Family functioning in the context of an adult family member with illness: A concept analysis

How do undergraduate nursing students learn to care for families and informal caregivers? A qualitative study with a grounded theory approach

BACKGROUND

Nurses play a crucial role in caring for families of ill individuals in care, requiring high-quality relational and communication skills to care for them. Yet these skills remain underutilized, leading to reported issues of inadequate inclusion and communication. Education is crucial to enhance nurses' competencies in caring for families and informal caregivers.

AIM

To explore the learning process of undergraduate nursing students to care for families and informal caregivers.

DESIGN

Qualitative study with a grounded theory approach.

SETTINGS

Bachelor's degree in nursing from two off-sites of a university and four local health units collaborating with the university in North Italy.

PARTICIPANTS

15 undergraduate nursing students, 10 nurse preceptors, and 10 nurse clinical teachers.

METHODS

We adopted initial and theoretical sampling and conducted semi-structured interviews from December 2023 to January 2024, lasting 16 to 62 min. The interviews were audio-recorded, transcribed verbatim, and analysed through open, selective, and theoretical coding.

RESULTS

We developed a theory of learning for undergraduate nursing students in caring for families and informal caregivers, comprising two themes, "Learning areas" and "Learning antecedents," and nine categories. Learning areas involve five stages of learning to care for families and informal caregivers and the most frequent opportunities to interact with families and informal caregivers. The five stages are "Seeing and considering families and informal caregivers", "Assessing the families' and informal caregivers' needs and resources", "Preparing for and planning intervention with families and informal caregivers", "Acting with families and informal caregivers", "Reflecting on the intervention with families and informal caregivers". Learning antecedents encompass student characteristics, interpersonal relationships, and the clinical training setting.

CONCLUSIONS

In this study, we delineate a five-stage learning process for undergraduate nursing students to care for families and informal caregivers, influenced by individual, interpersonal, and contextual factors. We emphasised the importance of relational skill development, tailored learning experiences, and supportive mentorship in enhancing students' preparedness to engage with and support families in healthcare settings. The developed theory provides a foundational framework for designing educational interventions to optimise nursing students' capacities in this domain.

The relationships among family function, psychological resilience, and social network of patients with chronic disease in the community

This study aimed to examine the relationships among family function, psychological resilience, and social network of patients with chronic disease in the community and to further identify whether psychological resilience played a mediating role in the relationship between family function and social network. A cross-sectional survey including 460 convenient samples of patients with chronic disease in four Chinese communities was conducted using a general characteristics questionnaire, the Family APGAR Index, the Connor-Davidson Resilience Scale, and the Lubben Social Network Scale 6. Data were analyzed using descriptive analysis, Student's t-test, one-way ANOVA, Pearson/Spearman correlation, hierarchical multiple regression analysis, and mediation analysis using the PROCESS macro. Family function, psychological resilience, and social network were significantly related. Psychological resilience partially mediated the relationship between family function and social network. Interventions designed to enhance family function and psychological resilience may improve social network among patients with chronic disease in the community.

Factors associated with stigma in patients undergoing hemodialysis: a meta-analysis and systematic review

BACKGROUND

Patients with hemodialysis (HD) frequently encounter stigma, which impacts their social network and adherence to treatment, increasing their risk of depression and lowering their quality of life. The factors associated with stigma among patients with HD remain poorly understood due to insufficient evidence. To fill this gap, this meta-analysis was conducted.

METHODS

We carried out a thorough literature review in both Chinese and English databases like China National Knowledge Infrastructure (CNKI), Wan Fang Knowledge Data Service Platform, PubMed, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Web of Science. We included literature up to May 25, 2024, focusing on the levels and factors related to stigma in HD patients. Data extraction and quality assessment of the included literature were separately carried out by two researchers, who also independently did the literature screening. Data analysis was carried out using Stata 15.1 software. The possible sources of heterogeneity were explored by sensitivity analysis and subgroup analysis, and the robustness of the results was evaluated.

RESULTS

A total of 12 papers were included, and the quality of these papers was evaluated as moderate or above. The findings of the meta-analysis demonstrated that the pooled stigma mean score was 59.30 [95% (Confidence interval) CI: 55.62 to 62.97]. Per capita monthly family income [MD (Mean Deviation) =4.95, 95% CI (1.55 to 8.35), P=0.004], residence [MD=-4.66, 95% CI (-6.96 to -2.36), P<0.001], complications [MD=4.76, 95% CI (0.92 to 8.61), P=0.015], family function [Z=-0.29, 95% CI (-0.38 to -0.21), P<0.001], self-efficacy [Z=-0.37, 95% CI (-0.48 to -0.26), P<0.001], levels of social support [Z=-0.35, 95% CI (-0.45 to -0.25), P<0.001], and levels of psychological distress [Z=0.59, 95% CI (0.26 to 0.91), P<0.001] were all significant factors contributing to stigma in patients undergoing HD.

CONCLUSION

Healthcare professionals should pay attention to the early assessment of stigma in patients with HD, implement personalized interventions targeting related factors, and promote effective coping strategies for managing the disease.

Path Analysis Between Family Functioning and Mental Health in People With Neuropathic Pain: Roles of Pain Intensity, Self-Perceived Burden, Pain Catastrophizing, and Functional Status

PURPOSE

This study aimed to explore the pathways between family functioning and mental health in people with neuropathic pain, as well as to discuss the mediating role of pain intensity, self-perceived burden, pain catastrophizing, and functional status.

DESIGN

Cross-sectional design reported using the STROBE guidelines.

METHODS

A total of 277 people with neuropathic pain completed face-to-face questionnaires to evaluate family functioning, pain intensity, pain catastrophizing, self-perceived burden, functional status, and mental health. Structural equation modeling (SEM) was constructed to analyze the pathways between these variables.

RESULTS

The positive total effect between family functioning and mental health was significant and partially mediated by self-perceived burden, pain catastrophizing, and functional status. In addition, better family functioning was associated with higher pain intensity, which worsens self-perceived burden, pain catastrophizing, and functional status, masking 23.68% of the positive effects between family functioning and mental health.

CONCLUSIONS

Better family functioning was associated with better mental health, as explained by reduced self-perceived burden, reduced pain catastrophizing, and improved functional status. However, this benefit may be partially masked by the relationship that better family functioning explains higher pain intensity.

CLINICAL IMPLICATIONS

Nurses' comprehensive assessment and management of neuropathic pain from both the family and individual levels, such as family functioning, pain intensity, self-perceived burden, pain catastrophizing, and functional status, may be beneficial in promoting patients' mental health. In addition, it is necessary to identify why good family functioning is associated with higher pain intensity and intervene in this regard.

Does Family Functioning Matter? Understanding the Relationship Between Family Interactions and Depressive Symptoms for Caregivers of Cancer Patients

BACKGROUND

Caregivers of cancer patients are at increased risk of depression and other health challenges. There is limited understanding of the role of the caregiver's own family members in promoting or discouraging mental wellbeing. Family functioning conceptualizes how family members interact to promote a positive family environment and has the potential to impact caregiver mental health. The purpose of this study is to assess the association between family interactions and depressive symptoms among family caregivers of cancer patients.

METHODS

Secondary analysis of baseline data from an NIH-funded randomized control trial of family caregivers of cancer patients recruited from academic palliative care clinics at three sites (2 Midwest, 1 East). We tested for an association between caregiver responses to the Family Quality of Life in Dementia-Family Interactions Subscale and Patient-Reported Outcomes Measurement Information System Depression Short Form 8A using a block-wise approach to linear modeling.

RESULTS

A total of 246 caregivers were included in analysis; caregivers were mostly White (82%), not Hispanic or Latina/o (96%), and female (65%), with an average age of 55 years. Overall, participants had high family interactions (mean 57.7, sd 11.7) and an average depressive symptom burden (t-score 52.4, SD 8.57). Family interactions was significantly negatively associated with depressive symptoms (b = -.163, se = .057) when accounting for relevant covariates.

CONCLUSION

Family caregivers with more positive family interactions are likely to have fewer depressive symptoms, suggesting family functioning may play a key role in bolstering family caregiver mental health and wellbeing.

The relationship between sleep disturbance and aggressive behaviour among community-dwelling schizophrenia patients: a moderated mesomeric effect model

OBJECTIVE

Sleep disturbance is the most common concern of patients with schizophrenia and can lead to a poor prognosis, a low survival rate and aggressive behaviour, posing a significant threat to social security and stability. The aim of this study was to explore the mediating role of depression in the relationship between sleep disturbance and aggressive behaviour in people with schizophrenia living in the community, as well as the regulatory role of family intimacy and adaptability. These findings, in turn, may provide a theoretical basis and constructive suggestions for addressing the physical and mental health problems of these patients.

METHOD

From September 2020 to August 2021, a convenience sampling method was used to select schizophrenia patients from the community attending follow-up appointments at the Fourth People's Hospital of Pengzhou City, China. The researchers conducted a survey in the form of a star questionnaire. The survey included questions about general demographic data and disease-related questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the revised Chinese version of the Modified Over Aggression Scale (MOAS), the Self-Rating Depression Scale (SDS), and the Family Adaptability and Cohesion Scale, Second Edition. FACES-II and SPSS 21.0 were used to organize and analyse the data.

RESULTS

A total of 818 schizophrenia patients living in the community participated in the survey, and 785 valid questionnaires were ultimately collected, for a response rate of 95.97%. The results of multivariate analysis indicated that sex, number of psychiatric medications used, outpatient follow-up, history of hospitalization for mental disorders and sleep disturbances were factors influencing aggressive behaviour. Depression played a partial mediating role between sleep disturbance and aggressive behaviour, and the indirect effect size was 0.043 (57.33% of the total). In addition to sleep disturbance, family intimacy (β=-0.009, P < 0.01) and adaptability (β=-0.145, P < 0.001) can significantly predict depression.

CONCLUSION

The findings indicate that sleep disturbance in schizophrenia patients in the community is a risk factor for aggressive behaviour, and depression plays a partial mediating role in the relationship among sleep disturbance, aggressive behaviour and family intimacy. In addition, adaptability plays a regulatory role in the relationship between depression and sleep disturbance.

Determinants influencing health-promoting behaviors in individuals at high risks of stroke: a cross-sectional study

Background

Quit smoking, moderate drinking, exercise, and healthy eating habits are all known to decrease the risk of stroke. As a result, understanding the health behaviors of high risk groups for stroke is crucial. Health behavior is influenced by knowledge, social environment, and health beliefs. However, little research has been done on these relationships. For a better grasp of the relationships mentioned above, consider using the COM-B model (capability, opportunity, motivation, and behavior). The purpose of this study was to investigate the variables related to health behavior and to test the mediating effect of health beliefs.

Methods

The cross-sectional study was carried out at a physical examination center of a tertiary hospital in Shanghai, China. 986 high-risk populations of stroke have been tested using the Health Behavior Scale (HBS-SP), Stroke Knowledge Questionnaire (SKQ), Health Beliefs Questionnaire (HBS), and Multidimensional Scale of Perceived Social Support (MSPSS). The structural equation modeling was used in this study.

Results

The scores for MSPSS, SKQ, HBS, and HBS-SP were 60.64 ± 13.72, 26.60 ± 9.77, 157.71 ± 34.34, and 2.46 ± 0.41, respectively. The revised model fits well (approximate root mean square error = 0.042; comparative fit index = 0.946). The health behavior was obviously and positively correlated to social Support, stroke knowledge, and health beliefs. Moreover, health belief has a mediating effect on the relation of social support, stroke knowledge, and health behavior.

Conclusion

Chinese high risk groups for stroke have a mediate level of health behaviors. Factors associated with health behaviors are knowledge of stroke, health beliefs, and social support. The COM-B-based model can be used to explain the health behavior of individuals at risk of stroke and to guide the formulation of effective health management programs.

Financial toxicity and its influencing factors in patients with non-Hodgkin lymphoma: A cross-sectional study

PURPOSE

Financial toxicity has emerged as a prevalent psychosocial problem in cancer patients, but data on non-Hodgkin lymphoma patients receiving chemotherapy remain limited. The present study aims to explore financial toxicity and its influencing factors among non-Hodgkin lymphoma patients.

METHODS

A total of 236 non-Hodgkin lymphoma patients were enrolled from March to June 2023 in the oncology department of a tertiary grade-A hospital in China. Hierarchical regression analysis was used to analyze potential influences on financial, including general information, symptom burden, family and social support.

RESULTS

The financial toxicity score for non-Hodgkin lymphoma patients was (19.24 ± 6.97). Among them, 92 participants (38.98%) were classified as experiencing high levels of financial toxicity, with a COST score of ≤17.5 points. Hierarchical regression analysis revealed that symptom burden accounting for 11.0% of the variance in financial toxicity, while family functioning and social support explained 5.8% and 4.9%, respectively.

CONCLUSION

The financial toxicity of non-Hodgkin lymphoma patients needs to be further improved. Patients with low household income, unemployment, high symptom burden, and inadequate family and social support may experience severe financial toxicity. Financial toxicity of non-Hodgkin's lymphoma patients must be assessed and targeted interventions must be implemented to reduce their financial burden.

Effects of family dignity interventions combined with standard palliative care on family adaptability, cohesion, and anticipatory grief in adult advanced cancer survivors and their family caregivers: A randomized controlled trial

Background

Family involvement and comfort are equally important in palliative care. Dignity undertook a new meaning and novel challenges as a result of restrictions on visits and companionship during the pandemic. Family-centered family dignity interventions have been shown to be effective in increasing patients' sense of dignity, increasing levels of hope, and reducing psychological distress; however, the effectiveness in enhancing family adaptability and intimacy in the survivor-caregiver binary and reducing expected grief have been inconclusive.

Objectives

The primary objective of this study was to assess the efficacy of family dignity interventions on family adaptability and cohesion. The secondary objective was to explore the effects of the interventions on anticipatory grief and psychological distress, and the lasting effect 1 month after the intervention.

Design

A single-blinded, two-arm parallel group, randomized controlled trial was conducted in China.

Settings

and methods: Ninety-eight dyads who met the inclusion criteria were randomly assigned to the family dignity intervention (n = 51) or standard palliative care group (n = 47) between June and August 2022. Study outcomes were measured at baseline, immediately post-intervention, and at the 1-month follow-up post-intervention evaluation. Data were analyzed using the Kolmogorov-Smirnov test, chi-square test, Fisher's exact test, independent sample t-test, Wilcoxon rank-sum test, and generalized estimation equations. The Intention-To-Treat analysis was performed for all available data.

Results

In comparison to the control group, significant improvements in family adaptability and cohesion and anticipatory grief over post-intervention and 1-month follow-up were demonstrated among the patients in the intervention group. The intervention group of caregivers had significant improvement in anticipatory grief at post-intervention and 1-month follow-up. The level of psychological distress was significantly lower in the intervention group than the control group (p < 0.05) at 1-month follow-up but the differences were not statistically significant at post-intervention. All outcomes showed clear differences from baseline after the intervention and at the 1-month follow-up evaluation but not between post-intervention and at the 1-month follow-up evaluation.

Conclusion

This study further verifies the actual effect of family dignity intervention program through randomized controlled trials, and provides a reference for improving the family relationship between advanced cancer patients and their family caregivers, and improving their mental health. The addition of family dignity intervention to standard palliative care greatly increased the adaptability and cohesion between survivors and their families, lessened the anticipatory grief of the survivor-caregiver pair, and relieved caregivers' anxiety and despair. We did not detect a statistically significant difference between post-intervention and the 1-month follow-up evaluation, suggesting that the intervention may have a durable impact at least 1 month.

Pain intensity and self-perceived burden mediate the relationship between family functioning and pain catastrophizing in patients with neuropathic pain

This cross-sectional study aimed to investigate the relationship between family functioning, pain intensity, self-perceived burden, and pain catastrophizing. Moreover, we also wanted to explore the multiple mediating roles of pain intensity and self-perceived burden. From October 2022 to March 2023, 252 Chinese people with neuropathic pain completed face-to-face questionnaires to assess family functioning, pain intensity, self-perceived burden, and pain catastrophizing. Data analysis was done using descriptive statistics and a structural equation model. The results showed better family functioning was significantly associated with more intense pain, less self-perceived burden, and less pain catastrophizing. Mediation analysis showed that family functioning could indirectly affect pain catastrophizing through pain intensity and self-perceived burden in addition to a direct effect on pain catastrophizing. Moreover, the mediating variable of pain intensity played a masking role. These findings suggest that good family functioning can effectively reduce the self-perceived burden and pain catastrophizing in patients with neuropathic pain. However, family functioning cannot show its maximum effectiveness, and it may be necessary to construct a model of family functioning suitable for patients with neuropathic pain in the future.

The cognitive appraisal path of stroke knowledge, coping traits, family functioning and stigma among stroke patients: A moderated parallel mediation model

AIMS

To establish a cognitive appraisal path model that examines the impact of stroke knowledge on stigma with the parallel mediating effects of negative and positive coping traits, as well as the moderating effects of family functioning.

BACKGROUND

Stroke-related stigma, a 'mixture' of negative emotions involving internal criticism and external judgement, has been shown to impair patients' health outcomes. However, the specific factors underlying cognitive appraisals and their pathways remain unknown.

DESIGN

A cross-sectional design.

METHODS

The cross-sectional sample was from two stroke centres in China. Questionnaires were administered to collect sociodemographic data, stroke knowledge, coping traits, family functioning and stigma. Hierarchical regression models and the moderated parallel mediation model were constructed to analyse influencing pathways. The study adhered to the strengthening the reporting of observational studies in epidemiology guideline.

RESULTS

All 144 samples reported stigma symptoms with a moderate-to-high standardising score. The best hierarchical regression model explains 55.5% of the variance in stigma. The parallel mediation model indicated that negative and positive coping traits co-mediating the association of stroke knowledge and stigma. After adding the family functioning as a moderator, the moderated parallel mediation model was confirmed with adequate fit indices.

CONCLUSION

Among the cognitive appraisal factors affecting stroke-related stigma, stroke knowledge reduces stigma by modifying coping traits, while poor family functioning may serve as an opposing moderator. Notably, when family support is insufficient, enhanced stroke knowledge might paradoxically exacerbate the stigma.

RELEVANCE TO CLINICAL PRACTICE

This study contributes knowledge on transforming health education and emphasises the pivotal roles of clinical nursing practitioners. In similar global contexts, the study highlights integrating health education, psychological counselling and family support to advance systematic nursing practices.

PATIENT OR PUBLIC CONTRIBUTION

None.

Intimate Partner Violence and School-Aged Children's Mental Health: Unpacking the Effects of Family Functioning, Mothers' Mental Health, and Social Capital

There is a limited understanding of the pathways through which intimate partner violence (IPV) affects school-aged children's mental health. This study aims to examine a hypothesized model in which fathers' perpetration of IPV against mothers affects school-aged children's mental health through family functions, mothers' mental health, and social capital. A cross-sectional study was conducted by recruiting 513 mothers from 17 different Primary Health Care centers in Saudi Arabia. Structural equation modeling was used to test a hypothesized model, controlling the family's financial status. The model accounted for 54.2% of the variance in children's mental health problems. This study reveals that IPV issue against mothers during the last 12 months influences school-aged children's mental health directly and indirectly through the current family functioning and mothers' mental health. The impact of IPV issues on school-aged children's mental health requires particular consideration. The study findings urge attention to preventing the IPV issue against mothers, as well as improving family functioning and treating mothers' mental health to protect school-aged children from mental health problems.

'How is our job affecting us?' Neonatal Intensive Care Unit healthcare providers and their pregnancy: A descriptive qualitative study

AIM

The aim of this study was to understand the Neonatal Intensive Care Unit (NICU) healthcare providers' (HCPs) experiences and needs during their own past, present and desired pregnancies. It has been reported that HCPs' personal and professional lives are mutually interconnected. Given the NICU HCPs' knowledge of the risks and potential adverse outcomes of newborns admitted to the NICU, their pregnancy experience may be more challenging than that of the general population. However, to date, these aspects are still little studied.

DESIGN

A qualitative descriptive study design was adopted.

METHODS

Semi-structured interviews were conducted between January and April 2021 in a single third-level NICU in northeastern Italy. Transcripts were analysed using inductive content analysis. Findings are reported according to the COREQ guidelines.

RESULTS

Nineteen HCPs participated in this study. Participants included 12 nurses, 6 medical doctors, and 1 paediatric physical therapist. All participants reported that their professional knowledge and experience influenced their pregnancy-related experiences, emotions and behaviours. Some participants employed adaptive coping strategies, while others were likely to experience post-traumatic stress reactions. The narratives of the men and women were similar. Three themes were identified: 'Feeling different'; 'Influence of work experience on decision-making'; 'Coping with difficulties'.

CONCLUSION

To reduce the potential impact of NICU HCPs' work experience on pregnancy, family functioning and infant health, management of parental emotions should be considered for this population.

IMPACT

Hospital managers could prevent the potential distress of vulnerable NICU healthcare workers during pregnancy by tailoring interventions aimed at supporting them in becoming aware and making sense of their work experiences or sensitizing individual psychological support. Moreover, university students should be offered self-help strategies to face potential dual role conflicts in their future careers.

PATIENT AND PUBLIC INVOLVEMENT

No patient or public contribution.

Relationship of family function and pre-hospital delay among Chinese patients with recurrent ischaemic stroke and the mediation effect of stigma

AIMS

Pre-hospital delay refers to the time span from the onset of symptoms to arrival at a hospital ≥ 3 h and is the main limitation of stroke reperfusion therapies. Family factors and stroke-related stigma may influence pre-hospital delay. However, few studies have confirmed the influence of stigma on pre-hospital delay or explored the relationships between family function, stigma, and pre-hospital delay among patients with recurrent stroke. This study aimed to explore the relationship between family function and pre-hospital delay among patients with recurrent stroke and examine the mediation role of stigma in this relationship.

METHODS AND RESULTS

A cross-sectional study was performed at the neurology departments of two hospitals in Guangzhou, China between July 2021 and April 2022. A total of 115 patients with recurrent stroke completed questionnaires and were included in the analysis. Data were collected using the Short Form Family Assessment Device, the Stroke Stigma Scale, and the Stroke Knowledge Questionnaire. Spearman's correlation and a structural equation model were used for data analysis. Family function directly influenced pre-hospital delay [β=0.27, P = 0.033, 95%CI = (0.02-0.51)] and indirectly influenced pre-hospital delay [β=0.17, P = 0.038, 95%CI = (0.02-0.34)] through stigma. Moreover, stigma partially mediated the effect of family function on pre-hospital delay.

CONCLUSION

Family function and stigma directly and indirectly influenced pre-hospital delay among patients with recurrent stroke. Future health education and interventions need to focus on strengthening and improving emotional support from family members to improve family function and reduce stigma, thereby reducing pre-hospital delay among patients with recurrent stroke.

Correlation between family function and quality of life in patients with atrial fibrillation

OBJECTIVES

Many studies have shown that the quality of life for patients with atrial fibrillation (AF) is significantly impaired, but the impact on family function is still unclear. This study aims to evaluate the family function and quality of life in patients with AF using scales, to analyze the correlation between family function and quality of life, and to predict the influencing factors of quality of life.

METHODS

A total of 223 patients with AF who were admitted to the Department of Cardiology and General Medicine of the Lanzhou University Second Hospital from January 1, 2021 to May 1, 2022, were selected as research subjects, the general information of patients with AF were collected via a questionnaire, the family function and quality of life were assessed by the Family Assessment Device (FAD) and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scale. The patients were divided into a non-family functional disorder group and a family functional disorder group on the basis of their FAD scores. The above data were analyzed using SPSS 26.0 statistical software.

RESULTS

Among the 223 patients, 64 (28.70%) were in the non-family functional disorder group, and 159 (71.30%) were in the family functional disorder group. The total score of FAD and scores of all dimensions in the family functional disorder group were higher than those in the non-family functional disorder group (all P<0.01). AFEQT total score and symptoms, treatment concerns and daily activities in the non-family functional disorder group were significantly higher than those in the family functional disorder group (all P<0.01). The Pearson linear analysis showed that there was a linear negative correlation between the total score and each dimension of FAD with the total score and each dimension of AFEQT (all P<0.01). The variables with statistical significance in the univariate analysis were included in the multiple linear regression analysis, and the result showed that female, and the problem solving, role, affective involvement, and general functioning dimensions of family function had an impact on the quality of life (all P<0.01).

CONCLUSIONS

Most patients with AF have different degrees of family dysfunction. The quality of life in patients with family functional disorder group is generally low. Female, and the problem solving, role, affective involvement, and general functioning of family function have a significant impact on the quality of life in patients with AF. In clinical treatment of AF, attention should be paid to the family function of patients, and family members can be involved in clinical intervention to improve family function and improve the quality of life.

Limitations on participation and global quality of life among CRC survivors with permanent stomas: moderated mediation analysis of psychological distress and family functioning

PURPOSE

Although a cancer diagnosis and stoma creation leave colorectal cancer (CRC) survivors with significant limitations on participation in life activities that would impair their global quality of life (QoL), the underlying psychological mechanisms are understudied. The aim of this cross-section study was to examine whether psychological distress mediates the association of limitations on participation in life activity with global QoL, and whether family functioning moderated the indirect effects of limitations on participation in life activities on global QoL through psychological distress.

METHODS

CRC survivors with permanent stomas (n = 282) completed questionnaires assessing socio-demographic and clinical characteristics, limitations on participation in life activities, psychological distress, family functioning, and global QoL. The mediation model and moderated mediation model were conducted using the PROCESS macro for SPSS.

RESULTS

Mediation analysis showed that the association of limitations on participation in life activities with global QoL was partially mediated by psychological distress (indirect effect = -0.087, 95% CI = -0.135 to -0.041). Moderated mediation analysis indicated that the indirect effects of limitations on participation in life activities on global QoL through psychological distress were significantly moderated by family functioning. Specifically, the indirect effects decreased were significant as family functioning levels increased.

CONCLUSION

CRC survivors with permanent stomas experienced poor global QoL. The moderated mediation model provides a better understanding of how limitations on participation in life activities, psychological distress, and family functioning work together to affect global QoL. Interventions aiming to improve QoL among CRC survivors with permanent stomas should consider targeting these aspects.

Family functioning of families experiencing intensive care and the specific impact of the COVID-19 pandemic: A grounded theory study

OBJECTIVES

In order to provide a deeper understanding of family functioning, the aim of this study was to identify, describe and conceptualise the family functioning of families where a formerly critically ill family member had stayed at the intensive care unit, with the impact of a pandemic.

RESEARCH METHODOLOGY/DESIGN

The study has a grounded theory design including interviews with eight families.

SETTING

Former adult intensive care patients cared for Covid-19 infection and their family. Eight patients and twelve family members from three different intensive care units.

MAIN OUTCOME MEASURES

The results presented are grounded in data and identified in the core category "Existential issues" and the categories "Value considerateness; Anxiety and insecurity in life; Insight into the unpredictability of life."

FINDINGS

The core category could be found in all data and its relationship and impact on the categories and each other. The core is a theoretical construction, whereas the family functioning of families where a formerly critically ill family member had stayed at the intensive care unit was identified, described, and conceptualised. Being able to talk repeatedly about existential issues and the anxiety and insecurity in life, with people that have similar experiences helps the patient and their family to consider and gain insight into the unpredictability of life, and thereby better cope with changes in life.

CONCLUSION

There is awareness about the love that exists within the family. A willing to supporting each other in the family even if the critical illness made the family anxious and afraid.

IMPLICATIONS FOR CLINICAL PRACTICE

Even if the pandemic Covid-19 led to restrictions inhibiting family focused nursing, it is important to confirm the family as a part of the caring of the ICU patient. The patients are not alone, their family are fighting together for the future.

Characteristics and influencing factors of social isolation in patients with breast cancer: a latent profile analysis

PURPOSE

The goal of this study is to investigate the social isolation (SI) subtypes of patients with breast cancer (BC) and to explore its influencing factors.

METHODS

A sample of 303 BC patients participated in the study from September to December, 2021. Latent profile analysis (LPA) was performed to identify SI clusters based on the three sub-scales of the Chinese version of the Social Anxiety Scale, the Chinese version of the Social Avoidance and Distress Scale, and the Chinese version of the Loneliness Scale.

RESULTS

We found that SI can be divided into three categories: high-level (Class 1), middle-level (Class 2), and low-level (Class 3), accounting for 20.46%, 33.00%, and 46.54%, respectively. Compared to Class 3, Class 1, which had the lower average monthly income per family member (RMB) (< 3000: OR = 5.298, P = .021; 3000 ~ 5000: OR = 5.320, P = .018), was more likely to suffer from SI due to occupation (Laborer: OR = 12.023, P = .009). Surgery (OR = 14.138, P < .001; OR = 2.777, P = .020), chemotherapy (OR = 10.224, P = .001; OR = 3.545, P = .001); poorer family functioning (OR = .671, P < .001; OR = .801, P = .002), and lower levels of self-transcendence (OR = .806, P < .001; OR = .911, P < .001) were important influencing factors for SI in Class 1 and Class 2 compared to Class 3.

CONCLUSION

SI is classifiably heterogeneous among patients with BC. Strategies that identify characteristics of SI and give targeted intervention focusing on family functioning and improving self-transcendence levels contribute to the prevention of SI among patients with BC.

Family functioning and nicotine dependence among smoking fathers: a cross-sectional study

BACKGROUND

Nicotine dependence is a significant public health issue, and understanding the factors associated with nicotine dependence in this population is crucial for developing effective interventions. This study examined the association between family functioning and nicotine dependence levels of smoking fathers based on the McMaster model of family functioning (MMFF), providing evidence for future interventions.

METHODS

In this study, we selected fathers of first- to fifth-grade students from 10 pilot elementary schools in Qingdao whose families smoked. We used the Fagerstrom test to assess nicotine dependence and the Family Assessment Device to evaluate family functioning. We performed univariate analysis to compare differences among those with different levels of nicotine dependence, and we used an ordinal logistic regression analysis to investigate the influences related to nicotine dependence.

RESULTS

This study included 874 smokers, with 78.5% having mild nicotine dependence, 11.7% having moderate dependence, and 9.84% having severe dependence. Univariate analysis showed that smokers with severe dependence had lower education levels, higher prevalence of chronic diseases, more frequent alcohol consumption, and poorer family functioning compared to those with mild to moderate dependence. Ordinal logistic regression analysis showed that poorer general functioning scores (OR = 1.087, 95% CI: 1.008-1.173, P = 0.030), poorer behavioral control (OR = 1.124, 95% CI: 1.026-1.232, P = 0.012), more quit attempts, frequent alcohol consumption, and longer smoking duration may be associated with a higher likelihood of developing severe nicotine dependence. The older age of starting smoking and higher education level may be associated with a lower likelihood of developing severe nicotine dependence. However, it is important to note that the cross-sectional nature of this study precludes the determination of causal relationships.

CONCLUSIONS

This study finds that heavy nicotine dependence in smoking fathers is associated with risky behaviors and demographics such as longer smoking duration and frequent alcohol consumption. Targeted smoking cessation interventions are crucial for this group, taking these specific factors into consideration. Family functioning, particularly general functioning and behavioral control, may also be linked to nicotine dependence, indicating the need for further research in this area.

Attitudes and perceptions of healthcare professionals related to family participation in surgical cancer care-A mixed method study

AIM

This study investigated healthcare professionals' attitudes and perceptions towards the family's participation in surgical cancer care.

DESIGN

A prospective mixed method study.

METHODS

The study was conducted at three hospitals in Sweden with registered nurses, assistant nurses and surgeons. Data included 43 completed Families Importance in Nursing Care (FINC-NA) questionnaires answered by registered nurses and qualitative data from 14 interviews with surgeons and assistant nurses. Data analysis was performed according to the Creswell convergent parallel mixed method.

RESULTS

Both quantitative and qualitative data demonstrated that the family was an important resource in nursing care, was highly valued as a conversational partner and had resources that should be considered. Each family should be supported in determining their role and as implements for maintaining a functioning family constellation and increasing their participation.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Life satisfaction and difficulties experienced by the family members of individuals with thalassemia

AIM

This study aimed to examine the life satisfaction and difficulties experienced by the family members of individuals with thalassemia.

DESIGN

This study design is mix-method research. This research adheres to the COREQ guidelines and checklist.

METHODS

The research was conducted in the Blood Diseases Polyclinic of a state hospital in a Mediterranean city in Turkey between February 2022 and April 2022.

RESULTS

The mean life satisfaction scale score was 11.18 ± 5.13, and a negative correlation was found between the mother's age and life satisfaction score (r = -0.438; p = 0.042, p < 0.05). Qualitative analysis of the experiences of the family members of individuals with thalassemia yielded 10 themes.

Determining Holistic Factors Related to Depressive Symptoms in Patients With Heart Failure

Identifying modifiable factors associated with depressive symptoms is important to develop corresponding strategies. This study aimed to determine the holistic factors related to depressive symptoms in heart failure (HF) patients. It was a secondary analysis of a cross-sectional study. We recruited 329 hospitalized HF patients from two hospitals in China. It is found that HF patients had a relatively high proportion (28.27%) of depressive symptoms. Red blood cell distribution width (RDW) (β = .222, p = .011) and physical symptoms (β = .151, p < .001) were positively associated with depressive symptoms, whereas resilience (β = -.241, p < .01) and family functioning (β = -.288, p = .001) were negatively associated with depressive symptoms. Thus, early screening and management of depressive symptoms are warranted. RDW may serve as a marker for screening depressive symptoms. Moreover, interventions focused on relieving physical symptoms and enhancing resilience and family functioning may reduce depressive symptoms.

Effect of caregiver burden on anticipatory grief among caregivers of elderly cancer patients: Chain mediation role of family functioning and resilience

This study aimed to explore the relationship between caregiver burden and anticipatory grief among caregivers of elderly cancer patients, and to examine the chain mediation effects of family functioning and resilience. A total of 624 valid questionnaires were collected. The Structural Equation Model was established to test the mediating effects of family functioning and resilience. Results showed that caregiver burden has a direct positive effect on anticipatory grief, both family functioning and resilience have negative effects on caregiver burden and anticipatory grief, and that resilience moderates the mediating effect of family functioning. Our findings suggest that reducing the caregiver burden among caregivers of elderly cancer patients, improving family functioning, and enhancing resilience have important effects in alleviating the anticipatory grief of caregivers. Our findings provide some references for further research. Medical staff should better understand the grief experience of caregivers and implement interventions to enable caregivers to better cope with anticipatory grief and psychological stress, so as to promote the quality of care for elderly cancer patients.

Adaptation of families of adult patients with brain tumor: Partial least squares structural equation modeling

Brain tumor patients experience physical, psychological, social, and cognitive changes. These changes are challenging for both the patients and their families. These patients and their families need to adapt together on the cancer treatment path. This study aimed to identify the factors affecting adaptation in families of adult patients with brain tumors. A quantitative, cross-sectional study of 165 families of adult patients with primary brain tumors was conducted using a self-administered questionnaire. Partial least squares structural equation modeling was used to test a hypothetical model. The results showed that family stress, family functioning, and family resources influenced on family adaptation in families of adult patients with primary brain tumors. Among these factors, family resources were identified to be the strongest factor associated with family adaptation. The results of this study may be utilized as a theoretical basis in nursing to improve the family adaptation of patients with brain tumors. Regarding nursing practices, the results suggest that nurses should provide family-centered nursing interventions and promote family resources to help brain tumor patients and their families to adapt.

Family functioning and life satisfaction among female university students during COVID-19 outbreak: the mediating role of hope and resilience

BACKGROUND

Literature review has showed that family functioning is positively associated with satisfaction with life. However, the internal mechanisms of this relationship are still unclear, especially during the COVID-19. This study examined the mediating role of hope and resilience in the association between family functioning and life satisfaction of female university students in COVID-19 pandemics.

METHODS

A cross-sectional online study was done throughout the fifth wave of the COVID-19 outbreak in Iran. A total of 480 female students were recruited from Lorestan University. Data was collected by the State Hope Scale, Satisfaction with Life Scale, Family APGAR Index, and Connor-Davidson Resilience Scale. Data analysis were based on structural equation modeling.

RESULTS

Family functioning exerted a significant direct effect on hope, on resilience and on life satisfaction. Also, according to the findings, hope and resilience pose a significant mediating effect in the association between family functioning and life satisfaction.

CONCLUSION

This study provides a better perspective regarding the protective role of hope, family functioning, and resilience on life satisfaction among female university students during the COVID-19 pandemic. Training of such skills is needed to increase life satisfaction in female university students.

Relationship between family functioning and self-transcendence in patients with breast cancer: A network analysis

Background

For patients with breast cancer, family functioning is an important factor affecting self-transcendence, which is a key source of happiness. However, network analysis studies of family functioning and self-transcendence are lacking, particularly among patients with breast cancer.

Purpose

The present study investigated the network structure of family functioning and self-transcendence in patients with breast cancer and aimed to identify bridge items to provide some theoretical support for the improvement and intervention of self-transcendence in patients with breast cancer.

Methods

A total of 294 patients with breast cancer were enrolled in our study. Self-transcendence was evaluated with the Self-Transcendence Scale. Family functioning was evaluated with the Family Adaptation, Participation, Growth, Affection, Resolution (APGAR) Scale. Network analyses were used for the statistical analysis.

Results

In the network of family functioning and self-transcendence in patients with breast cancer, there were 22 edges across communities, of which the 5 strongest edges connected to the 5 dimensions of family functioning are "Adaptation" with "Enjoyment of hobbies", "Participation" with "Life enjoyment", "Growth" with "Acceptance of bodily changes", "Affection" with "Life enjoyment", "Resolution" with "Help acceptance". "Adaptation" had the highest bridge expected influence value (0.30) in the family functioning community, while "Life enjoyment" had the highest bridge expected influence value (0.27) in the self-transcendence community.

Conclusion

Complex patterns of associations existed in the fine-grained relationship between family functioning and self-transcendence in patients with breast cancer. From the perspective of network analysis, the "Adaptation" aspect of family functioning and the "Life enjoyment" aspect of self-transcendence may be the best targets for improving self-transcendence. These results have important implications to clinical practice, which provided potential targets for interventions to improve self-transcendence from the perspective of family functioning.

Proportion and risk factors of diabetic retinopathy by stage in less-developed rural areas of Hunan province of China: A multi-site cross-sectional study

Aims

To investigate the proportion and risk factors of diabetic retinopathy (DR) by stages in less-developed rural areas in Hunan Province of China.

Background

DR is common among people with diabetes but not well recognized in less-developed rural areas. There is insufficient evidence on the risk factors of DR by stages, making it challenging to develop targeted prevention and intervention programs for DR in primary care settings.

Methods

A multi-site cross-sectional survey was conducted among people with type 2 diabetes mellitus (T2DM) from four less-developed counties in Hunan Province of China. All participants underwent the screening of DR via digital fundus photography and completed self-reported questionnaires on their socio-demographic and clinical characteristics, diabetes self-efficacy, diabetes self-care behaviors, social support, family function, and health service accessibility. The multinomial logistic regression models were employed to explore the risk factors of DR by stage, which were selected based on the socio-ecological model, literature, and clinical experience.

Results

A total of 196 participants were included in this study with an average age of 57.43 ± 10.26. 59.6% (117/196) of the participants were identified as DR, including 37.2% (73/196) non-proliferative DR and 22.4% (44/196) proliferative DR. Compared to the non-DR group, the risk factors of non-proliferative DR and proliferative DR were diabetes duration (OR: 1.10, 95 CI%: 1.04–1.17; OR: 1.14, 95 CI% 1.06–1.22) and self-monitoring of blood glucose (OR: 1.09, 95 CI% 1.01–1.17; OR: 1.11, 95 CI%: 1.02–1.20); the protective factors of non-proliferative DR was accessible complication prevention and management education (OR: 0.37, 95 CI% 0.14–0.94) while the protective factors of proliferative DR were physical activities (OR: 0.89, 95 CI%: 0.80–0.98). Compared to the non-proliferative DR group, the protective factors of proliferative DR were physical activities (OR: 0.89, 95 CI% 0.02–0.89) and family function (OR: 0.84, 95 CI%: 0.04–0.84).

Conclusion

DR was prevalent among people with T2DM in less-developed rural areas, indicating the need of strengthening DR screening. Risk factors of DR varied by stage while sharing some common factors. Future DR prevention and intervention programs may benefit from improving these factors to reduce the risk of DR by stage.

Psychosocial Adaptation Among Inflammatory Bowel Disease Patients and Associated Factors: A Cross-Sectional Study

Purpose

Patients with inflammatory bowel disease (IBD) suffer from physical symptoms and psychosocial issues. This generates risks of psychosocial maladjustment that is closely linked with self-care ability and health-related quality of life. The study aimed to explore psychosocial adaptation of IBD patients in China and the influencing factors from individual and family levels.

Patients and Methods

Using a cross-sectional design, 191 Chinese patients with IBD were recruited from October 2020 to September 2021. General information questionnaire, general family functioning scale, resilience scale for IBD, and psychosocial adaptation questionnaire for IBD were used for investigation. Multivariate linear regression was used to identify predictive factors of psychosocial adaptation.

Results

IBD patients reported a moderate level of psychosocial adaptation. Regression analysis showed that personal resilience especially the three dimensions (i.e., positive illness perception, disease management, and support from fellow IBD patients), general family functioning, and disease conditions (i.e., extra-intestinal manifestations and current disease status) were the main contributing factors of psychosocial adaptation, explaining 49.3% of the total variance.

Conclusion

The findings suggest that healthcare providers could focus on improving patients’ illness perception about IBD and strengthening their disease management abilities, together with optimizing patients’ family functioning to enhance their psychosocial adaptation level.

Cardiovascular health control in the family health strategy

Introduction

In Brazil, the Unified Health System (SUS) controls and oversees public health care, and the Family Health Strategy (FHS) is its primary access, with 60% of the population registered in it. The surveillance of risk factors for cardiovascular diseases (CVD) is the responsibility of the FHS. In 2010, the American Heart Association (AHA) proposed the evaluation of seven metrics (smoking, Body Mass Index (BMI), physical activity, diet, total cholesterol, blood pressure and blood glucose) with an aim to monitoring cardiovascular health (CVH). However, the results of the FHS regarding the CVH of the Brazilian population are unascertained.

Objective

Evaluate the control of CVH among adult patients treated by the FHS in the city of Aracaju, Sergipe, Brazil.

Material and methods

A cross-sectional study was conducted using the seven metrics recommended by the AHA to evaluate CVH among patients treated by the FHS. The city of Aracaju has a population of 571,149 inhabitants, with 394,267 > 20 years of age; therefore, it was admitted that in a simple random sample, sampling error of 5% with 95% CI, 329 individuals would be needed.

Results

Among 400 patients, only 32.5% had controlled CVH. In a univariate analysis, the adjusted multivariate analysis found that being female (aOR: 2.07 IC: 1.20 to 3.60 p: 0.006) under 45 years old (aOR: 1.61 IC: 1.15 to 2.28 p: 0.006) and with the habit of following health advice from family members and neighbors (aOR: 1.28 IC: 1.15 to 2.28 p: 0.040) were associated with control of CVH. On the other hand, those ones who had a greater number of children (aOR: 0.91 IC: 0.84 to 0.95 p: 0.020) were associated with less control of CVH.

Conclusions

The study showed that only 32.5% of patients have controlled CVH. Being a woman, young and following health advice from family members and neighbors have a positive influence in controlling CVH. More children reduced controlling these metrics.

The relationship of family functioning and family health with hospital readmission in patients with heart failure: insights from an international cross-sectional study

BACKGROUND

The growing hospital readmission rate among patients with heart failure (HF) has imposed a substantial economic burden on healthcare systems. Therefore, it is essential to identify readmission associating factors to reduce hospital readmission.

AIMS

This study aimed to investigate the relationship of family functioning and family health with hospital readmission rates over six months in patients with HF and identify the sociodemographic and/or clinical variables associated with hospital readmission.

METHODS

This international multicentre cross-sectional study involved a sample of 692 patients with HF from three countries (Denmark 312, Iran 288, and Iceland 92) recruited from January 2015 to May 2020. The Family Functioning, Health, and Social Support questionnaire was used to collect the data. The number of patients' hospital readmissions during the six-month period was retrieved from patients' hospital records.

RESULTS

Of the total sample, 184 (26.6%) patients were readmitted during the six-month period. Of these, 111 (16%) had one readmission, 68 (9.9%) had two readmissions, and 5 (0.7%) had three readmissions. Family functioning, family health, being unemployed, and country of residence were significant factors associated with hospital readmission for the patients.

CONCLUSION

This study highlights the critical roles of family functioning and family health in six-month hospital readmission among patients with HF. Moreover, the strategy of healthcare systems in the management of HF is a key determinant that influences hospital readmission. Our findings may assist the investigation of potential strategies to reduce hospital readmission in patients with HF.

Family implications during deprivation of liberty and Attachment Theory: a qualitative metasynthesis

OBJECTIVES

to synthesize evidence from qualitative studies about the implications that the deprivation of liberty process has on incarcerated adults' family relationships.

METHODS

a qualitative meta-synthesis, carried out in January 2021, by searching for publications indexed in six databases. The sample consisted of 10 studies, which were analyzed by MaxQDA®, and an interpretative synthesis was performed based on Attachment Theory.

RESULTS

based on first-order concepts, it was possible to synthesize second- and third-order concepts and present them in two interpretive context units: Strategies for strengthening family ties; Relationships that contribute to breaking down family ties. It was evidenced that visits, phone calls and letters favor the strengthening of secure attachment.

FINAL CONSIDERATIONS

incarceration causes consequences in tie formation, reflecting on the attachment process between family members.

Family Functioning and Optimism as Protective Factors of Life Satisfaction Among Stroke Patients During the COVID-19 Epidemic in Shenyang, China

The coronavirus disease-19 (COVID-19) pandemic may result in detrimental consequences for stroke patient's wellbeing. Family functioning and optimism could help stroke patients cope with crises leading to possible improvements in life satisfaction. This study aims to explore the protective effects of family functioning and optimism on life satisfaction among stroke patients during the COVID-19 pandemic in China. This study was designed as a cross-sectional survey. A total of 207 stroke inpatients who were receiving pharmacotherapy and rehabilitation in general public hospital of Liaoning province during the COVID-19 pandemic in China were consecutive selected and interviewed by online questionnaires via the WeChat platform effectively from April 8 to 30, 2020. The scales included: Satisfaction with Life Scale (SWLS), Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Scale and Revised Life Orientation Test (LOT-R). Hierarchical multiple regression (HMR) analysis was conducted to test the associated factors of life satisfaction. Stroke patient's life satisfaction was at a high level (Mean = 26.46, SD = 6.23) during the pandemic. Stroke patient's residence, duration of stroke, stroke type, and community shut down measures were the strong predictors of life satisfaction. Family functioning and optimism increased life satisfaction among stroke patients. This study contributes to the research on the association between family functioning and optimism on life satisfaction among stroke patients during the COVID-19 pandemic. Interventions that improve family functioning and enhance optimism should be provided in order to elevate life satisfaction for stroke patients.

Effects of Disability Severity on the Family Burden of Home-Dwelling Uygur and Kazakh Aged in Rural Western China: Family Function as a Mediator

INTRODUCTION

Caring for the disabled elderly puts heavy burdens on their families. This study aimed to explore family function (FF) as a mediator in the relationship between disability severity (DS) and family burden (FB) of the Uygur and Kazakh home-dwelling disabled elderly cared for by informal caregivers in China.

METHOD

A cross-sectional design with multistage sampling was used to recruit 431 families with Uygur and Kazakh disabled elderly in Bortala, Xinjiang, China. Data were collected using the Activities of Daily Living Scale, Family Burden Interview Schedule, and Family Adaptation, Partnership, Growth, Affection, and Resolve Index Scale and then analyzed using hierarchical regression.

RESULTS

FF had a partial mediating effect on the relationship between DS and FB (β = 0.131; 95% confidence interval [CI] = [0.074, 0.197]; p < .01); the effective rate was 41.46%.

DISCUSSION

Multidisciplinary care teams should implement targeted interventions to improve FF of the disabled elderly to alleviate FB.

Mother’s Concern in the Family about Her Child with Post-Traumatic Due to the Tornado in Central Java, Indonesia – A Qualitative Study

BACKGROUND: Natural disasters continue to occur worldwide, influencing the economy, finances, and psychological problems. Traumatic on children is an impact of the catastrophe likely a burden on the family, especially mothers who accompany their children as caregivers. AIM: The purpose of the study was to explore children’s traumatic experiences from mothers in a family in a rural community in Indonesia. METHODS: We conducted six focus groups with mothers to explore their traumatic children’s experiences using a qualitative research design. Thirty mothers with children 3−10 years old contributed to the focus groups across all sites. We formed focus groups with six mothers and continued in-depth interviews, including nine mothers. RESULTS: The mothers had similar experiences understanding their children’s trauma due to natural tornado disasters. This study revealed three overarching themes shaping the mothers’ experience: anxiety in children, trauma trigger, and lingering distress. All themes lead to the main theme is psychological distress in the face of a child suffering from PTSD. From the hermeneutical perspective, topics can be identified as terms, including being-thrownness, being-fallenness and being-alongside. CONCLUSION: Children with post-traumatic stress disorder may impact family physiological problems, especially the mother. The study found that may place the burden of care for children on the person’s families.

Relationship Between Family Functioning and Medication Adherence in Chinese Patients With Mechanical Heart Valve Replacement: A Moderated Mediation Model

Background: Medication adherence is crucial for patients with mechanical heart valve replacement. Although families functioning is positively associated with medication adherence, little is known about the underlying mechanisms. Objective: To test whether family functioning affects medication adherence through illness perceptions and whether this mediating effect was moderated by medication literacy. Methods: 319 patients after mechanical heart valve replacement were included in this cross-sectional study from June 2021 to October 2021. Data regarding family functioning, illness perceptions, medication adherence, and medication literacy were collected through questionnaires. The moderated mediation model was examined by Hayes's PROCESS macro, based on the bootstrapping method. Results: The results revealed illness perceptions partially mediated the association of family functioning on medication adherence [β = 0.08, 95% confidence intervals: (0.04, 0.12)], and this effect was stronger for patients with low medication literacy than those with high literacy [β = -0.36, 95% CI: (-0.50, -0.22)]. Furthermore, the relationship between family functioning and medication adherence was only significant in patients with low medication literacy [β = 0.36, 95% CI: (0.23, 0.50)]. Conclusion: The mediating effect of illness perceptions between family functioning and medication adherence was moderated by medication literacy. Efforts to improve medication adherence by targeting at improving family functioning may be more effective when considering illness perceptions, especially for patients with limited medication literacy.

Neuro-Oncological Symptoms: A Longitudinal Quantitative Study of Family Function, Perceived Support, and Caregiver Burden

The aim of this study was to establish preliminary quantitative evidence for the longitudinal change in family function, perceived support, and caregiver burden, acknowledging that physical and emotional symptoms are important variables for quality of life in families affected by a brain cancer diagnosis. This longitudinal quantitative study measured patient-reported and family member-reported outcomes at four different time points in 1 year. The patients reported that the symptom burden hindered their relationships with other people. Furthermore, the generally high level of strain due to the caregiver burden had an especially negative impact on close social relationships. Data indicate that family functioning was continually negatively affected as perceived by both patients and family caregivers. No significant changes over time were identified. The results underline the importance of providing systematic and ongoing support to the whole family that acknowledges their contribution as a valuable social support system for the individual experiencing high-grade glioma.

Perceptions of Treatment Burden Among Caregivers of Elders With Diabetes and Co-morbid Alzheimer's Disease and Related Dementias: A Qualitative Study

Many older adults with diabetes (DM) have co-occurring Alzheimer's Disease (AD) and AD-Related Dementias (ADRD). Complex treatment plans may impose treatment burden for caregivers responsible for day-to-day self-management. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for people with DM-AD/ADRD. Caregivers (n = 33) of patients with DM-AD/ADRD participated in semi-structured interviews about their caregiver role and perceptions of treatment burden of DM-AD/ADRD management. Qualitative data were analyzed using content analysis (ATLAS.ti). Caregivers reported high levels of burden related to complex treatment/self-management for patients with DM-AD/ADRD that varied day-to-day with the patient's cognitive status. Four themes were: (1) trajectory of treatment burden; (2) navigating multiple healthcare providers/systems of care; (3) caregiver role conflict; and (4) emotional burden. Interventions to reduce caregiver treatment burden should include activating supportive services, education, and care coordination especially, if patient treatment increases in complexity over time.

Self-management of depression among Chinese community individuals: A cross-sectional study using the transtheoretical model

PURPOSE

To investigate the self-management of depression among members of a Chinese community.

DESIGN AND METHODS

A cross-sectional survey was conducted in Wuhan. The Depression Prevention and Management Survey was used to identify 429 participants' stage of change, perceived benefits, process of change and self-efficacy, based on the transtheoretical model perspective.

FINDINGS

A majority of participants (69.0%) were at the inactive stage of depression self-management. The mean score of the process of change was 87.62 (SD = 24.83). ANOVA analysis showed gender, education, and family function were significant influencing factors in the process of change.

PRACTICE IMPLICATIONS

Mental health nurses need to target their approach to the level of the individual based on the transtheoretical model to assist them to enhance their awareness and motivation. More consideration should be given to gender, education, and family function in the context of depression self-management.

Family Functioning is Associated with Post-Stroke Depression in First-Ever Stroke Survivors: A Longitudinal Study

BACKGROUND

Post-stroke depression (PSD) can aggravate the mortality and recurrence rate in stroke patients. The relationship between family functioning and PSD at different phases after a first-ever stroke is unclear. The purpose of this longitudinal study was to investigate the patterns and relationship of family functioning and PSD at acute hospitalization and 6 months post-discharge in first-ever stroke survivors.

METHODS

This is a longitudinal study conducted in Guangzhou, China. Family functioning and depression were measured by the Short Form Family Assessment Device (SF-FAD) and Self-Rating Depression Scale (SDS) at baseline and 6 months post-discharge. Multiple linear regression analysis was used to explore the relationship between family functioning and PSD.

RESULTS

The prevalence of PSD at acute hospitalization and 6 months post-discharge was 32.9% and 20.0%, respectively. SDS scores decreased significantly from baseline to 6 months post-discharge, while SF-FAD scores did not change significantly during this period. The Pearson correlation coefficient showed that SF-FAD scores were positively associated with SDS scores at the two time points (r ₁ = 0.341, r ₂ = 0.510, P < 0.05). Multiple linear regression analyses indicated that SF-FAD scores could predict PSD at baseline (unstandardized coefficient: 7.010, P < 0.05) and 6 months post-discharge (unstandardized coefficient: 9.672, P < 0.001).

CONCLUSION

This study found that first-ever stroke survivors had good family functioning at baseline and 6 months post-discharge. The findings in this study verified that poor family functioning is positively associated with PSD at different phases post-stroke. Good family functioning is an important protective factor against PSD.

Implicações familiares durante a privação de liberdade e a Teoria do Apego: uma metassíntese qualitativa

RESUMO Objetivos: sintetizar as evidências de estudos qualitativos acerca das implicações que o processo de privação de liberdade apresenta nas relações familiares de adultos apenados. Métodos: metassíntese qualitativa, realizada em janeiro de 2021, por meio da busca de publicações indexadas em seis bases de dados. A amostra foi composta por 10 estudos, que foram analisados pelo software MaxQDA®, e realizada a síntese interpretativa com base na Teoria do Apego. Resultados: com base nos conceitos de primeira ordem, foi possível sintetizar os conceitos de segunda e terceira ordem e apresentá-los em duas unidades de contexto interpretativo: Estratégias de fortalecimento de vínculos familiares; Relações que contribuem para a ruptura de vínculos familiares. Foi evidenciado que as visitas, telefonemas e cartas favorecem o fortalecimento do apego seguro. Considerações Finais: o encarceramento provoca consequências na formação de vínculos, refletindo no processo de apego entre os familiares.

The impact of family function on mental health status in patient with inflammatory bowel disease: The mediating role of self-esteem

OBJECTIVE

Family function is a protective factor for mental health status in IBD patients; however, the underlying processes are unknown. This study aimed to investigate the mediating influence of self-esteem on family functioning and mental health.

METHODS

This cross-sectional study comprised a total of 133 IBD patients who were assessed for family function (APGAR) and depression symptoms. (PHQ-9), anxiety symptoms. (GAD-7) and self-esteem (RSES) via self-administered questionnaires. Mediating effects were tested using the SPSS Process program with bootstrap.

RESULTS

The total score of PHQ-9 was 7.44 ±5.54. The total score of GAD-7 was 6.15±4.78. Significant associations were identified among family function, self-esteem, depression, and anxiety symptoms. Results revealed a significant indirect effect, suggesting that the effects of family function on depression and anxiety symptoms were mediated by self-esteem; the indirect effects percentages were 41.63 and 29.25.

CONCLUSION

These results indicate that the family function of IBD patients can predict their mental health condition. As self-esteem is a mediating element, which may have been influenced by family function, mental health status is indirectly affected. Therefore, promoting the self-esteem of IBD patients is crucial for facilitating long-term mental wellness.

The Association of Maternal Emotional Status With Child Over-Use of Electronic Devices During the COVID-19 Pandemic

The quarantine during the COVID-19 pandemic may generate high levels of maternal depression/anxiety, and maternal emotional status may affect child behavioral development. Online education during the pandemic may induce child over-use of electronic-devices. However, child electronic-device over-use (especially among children under 12 who are immature in physical and mental development) during the pandemic has not attracted sufficient attention, and the association of child over-use with maternal emotional status remains unknown. Therefore, this study aims to assess the characteristics of child electronic-device over-use and the association between maternal emotional status and child over-use among 1,300 children from nurseries (<3 years), kindergartens (3-6 years), and primary schools (6-12 years) in Shanghai and Wuhan during COVID-19. Mothers completed an online questionnaire (including the Self-Rating-Depression/Anxiety-Scales and Family-Environment-Scale). The use of electronic devices (mobile-phones, iPads, computers, and televisions) and online courses taken by the children were investigated. Associations of maternal emotional status with electronic-device-use by child age were analyzed. The proportions of children in nurseries, kindergartens and primary schools were 8.5, 44.5, and 47.0%, their percentages following online-courses were 24.5, 48.4, and 99.0%, and their rates of electronic-device over-use were 34.2, 62.2, and 93.4%, respectively. Significant associations were observed between higher maternal anxiety/depression levels and higher risks of mobile-phone/iPad over-use among preschoolers and primary-school students. Lower family intimacy and higher conflict levels were associated with higher maternal depression/anxiety levels and higher risks of electronic-device over-use. Our findings suggested that over-use of electronic-devices among children under 12 was common during COVID-19, especially among children ≥6 years, and online-teaching may exacerbate over-use. Maternal anxiety/depression levels were associated with over-use of portable internet-devices (mobile-phone/iPad), especially among preschoolers and school-aged students, and family environment may mediate the association. These findings may contribute to a better understanding of factors leading to over-use of electronic-device and developing strategies to decrease over-use during COVID-19.

Relationship between family functionality and the quality of life of the elderly

OBJECTIVE

To analyze the correlation between family functionality and the quality of life of the elderly.

METHOD

Sectional and correlational study conducted with 692 Brazilian elderly between July and October 2020. The elderly filled three instruments: biosociodemographic, family APGAR and WHOQOL-Old. The tests Kruskal-Wallis, Pearson correlation, and linear regression analyzed the data. The study considered a 95% confidence interval (p < 0.05) for all analyses.

RESULTS

The elderly with mild and severe family dysfunction presented worse quality of life when compared to the elderly with a functional family. All facets of quality of life correlated positively with family functionality.

CONCLUSION

Family functionality is positively correlated with the quality of life of the elderly, therefore requiring the inclusion of the family in health care plans to identify potential family stressors early and plan interventions to solve the problems raised.

What matters in care continuity on the chronic care trajectory for patients and family carers?-A conceptual model

AIMS AND OBJECTIVES

To describe essential aspects of care continuity from the perspectives of persons with complex care needs and their family carers.

BACKGROUND

Continuity of care is an important aspect of quality, safety and efficiency. For people with multiple chronic diseases and complex care needs, care must be experienced as connected and coherent, and consistent with medical and individual needs. The more complex the need for care, the greater the need for continuity across different competencies, services and roles.

DESIGN

A constructivist grounded theory approach was applied.

METHODS

Sixteen patients with one or more chronic diseases needing both health care and social care, living in their private homes, and twelve family carers, were recruited. Semi-structured interviews were conducted and analysed with constructivist grounded theory. The COREQ checklist was followed.

RESULTS

A conceptual model of care continuity was constructed, consisting of five categories that were interconnected through the core category: time and space. Patients' and family carers' experiences of care continuity were closely related to timely personalised care delivery, where access to tailored information, regardless of who was performing a care task, was essential for mutual understanding. This required clarity in responsibilities and roles, interprofessional collaboration and achieving a trusting relationship between each link in the chain of care, over time and space. To achieve care continuity, all the identified categories were important, as they worked in synergy, not in isolation.

CONCLUSION

Care continuity for people with complex care needs and family carers is experienced as multidimensional, with several essential aspects that work in synergy, but varies over time and depends on each person's own resources and situational and contextual circumstances.

RELEVANCE TO CLINICAL PRACTICE

The findings promote understanding of patients' and family carers' experiences of care continuity and may guide the delivery of care to people with complex care needs.

Living with Long Term Conditions from the Perspective of Family Caregivers. A Scoping Review and Narrative Synthesis

(1) Background: When living with one or more long term conditions (LTCs), both the patient and the family experience the impact of the condition at different levels. The family's needs and perceptions should be considered in the process of caring for people with LTCs. The aim of this review is to understand "the process of living with LTCs" from a family perspective. (2) Methods: A scoping review and narrative synthesis were conducted using a systematic methodology in MEDLINE, CINAHL, Web of Science and PsycINFO, in English and Spanish, including evidence from 2018. (3) Results: A total of 28 articles were included in the review. Acceptance, coping, self-management, integration, and adjustment were key attributes in the process of living with LTCs from the perspective of family caregivers that interrelated in a dynamic way through different mechanisms: being aware of the changing situation, personal networks, information and education, personal conditions, attitude to life and communication. (4) Conclusions: The five attributes that comprise living with LTCs from the perspective of the family caregiver are closely connected of to those of patients living with LTCs; however, self-management and integration have a different meaning and application.

Family perceptions and experiences of living with patients with fibromyalgia syndrome

PURPOSE

To explore the perception of the illness and the experience of the illness for relatives of fibromyalgia syndrome (FMS) patients.

MATERIALS AND METHODS

This qualitative interpretative study adopted a grounded theory research methodology with a purposive sample. We conducted a focus group with 11 family members of FMS patients. There were six men and five women, five were spouses and six were children (four husbands and one wife, and five daughters and one son).

RESULTS

Three categories of family perceptions of FMS emerged: (1) manifestations of FMS; (2) FMS is regarded as a psychological problem; (3) FMS interferes with traditional gender roles. Three categories of family members' experience of living with FMS patients were identified: (1) emotional concerns and exhaustion; (2) overprotective family members; and (3) escape coping.

CONCLUSIONS

Family members feel emotionally burdened, can be overprotective and over-involved and find it difficult to set limits ultimately succumbing to a vicious cycle of caregiving and emotional exhaustion from which they find it difficult to escape. As the perceptions and experiences of family members of FMS patients are not commonly studied, the present findings offer new insights for families and elucidate important points of intervention.Implications for rehabilitationBecause family members tend to dismiss fibromyalgia as a psychological problem for which ignoring or distracting the patient is the best approach to coping, rehabilitation programs should give family members education and training to develop the ability to better understand fibromyalgia and reduce stereotypes about the condition.Rehabilitation programs should work to identify and manage marital and family systems dysfunction that may be interfering with fibromyalgia patients' adjustment and quality of life.Family members often engage in maladaptive escape coping to manage the demands of living with patients with fibromyalgia, and rehabilitation professionals should be ready to engage and refer to allied specialists to assist family members in finding alternatives for more effective coping approaches that improve patient and family mental health and social relations.Rehabilitation programs for fibromyalgia patients should use a gender perspective and emphasize patient and spouse equality in activities of daily living as many patients and family members feel uncomfortable about not fulfilling traditional gender roles.

Psychiatric Social Work Services In Neurology Emergency Care Setting

BACKGROUND

Psychiatric social workers are important multi-disciplinary team members, and they assess patients and their families social, emotional, environmental, financial, and support needs in emergency settings. They support patients and their families through difficult times and improve patient lives.

AIM

To study the profile of patients availed psychiatric social work services in neurology casualty and emergency settings.

MATERIALS & METHODS

The study was retrospective in nature. The ex-post facto research design was used in the study. Data were obtained from a casualty & emergency psychiatric social work referral registry maintained by the psychiatric social work team at the Neurology emergency setting at NIMHANS, Bangalore. Patients referred for psychiatric social work interventions from April 2020 to March 2021 were considered for the study purpose. Frequency and percentages were used to describe the data.

RESULTS

Psychiatric social work services at the neurology emergency setting were started in July 2018. Social workers get referrals from triage (four hours to 24 hours), followed by priority ward (72 hours to two weeks), observation ward (72 hours days - two weeks) and emergency ICU. There are 100 beds available for neuro-emergency settings. Of ≈15,939 patients who availed the neurology emergency services, 159 patients were referred for psychiatric social work services. A majority (61.6%) received neuro-education about their illness; awareness about their illness were given to patients and their family members. More than half of them were given guidance for availing treatment welfare benefits under below poverty line and Ayushman Bharath Scheme (54%), 43.3% received supportive psychotherapy, 35.2% pre-discharge counselling, one-third received crisis intervention,12.6% family interventions, 10.7% were facilitated for hospital charges waiver off, few unknown patients management and tracing their family members. Most patients were diagnosed with a stroke, GBS, neuro-infections, and seizure disorder patients who sought psychiatric social work services in emergency and casualty settings. Assessment of their functionality revealed that most were partially independent and dependent. Social workers work from 9 am to 9 pm in the neuro-emergency setting. Immediate social work referrals were made for unknown patients, tracing the caregivers who left the emergency ward without permission, which required financial assistance and communicating poor prognosis (breaking the bad news).

CONCLUSION

The most common psychiatric social work intervention provided in the neurology emergency care setting were education about the illness, facilitating poor patients to avail social welfare benefits, supportive psychotherapy and crisis intervention.

Family and Social Variables Associated with Family Health

The current study examined the interrelationships among potentially relevant family and social factors associated with family health. A cross-sectional study was conducted by collecting demographic information from 432 families, including family typology, family life cycle (FLC), and social status as well as social support and stressful life events (SLEs), with self-perception of family health being measured as a dependent variable. Descriptive analysis of the sample and univariate and multivariate linear regression analyses were performed. Multivariate analyses showed that the FLC stage of families as launching centers, lower educational level of household heads, and impact of SLEs were negatively associated with family health, whereas adequate perceived social support and the number of close friends and relatives were positively associated with family health. Therefore, these factors must be considered by family nurses to promote family health and prevent family dysfunction.

Family Functioning Mediates the Relationship Between Activities of Daily Living and Poststroke Depression

BACKGROUND

Poststroke depression is common and includes depressive and somatic symptoms. However, few studies have confirmed the influence of family functioning on poststroke depression or explored the association among daily activities, family functioning, and poststroke depression.

OBJECTIVES

We examined the independent risk factors of daily activities and family functioning for poststroke depression and identified the mediating effect of family functioning on the association between daily activities and poststroke depression.

METHODS

This cross-sectional study design used convenience sampling to recruit 422 stroke survivors from the neurology department of a hospital in Harbin, China, from February to July 2018. We assessed participants' demographic and clinical variables, including depression, daily activities, and family functioning. Pearson's correlations and multiple linear regression analyses were conducted, and a path analysis with bootstrapping was utilized to define direct/indirect effects.

RESULTS

Daily activities and family functioning had a significant and direct negative effect on participants' depression. The indirect effect of 1,000 bootstrap samples after bias correction with a 95% confidence interval was below zero, indicating that family function had a significant mediating effect on the association between depression and daily activities.

DISCUSSION

This study revealed the importance of family functioning in the association between depression and daily activities in stroke survivors. To the best of our knowledge, this study was the first to explore the mediating role of family functioning in poststroke depression, emphasizing the importance of family for the mental health of stroke patients. To reduce the incidence of poststroke depression, interventions that enhance daily activities and family functioning may include nurses, family therapists, rehabilitation physicians, and community workers.

Potential Factors for Psychological Symptoms at Three Months in Patients with Young Ischemic Stroke

Objective

Psychological status plays a vital role in the recovery in young ischemic stroke patients. However, few reports on the psychological symptoms in Chinese young ischemic stroke patients have been published. In the present study, we aimed to outline the psychological status of young ischemic stroke patients and its risk factors at three months after their stroke.

Methods

364 patients with young ischemic stroke and 384 age-matched healthy controls were consecutively recruited from our study hospitals of the mainland of China between June 2018 and November 2020. Social demographic and clinical data were collected from all enrolled participants in the acute stage of their stroke, and their psychological variables were assessed via the Symptom Checklist 90 Revised (SCL-90-R) at three-month timepoint after their stroke. Multivariable logistic regression analyses were run to identify the independent factors for psychological variables in patients.

Results

Compared with healthy controls, patients with young ischemic stroke had significantly higher total score of SCL-90-R and all subscale total scores (p < 0.01 or 0.05). 22.3% (81/364 cases) in young ischemic stroke patients had psychological abnormalities. Compared with young ischemic stroke patients without psychological symptoms (n = 283), patients with psychological symptoms (n = 81) had higher rate of married status (p = 0.03), rate of hypertension (p = 0.01), infarct size (p = 0.01), and the family dysfunction (p < 0.01). Multivariate logistic regression analyses revealed that the family dysfunction (odds ratio [OR], 2.50, 95% confidence interval [CI]: 1.71 to 3.54, p < 0.01), having hypertension (OR, 3.27, 95% CI: 1.92 to 4.27, p = 0.02), and ≥20mm³ infarct size (OR, 2.39, 95% CI: 1.53 to 3.45, p < 0.01) were independent factors for having psychological abnormalities in patients with young ischemic stroke at three months after their stroke. Single (OR, 1.23, 95% CI: 1.03 to 1.54, p = 0.01), poor family function (OR, 1.21, 95% CI: 1.05 to 1.45, p = 0.03), and ≥20mm³ infarct size (OR, 1.74, 95% CI: 1.14 to 3.13, p = 0.02) were independent factors for having depression in patents with psychological symptoms. The family dysfunction (OR, 2.32, 95% CI: 1.51 to 2.80, p < 0.01) and hypertension (OR, 2.41, 95% CI: 1.54 to 3.46, p = 0.03) were independent factors for emerging somatization and anxiety in patients with psychological symptoms, respectively.

Conclusions

At three months after their stroke, young ischemic stroke patients had psychological problems and risk factors for developing them.