Family dynamics of families with cancer in Finland

Factors influencing family resilience in adult patients with acute leukemia undergoing chemotherapy: A qualitative study

Objective

To explore the factors influencing family resilience in adult patients with acute leukemia undergoing chemotherapy, with the aim of providing a theoretical basis for the development of strategies to strengthen their family resilience.

Methods

A descriptive phenomenological qualitative research method was used to select 11 adult acute leukemia chemotherapy patients for semi-structured interviews. Colaizzi 7-step analysis and NVivo 12.0 were used to summarize information and refine themes.

Results

The main outcomes consisted of two themes and 11 sub-themes: protective factors for family resilience (positive traits, cognitive restructuring, positive family beliefs, organizational flexibility, clear communication, and social support) and risk factors for family resilience (symptom burden, self-concealment, role overload, economic distress, and social alienation).

Conclusions

Health care professionals should pay attention to screening protective and risk factors for family resilience in adult acute leukemia chemotherapy patients, affirming the positive role of internal and external resources available in the family in stressful situations, alleviating patients' negative experiences, and promoting the recovery of family function.

Family Functioning Assessed by Family Members in Finnish Families of Heart Patients

BACKGROUND

The role of family is central to the wellbeing and health of individuals. Family attitudes, habits and routines affect the way individuals promote their health. Family functioning and family health are threatened when one family member develops heart disease.

AIMS

The aim of the study was to describe family functioning and to ascertain factors related to family functioning of families with heart patient as assessed by family members.

METHODS

Data collection was done using a questionnaire (FAFHES) in 2000. The sample consisted of 161 family members of patients receiving treatment on two medical wards. The data were analysed by means and tested by parametric and non-parametric tests. The multivariate method used was stepwise regression analysis.

RESULTS

The better the family values were materialized and the greater the family's contribution to family health, the better the family's functioning is. Concrete aid was also related to family health. The more concrete aid the family received from nurses, the better family functioning is. When the background variables were included, values and activities remained in the model, but two new variables explained family functioning: family member's age and knowledge of health issues. The older the family member is and the better the knowledge in the family is, the better is family functioning.

CONCLUSION

Family functioning of families with heart patients can be supported and developed by family nursing, e.g. concrete aid from nurses. Other aspects of support, e.g. consideration of family member's age and knowledge of health issues also need to be further considered and studied as the basis of care.

The state of the science of family caregiver-care receiver mutuality: a systematic review

This review critically examines the current state of the science on the concept of family caregiver-care receiver mutuality, summarizes accomplishments and gaps and identifies directions for future theory development and research. Mutuality between family caregivers and care receivers is of increasing interest to researchers. However, no analysis of the current state of the science of this important concept has been published. Our literature search revealed 34 research articles that met inclusion criteria. The studies were assessed in terms of conceptualization of mutuality, instrument development, populations studied, research designs and methods and findings. Significant scientific progress during the past 30 years includes the development of clear definitions and new instruments, expansion of research beyond the clinical populations in which mutuality was first studied, the use of a variety of research designs, and increasingly sophisticated methods of data analysis. Growing evidence suggests that mutuality is associated with caregiver emotional health outcomes and may decrease over time in the context of chronic illness. Directions for future research include development of new theoretical frameworks grounded in relational theory, development of theory on the dynamics of mutuality over time, exploration of mutuality in diverse cultures and populations, and intervention studies aimed at enhancing mutuality.

Adaptação e validação da Family Dynamics Measure II para familiares de mulheres com câncer de mama

O estudo objetivou adaptar e validar a Family Dynamics Measure II para uso com famílias de mulheres com câncer de mama. O processo incluiu tradução, retrotradução, análise da equivalência semântica pela autora principal do instrumento, análise semântica por amostra da população-alvo, análise de conteúdo por juízes e avaliação das propriedades psicométricas da escala aplicada a 251 familiares de mulheres com câncer de mama. Obteve-se versão adaptada com fidedignidade geral boa (α = 0,90); a análise fatorial não confirmou a dimensionalidade teórica do instrumento original; as correlações com a Escala de Ansiedade e Depressão Hospitalar foram invertidas e de baixa a moderada intensidade. A escala foi considerada válida para uso no Brasil. Novos estudos foram sugeridos para fortalecer as evidências.

Palliative care: A need for a family systems approach

Objective:

When a family member is faced with a terminal illness, the impending death presents a crisis and a challenge to the entire family as a system. This article highlights the importance of caring for a family when one member has a life-threatening illness, and describes the applicability of Family Systems Theory and its major tenets to the palliative cancer population.

Methods:

A MedLine and CINAHL search of Family Systems Theory related papers was conducted.

Results:

Research studies that have been done fail to capture the view of the entire family system, often limiting the perspectives of the family to one single member. The concepts of holism, balance, boundaries, and hierarchal subsystems must be addressed in the care of any family, including those who have a family member who is dying.

Significance of results:

A Family Systems Theory framework can be useful in helping health care providers, and particularly nurses, deliver optimal care to palliative cancer patients and their families and standardize the way research is done by providing an appropriate framework with which to study the family. In addition, the adoption of Family Systems Theory as the standard framework from which to study families in palliative care will provide consistency for future studies that is presently lacking. Finally, nursing interventions to care for the family are suggested based on Family Systems Theory.

Development of the Ways Of Helping Questionnaire: a measure of preferred coping strategies for older African American cancer survivors

Although researchers have identified beneficial coping strategies for cancer patients, existing coping measures do not capture the preferred coping strategies of older African American cancer survivors. A new measure, the Ways of Helping Questionnaire (WHQ), was evaluated with 385 African American cancer survivors. Validity evidence from factor analysis resulted in 10 WHQ subscales (Others There for Me, Physical and Treatment Care Needs, Help from God, Church Family Support, Helping Others, Being Strong for Others, Encouraging My Healthy Behaviors, Others Distract Me, Learning about Cancer, and Distracting Myself). Reliability evidence was generally strong. Evidence regarding hypothesized relationships with measures of well-being and another coping measure was mixed. The WHQ's content coverage makes it especially relevant for older African American cancer survivors.

Cancer families with children: factors associated with family functioning—a comparative study in Finland

OBJECTIVE

The objective is to examine the factors associated with family functioning in families with children where a parent has cancer in comparison to families without cancer.

SAMPLE AND METHODS

Eighty-five families including 85 cancer patients, 61 healthy spouses and 68 children between 11 and 17 years of age, and a control group of 59 families including 105 adults and 65 children were given a set of questionnaires including a background variable questionnaire, the Family Assessment Device, the Beck Depression Inventory and the Sense of Coherence (SOC). A statistical multilevel model allowing the use of data from several informants belonging to the same family was constructed for the analysis of associations between variables.

RESULTS

Maternal depression and SOC of family members were associated with family functioning; maternal depression impaired family functioning and family members' SOC improved it. No difference was found between the clinical group and the control group.

CONCLUSION

In clinical work with cancer families with children, maternal depression and SOC should be focused on.

Family dynamics in families of severe COPD patients

AIM AND OBJECTIVES

The purpose of this study was to describe family dynamics in families with severe chronic obstructive pulmonary disease (COPD) on the basis of Barnhill's framework for healthy family systems. The sample consisted of 35 severe COPD patients and 30 family members at Tampere University Hospital, Finland or in the neighbouring regions.

BACKGROUND

Chronic obstructive pulmonary disease is a public health problem worldwide. It is a slowly progressive airway disease, producing a decline in lung function which is not fully reversible.

DESIGN

The sample included the families of patients without oxygen therapy and the families of patients who had long-term oxygen therapy (LTOT). The data were collected using the Family Dynamics Measure 2 (FDM2) and the Family Dynamics Questionnaire (FDQ).

METHOD

A quantitative research method was employed in the study. Frequency and percentage distributions, as well as cross-tabulations, were used to describe the data. Mean values and standard deviations were calculated for the sum variables of six dimensions of the FDM2.

RESULTS

In the dimensions of individuation, mutuality and flexibility, dynamics in the families of patients with LTOT was significantly better than of the patients without oxygen therapy. Especially in the dimension of mutuality, the families of LTOT patients functioned very well, while in the dimensions of communication and roles, family dynamics in these families was notably worse, although still good.

CONCLUSION

Poor self-identity--enmeshment, isolation from others and lack of flexibility to varying conditions--in families with severe COPD can weaken the ability of the families to manage in everyday life.

RELEVANCE TO CLINICAL PRACTICE

Families need family nursing to adapt to alterations occurring when a family member has severe COPD. Nurses can give support and help for these families for their roles of patient and caregiver, as well as opportunities to speak with someone about their situation.

The Ovarian Cancer Journey of Families the First Postdiagnostic Year

Ovarian cancer care has shifted from hospitals to families and has resulted in an unanticipated cancer journey as survivability for women so diagnosed has increased. This research investigated the impact of this responsibility on selected aspects of family functioning. Eighteen families participated in 5 family research visitations over the first postdiagnostic year. Quantitative data were obtained on socioemotional responses, behaviors, and coping strategies. Accounts of family experiences were recorded in field notes and narrative descriptions. Descriptive and narrative analyses were used. Subject families were strong and experienced a mosaic of variations in socioemotional and behavioral responses. Coping responses relied primarily on reframing and spiritual support. Families had hope and optimism and received socioemotional support from kin and friends. Response patterns consisted of providing support and care to sick members; making transformative changes in family structures, roles, and functions; reorganizing daily living experiences to integrate new situations; and minimizing gaps between professional and familial perspectives and realities. On this journey, families could have used timely knowledge and professional expertise to plan care, balance illness and family needs, restructure roles and responsibilities, maintain family unity, and give meaning and wholeness to experiences. Family-based oncology nursing is essential for family well-being and growth.

An ovarian cancer diagnosis-seeking process: unraveling the diagnostic delay problem

PURPOSE/OBJECTIVES

To propose a conceptualization that identifies when diagnostic delays occur and suggests a delay-reduction strategy for the diagnosis of ovarian cancer.

DATA SOURCES

Findings and extrapolations from published national and international research studies, research reviews, books, Internet sources, and a family-functioning research project.

DATA SYNTHESIS

Three phases of diagnosis seeking were identified. Self-care was characterized by self-diagnosis, self-interpretation of symptoms, and self-management. Primary provider care was characterized by misdiagnosis and ineffective symptom management. Specialist care was characterized by specialized examinations, tests, and definitive diagnoses. Diagnostic delays were associated with extended periods of self-care and the misinterpretation of symptoms in primary care.

CONCLUSIONS

Periods of opportunity for early diagnosis occurred in the early symptom stages, when self- and primary care were dominant.

IMPLICATIONS FOR NURSING

Women must be taught to self-monitor for early ovarian cancer symptoms. Primary care providers should be urged to attend frequent state-of-the-science updates that regard early symptoms as manifestations of ovarian cancer.

Instrument translation process: a methods review

BACKGROUND

Cross-cultural and international collaborative studies are needed in nursing research. Therefore, it is necessary to translate research instruments into the language of the culture being studied. In this methods review, different processes of instrument translation and evaluation of translation adequacy in published nursing research are described and classified into a hierarchy.

METHODS

Studies including translation of quantitative research instruments were reviewed. Forty-seven studies were included. These were classified into six categories.

RESULTS

Studies were classified into categories as follows: forward-only translation (2), forward-only translation with testing (7), back-translation (13), back-translation with monolingual test (18), back-translation with bilingual test (3), and back-translation with both monolingual and bilingual test (4). Strengths and weaknesses are analysed.

CONCLUSION

The studies reviewed used diverse methods of varying quality. There is need for consensus among researchers in how to achieve quality of instrument translation in cross-cultural research. Researchers should carefully attend to achieving and reporting evidence of the accuracy and validity of instrument translation. When back-translation fails to achieve semantic equivalence, the instrument development process should be replicated in the target language.

Impact of chronic obstructive pulmonary disease on family functioning

PURPOSE

The purpose of this study was to ascertain family dynamics of Finnish patients with severe chronic obstructive pulmonary disease (COPD) on the basis of Barnhill's framework for healthy family functioning.

DESIGN AND METHOD

This study used description and comparison and an interview-administered questionnaire and survey.

SAMPLE

Participants were patients with COPD and their family members (n = 65) living in the Tampere University Hospital catchment area. The sample consisted of families of home oxygen therapy patients (n = 36) and families of inpatients (n = 29). Families consisted of patients and their family members.

INSTRUMENTS

Data were collected from patients by interview-administered questionnaires and from family members by survey. The instrument used was the Family Dynamics Measure 2, operationalized and tested by the American Family Research Group.

RESULTS

Families of home oxygen therapy patients experienced significantly more mutuality (P =.03) and made decisions about their illness and life significantly more independently (P =.05) than families of inpatients. Families of home oxygen therapy patients handled change significantly more flexibly (P =.03) than families of inpatients.

DISCUSSION

For the most part, families of both patient groups functioned well, but overall family functioning was clearly better in families of home oxygen therapy patients. The sample included some dysfunctional and even severely dysfunctional families. The results of this study cannot be generalized beyond the study sample because of the small sample size, but they provide suggestions for developing the care of patients with COPD and their families.

Symptom distress, functional status and health-related quality of life before high-dose chemotherapy with stem-cell transplantation

The aims of this study were to describe how a group of patients with different malignant diseases perceived symptom distress (SD), functional status (FS) and health-related quality of life (HRQOL) on admission to the hospital for stem-cell transplantation (SCT), to compare the obtained data regarding FS and HRQOL with similar data from two general-population groups, and to relate the results to disease- and treatment-specific data. Fifty-one patients participated in the study. Three instruments were used to collect data: SFID-SCT, SIP and SWED-QUAL. The majority of the patients (92%) reported ongoing symptoms even before the SCT with tiredness (67%) and anxiety (53%) as the two most commonly reported symptoms. Although tiredness and anxiety were reported to be the most frequently occurring symptoms, these symptoms were not considered to cause that much distress. Instead, vomiting, reduced mobility and fever, although less commonly occurring, were reported as highly distressing when present. Compared with the general-population groups, the patients reported significantly poorer FS and HRQOL but no statistically significant correlations were found between SD, FS or HRQOL and the time since the last chemotherapy cycle or cycles respectively. Patients with advanced disease and patients with multiple myeloma were found to report more SD and poorer FS and HRQOL.

Finnish students' perceptions of a visiting professor

Although nurse educators enthusiastically endorse visiting professors, cross-school collaboration, cross-cultural teaching, and international faculty exchange programs, no previous studies have documented students' perceptions of visiting faculty. An open-ended questionnaire was used to identify Finnish students' perceptions of a visiting Fulbright professor and how faculty and students can better prepare for educational exchanges. Four themes emerged from the content analysis of responses to the questionnaire: course content, teaching methods, the role of the teacher, and expectations and developmental challenges. Generally, students were satisfied with the course content and teaching methods. They indicated that it was important that the teacher was encouraging and positive and challenged them to speak up in class. Students commented that the visiting professor should perhaps have been more knowledgeable about and therefore able to make applications to Finnish culture, education, and the health care system. Others noted that it was helpful to learn about the American health care system and then to make applications to Finnish culture themselves. Overall, the findings of this project support continuation of visiting professors and continued research on methods of increasing visiting faculty program effectiveness.