Nursing intervention studies on patients and family members: a systematic literature review

Translation, Cultural Adaptation, and Psychometric Validation of the European Portuguese Version of the Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ)

A family's experience of mental illness can change the family's functioning. In clinical contexts, valid and reliable instruments that assess family functioning, therapeutic changes, and the effects of family nursing interventions are needed. This study focuses on the linguistic and cultural adaptation of the Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ) to European Portuguese and examines the psychometric properties of this instrument. A non-random sample of 121 Portuguese depressed patients and their relatives completed the questionnaire. Principal components analysis extracted 4 factors, explaining 55.58% of the total variance. Confirmatory factor analysis revealed acceptable adjustment quality indices. Cronbach's alpha coefficient was adequate for the global scale α = .86 and for the 4 subscales: communication α = .79, expression of emotions α = .68, problem-solving α = .71, and cooperation α = .61. The Portuguese version of ICE-EFFQ is a sensitive, valid, and reliable instrument for use with Portuguese families with adult members with depression and can be valuable in assessing these families' expressive functioning, before and after intervention.

Italian nursing students' attitudes towards care of the dying patient: A multi-center descriptive study

BACKGROUND

International literature reports that nursing students feel unprepared when facing patients and families within dying care. They consider their curricula inadequate in teaching end-of-life care and promoting the attitudes required to care for dying patients. Findings of recent studies exploring nursing students' attitudes towards care of the dying patient are often contradictory.

OBJECTIVES

To explore Italian nursing students' attitudes towards caring for dying patients.

DESIGN

A multicenter cross-sectional study was conducted.

SETTINGS

The Bachelor's Degree in Nursing courses of four Universities of the Lazio Region.

PARTICIPANTS

The sample included 1193 students.

METHODS

Data were collected between September 2017 and March 2018 using the Italian version of FATCOD-B-I. The differences between the mean scores were compared through t-test or ANOVA. Associations between scores and participant characteristics were evaluated through generalized linear regression.

RESULTS

The mean score of FATCOD-B-I was 115.3 (SD = 9.1). Higher scores were significantly associated with training in palliative care (p < 0.0001) and experience with terminally ill patients (p < 0.0001). Students manifested more negative attitudes when they perceived patients losing hope of recovering, and patient's family members interfering with health professionals' work. Uncertainties emerged around knowledge of opioid drugs, decision-making, concepts of death and dying, management of mourning, and relational aspects of patient care.

CONCLUSIONS

Italian nursing students seem to have more positive attitudes towards care of dying patients than most other countries. They believe that caring for a terminal patient is a formative, useful experience but they do not feel adequately prepared in practice. Deeper palliative care education, integrated with practical training, would prepare students better, enabling them to discover their own human and professional capacity to relieve suffering.

The relationship between health literacy and quality of life among hemodialysis patients: An integrative review

BACKGROUND

Various studies have highlighted the correlates to health literacy and quality of life among patients receiving hemodialysis therapy. However, evidence of how these two outcomes could influence each other is not clear.

OBJECTIVE

This study aimed to assess the correlation between health literacy and quality of life among patients receiving hemodialysis.

METHODS

This is an integrative review of correlational studies. This study conforms to the preferred reporting items for integrative reviews described by Whitemore and Knafl. We search for studies reporting on the correlation of health literacy and quality of life among patients receiving hemodialysis in six databases, that is PubMed, Web of Science/Knowledge, Scopus and Embase, Google Scholar and Ovid MEDLINE.

RESULTS

In this review five studies were included after screening them against the inclusion criteria. Two studies were identified from Iran, and one study was identified each from Australia, Turkey, and the USA. Most studies were descriptive comparative in nature, while two studies were experimental. Shayan's study had the highest number of participants. This study reports on 1,063 patients receiving dialysis. Most studies were conducted at different centers. Findings from three studies showed that there was a significant relationship between health literacy and quality of life among patients receiving hemodialysis.

CONCLUSION

There is a relationship between health literacy and quality of life among patients receiving hemodialysis. Conclusively, addressing health literacy may improve the quality of life among patients receiving hemodialysis.

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

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

Effectiveness of a psychoeducational intervention for caregivers of People With Dementia with regard to burden, anxiety and depression: A systematic review

AIM

To assess the effectiveness of psychoeducational interventions with respect to burden, anxiety and depression in family caregivers of People With Dementia living at home.

BACKGROUND

In dementia, the family assumes the role of main caregiver, maintaining the patient in a good state of health. Nevertheless, burden, anxiety and depression may have negative repercussions in caregivers. Therefore, professional supports through psychoeducational programmes are recommended as interventions for improving caregivers' health.

DESIGN

A quantitative systematic review.

DATA SOURCES

Electronic searches were performed in CINAHL/AMED/CENTRAL/Web of Science/LILACS/PUBMED from January 2005-August 2018.

REVIEW METHODS

The review was conducted using the JADAD scale to assess bias risk and the quality of the randomized controlled trials (RCTs) and the CONSORT instrument to assess study quality report. The extracted data were reviewed by independent reviewer pairs. The review was reported using PRISMA.

RESULTS

A total of 18 RCTs met inclusion criteria. Seven were classified as Technology-based Interventions and 11 as Group-based Interventions.

CONCLUSION

Psychoeducational interventions for caregivers allow them to increase their knowledge of the illness, develop problem-solving skills and facilitate social support. Technology-based Interventions significantly affect burden while Group-based Interventions affect anxiety, depression, insomnia and burden and quality of life and self-efficacy.

IMPACT

Research findings can be used to classify caregivers in future interventions according to illness stage to obtain more precise results.

Creating a space to talk about one's experience of suffering: families' experience of a family nursing intervention

STUDY RATIONALE

The impacts of health problems on individual and family functioning, as well as the influence of family on health, are well documented. However, health care and services in the West are mostly oriented towards individuals, and the needs of families often receive little consideration. The Family Support Service (FSS) was developed to address this situation. Its aim is to improve the education of nursing students and contribute to the health of the community by offering family conversations to families whose members have a health problem or who have difficulty adjusting to certain transitions.

AIMS AND OBJECTIVES

The objective of this study was to explore families' experience of the family conversations in which they participated and their satisfaction with the FSS.

METHODOLOGICAL DESIGN AND JUSTIFICATION

This study used a descriptive qualitative design based on semi-structured interviews and thematic analysis. The study followed ethical codes of conduct and conformed to the Canadian Tri-Council Policy Statement (TCPS).

RESEARCH METHODS

Qualitative interviews were conducted with 22 participants who had participated in family conversations as interventions, to evaluate their experience of those family conversations and their satisfaction with the FSS.

RESULTS

The families reported a very positive experience of the family conversations. Three themes emerged from their statements and explained this satisfaction: (i) the nurse's attitudes and skills as the foundation for meaningful encounters; (ii) a family systems intervention where families feel recognised; and (iii) a structure adapted to the needs of families.

CONCLUSIONS

This study adds to the existing body of knowledge on families' experience of family system nursing and invites nurses to develop attitudes that are conducive to meaningful encounters with families.

Becoming visible - Experiences from families participating in Family Health Conversations at residential homes for older people

Having a sick family member living at a residential home for older people can be difficult for families, who as a result often suffer from feelings of forsakenness and powerlessness. In response, the purpose of this study was to illuminate family members' experiences with participating in Family Health Conversations at residential homes for older persons 6 months after concluding the conversation series. Twenty-two family members who participated in the conversations later took part in group interviews, the texts of which were analyzed according to qualitative content analysis. Findings showed that participating in Family Health Conversations mediated consolation, since within such a liberating communicative interaction, family members for the first time felt visible as persons with individual significance. Family members reported a positive experience involving both being open to each other and speaking and listening to each other in a new, structured way. As a result, families were able to discover their family members' problems and suffering, as well as to identify their family's resources and strengths.

Hierarchical clusters in families with type 2 diabetes

Families represent more than a set of individuals; family is more than a sum of its individual members. With this classification, nurses can identify the family health-illness beliefs obey family as a unit concept, and plan family inclusion into the type 2 diabetes treatment, whom is not considered in public policy, despite families share diet, exercise, and self-monitoring with a member who suffers type 2 diabetes. The aim of this study was to determine whether the characteristics, functionality, routines, and family and individual health in type 2 diabetes describes the differences and similarities between families to consider them as a unit. We performed an exploratory, descriptive hierarchical cluster analysis of 61 families using three instruments and a questionnaire, in addition to weight, height, body fat percentage, hemoglobin A1c, total cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein. The analysis produced three groups of families. Wilk's lambda demonstrated statistically significant differences provided by age (Λ = 0.778, F = 2.098, p = 0.010) and family health (Λ = 0.813, F = 2.650, p = 0.023). A post hoc Tukey test coincided with the three subsets. Families with type 2 diabetes have common elements that make them similar, while sharing differences that make them unique.

Staff views on how to improve mealtimes for elderly people with dementia living at home

Dementia commonly leads to difficulties in performing daily activities, which can also often affect the ability to prepare and eat meals. As a result, formal support to maintain good nutritional intake might be needed, but there is a lack of knowledge concerning how to support older persons with dementia living at home. The aim of this study was to explore and describe staff views on how to improve mealtimes for persons with dementia who are still living at home. A qualitative descriptive study was performed and data were collected during 2011–2012 through four focus group interviews with staff working in the homes of persons with dementia. Data were analyzed using inductive content analysis. The participants described several ways to improve mealtimes for persons with dementia and advocated adjustments facilitating the preservation of the persons’ independence. Finding suitable actions calls for knowledge about the person and his/her individual situation. Proposed actions were enabling meals at home, taking over, and moving meals outside of the home. In addition, it was found that, the types of meals served to these persons should be as familiar to the individual as possible. The results of this study indicate the importance of using a person-centered approach and meeting the individual needs when supporting people with dementia in regards to their meals when living at home. Individualized care in the home may be expensive, however, it is fair to say that people who become malnourished and admitted to hospitals is even more costly. Furthermore, sharing and reflecting experiences and knowledge can assist staff to identify ways to manage complex situations. Therefore, the use of refection should be a part of staff members’ everyday work.

Possibilities for evaluating cost-effectiveness of family system nursing: An example based on Family Health Conversations with families in which a middle-aged family member had suffered stroke

Family Health Conversations (FamHC) increase health and well-being, but knowledge about their cost-effectiveness, and how to best calculate this, is lacking. In this feasibility study we evaluated the cost-effectiveness of using FamHC with families in which a middle-aged family member had suffered stroke. Seven families participated in a FamHC intervention and seven families received ordinary care. Health-related quality of life (HRQoL) was estimated with SF-6D and EQ-5D over a six-month period. The cost-effectiveness of the intervention was calculated. Families receiving FamHC intervention had significantly increased HRQoL at follow up. Cost per quality adjusted life year differed depending on the instrument and analysis method used in the calculation. However, all calculations showed that FamHC were cost-effective. We conclude that FamHC significantly increase HRQoL and suggest that they are cost-effective. Both instruments seemed to be able to capture changes. Considering the participants’ experience of answering the two instruments, we advocate the use of EQ-5D.

Family health conversations: how do they support health?

Research shows that living with illness can be a distressing experience for the family and may result in suffering and reduced health. To meet families' needs, family systems intervention models are developed and employed in clinical contexts. For successful refinement and implementation it is important to understand how these models work. The aim of this study was therefore to describe the dialogue process and possible working mechanisms of one systems nursing intervention model, the Family Health Conversation model. A descriptive evaluation design was applied and 15 transcribed conversations with five families were analyzed within a hermeneutic tradition. Two types of interrelated dialogue events were identified: narrating and exploring. There was a flow between these events, a movement that was generated by the interaction between the participants. Our theoretically grounded interpretation showed that narrating, listening, and reconsidering in interaction may be understood as supporting family health by offering the families the opportunity to constitute self-identity and identity within the family, increasing the families' understanding of multiple ways of being and acting, to see new possibilities and to develop meaning and hope. Results from this study may hopefully contribute to the successful implementation of family systems interventions in education and clinical praxis.

Coping with the effects of myocardial infarction from the viewpoint of patients' spouses

The spouse of a patient who has experienced a myocardial infarction (MI) reportedly has psychological and social needs and challenges during the patient's hospitalization but there is a lack of knowledge regarding spouses' coping experiences and resources. The aim of this study was to develop a substantive theory to help explain the coping experiences of the spouse during the patient's hospitalization following an acute MI. Twenty eight spouses of patients in two Finnish hospitals participated in an open-ended interview within 2 to 5 days of the MI and included 12 husbands and 16 wives. The core category "Seeking balance" included the spouses' emotional, cognitive, and social coping experiences following an acute MI. This study adds new information about spouses' coping experiences as well as tensions and problems in interaction between the patient and the spouse. Challenges were reported in talking about serious illness concerns between the spouse and patient and also with other family members.

The needs of informal caregivers of elderly people living at home: an integrative review

BACKGROUND

Over the past years, researchers have developed studies about informal caregivers who care for the elderly living at home. Meeting these needs can help these professionals to provide more appropriate care.

AIM

To explore and define the current status of published literature related to the needs of informal caregivers who care for the elderly living at home.

METHOD

This study follows an integrative literature review using Whittemore and Knafl's method. Given the lack of higher-level evidence on this area of study, this method was considered to be the most appropriate to explore and define the current status of the available literature, which comes from a variety of scientific sources, and diverse methodologies. The literature research was performed using eleven electronic databases. The search was developed during the months of December 2010 and February 2011 and updated from March to April 2011. Studies written in English, Portuguese and Spanish were included. A total of 14 articles met the criteria in this review. Data were extracted from primary studies using quantitative, qualitative and mixed methods.

RESULTS

The literature review showed a shortcoming of studies about the needs of caregivers of the elderly at home. It also identified a lack of high-quality scientific evidence in this area. From the literature available, four core themes were generated to reflect the literature: information and training, professional support, effective communication and legal and financial support.

CONCLUSION

This integrative review offers important insight into the needs of informal caregivers, specifically for the elderly. The inclusive nature of integrative review method enabled us to provide a good understanding of underlying issues on the needs of informal caregivers. Challenges for the future are to broaden and enhance the scope of research in this area to provide effective support to intervention projects, services and care to informal caregivers.

Randomized controlled trial of CARE: an intervention to improve outcomes of hospitalized elders and family caregivers

In this randomized controlled trial we tested the efficacy of an intervention program (CARE: Creating Avenues for Relative Empowerment) for improving outcomes of hospitalized older adults and their family caregivers (FCGs). FCG-patient dyads (n = 407) were randomized into two groups. The CARE group received a two-session empowerment-educational program 1-2 days post-admission and 1-3 days pre-discharge. The attention control group received a generic information program during the same timeframe. Follow-up was at 2 weeks and 2 months post-discharge. There were no statistically significant differences in patient or FCG outcomes. However, inconsistent evidence of role outcome differences suggests that CARE may benefit certain FCG subgroups instead of being a one-size-fits-all intervention strategy. Closer examination of CARE's mechanisms and effects is needed.

A discussion of HIV/AIDS family interventions: implications for family-focused nursing practice

AIM

This article presents a discussion on the role of family interventions in HIV/AIDS disease prevention and care.

BACKGROUND

Although HIV/AIDS epidemic and its impact on the society traditionally has been measured in terms of individual risk behaviours and individual-level HIV prevention, HIV/AIDS family-focused prevention and management strategies are increasingly becoming a priority. However, little is known as to what constitutes a HIV/AIDS family intervention.

DATA SOURCES

The search was limited to English and published literature starting in the year 1983 to date. CINAHL and PubMed were emphasized using a combination of text words and subject headings. Cochrane Library, PsycInfo, Scopus, and the ISI Web of Science databases were also searched using keywords and in the case of PsycInfo, subject headings were used. The main keywords were 'nurse', or 'nursing', 'HIV/AIDS', 'family interventions', 'family support' and 'family education', and/or 'family subsystems'.

DISCUSSION

The process of theorizing about 'family interventions' and 'HIV/AIDS-family interventions' is critical for putting forth essential components unique for designing culturally specific HIV/AIDS family interventions. In addition, any proposed design of HIV/AIDS family intervention should consider the impact of HIV/AIDS on the family across the family life span, disease trajectory, and from an interdisciplinary perspective.

CONCLUSION

Training needs of family nurses should be met when designing multidisciplinary HIV/AIDS-FIs. Furthermore, nurses should be proactive in advocating for HIV/AIDS family intervention and HIV/AIDS family policies to improve outcomes in family functioning, processes, and relationships. More needs to be done in regard to research on families, family interventions, effectiveness, and cost of family-focused approaches.

Organizational Interventions concerning Palliation in Community Palliative Care Services: A Literature Study

Background. Studies indicate problems between different professional groups working with palliative care and the organisation of palliative home care at nursing homes. The purpose of this study is to examine international experiences and cooperative development initiatives regarding the organisation of community palliative care services. Method. The study has been carried out as a literature study based on bibliographic searches in international databases with selected key words. Results and Conclusion. The study of the literature identified 19 studies described in 20 articles that relate to development efforts and interventions regarding the organisation of palliative care in communities. Nearly, all of the studies were based on health care professionals' assessments of users (the relatives). However, it is unknown whether or how patients and relatives experience a positive effect of the interventions. The literature study shows that it is a great methodological challenge to complete and evaluate studies concerning organisation and cooperation using methods that make the results useful for others.

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.

The importance of social support for people with type 2 diabetes - a qualitative study with general practitioners, practice nurses and patients

OBJECTIVE

Social support is an important element of family medicine within a primary care setting, delivered by general practitioners and practice nurses in addition to usual clinical care. The aim of the study was to explore general practitioner's, practice nurse's and people with type 2 diabetes' views, experiences and perspectives of the importance of social support in caring for people with type 2 diabetes and their role in providing social support.

METHODS

Interviews with general practitioners (n=10) and focus groups with practice nurses (n=10) and people with diabetes (n=9). All data were audio-recorded, fully transcribed and thematically analysed using qualitative content analysis by Mayring.

RESULTS

All participants emphasized the importance of the concept of social support and its impacts on well-being of people with type 2 diabetes. Social support is perceived helpful for people with diabetes in order to improve diabetes control and give support for changes in lifestyle habits (physical activity and dietary changes). General practitioners identified a lack of information about facilities in the community like sports or self-help groups. Practice nurses emphasized that they need more training, such as in dietary counselling.

CONCLUSIONS

Social support given by general practitioners and practice nurses plays a crucial role for people with type 2 diabetes and is an additional component of social care. However there is a need for an increased awareness by general practitioners and practice nurses about the influence social support could have on the individual's diabetes management.

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.

Family nursing research for practice: the Finnish perspective

This article summarizes the efforts of the Department of Nursing Science, University of Tampere, Finland, to advance knowledge about family nursing over the past 15 years. Definitions of family, family nursing, and family nursing science are offered. Programs of research include families' experiences of care received in health care settings, family violence and child maltreatment, and the psychometric development of instruments to assess family functioning and family health. Research is currently examining the effectiveness of family nursing interventions. Recommendations are offered to strengthen collaboration between family nursing researchers, educators, and practitioners at the local level and initiate greater collaboration between family researchers at the interdisciplinary and international levels.