Systematic review of measurement properties of instruments assessing nurses' attitudes towards the importance of involving families in their clinical practice

Nurses' attitudes to family importance in nursing care: A two-sited cross-sectional study

AIM

This study aimed to describe nurses' attitudes and beliefs towards the importance of family in nursing care and explore differences in nurses' attitudes and beliefs towards family-centered care between different healthcare institutions, such as community healthcare centers and hospitals.

BACKGROUND

Family significantly affects the well-being and health of individuals. Therefore, nurses should support family engagement in nursing care. In recent years, family nursing research has emphasized the importance of teaching family nursing skills in continued education in healthcare institutions. Research has indicated that nurses who believe that illness concerns the family as a whole are more likely to involve the family in patient care.

DESIGN

A cross-sectional research design was used.

METHOD

Data were collected at one timepoint between March and September 2019 from 425 nurses working at the Primary Health Care Centers of the Capital Area (n=112) and in clinical settings at the University Hospital in Iceland (n=313).

RESULTS

The main findings indicated that nurses working in the women-and-child division at the University Hospital reported significantly more positive attitudes towards family evolvement in patient care than nurses working in the intensive care or surgical units. For nurses working at healthcare centers, a significant difference was also found in the nurses' attitudes towards involving families in patient care. The nurses who were working in home care had significantly more positive attitudes when compared to those working in the infant and young children health promotion units.

CONCLUSIONS

Greater collaboration is required between healthcare providers and families to improve the quality of care and health-related outcomes. Therefore, it is crucial to enhance nurses' knowledge about the importance of families during patient care.

TWEETABLE ABSTRACT

This study aimed to describe nurses' attitudes and beliefs towards family care. Differences were found between nurse's attitudes by units but not by institutions.

Families' importance in nursing care-families' opinions: a cross-sectional survey study in the homecare setting

BACKGROUND

Informal care is an essential part of support provided in the homecare setting. To ensure effective healthcare provision, good communication and collaboration between informal and formal care providers are crucial. To achieve this aim, it is necessary to have a clear understanding of the perspectives of all stakeholders. In the scientific literature, limited knowledge is available regarding family members' opinions about their involvement in care. To date, no instruments have been developed that accurately measure these opinions. This study aims to elucidate the opinions of family members about their involvement in nursing care.

METHODS

A cross-sectional survey approach was employed. The methodological steps in this study were (1) convert the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) from a nurses' perspective to a family perspective and thus develop the Families' Importance in Nursing Care-Families' Opinions (FINC-FO) and (2) measure families' opinions regarding their involvement in home nursing care. The questionnaire was sent to 3,800 patients with activated patient portals, which accounts for about 17% of the total patient base. Responses were received from 1,339 family members, a response rate of 35%.

RESULTS

The developed FINC-FO questionnaire showed homogeneity and internal consistency. The results of the questionnaire indicate that family members consider it important to be involved in care and that they wish to be acknowledged as participants in discussions about care (planning) but are less inclined to actively participate in the provision of care by nurses. Family members expressed less explicit opinions about their own support needs. Factors such as level of education, type of partnership, and amount of care provided are seemingly associated with these opinions.

CONCLUSIONS

Family members in the homecare setting wish to be involved in discussions about care (planning). The transition in care from primarily formal to more informal care necessitates an awareness and clear definition-on part of both healthcare professionals and families-of their respective roles in the provision of care. Communication about wishes, expectations, and the need for support in care is essential to ensure quality of care and that the family can sustain caregiving.

Cultural adaptation and validation of the Family Nursing Practice Scale (FNPS) for use with Spanish-speaking Nursing Degree students

AIM

The task proposed was to conduct a cultural adaptation of the Family Nursing Practice Scale and to assess the psychometric properties of the resulting instrument.

BACKGROUND

Nursing students must obtain sufficient personal competence and confidence to act with patients and their families. For this purpose, an assessment scale is needed to inform teachers of the student's progress and to determine whether further training or changes in teaching methods are required.

DESIGN

A cross-sectional study design was used.

METHODS

The researchers conducted this study with 202 students of nursing at two Spanish universities. In the cultural adaptation, the following steps were followed: definition of concepts, translation, back translation, expert group review and implementation by a pilot group with a subsequent cognitive interview. Internal consistency was determined by Cronbach's alpha. Reliability was verified by an initial application of the scale, followed by a repetition after seven days, analysing the results obtained in terms of the intraclass correlation coefficient, the construct validity (by Spearman's non-parametric correlation test) and confirmatory factor analysis (using JASP 0.16.4 statistical software).

RESULTS

Cronbach's alpha resulted in 0.95. Spearman's correlation coefficient Family Nursing Practice Scale total with the course year was -0.26 < 0.001. The intraclass correlation coefficient for the total score of the scale was 0.91. The confirmatory factor analysis was performed on a model in which the total score for the scale was considered in relation to the two subscales, and each subscale in relation to its constituent items. The p-value associated with the chi-square was 0.550. The root mean square error of approximation and comparative fit indices presented values of <0.001 (90 % C.I. <0.001-0.048) and 1.000, respectively.

CONCLUSIONS

These results indicate that the Spanish version presents good internal consistency, construct validity and reliability. Moreover, the confirmatory factor analysis confirms that it presents a good fit to the model initially proposed for this scale for Nursing Degree students.

Influence of perceived benefits, barriers and activities of family engagement in care on family nursing practice: A cross-sectional correlational study

AIMS

To describe nurses' perceptions of family nursing practice and to explore the influence of their perceptions of the benefits, barriers and activities of family engagement in care on family nursing practice.

DESIGN

A cross-sectional correlational study.

METHODS

In total, 460 nurses from two tertiary hospitals in the central region of Uganda participated. Quantitative and qualitative data were collected between August 2020 and January 2021 using the Family Nursing Practice Scale. Analyses included descriptive statistics, t-test, Pearson correlation, analysis of variance and ordinal logistics regression. Quantitative content analysis was carried out on the textual data.

RESULTS

Nurses who perceived that family engagement in care improves patient and family outcomes were more likely to rate family nursing practice highly. Perceived barriers to family engagement in care particularly time constraints, work overload and family-related conflicts have a negative and significant influence on family nursing practice. Nurse characteristics such as education, usual shift pattern and personal experience of having a family member in hospital are significantly associated with family nursing practice; nurses who work morning shifts were likely to report higher family nursing practice.

CONCLUSION

The study reveals that several parameters (perceived barriers, perceived benefits and nurse characteristics) influence nursing practice with families. Thus, bearing in mind the diversity of healthcare contexts, the findings show that multiple interacting factors are important for advancing family nursing interventions and practice.

IMPACT

Probabilistic factor-specific predictions of nursing practice with families are provided in this study - this addresses a gap in the evidence regarding the elements that should be optimized when designing well-informed policies and interventions to advance family nursing practice. A comparison of results in the literature with the present study's findings suggests a need to broaden the scope and context perspective in future research and broaden the understanding of how nurses´ perceptions influence family engagement in care.

REPORTING METHOD

The study adheres to the STROBE reporting guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Family members/caregivers were involved in the design of the study particularly in assessment of validation of the tools used in the study.

Attitudes towards family involvement in nursing care among psychiatric nurses in Hong Kong: A cross-sectional descriptive study

WHAT IS KNOWN ON THE SUBJECT?: Family-involved interventions can result in better outcomes than traditional mental health care for both service users and their families. Nurses' attitudes towards family involvement can affect family participation in care. Earlier studies on psychiatric nurses' attitudes towards family involvement in care report ambiguous findings. Hong Kong's unique integrated cultures may influence Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The majority of psychiatric nurses had positive views on family involvement in care in Hong Kong. Four variables (i.e. gender, clinical experience, nature of working unit and family nursing training) of psychiatric nurses are associated with their attitudes towards family involvement in care in Hong Kong. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Policy makers should develop strategies to increase psychiatric nurses' awareness of the importance of family involvement in patient care. Nurse educators help to design family nursing training to enhance psychiatric nurses' competence in collaborating with families of people suffering from mental disorders.

ABSTRACT

INTRODUCTION: In Hong Kong, involving the family in nursing care is still optional and mainly depends on nurses' attitudes and the willingness of the family. Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care may be influenced by the unique integrated Eastern and Western cultures, however earlier studies report ambiguous findings.

AIMS

This study aimed to assess Hong Kong psychiatric registered nurses' attitudes towards family involvement in care and its associated factors.

METHODS

This study is a cross-sectional descriptive online survey with convenience sampling based on the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) instrument.

RESULTS

Most of the psychiatric nurses had supportive attitudes towards family involvement in care. Females with more clinical experience, working in a rehabilitation-related unit and having attended a family nursing education course were associated with positive attitudes towards family involvement in care.

DISCUSSION

The supportive attitude of psychiatric nurses may be explained by the shift of mental health nursing care from hospital care to community care in recent decades.

IMPLICATIONS FOR PRACTICE

Mental health nurse education and training in Hong Kong could place more emphasis on building family work skills, particularly for newly qualified nurses and those working in acute inpatient settings.

Psychometric Evaluation of the Spanish Families Importance in Nursing Care: Nurses' Attitudes Scale Through Classical Test Theory and Rasch Analysis

Nurses' attitudes toward families play an important role in improving relationships with patients' families. It is essential to have valid and reliable instruments to assess nurses' attitudes toward involving families. The aim of this study was to analyze the psychometric properties of the refined Spanish version of the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) according to classical test theory and the Rasch model (N = 263). Cronbach's alpha values were .73 to .87 and intraclass correlation coefficients ranged from .72 to .86. Rasch analysis results suggested that it was a multidimensional scale with four dimensions and a simpler response scheme than the original scale. Except for one item, the scale was free from bias regarding age and experience time. The FINC-NA is a reliable and valid measure showing a good fit to the Rasch model and is ready to map nurses' attitudes and measure the effectiveness of family nursing educational interventions.

Factors associated with nurses' positive attitudes towards families' involvement in nursing care: A scoping review

AIM

To map the factors associated with nurses' positive attitudes towards families' involvement in nursing care and to identify any existing gaps in knowledge.

BACKGROUND

Several tools have been proposed to assess the attitudes, beliefs and practices of nurses towards families in different care contexts. However, there is a knowledge gap on how the results of these tools can identify the factors that are associated with more positive attitudes of nurses.

DESIGN

A scoping review based on the steps proposed by the Joanna Briggs Institute.

METHODS

Three independent reviewers searched the databases: PUBMED/Medline; LILACS; Virtual Health Library; PsycInfo; Google Scholar; SCOPUS and CINAHL, from 2006 to August 2021, guided by the question: What are the factors associated with nurses' positive attitudes towards families´ involvement in nursing care, in studies that used one or both of the following two scales 'Families' Importance in Nursing Care- Nurses' Attitudes' and 'Family Nursing Practice Scale'? This review was conducted in accordance with PRISMA-ScR.

RESULTS

Twenty-six primary studies were identified, in which 9,620 nurses participated. Positive attitudes were associated with three types of variables: (a) personal-longer working career (42.3%) and older age (26.9%); (b) educational-higher level of academic education (30.8%) and family nursing education (23.0%); and (c) workplace-working in primary health care and/or outpatient clinics (34.6%) or in a unit with philosophy/approach to families (23.0%).

CONCLUSIONS

Personal variables such as age and time of service are non-modifiable aspects, but educational and workplace variables are subject to intervention to improve nurses' attitudes towards families' involvement in nursing care. Continuing development programmes about family care can constitute important strategies to improve positive attitudes of nurses towards families in practice.

RELEVANCE TO CLINICAL PRACTICE

Recognising the characteristics associated with nurses´ positive attitudes towards families may enable the development of tailored interventions that promote family-focused care.

Personal and Contextual Factors to the Successful Implementation of a Family Nursing Approach in Oncology Care

The aim of this study was to explore nurses' attitudes and beliefs about the importance of families in nursing care, as well as the barriers and facilitators within the clinical context that influence the implementation offamily nursing in an in-patient oncology service. A cross-sectional study design, incorporating quantitative and qualitative measurements, was used with a sample of nurses in Spain from an oncology service (N = 39). In general, oncology nurses reported positive attitudes and beliefs about the importance of family in nursing care. However, they did not effectively involve the family in their daily clinical practice. This was due to the nurses' lack of clinical skills and competence to work with families as well as contextual factors such as the lack of time and workload that acted as barriers to the implementation of family-oriented care. This study identified areas of improvement that are needed to promote the effective and sustainable implementation of family nursing knowledge in clinical practice 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.

Comparison of Swedish nurses' attitudes toward involving families in care over a decade

Background

Involving families in care benefits both patients and their families. Sweden was one of the first countries to introduce family nursing, but its effect on nurses’ attitudes toward involving families in care was unknown. First, this study aimed to investigate registered nurses’ attitudes about the importance of involving families in nursing care. Second, it aimed to compare these attitudes over a decade.

Methods

This comparative study was based on data from two separate studies. Data were collected using the Families Importance in Care – Nurses’ Attitudes questionnaire. The first phase of data collection took place in 2009, and the second phase was conducted in 2019.

Results

Overall, the nurses were positive towards involving families in care, both in 2009 and 2019. Overall, no significant difference was found between the two studies from 2009 and 2019. On a subscale level, nurses reported significantly higher levels on family as a resource in the study from 2009 compared to the study from 2019. The opposite was shown for the subscales family as a burden and family as an own resource. According to the R² values (0.002 – 0.04), the effect sizes were small.

Conclusion

In Sweden, nurses’ attitudes toward involving families in care did not change over the studied decade, despite changes in nursing, healthcare-system, and society.

Nurses' Attitudes Toward the Importance of Families in Nursing Care: A Multinational Comparative Study

The aim of this study was to examine nurses' attitudes about the importance of family in nursing care from an international perspective. We used a cross-sectional design. Data were collected online using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire from a convenience sample of 740 registered nurses across health care sectors from Sweden, Ontario, Canada, and Hong Kong, China. Mean levels of attitudes were compared across countries using analysis of variance (ANOVA). Multiple regression was used to identify factors associated with nurses' attitudes and to test for interactions by country. Factors associated with nurse attitudes included country, age, gender, and several practice areas. On average, nurses working in Hong Kong had less positive attitudes compared with Canada and Sweden. The effects of predictors on nurses' attitudes did not vary by country. Knowledge of nurses' attitudes could lead to the development of tailored interventions that facilitate nurse-family partnerships in care.

Nurse anesthetist attitudes towards parental presence during anesthesia induction- a nationwide survey

AIMS

To describe nurse anesthetists' attitudes towards the importance of parental presence during their child's anaesthesia induction and to explore associating factors.

DESIGN

A cross-sectional design.

METHODS

Nurse anesthetists from 55 Swedish hospitals were asked to participate (n = 1,285). A total of 809 completed the questionnaire, Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) during 2018. Data were analysed by descriptive statistics and multiple linear regression analysis.

RESULTS

Nurse anesthetists generally had a positive attitude towards the importance of parental presence. They reported a more positive attitude in family as a resource in nursing care (median = 40) followed by family as a conversational partner (median = 25), family not as a burden (median = 17) and family as its own resource (median = 13). Multiple linear regression analyses showed that working in a district hospital, working only with children, having routines/memorandum about parental presence, being a woman, allowing both parents to be present in their child's anaesthesia and greater experience of children's anesthesia, were associated with a more positive attitude.

CONCLUSION

This nationwide survey contributes important knowledge for understanding nurse anesthetists' attitudes and the result shows that nurse anesthetists generally have a positive attitude towards the importance of parents. Areas of improvement were, however, identified; the nurses tend to not value family as its own resource and family as a conversational partner highly.

IMPACT

Nurse anesthetists have a crucial role in children's anesthesia care since the quality of parental presence experience depends on a positive attitude from the nurses. Parental involvement is important to establish a child-centered anaesthesia care, which should be highlighted in the education of nurse anesthetists. Parental involvement should also be addressed in healthcare policies and routines should be established.

Psychometric evaluation of the German version of the instrument: Families' Importance in Nursing Care - Nurses' Attitudes (FINC-NA)

BACKGROUND

The involvement of families in care has long been advocated for acute and critical care settings to improve quality and safety of care. Nurses' attitudes towards families influence the way they involve and partner with families in the planning and delivery of care. Therefore, instruments with proven psychometric properties are necessary to assess the attitudes of nurses towards involving families in nursing care.

AIMS

To cross-culturally adapt and psychometrically test the German version of the Families' Importance in Nursing Care - Nurses' Attitudes (FINC-NA) scale with acute and critical care nurses.

METHODS

A cross-sectional study was carried out with 316 acute-critical care nurses, who filled in the FINC-NA between December 2016 and May 2018. Exploratory factor analysis was performed to assess structural validity. Internal consistency and homogeneity were determined using Cronbach's alpha.

RESULTS

The four-factor structure of the FINC-NA - family as partner in care, family as resource in nursing care, family as their own resource and family as burden - was confirmed in the German version. Due to low primary and multiple loadings, seven items were removed. Moreover, five items loaded on different factors than the original version. Cronbach's alpha of factors ranged between 0.68 and 0.86.

CONCLUSION

The cross-cultural adaptation and psychometric testing of the German version of the FINC-NA resulted in a 19-item scale that measure nurses' attitudes towards the importance of families in nursing care. Further testing is needed to refine the structural validity and establish construct validity of the FINC-NA German version.