‘You put it all together’ - families' evaluation of participating in Family Health Conversations

The Role of Informal Social Support for Patients Undergoing Bariatric Surgery

BACKGROUND

Bariatric surgery is underutilized as a treatment for metabolic disease and its associated comorbidities. While social support is known to play a crucial role in outcomes following bariatric surgery, little is known about the role of social support prior to surgery, which may impact preparedness for and willingness to undergo surgery. The study's objective was to examine the role of informal social support prior to bariatric surgery, the types of support received, and patient attitudes toward different demonstrations of support.

METHODS

We conducted semi-structured interviews with patients who had previously undergone bariatric surgery (n = 20) from two high-volume bariatric surgery centers. Interviews focused on patient engagement with and attitudes about social support during the preoperative process. Transcripts from each interview were iteratively analyzed through steps informed by deductive and inductive thematic analysis.

RESULTS

Four major themes emerged characterizing social support among patients undergoing bariatric surgery: (1) emotional support, (2) instrumental support, (3) informational support, and (4) self-support. Examples of meaningful support participants received included "cheerleading" (i.e., unconditional encouragement), advice from role models who had previously undergone surgery (e.g., receiving information on the process), shared experiences with loved ones regarding dietary and activity modifications (e.g., exercising with friends), and self-support measures (e.g., seeking therapy).

CONCLUSIONS

A comprehensive understanding of how patients receive informal social support can offer valuable insights for individuals considering surgery. Further, such knowledge may enable providers to effectively counsel patients through the decision-making process and to ensure the establishment of support systems both pre- and post-surgery.

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.

A Shifting Paradigm Toward Family-Centered Care in Neuro-Oncology: A Longitudinal Quasi-Experimental Mixed-Methods Feasibility Study

Family-centered intervention can help families facing illness-related issues. We investigated the feasibility of Family and Network Conversations (FNCs) in high-grade glioma patients and their families. Quasi-experimental feasibility study with longitudinal mixed-methods design. Patients and families were invited to three FNCs over 1 year. They completed questionnaires at four time points and expressed their perspectives on the intervention through telephone interviews. Nurses' perspectives were collected in a focus group. Twenty-one patients and 47 family members were included. On average, patients were 66 years old, mainly male, married, living with caregivers, with unifocal cancer. On average, caregivers were 47 years old, mainly female, being spouses or children of the patient. Quantitative and qualitative data did not always match and expanded each other. Nurse-delivered FNCs holistically addressed families' needs while strengthening family's dialogue and union. Nurses felt empowered, underling that advanced competencies were required. Nurse-delivered FNCs are feasible to provide family-centered care, but they should be tailored to each family's needs.

Patients' and Family Members' Experiences of a Novel Nurse-Led Intervention Using Family Conversations Targeting Families Afflicted by Chronic Non-Cancer Pain

Purpose

To explore patients' and family members' experiences of participating in an intervention using nurse-led family nursing conversations (NLFCs) targeting families affected by chronic non-cancer pain (CNCP), including the perceived impact of the intervention on the individual and the family. CNCP substantially impacts patients and families. Due to a lack of simple treatment solutions, the condition needs to be managed rather than cured. Family involvement seems a promising tool, but research evaluating specific approaches is limited. Interventions based on the family systems nursing framework by Wright and Leahey have been helpful in other populations. Nonetheless, the approach warrants further investigation and evaluation in patients with CNCP.

Patients and Methods

A phenomenological hermeneutical design was applied, and individual interviews were conducted with ten patients and ten family members who received the intervention. The analysis was inspired by Ricoeur's philosophy of text interpretation.

Findings

Three themes emerged during the analysis. "Taking part in the intervention while being affected by previous experiences" showed that patients and family members were affected by different experiences and burdens and therefore entered the intervention with varied starting points. "Being empowered through validation and understanding" showed that participants mainly viewed the intervention as beneficial, increasing patients' and family members' mutual understanding and underpinning acceptance of the chronic pain condition. "Being receptive to the intervention - mechanisms contributing to achieving benefit" identified contributing mechanisms influencing patients' and family members' experiences of the intervention. These mechanisms included confidence in the nurses' facilitation of the intervention, the timing of the intervention, the participant's level of acceptance, and readiness to engage in the intervention.

Conclusion and Relevance to Clinical Practice

The intervention was mainly experienced as helpful. Thus, healthcare settings treating CNCP should consider implementing NLFC in clinical practice with adjustments to meet the vulnerability of the CNCP population.

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.

Hospital and homecare nurses' experiences of involvement of patients and families in transition between hospital and municipalities: A qualitative study

BACKGROUND

Involving patients and families in nursing care is essential to improve patients' health outcomes. Furthermore, families play an essential role in supporting patients by helping nurses understand the patient's everyday life. However, families also need support. Involvement of patients and families is especially important when patients are transferred between hospital and home as transitions heighten the risk of compromising quality and safety in care. However, no consensus exists on how to involve them. Consequently, this may challenge a systematic approach toward patient and family involvement.

AIM

To describe hospital and homecare nurses' experiences with involving patients and their family members in nursing care in the transition between hospital and municipalities.

METHOD

Focus group interviews were conducted in the Gastro unit at a large university hospital in Denmark. Participants included 10 hospital nurses from three wards at the Gastro unit and six homecare nurses from one of three municipalities in the hospital catchment area (total n = 16). Data were analysed using qualitative content analysis. The study is reported according to the Consolidated Criteria for Reporting Qualitative Research.

FINDINGS

Our analysis revealed one overall theme - "The complexity of involvement" - based on four categories: gap between healthcare sectors increases the need for patient and family involvement, lack of time is a barrier to patient and family involvement, involvement is more than information, and involvement as a balancing act.

CONCLUSION

The nurses experienced patients' and families' involvement as essential, but a discrepancy was found between nurses' intentions and their actions. Aspects related to a gap between healthcare sectors and various understandings of involvement challenged the systematic involvement of patients and families in the transition between healthcare sectors. However, the nurses were highly motivated to achieve a close cross-sectoral collaboration and to show commitment towards patients and families.

Calgary Family Intervention Model-Based Family Support and Psychoeducation Related Intervention Experiences of Family Members Caring for Patients with a Chronic Mental Illness: "We Are All in the Same Boat"

In the study, it was aimed to investigate the Calgary Family Intervention Model-based Family Support and Psychoeducation Intervention experiences of family members who cared for patients with a chronic mental illness. The sample of this study consisted of 15 caregivers of chronic psychiatric patients who participated in the Calgary Family Intervention Model-based family support and psychoeducation intervention and met the inclusion criteria. Data were collected through semi-structured questions and individual interviews. The interviews were recorded on a voice recorder. In the analysis of the data, content analysis was used. At the end of the study, the following four main themes were obtained: "we are all in the same boat," "shared feelings and mutual learning," "awareness and hope" and "suggestions." The results obtained from the study indicate that cognitive and emotional support need of those who provide care for family members with a chronic mental illness is an important issue that should not be ignored. Creating environments where individuals with similar experiences can share their experiences and providing the support, they need are an important tool that reinforces their hope and awareness.

Family systems nursing conversations: influences on families with stroke

Background

Since a family member’s stroke affects the entire family, family systems nursing conversations (FSNCs) may be an appropriate intervention to support the family as a whole. The purpose of our study was to illuminate family members’ experiences within their family situations 6 months after participating in FSNCs when a family member under 65 years of age had suffered a stroke.

Methods

Fourteen semi-structured follow-up interviews were conducted with family members 6 months after they had completed a series of 3 FSNCs. The interview transcripts were subjected to qualitative content analysis.

Results

Family members experienced that the FSNCs had contributed to greater understanding of each other and greater closeness in the family. The FSNCs had also facilitated a mutual understanding of the family’s situation, which they could better manage and move forward with together.

Conclusions

FSNCs can support relational aspects and healthy transitions within families. However, long-term follow-up research is needed to generate sound evidence and inform education about FSNCs, as well as to facilitate their implementation. As a result, families may become better able to prevent the negative outcomes of illness in the family.

How Family Members Experienced a Family-Focused Atrial Fibrillation Intervention in an Outpatient Setting—A Qualitative Study

Introduction

Family-focused nursing has gained ground worldwide, and a range of healthcare systems are now practicing family-focused nursing, which has been shown to increase the quality of care. Even so, a lack of research remains into family-focused nursing for various groups of patients in clinical practice.

Objectives

The purpose of this study was to explore how family members (FMs) of patients with atrial fibrillation (AF) experienced a family-focused nursing intervention in a clinical outpatient setting.

Methods

This was a qualitative phenomenological interview study employing Reflective Lifeworld Research (RLR) to explore humans’ lived experiences. The data reported herein were derived from semi-structured interviews with seven FMs of patients with AF who participated in a clinical trial which tested a family-focused intervention in a Cardiology outpatient clinic treating patients with AF. The transcribed interviews were analyzed in four phases which is an iterative process as proposed by Dahlberg and Dahlberg.

Findings

The essence of the phenomenon was experiencing less panic and finding peace, which emerged from the following four patterns. (1) The FMs’ post-AF experience, (2) Enhanced understanding and knowledge of AF, (3) Personal interaction with a nurse specialist and (4) AF becomes manageable. A space facilitating reflection upon the disease and daily life with the disease was established through group sessions and family conversations.

Conclusion

A family-focused nursing intervention facilitated by specialized nurses with extensive communication skills filled a knowledge gap related to AF thereby reducing panic and increasing peace among FMs. Furthermore, the intervention facilitated family awareness of their resources to bring about change, regain balance, and enhance well-being in their everyday lives and initiated a healing process in the families. Future interventions for patients with AF should consider FMs as well as patients as an entity of care.

Patients' and family members' perspectives on the benefits and working mechanisms of family nursing conversations in Dutch home healthcare

The aim of this study is to propose a model of the benefits and working mechanisms of family nursing conversations in home healthcare from the perspective of participating patients and their family members. Family nursing conversations in this study are intended to optimise family functioning, improve collaboration between family and professional caregivers and ultimately prevent or reduce overburden of family caregivers. In a qualitative grounded theory design, data were collected in 2017 using intensive interviewing with participants of family nursing conversations in home healthcare. A total of 26 participants (9 patients and 17 family members) from 11 families participated in a family nursing conversation and the study. Seven nurses who received extensive education in family nursing conversations conducted them as part of their daily practice. Interviews occurred 4-6 weeks after the family nursing conversation. The model that was constructed in close collaboration with the families consists of three parts. The first part outlines working mechanisms of the conversation itself according to participants, i.e. structured and open communication about the care situation and the presence of all of the people who are involved. The second part consists of the benefits that participants experienced during and immediately after the conversation - an increased sense of overview and improved contact among the people involved - and the related working mechanisms. The last part consists of benefits that emerged in the weeks after the conversation - reduced caregiver burden and improved quality of care - and the related working mechanisms. Insight into the benefits and working mechanisms of family nursing conversations may assist healthcare professionals in their application of the intervention and provides directions for outcomes and processes to include in future studies.

Parents' experiences of family health conversations after having a child in need of neonatal intensive care

BACKGROUND

When a newborn child requires neonatal intensive care, it is often the beginning of a journey of stress and worry for the parents. Such situations could cause difficulties in problem-solving and communication within the family and result in decreased family functioning. Studies have shown that nurse-led interventions in the form of Family Health Conversations promote family's well-being and functioning and strengthen their relationships. However, this model has not previous been used and evaluated with families who have a child in need of neonatal intensive care.

AIM

To describe parents' experiences of participating in Family Health Conversations after having a child in need of neonatal intensive care.

METHOD

Family interviews were conducted with 12 families from three neonatal intensive care units in southern Sweden, six months after a Family Health Conversations intervention. Data were analysed using qualitative content analysis.

FINDINGS

The parents experienced the Family Health Conversations as an opportunity to co-create a comprehensive picture of what had happened after their child was born. Parents shared their experiences of the Family Health Conversations in terms of feeling validated and strengthened as individuals, as a couple, and as a family. They found the conversations to be supportive to their well-being and to processing experiences and becoming equipped for the future. The parents reported that it was valuable to talk with conversational leaders who had knowledge in neonatal care and who thereby understood what the parents were talking about. This provided a different type of support compared with other conversational contacts.

CONCLUSION

These results highlight the importance of having an early onset of family conversations in order to help the parents to cope with their challenges and improve their well-being.

"Sometimes it feels like thinking in syrup" - the experience of losing sense of self in those with young onset dementia

Purpose: To explore and describe the experience of people having young-onset dementia.Methods: This was a qualitative study that used semi-structured interviews to collect data from nine persons with young-onset dementia (aged 47-65; five men and four women). Data were collected in the spring of 2018. All interviews were conducted at the participants' choice and in their own homes by one interviewer. The collected data were analysed using the six-stage process of reflexive thematic analysis model.Results: The analysis revealed three themes: Dementia causing loss of control over oneself; becoming a burden to the family while sense of self disappears; and fearing a humiliating future.Conclusions: The experience of having and living with young onset dementia affected the persons' thoughts and memory and was experienced through the persons' loss of personality and sense of self. Thoughts about the future were associated with fear, and the risk of changing their personalities to something different from the one which they had experienced as humiliating throughout most of their lives.

Young Adults and Their Families Living With Mental Illness: Evaluation of the Usefulness of Family-Centered Support Conversations in Community Mental Health care Settings

The aim of this study was to evaluate the usefulness of Family-Centered Support Conversations (FCSC) offered in community mental health care in Norway to young adults and their families experiencing mental illness. The FCSC is a family nursing intervention based on the Calgary Family Assessment and Intervention Models and the Illness Beliefs Model and is focused on how family members can be supportive to each other, how to identify strengths and resources of the family, and how to share and reflect on the experiences of everyday life together while living with mental illness. Interviews were conducted with young adults and their family members in Norway who had received the FCSC intervention and were analyzed using phenomenography. Two descriptive categories were identified: "Facilitating the sharing of reflections about everyday life" and "Possibility of change in everyday life." The family nursing conversations about family structure and function in the context of mental illness allowed families to find new meanings and possibilities in everyday life. Health care professionals can play an important role in facilitating a safe environment for young adults and their families to talk openly about the experience of living with and managing mental illness.

The Usefulness of Brief Family Health Conversations Offered to Families Following the Diagnosis of Breast Cancer

Currently, there are few studies which examine targeted family-focused support when a family member is diagnosed with breast cancer. Thus, the aim of this study was to explore families' experiences of participating in a family nursing intervention identified as Brief Family Health Conversations (BFamHC) following the diagnosis of breast cancer. Semi-structured family interviews were conducted with nine families (including 29 family members) 2 weeks following the family-focused intervention of three sessions of BFamHC. Thematic analysis was used to analyze the data. Families reported the BFamHC as positive and as a unique kind of family health conversation, one that afforded them the opportunity to communicate and share their experiences as a family group. A family conversation, even one as time-limited as BFamHC, offered a sense of relational sharing and togetherness, thus preventing feelings of isolation and vulnerability. Therapeutic family-focused conversations, such as BFamHC, hold promise as a useful family nursing intervention following the diagnosis of breast cancer.

Effects of family nursing conversations on families in home health care: A controlled before-and-after study

AIM

To assess the effects of family nursing conversations on family caregiver burden, patients' quality of life, family functioning and the amount of professional home health care.

DESIGN

A controlled before-and-after design.

METHODS

Intervention group families participated in two family nursing conversations incorporated in home health care; control group families received usual home health care. Patients and family members completed a set of questionnaires on entering the study and 6 months later to assess family caregiver burden, family functioning and patients' quality of life. The amount of home health care was extracted from patient files. Data were collected between January 2018-June 2019.

RESULTS

Data of 51 patients (mean age 80; 47% male) and 61 family members (mean age 67; 38% male) were included in the results. Family caregiver burden remained stable in the intervention group whereas it increased in the control group. Family functioning improved significantly compared with the control group for patients and family members in the intervention group. No significant effects on patients' quality of life emerged. The amount of professional home health care decreased significantly in the intervention group whereas it remained equal in the control group.

CONCLUSION

Family nursing conversations prevented family caregiver burden, improved family functioning, but did not affect patients' quality of life. In addition, the amount of home health care decreased following the family nursing conversations.

IMPACT

Countries with ageing populations seek to reduce professional and residential care and therefore encourage family caregiving. Intensive family caregiving, however, places families at risk for caregiver burden which may lead to increased professional care and admission into residential care. This study demonstrates that family nursing conversations help nurses to prevent family caregiver burden and improve family functioning while decreasing the amount of home health care.

Mental Health Professionals' Experiences with Applying a Family-Centred Care Focus in Their Clinical Work

Family members play vital roles in supporting their young adults with mental health challenges, implying that professionals are challenged to apply a Family-Centred Care approach (FCC) in community mental health services. By applying a qualitative phenomengraphic approach, this study aimed to explore and describe professionals' experiences of applying a FCC approach. Based on data from 13 individual interviews, the descriptive categories were: Mutual understanding, Facing dilemmas and Dealing with barriers. Despite the professionals' expressed desires to involve the family, individual treatment and follow-up seemed to characterize their daily clinical practice, often due to the young adults' own wishes.

A challenging journey: The experience of elderly patients and their close family members after major emergency abdominal surgery

RATIONALE

Knowledge of how elderly patients undergoing major emergency abdominal surgery and their close family members experience the course of illness is limited. Little is known about how such surgery and hospitalisation affect elderly patients' daily life after discharge. It is well known that such patients have an increased risk of mortality and that their physical functional level often decreases during hospitalisation, which can make them dependent on family or homecare services. Critical illness and caregiving for a close relative can be a stressful experience for families, which are at risk of developing stress-related symptoms.

AIM

To explore how elderly patients and their families experience the course of illness during hospitalisation and the first month at home after discharge.

METHOD

A phenomenological study was conducted to gain in-depth descriptions through 15 family interviews with 15 patients who had undergone major emergency abdominal surgery and 20 of their close adult family members. Data were analysed using a phenomenological approach inspired by Giorgi.

FINDINGS

The essence of the phenomenon is captured in three themes: (1) Being emotionally overwhelmed, (2) Wanting to be cared for and (3) Finding a way back to life.

CONCLUSION

Patients and their close family members experienced the course of illness as a challenging journey where they longed for life to become as it was before illness. They experienced illness as a sudden life-threatening incidence. In this situation, it was crucial to be met with empathy from healthcare professionals. The patients' experience of fatigue and powerlessness remained intense one month after discharge and affected their and their close family members' lives.

Family and health professional experience with a nurse-led family support intervention in ICU: A qualitative evaluation study

OBJECTIVES

To investigate family and health professional experience with a nurse-led family support intervention in intensive care.

DESIGN

Qualitative evaluation study.

SETTING

A twelve-bed surgical intensive care unit in a 900-bed University Hospital in Switzerland.

MAIN OUTCOME MEASURES

Data were collected through 16 semi-structured interviews with families (n = 19 family members) and three focus group interviews with critical care staff (n = 19) and analysed using content analysis strategies.

FINDINGS

Four themes related to the new family support intervention were identified. First, families and staff described it as a valuable and essential part of ICU care. Second, it facilitated staff-family interaction and communication. Third, from staff perspective, it promoted the quality of family care. Fourth, staff believed that the family support intervention enabled them to better care for families through increased capacity for developing and sustaining relationships with families.

CONCLUSIONS

An advanced practice family nursing role coupled with a family support pathway is an acceptable, appreciated and beneficial model of care delivery in the inttensive care unit from the perspective of families and critical care staff. Further research is needed to investigate the intervention's effectiveness in the intensive care unit.

Expectations and Prospects of Young Adult Caregivers Regarding the Support of Professionals: A Qualitative Focus Group Study

There is a lack of service provision for young adult caregivers (18-25 years of age). This study aims to describe the expectations and prospects of young adult caregivers regarding support from health and education professionals. A qualitative focus group design was used. Twenty-five young Dutch adults (aged 18-25 years) who were growing up with a chronically ill family member participated in one of seven focus groups. Qualitative inductive analysis was used to identify codes and main themes. Two overarching themes with five sub-themes emerged from the focus group discussions. The overarching themes are: the 'process of approaching young adults' and the 'types of support these young adults require'. The process of approaching young adults contains the sub-themes: 'recognition, attention, and listening', 'open-minded attitude', 'reliability', and 'respecting autonomy'. The types of support this group requires contains the sub-themes: 'information and emotional support'. Health and education professionals should first and foremost be aware and listen to young adult caregivers, pay attention to them, have an open-minded attitude, respect their autonomy, and have the knowledge to provide them with information and emotional support. Further research could yield comprehensive insights into how professionals can meet these requirements and whether these results apply to male young adult caregivers and young adult caregivers not enrolled in a healthcare-related study program.

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

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

Nurses' attitudes regarding the importance of families in nursing care: A cross-sectional study

AIMS AND OBJECTIVES

To investigate attitudes towards family involvement in care among a broad sample of Danish nurses from all sectors and healthcare settings.

BACKGROUND

Evidence suggests that nurses hold both supportive and less supportive attitudes about involvement of family members in the care of patients, and the existing findings are limited to specific healthcare contexts.

DESIGN

A cross-sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology for reporting observational studies.

METHODS

Using snowball sampling, the Families' Importance in Nursing Care-Nurses' Attitudes questionnaire was initially administered to a broad, convenience sample of Danish registered nurses through social media: Facebook interest groups and the homepage of the Danish Family Nursing Association. These nurses were encouraged to send the invitation to participate in their network of nursing colleagues. Complete data sets from 1,720 nurses were available for analysis.

RESULTS

In general, the nurses considered the family as important in patient care. Nurses who held master's and doctorate degrees scored significantly higher than nurses with a basic nursing education. Nurses who had had experience with illness within their own families tended to score higher on the family as a conversational partner subscale than those without this experience. Nurses with the longest engagement within hospital settings scored significantly lower than those with the longest engagement within primary health care and/or psychiatry.

CONCLUSIONS

Families are considered important in nursing care. Younger nurses with a basic education, short-term engagement at a hospital and no experiences with illness within their own families were predictors of less supportive attitudes towards including the family in nursing care.

RELEVANCE TO CLINICAL PRACTICE

Clinical leaders and managers should promote education on the importance of active family involvement in patient care in clinical practice and undergraduate education. More focus on collaboration with families in the hospital setting is needed.

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

STUDY RATIONALE

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

AIMS AND OBJECTIVES

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

METHODOLOGICAL DESIGN AND JUSTIFICATION

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

RESEARCH METHODS

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

RESULTS

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

CONCLUSIONS

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

Nurses' application of the components of family nursing conversations in home health care: a qualitative content analysis

AIM

The purpose of this study was to describe how nurses apply the components of family nursing conversations in their home healthcare practice.

METHOD

A qualitative content analysis with a deductive approach was conducted. Home healthcare nurses conducted family nursing conversations with families from their practice. Families were selected based on three nursing diagnoses: risk of caregiver role strain, caregiver role strain or interrupted family processes. Nurses audio-recorded each conversation and completed a written reflection form afterwards. Transcripts of the audio-recorded conversations were analysed in Atlas.ti 8.0 to come to descriptions of how nurses applied each component. Nurses' reflections on their application were integrated in the descriptions.

RESULTS

A total of 17 conversations were audio-recorded. The application of each component was described as well as nurses' reflections on their application. Nurses altered or omitted components due to their clinical judgment of families' needs in specific situations, due to needs for adjustment of components in the transfer from theory to practice or due to limited skill or self-confidence.

CONCLUSION

All of the components were applied in a cohesive manner. Nurses' application of the components demonstrates that clinical judgment is important in applying them. Further training or experience may be required to optimise nurses' skill and self-confidence in applying the components. This study demonstrates the applicability of the family nursing conversations components in home health care, allowing exploration of the working mechanisms and benefits of family nursing conversations for families involved in long-term caregiving in future studies.

Family Health Conversations create awareness of family functioning

BACKGROUND

The whole family is affected if one family member is critically ill. The Family Health Conversation Intervention may give the family tools that support healthier family functioning.

AIMS AND OBJECTIVES

The aim of this study was to identify which components of family function are affected when families participate in Family Health Conversations.

DESIGN

A secondary analysis was performed of existing qualitative interviews. The Family Health Conversation is an intervention where nurses ask the family reflective questions, and reflection is made possible in three conversation sessions.

METHODS

This study included transcribed data from 13 follow-up interviews from seven families attending Family Health Conversations after three and 12 months. Data were analysed with narrative analysis, focusing on family function.

RESULTS

Three themes were identified. The families' family functioning had been supported with: improved understanding of each other-there was an understanding of being in the same situation but still having totally different experiences; more concern for each other-they talked about their different experiences and felt they had become closer to each other; and a process of working through-they had experienced working through various experiences, standing by and supporting, and then being able to move on.

CONCLUSIONS

The Family Health Conversation Intervention is provided to families, accompanied by nurses. The families in this study gained an awareness of their family function that brought the family closer because of improved understanding of each other and the situation. The families experienced openness, and the family members spoke more freely with each other, which facilitated the progress of working through the experience of critical illness and helped to maintain healthy family functioning.

RELEVANCE TO CLINICAL PRACTICE

It is important to have an overall perspective and to recognize the patient and the family as equally important within the family for awareness of family function.

Parents Experiences Raising a Child with Food Allergy; A Qualitative Review

PROBLEM

Food allergies are one of the fastest growing public health concerns without a cure, affecting approximately 8% of the world's child population. Being the parent of a child with allergies may lead to concerns, and affect everyday life in the family. The aim was to synthesize and describe parents' experiences of living with food allergies in families when one of the children has a food allergy.

ELIGIBILITY CRITERIA

A systematic search using subject terms and text words was performed in Cinahl (Ebsco), Swemed+, Medline (OVID) and Scopus in October 2017. The search was limited to parents with children and adolescents, for the years from 2006 to October 2017.

SAMPLE

One hundred and forty articles were screened and 24 were included.

RESULTS

A meta-summery of the results from the included studies were conducted. The parents lived in fear, after their child had their first reaction and had become allergic, a life threatening experience. They tried to live an ordinary family life and parents had to learn how to be one-step ahead and understand early signs. The family's social life was also influenced. Parents asked for support and information from health professionals and more knowledge and skills increased parents' manageability.

CONCLUSION

Parents need support and a seamless encounter with health professionals, with multidisciplinary collaboration and knowledge sharing to develop the parents' self-efficacy.

IMPLICATIONS

Health professionals must provide information and support parents on their path through the health-care system in having a child with a food allergy.

Do family health conversations impact patients with glioblastoma multiforme and their family members?

AIMS AND OBJECTIVES

To assess the impact of family health conversations (FamHC) as a supplement to conventional care on health-related quality of life (HRQoL), family functioning (FFSS) and family hardiness or resilience (FHI) 4 and 14 weeks postoperatively among patients with glioblastoma multiforme and their family members.

BACKGROUND

There is a lack of knowledge about the efficiency of FamHC among families experiencing glioblastoma multiforme.

DESIGN

A quasi-experimental pre- and post-test design adhering to the STROBE (Strengthening the reporting of observational studies in epidemiology) guidelines for case-control studies. Patients and family members were included consecutively in the pretest period from November 2013-December 2014 for the control group (offered traditional care only), and in the post-test period from January 2015-December 2015 for the intervention group (offered traditional care and FamHC). For both groups, 4 and 14 weeks postoperative measurement were obtained.

METHODS

Differences in outcomes were assessed using a difference-in-difference regression analysis approach measuring difference across pre and post groups and across 4 and 14 weeks measurements.

RESULTS

The study does not reveal significant effects of FamHC (all p-values larger than 0.05) as measured by the three instruments WHOQOL-BREF, FFSS and FHI.

CONCLUSIONS

The present study was not able to show significant effects of FamHC. However, it cannot be left out that the intervention might be helpful and supportive at a later state of the illness trajectory.

RELEVANCE FOR CLINICAL PRACTICE

The study adds to the growing evidence-based knowledge on FamHC by questioning their potential use in different cultural contexts among families experiencing critical illness. Oncological nurses need to adapt this information to support their daily care for the patients and their close relatives. For future studies, it is recommended that the families themselves choose when the conversations should take place during the course of the illness.

Expressed emotions and experiences from relatives regarding having a family member living in a nursing home for older people

Objectives:

The purpose of this study was to describe the topics relatives with a family member in a nursing home for older persons choose to talk about and focus on when participating in a nurse-led “Family Health Conversations” intervention. Family Health Conversations consisted of a series of three nurse-led conversations with each family, with a 2-week interval between meetings.

Methods:

The Family Health Conversations meetings were tape-recorded and analyzed using qualitative content methods. The participants were relatives of family members living in a nursing home for older persons in a municipality in Sweden.

Results:

The findings showed how the relatives talked about their suffering and difficulties concerning the new situation. The relatives talked about frustration and sadness together in a new way, with a focus on how to manage the future. They also wished that they had been offered an opportunity to talk about this with nurses earlier in the illness trajectory.

Conclusion:

The relatives had a significant need to talk about their experiences together within the family and together with the nurses. Nurses have an especially important task in supporting relatives having a family member living in a nursing home.

Nurses' perceptions about a web-based learning intervention concerning supportive family conversations in home health care

Aims and objectives

To describe the perceptions that municipal primary healthcare nurses and municipal registered nurses had about a web‐based learning intervention concerning supportive family health conversations in municipal home health care.

Background

Even though family health conversations are well grounded in theory with several reported benefits for patients and families, most working nurses have little or no training in practising family systems nursing including family health conversations. Continued learning is necessary for nurses, where web‐based learning may be one answer of updating the professional skills and knowledge of nurses regarding supporting families.

Design

The study used a descriptive design and followed the “Consolidated criteria for reporting qualitative research” (COREQ) checklist.

Methods

Twenty‐one nurses participated in an educational intervention that consisted of web‐based learning and two face‐to‐face seminars about family systems nursing including family health conversations. The nurses were interviewed after completion, and the audio‐recorded interviews were transcribed verbatim and analysed using qualitative content analysis.

Results

The findings consist of nurses’ perceptions regarding the disposition of instruction, the prerequisites for learning and a changed approach when working with families. The findings are further reflected on through Illeris’ theory concerning learning triangle.

Conclusions

The findings are encouraging for educating nurses in family health conversations at their workplace, with the purpose of supporting patients and families. However, it is important to be aware of the different dimensions of learning, in addition to the appraisal of social aspects and organisational circumstances when educating nurses as they influence the utilisation of the knowledge.

Relevance to clinical practice

This web‐based learning intervention seems to be suitable for educating nurses in family health conversations and could be an appropriate step towards implementing these conversations in home health care with the purpose of supporting families.

The Core of Parents' Main Concerns When Having a Child With Cataract and Its Clinical Implications

PURPOSE

To investigate the main concerns associated with being a parent of a child with cataract and how the parents deal with these concerns.

DESIGN AND METHOD

Twenty-three parents; 6 mothers, 5 fathers and 6 couples with a child with cataract were included in this study. The parents included some with a personal experience of cataract and some without. Data was collected through 17 in-depth interviews, which were recorded and transcribed verbatim for analysis by the method of Grounded Theory developed by Charmaz.

RESULTS

The Grounded Theory describes the parents' efforts to balance the child's inability and ability in order to maintain their social functioning and lead a normal life through a process comprising four main categories; Mastering, Collaborating, Facilitating, and Adapting. This process makes the path of transition evident, starting when the child is diagnosed and continuing for several years during her/his growth and development.

CONCLUSION

The core of parent-child interaction is mastering the balance between the child's disability and ability in order to achieve the best possible outcome, visually and habitually. The interactions changes through a process towards adjustment and acceptance. All the parents emphasized that you do what you have to do to achieve a successful visual outcome of the child.

CLINICAL IMPLICATIONS

The model provides a comprehensive understanding of parental self-management that can be used by a case manager, preferable a nurse, to pilot the parents through the process.

Next of kin's protracted challenges with access to relevant information and involvement opportunities

Background

Next of kin are considered a resource for both the patient and the health service. Need for information varies with severity and duration of health changes. A clear requirement is about what to expect upon homecoming, and what supportive services are available. The picture of relatives’ access to involvement and information is still somewhat unclear.

Objective

To investigate what information, knowledge, and involvement next of kin considered important for managing their caring role and collaboration with their close relatives who experienced events that led to chronic illness.

Design, setting, and methods

A qualitative exploratory design. Seventeen informants were recruited through various courses offered to relatives. Data were collected in 2017 from individual interviews, analyzed in an interpretative tradition, and involved qualitative content analysis.

Results

The results reflect a long intervening period in between the activating incident and a clarification of the situation. This period was characterized by unpreparedness for duration of anxiety and amount of energy involved in balancing the relationship. Further, the interviewees saw retrospectively that information about disease and treatment was available, but they had to find such resources themselves. Information about how to handle the situation was almost absent. Ultimately, they were disappointed over not being involved.

Conclusion

Previously provided prospective information about the embedded anxiety in the situation and consequences for relationships, involvement in patients’ services, and better communication about existing services seem to be significant. Health care professionals, especially in outpatient care, may improve their services by debating how they can implement family-oriented care in personalized treatment as usual. Focus on prospective information, early involvement, and relevant information about existing resources may empower relatives and relieve the experience of care burden.

Family Health Conversations Conducted by Telephone in Heart Failure Nursing Care: A Feasibility Study

Registered nurses (RNs) in heart failure (HF) nursing care have a key role in providing family support, which positively affects the outcome for the patient. Telephone interventions conducted by RNs have been reported to be successful in HF nursing care, but Family Health Conversations (FamHCs) involving the patient and the family, have not previously been tested. The purpose of the current study was to explore the experiences and feasibility of nurse-led FamHCs conducted by telephone with patients and their family caregivers. A single-group intervention study with a pretest–posttest design was conducted in three regional hospitals that had a nurse-led HF clinic. Five RNs, eight patients, and eight family caregivers participated. Three FamHCs were conducted by telephone with each family every 2 weeks. Qualitative and quantitative data were collected through semistructured interviews and questionnaires. FamHCs improved the nurse–family relationships and relationships within the families and provided RNs with new knowledge about the families. FamHCs conducted by telephone were considered to be feasible for both families and RNs, although RNs preferred fewer and shorter FamHCs. The RNs preferred meeting face-to-face with the families as nonverbal communication between the family members could be missed because of lack of visual input. On the other hand, RNs appreciated to focus entirely on the conversation without the need to perform illness-related routine checks. In conclusion, the advantages of FamHCs conducted by telephone outweighed the disadvantages. Visual contact, provided by video telephony, and a shorter version of the tested FamHC would facilitate the use in HF nursing care.

Health-promoting conversations-A novel approach to families experiencing critical illness in the ICU environment

AIMS AND OBJECTIVES

To identify and describe the outcomes of a nurse-led intervention, "Health-promoting conversations with families," regarding family functioning and well-being in families with a member who was critically ill.

BACKGROUND

Families who have a critically ill family member in an intensive care unit face a demanding situation, threatening the normal functioning of the family. Yet, there is a knowledge gap regarding family members' well-being during and after critical illness.

DESIGN

The study used a qualitative inductive-descriptive design.

METHODS

Eight families participated in health-promoting conversations aimed to create a context for change related to the families' identified problems and resources. Fifteen qualitative interviews were conducted with 18 adults who participated in health-promoting conversations about a critical illness in the family. Eight participants were patients (six men, two women) and 10 were family members (two male partners, five female partners, one mother, one daughter, one female grandchild). The interviews were analysed by conventional content analysis.

RESULTS

Family members experienced strengthened togetherness, a caring attitude and confirmation through health-promoting conversations. The caring and calming conversations were appreciated despite the reappearance of exhausting feelings. Working through the experience and being confirmed promoted family well-being.

CONCLUSION

Health-promoting conversations were considered to be healing, as the family members take part in sharing each other's feelings, thoughts and experiences with the critical illness.

RELEVANCE TO CLINICAL PRACTICE

Health-promoting conversations could be a simple and effective nursing intervention for former intensive care patients and their families in any cultural context.

The health promoting conversations intervention for families with a critically ill relative: A pilot study

BACKGROUND

After intensive care unit treatment, patients often have prolonged impairments that affect their physical, cognitive and mental health. Family members can face overwhelming and emotionally challenging situations and their concerns and needs must be addressed.

OBJECTIVE

We investigated the outcomes of pilot randomised control trial, a nurse-led family intervention, Health Promoting Conversations, which focused on family functioning and wellbeing in families with a critically ill member.

STUDY DESIGN

This randomised controlled pilot study used a pre-test, post-test design with intervention and control groups to investigate the outcomes of the nurse-led intervention in 17 families.

OUTCOME MEASURES

The Health Promoting Conversations intervention was evaluated using validated instruments that measure family functioning and family wellbeing: the General Functioning sub-scale from the McMaster Family Assessment Device; the Family Sense of Coherence, the Herth Hope Index, and the Medical Outcome Short-Form Health Survey. Descriptive and analytical statistical methods were used to analyse the data.

RESULTS

After 12 months, the intervention group reported better family functioning than the control group. The intervention group also had better social functioning and mental health after 12 months.

CONCLUSION

This intervention may improve family wellbeing by improving family function, reducing stress, and promoting better mental health.

Family Health Conversations at a Pediatric Oncology Center - A Way for Families to Rebalance the Situation

PURPOSE

The study aimed to describe and understand adult family members' experiences of participating in a Family Health Conversation (FamHC) when a child is diagnosed with cancer.

DESIGN AND METHODS

Twelve individual interviews were performed with adult family members who had participated in a FamHC. During the interviews each interviewee was a spokesman for his or her respective family. Thereby the family was included as a system. The interviews were analyzed using a hermeneutic approach.

RESULTS

The analysis resulted in four themes: "To unburden the burden," "Seeing things in a new light," "To be seen the way you are," and "Talking to someone who is both within and alongside." Finally an overarching theme evolved, "To rebalance the situation" revealing the meaning of taking part in the FamHC.

CONCLUSION

All participants considered the FamHC to be valuable. It was surprising that such a relatively small investment of two family conversations and a closing letter could have such significance for the families in their difficult situation.

PRACTICE IMPLICATIONS

With training, clinical nurses can use a well-established structured interview process such as the Family Health Conversation to help family members to gain insight into each other's experiences, which increase their ability to cope and regain control.

Experiences of encounters with healthcare professionals through the lenses of families living with chronic illness

AIMS AND OBJECTIVES

To describe and explore the experience of healthcare encounters in families living with chronic illness.

BACKGROUND

Living with chronic illness is a family concern and often includes frequent encounters with healthcare professionals. These encounters affect how persons with illness and family members handle everyday life. Disease-related explanations are perceived by healthcare professionals as being of higher importance than the actual experience of illness, even though patients are concerned with issues involving their everyday life.

DESIGN

A descriptive design with a qualitative approach.

METHODS

Narrative family interviews were conducted with twelve families, using a qualitative content analysis.

RESULTS

One main category was indicated following analysis, specifically "The impact of an accompanying family member." Additionally, three subcategories were revealed; "The importance of collaboration," "Mutual understanding," "A desire to be confirmed in one's illness".

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

Having a participating family member increased the sense of power in families during encounters with healthcare professionals. This participation constitutes a level of support, making it easier for families to handle everyday life due to illness. Family members are, in most cases, included in discussions and decisions, both before and after encounters, and it should be a natural for healthcare professionals to invite them to the encounter too. This is an offer that may not fit every family, but the person with illness or the family should at least have the opportunity to choose.

Family Health Conversations have Positive Outcomes on Families - A Mixed Method Research Study

BACKGROUND

Having a family member living in a residential home affects the entire family and can be hard to handle. Family members require encouraging and open communication support from nurses during and after relocation to a residential home. A Family Systems Nursing intervention, "Family Health Conversations" (FamHC) was conducted in order to strengthen the health of families having relatives at residential home for older people.

OBJECTIVES

The aims of this study were to evaluate the responses to the Family Health Conversations in families with a member living at a residential home for older people and to integrate the empirical results with a theoretical assumption upon which the intervention was based.

METHODS

A mixed methods research design was used. The Swedish Health-Related Quality of Life Survey and the Family Hardiness Index were administered before and 6 months after the intervention. Qualitative data was collected by semi-structured interviews with each family 6 months post-intervention. The sample included 10 families comprising 22 family members.

RESULT

Main finding was that FamHCs helped family members process their feelings about having a member living at a residential home and made it easier for them to deal with their own situations. FamHCs helped to ease their consciences, improve their emotional well-being, and change their beliefs about their own insufficiency and guilt. Seeing problems from a different perspective facilitated the families' thinking in a new way.

CONCLUSION

These findings showed that FamHC could be an important type of intervention to improve family functioning and enhance the emotional well-being.

Children as relatives to a sick parent: Healthcare professionals’ approaches

An illness or injury sustained by a family member affects all family members. It is consequently important that a child’s need to be involved in a family member’s care is clearly recognized by healthcare professionals. The aim of this study was to describe healthcare professionals’ approaches to children as relatives of a parent being cared for in a clinical setting. A web-based study-specific questionnaire was sent and responded to by 1052 healthcare professionals in Sweden. Data were analysed using descriptive statistics and qualitative analysis. The results show that guidelines and routines are often lacking regarding involving children in the care of a parent. Compared to other areas, psychiatric units seem to have enacted routines and guidelines to a greater extent than other units. The results indicate that structured approaches based on an awareness of the children’s needs as well as a child-friendly environment are vital in family-focused care. These aspects need to be prioritized by managers in order to support children’s needs and promote health and wellbeing for the whole family.

Associations of Emotional Distress and Perceived Health in Persons With Atrial Fibrillation and Their Partners Using the Actor-Partner Interdependence Model

Individual behavior affects and is affected by other people. The aim of this study was to examine if emotional distress in patients with atrial fibrillation (AF) and their spouses was associated with their own and their partner's perceived health. Participants included 91 dyads of patients and their spouses. Emotional distress was measured using the Hospital Anxiety and Depression Scale and perceived health was measured with the Short Form 36 Health Survey. The Actor-Partner Interdependence Model was used for dyad-level analyses of associations, using structural equation modeling. Higher levels of anxiety and depression were associated with lower levels of perceived health in patients and spouses. Higher levels of depression in patients were associated with lower levels of vitality in spouses and vice versa. As AF patients and their spouses influence each other, health-care interventions should consider the dyad to address dyadic dynamics. This may benefit the health of the individual patient and of the couple.

Experiences With Family Health Conversations at Residential Homes for Older People

The aim of this study was to highlight family members’ experiences of participating in Family Health Conversation (FamHC), based on families in which a family member was living in a residential home for older people. A total of 10 families and 22 family members participated in evaluating family interviews 1 month after participating in FamHC. The interviews were analyzed by qualitative content analysis. The main finding was being a part of FamHC increased family members’ insights, understanding, and communication within the family. Getting confirmation from nurses was essential to cope with the new life situation, which also meant that they felt comfortable to partly hand over the responsibility for the older person who moved to the residential home. By being open and expressing their feelings, a bad conscience could be relieved. These findings showed that FamHC could be helpful for family members in adapting to this novel situation.

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

AIMS

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

METHODS

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

RESULTS

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

DISCUSSION

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

Family Nursing Therapeutic Conversations in Heart Failure Outpatient Clinics in Denmark: Nurses' Experiences

As part of the Heart Failure Family Trial presently being conducted in Denmark, this qualitative process evaluation explored the perceptions of seven practicing cardiac nurses who offered family nursing therapeutic conversations (FNTC) to families in three heart failure outpatient clinics. FNTC were guided by the Calgary Family Assessment and Intervention Models. Data consisted of 34 case reports written by the nurses which documented the use of FNTC, including family responses to the FNTC. A focus group interview with the six of the nurses about their experience of offering FNTC was also conducted. Content analysis was performed using a combined deductive and inductive process. Nurses reported developing a distinct, closer, and more constructive relationship with the patients and their families and reported FNTC increased family bonding and strengthened family relationships. The nurses considered FNTC to be feasible interventions in the routine care provided in heart failure outpatient clinics.

A Family Systems Nursing Approach for Families Following a Stroke: Family Health Conversations

Stroke in midlife is a life altering, challenging experience for the whole family thereby necessitating a family approach to intervention. The aim of this study was to describe the experiences of 17 family members living in Sweden, including seven adult stroke patients (six males; one female) under the age of 65 who participated in a series of three nurse-led family conversations that were offered in each family's home. These Family Health Conversations (FamHC) were guided by the conceptual lens of Family System Nursing. Individual, semi-structured, evaluative interviews conducted with each participant one month after the FamHC were analyzed by qualitative content analysis. The FamHC were described by family members as a unique conversation that they had not previously experienced in health care contexts. Family members described possibilities for relational sharing and meaningful conversations as well as changes in family functioning that support the suitability of FamHC for family stroke care.

Nurses' perspective of conducting family conversation

Introduction

Nurses are in a prime position to manage to support families that have a family member living in a residential home for older people. Nurses’ attitudes about meeting patients’ family members vary. Studies describe that some nurses consider family members as a burden. But some nurses consider family members a resource and think it is important to establish good relationships with them.

Aim

The aim of this study was to describe how registered nurses (RNs) experienced to participate in and conduct the intervention Family Health Conversations (FamHCs) with families in residential homes for older people.

Methods

The intervention FamHC was accomplished at three residential homes for older people. FamHC is a family systems nursing (FSN) intervention developed to support families facing the ill health of someone in the family. One RN from each residential home conducted the conversations. The RNs wrote diary notes directly after each conversation. The RNs were also interviewed 1 month after they had each conducted four FamHCs. The diary notes and the interviews were analysed separately by qualitative content analysis, and the findings were then summarized in one theme and further discussed together.

Findings

The main findings were that the RNs experience the conversations as a valuable professional tool involving the whole family. The RNs grasped that silence can be a valuable tool and had learned to attentively listen to what the families were saying without interrupting, allowing them and the families to reflect upon what the family members said.

Conclusion

The findings show that the FamHC can be helpful for RNs in their work, helping them to perceive and understand the needs and desires of the families.

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

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

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

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