the delivery of effective family-focused interventions and evidence-based practice to families.

Family nursing hospital training and the outcome on job demands, control and support

The purpose of this study was to evaluate the impact of a family systems nursing hospital training educational program (ETI program) on nurses' and midwives' perception of job demands, control, and/or support. Of the nurses and midwives who were working in the Women's and Children's Services Division at The National University Hospital in Iceland, 479 participated in the study on three time periods from 2009 to 2011. Scores for the characteristics of job demands and job control were created to categorize participants into four job types (Karasek and Theorell, 1990). These four job types are high strain (high demand, low control), passive (low demand, low control), low strain (low demand, high control), and active (high demand, high control). However, when the data were evaluated based on the proportion of job characteristics as reported by the nurses and the midwives, no significant difference was found over time (2009 to 2011) (χ(2)=5.203, p=.518). However, based on the results from the independent t-tests at time 1, a significant difference was found amongst the high strain job group regarding perceived support from administrators and colleagues among the nurses and midwives who had taken the ETI program compared to those who had not taken the program (χ(2)=2.218, p=.034). This indicates that the health care professionals who characterized their job to be of high demand but with low control evaluated the support from their administrators and colleagues to be significantly higher if they had taken the ETI program than did the nurses and midwives who did not take the ETI program. These findings are promising because they might, in the long run, increase the nurses' and midwives' autonomy and control over their own work.

The Impact of a Web-Based Educational and Support Intervention on Parents’ Perception of Their Children’s Cancer Quality of Life

The purpose of this exploratory study was to (1) describe the development of an evidence-based web educational and support intervention for families of children with cancer and (2) assess the favorability of the website, and whether there was any impact on the cancer communication aspect of the quality of life instrument. In the study, 38 persons participated—15 mothers, 12 fathers, and 11 children. The favorability score of the website was found to be very high. The mothers rated the website most favorable, followed closely by the fathers. Furthermore, even though it was not significant, an increase was found in the mothers’ evaluation of cancer communication based on the Pediatric Quality of Life Questionnaire (PedsQL) after the intervention as compared with before. The findings suggest that the use of an evidence-based website is feasible, appears to enhance cancer knowledge and might, in that way, contribute to better management of the cancer situation for the families.

Strengths-oriented therapeutic conversations for families of children with chronic illnesses: findings from the Landspitali university hospital family nursing implementation project

Psychosocial services have been recommended for families of children with chronic illnesses to assist them in adjusting to the illness experience. However, little is known about the benefit of psychosocial interventions in clinical practice. This study aimed at evaluating the benefits of a two-session family therapeutic conversation intervention (FAM-TCIs) for families of children diagnosed with asthma, cancer, or diabetes. A secondary data analysis was conducted on intervention data from 37 families of children with chronic illnesses. Mothers of the children/teenagers perceived significantly higher family support after the FAM-TCI compared with before; mothers reported significantly higher collaboration and problem-solving abilities on the expressive family functioning scale after the FAM-TCI. However, no significant differences were found on the fathers' perceived family support nor on their expressive family functioning after the FAM-TCI compared with that before the intervention. It is promising that mothers of children with chronic illness perceived the two-session FAM-TCI to be beneficial to them. More attention should be paid to psychosocial interventions for families of children with chronic illnesses.

Does a therapeutic conversation intervention in an acute paediatric setting make a difference for families of children with bronchiolitis caused by respiratory syncytial virus (RSV)?

AIMS AND OBJECTIVES

To measure the benefit of a short-family therapeutic conversation (STC) intervention in an acute paediatric unit.

BACKGROUND

Studies of children with bronchiolitis caused by respiratory syncytial virus (RSV) have shown that this virus may have an impact on their respiratory system in the form of a wheezing disorder, asthma and even allergy during their childhood. Studies of the parents of these children indicate that they experience distress, vulnerability and anxiety through the illness period and therefore need support from healthcare professionals. However, little is known about what intervention is of most benefit for these parents.

DESIGN

Quasi-experimental.

METHOD

Data were collected from a convenience sample from February throughout April 2009 at an acute unit at a children's hospital in Iceland. Parents of infants diagnosed with bronchiolitis caused by RSV were invited to attend. In total, there are 41 participants: 21 in the intervention group (n = 21) and 20 in the control group (n = 20). Parents in both groups answered questionnaires about perceived support and family expressive functioning both before the intervention and on an average of 11 days after the intervention.

RESULTS

The main findings showed that mothers in the intervention group perceive significantly higher support after the intervention compared with the control group. The findings also showed a significant difference between the genders (mothers and fathers) in the intervention group. The mothers perceived higher cognitive support than the fathers.

CONCLUSIONS

Despite the often chaotic environment in an acute care setting, the research findings give paediatric nurses reason to conclude that a STC intervention benefits mothers of infants with bronchiolitis caused by RSV.

RELEVANCE TO CLINICAL PRACTICE

A STC intervention offered by a nurse within an acute paediatric unit can support families in handling the illness experience.

Therapeutic conversations intervention in pediatrics: are they of benefit for families of children with asthma?

This article reports a quasiexperimental family level intervention study to measure effectiveness of a theory-based family therapeutic conversation intervention (FAM-TC) for families of children with asthma on perceived family support and asthma-related quality of life (QOL). Perceived family support increased significantly for mothers in the experimental group. The children of the parents in the experimental group reported significantly lower problems with asthma treatment on the treatment problems subscale of the asthma QOL scale after the intervention. These results highlight the benefit of therapeutic conversations for families of children and adolescent with asthma to support or enhance QOL.

The international school nurse asthma project: barriers related to asthma management in schools

AIM

This article is a report of an international study of barriers to asthma care from the perspectives of school nurses in Reykjavik, Iceland and St. Paul, Minnesota, in the context of their schools, communities and countries.

BACKGROUND

Globally, asthma affects the health and school performance of many adolescents. School nurses play a key role by providing care to adolescents with asthma in school settings. Understanding universal barriers to asthma management in schools is important for developing interventions that are effective in multiple societal contexts.

DESIGN

Exploratory, descriptive study.

METHODS

Parallel studies were conducted from September 2008-January 2009, through six focus groups among school nurses (n = 32, in Reykjavik n = 17 and St. Paul n = 15) who were managing asthma in adolescents. Focus groups were audio-recorded and transcribed verbatim in English or Icelandic. The Icelandic transcripts were translated into English. Descriptive content analytic techniques were used to systematically identify and categorize types of barriers to asthma care.

RESULTS

School nurses in both countries identified common barriers, such as time constraints, communication challenges and school staff barriers. The primary difference was that St. Paul school nurses identified more socio-economic and health access barriers than school nurses in Reykjavik.

CONCLUSION

Greater cultural and linguistic diversity and socio-economic differences in the student population in St. Paul and lack of universal healthcare coverage in the US contributed to school nurses' need to focus more on asthma management than school nurses in Reykjavik, who were able to focus more on asthma prevention and education.

Psychometric development of the Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ)

Instruments that are able to capture changes related to an intervention are of great value to the scientific as well as to the clinical community. The Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ) measures expressive emotions, collaboration, problem solving, communication, and behavior in families experiencing a chronic or an acute illness. The conceptual framework of the Calgary Family Assessment Model (Wright & Leahey, 2009) was used to construct the original questionnaire of 45 items and 10 subcategories. A total of 557 family members with a recent illness experience of a close relative answered the ICE-EFFQ in three different studies. Principal component factor analysis reduced the original questionnaire to 22 items with five factors emerging and a total Cronbach's alpha coefficient of α = 0.912 accounting for 60.3% of the total variability. Confirmatory factor analysis from two studies produced the final version of the questionnaire consisting of 17 items and four factors.

Knowledge translation in family nursing: does a short-term therapeutic conversation intervention benefit families of children and adolescents in a hospital setting? Findings from the Landspitali University Hospital Family Nursing Implementation Project

In an effort to examine translation of family nursing knowledge to practice, the Landspitali University Hospital Family Nursing Implementation Project (2007-2011), was thoughtfully initiated in Reykjavik, Iceland and systematically evaluated. The mission was to implement family nursing in every department of the hospital. This publication is the first formal research report from this landmark project. The purpose of this research was to evaluate the effectiveness of a short-term therapeutic conversation intervention with families who were receiving health care services at the Children's Hospital at Landspitali University Hospital in Iceland related to childhood and adolescent acute and chronic illnesses. The therapeutic conversation was guided by Family Systems Nursing and used the Calgary Family Assessment and Intervention Models (Wright & Leahey, 2005, 2009). Families (N = 76) were randomly assigned to either an experimental group (short-term therapeutic conversation: n = 41) or to a control group (traditional care: n = 35). Parents in the experimental group reported significantly higher family support after the intervention, compared to the parents in the control group. Differences were noted between families experiencing acute versus chronic illnesses. Recommendations are made for conducting and designing intervention research with families experiencing the hospitalization of a child or adolescent.

Psychometric development of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ)

Valid and reliable instruments are needed to measure how family members perceive support from nurses when a family member is experiencing serious illness. The purpose of this article is to describe the development and psychometric testing of a new instrument, the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ). The concepts in the original version of the ICE-FPSQ (suggesting 24 items and 4 categories) were developed from the Calgary Family Intervention Model. In the first phase of the instrument construction, 179 family members answered the original ICE-FPSQ, and 236 answered the questionnaire in the second phase of testing. Principal Component Analysis (PCA) reduced the original questionnaire to 21 items. Cronbach's α = .959 explained 68% of the total variance, with three factors emerging: (a) emotional support (α = .925), (b) recognition of families' strengths (α = .926), and (c) cognitive support (α = .841). Confirmatory Factor Analyses (CFA) resulted in a final version of the questionnaire containing 14 items with total alpha of .961 and two factors: (a) cognitive support (α = .881) and (b) emotional support (α = .952). The instrument measures family's perceptions of support provided by nurses and will be helpful in examining the usefulness of family nursing interventions.

Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program

This study measures the attitudes of the psychiatric nurses, after having received an education and training intervention program (ETI-PROGRAM) in family systems nursing, towards the importance of the families in their care. Nurses' knowledge of the impact that family nursing intervention can have on family members may increase positive attitudes towards families. However, little is known about the impact that education and training intervention can have on nurses' attitudes, towards families in clinical practice. Quasi-experimental design was used to assess the change in nurses' attitudes towards families in psychiatric care after the intervention, which included a one-day seminar on the Calgary family nursing conceptual frameworks and skills training with clinical vignettes of families from psychiatry. The Families Importance in Nursing Care - Nurses' Attitude questionnaire was used to evaluate nurses' attitudes. A total of 81 nurses (65%) working in psychiatric care responded to the questionnaire. Nurses with more than 15 years of work experience were significantly more supportive of families in their care compared with less experienced nurses. Out of the 81 nurses, 52 (64%) answered the questionnaire again 14 months later. Furthermore, psychiatric nurses saw families significantly less burdensome after having participated in the ETI-PROGRAM.

Cultural differences in parent-adolescent agreement on the adolescent's asthma-related quality of life

The primary purpose of this exploratory, cross-sectional study was to determine the degree of agreement between parents' and adolescents' rating of adolescents' asthma-related quality of life (QOL). A secondary aim was to compare the degree of agreement between parent-adolescent dyads in two countries; 15 dyads each were recruited from Kentucky and Iceland. Both adolescent and adult participants completed separate paper surveys at the time of the adolescent's clinic appointment. The QOL instrument used (PedsQL 3.0 Asthma Module) contains the subscales of asthma symptoms, asthma treatment, worry, and communication. Parent-adolescent differences were determined using paired t-tests; associations were assessed with intraclass correlation coefficients (ICCs). Two-sample t-tests investigated between-country differences in parent-child consistency in the assessment of the adolescent's asthma-related QOL. Adolescents rated their QOL higher than their parents did, but not significantly. The ICC of the QOL score for the 30 dyads was 0.39. The degree of agreement was high for asthma symptoms, but low for asthma treatment, worry, and communication. U.S. parents tended to underrate their child's QOL, while parents from Iceland overrated it (p = 0.007). Family-centered interventions may improve parents' understanding of how asthma affects QOL in adolescents, and such interventions may have to be tailored for cultural differences.

How effective is a short-term educational and support intervention for families of an adolescent with type 1 diabetes?

PURPOSE

To study adaptation and coping strategies of parents who had adolescents with diabetes and the effect of a short-term educational and support intervention.

DESIGN AND METHOD

A quasi-experimental design was used in the study on 23 families of adolescents with diabetes.

RESULTS

A significant difference was found between parents' coping patterns before the intervention. Fathers were, however, found to rate their coping patterns significantly more helpful after the intervention than before. The mothers demonstrated, nevertheless, a significantly greater use of all the coping patterns.

PRACTICE IMPLICATIONS

Educational and support intervention is helpful for parents of adolescents with diabetes.

Implementing family nursing: how do we translate knowledge into clinical practice?

Health care systems worldwide are faced with the challenge of improving the quality of care, closing the knowledge-to-practice gap, and identifying the facilitators in these processes. Knowledge translation that promotes circularity between knowledge and practice is often overlooked. Knowledge transfer and translation are defined and briefly discussed in this article. Examples of knowledge translation in family nursing are provided, including knowledge creation research in pediatrics and adult pulmonary health at a University Hospital in Iceland. A second example focuses on the application of knowledge in mental health urgent care in a community health center in Calgary, Canada. Improving and speeding the circularity between knowledge translation and clinical practice reaps benefits for patients, families, health care providers, and the health care system. Conclusions about facilitating the implementation of family nursing knowledge into clinical practice are offered. The circularity between knowledge translation and practice is emphasized.

Adolescents with asthma: predictors of quality of life

AIM

This paper is a report of a study to determine the demographic, personal, interpersonal and illness factors associated with asthma quality of life (QOL), as self-reported by adolescents from the United States of America (USA) and Iceland.

BACKGROUND

Asthma affects 12% of children in the USA and an estimated 9% in Iceland. Limited research has addressed asthma QOL for adolescents.

METHODS

This cross-sectional exploratory study included adolescents with asthma (n = 15 from the USA; n = 15 from Iceland), aged 13-17 years, primarily recruited from paediatric practices in central Kentucky, USA and Reykjavik, Iceland. Data were collected in 2006. Adolescents in the USA (47% male) had a mean age of 14.1 years (sd = 1.5); Icelandic adolescents (73% male) had a mean age of 15.1 years (sd = 1.4). Participants completed questionnaires measuring sociodemographic and asthma characteristics, degree of limitations due to asthma, self-rated health, depressive symptoms and asthma QOL. Multiple regression was used to determine predictors of asthma QOL.

RESULTS

Gender was statistically significantly associated with QOL. The difference in QOL between adolescents in the USA and Iceland was not statistically significant. Statistically significant predictors of higher asthma QOL were a better rating of overall health (P < 0.01), not having had a severe asthma attack in the last 6 months (P < 0.01), and lower depressive symptoms (P < 0.05).

CONCLUSION

Interventions designed to decrease depression and prevent asthma exacerbations may improve QOL for adolescents with asthma.

Excellence in nursing: a model for implementing Family Systems Nursing in nursing practice at an institutional level in Iceland

An innovative opportunity is being created by nursing leaders from practice and education in Iceland to implement Family Systems Nursing at an institutional level on all units and divisions with the Landspitali University Hospital. This article describes the phases of the implementation model for knowledge translation that will be operationalized over four years. The goals of implementing Family Systems Nursing at the Landspitali University Hospital are to (a) educate all practicing nurses in Family Systems Nursing and, in particular, the Calgary family assessment and intervention models; (b) strengthen practicing nurses' clinical skills for intervening with families by offering specific clinical training courses to all nurses using family skills labs; and (c) explore and assess the difference that the theoretical and clinical programs make for the nurses, the patients and their families, and the nurses' practice (the family-nurse relationship).

Listening to the family's voice: Nordic nurses' movement toward family centered care

Clinical nurses, teachers, and researchers in the Nordic countries are faced with increasing expectations in identifying their contribution to knowledge development in family nursing at national and international levels. In this paper, I provide an insight into the contribution of Nordic nurses to family centred care (family system nursing), present findings from an integrative review on family nursing in the Nordic countries, share with you examples of family level interventions, and offer some ideas regarding where we might want to direct our focus in family system nursing in the future.

Health-related quality of life in Icelandic school children

This study evaluated generic health-related quality of life (HRQOL) among 10 to 12-year-old Icelandic school age children who were either with or without chronic health condition. The children and their parents answered self-report questionnaires. For the 480 children who participated, girls were found to perceive their HRQOL significantly higher than the boys, children who visited the school nurse over a one-week period and children who indicated they were bullied by other children, perceived their HRQOL to be significantly lower than children who did not visit the school nurse over this time period or children who did not indicate they were bullied by other children in school. From the stepwise regression analysis, perception of health, school connectedness, health promotion, bullying victimization, visits to the school nurse and age, significantly predicted 43.8% of the variance of the girls' perception of their HRQOL. However, perception of health, school connectedness, and chronic health condition/illnesses, bullying victimization and after school activities predicted 48.1% of the boys' perception of their HRQOL. Children with chronic health condition or illnesses, reported their HRQOL to be significantly lower than children without chronic health condition. Assessing HRQOL among 10 to 12-year-old children might be helpful to take preventive action early on in children's life and development.