Living with heart failure: perspectives of ethnic minority families

Family-Oriented Therapeutic Conversations: A Systematic Scoping Review

There is increasing evidence that highlights the benefits of Family-oriented Therapeutic Conversations (FAM-TC) for the patient and the family; however, studies show variability regarding the content and the way these interventions are offered. This may hamper its further development in clinical practice. This review systematically maps the available literature on nurse-led FAM-TC and offers a solid synthesis of the characteristic, effectiveness, and feasibility of these interventions. A systematic search in PubMed, CINAHL, Cochrane, Web of Science, PsycINFO, Trip (Turning Research Into Practice), BASE (Bielefeld Academic Search Engine), OATD (Open Access Theses and Dissertations), and ProQuest databases identified 37 studies. The interventions varied in interventionist nurses' profile, the intervention content, or the duration of the sessions offered. Most of the interventions showed beneficial effects on perceived family support and family functioning. This review offers suggestions for future studies, such as the inclusion of specific theoretical frameworks for intervention design, targeting both the patient and the family and offered by nurses with family nursing competency.

Lived Experience of Adult With Heart Failure at Tibebe Ghion Specialized Teaching Hospital Northwest Ethiopia, Qualitative Phenomenological Study

Background

Heart failure is major public health problem that affects many people worldwide. It affects all aspects of patients' lives, leading to extreme physical, social, and functional restriction and increasing psychological distress. The purpose of this study was to explore the lived experience of adult patient with heart failure at Tibebe Ghion Specialize Hospital, Ethiopia, 2022.

Method

Qualitative Phenomenological study design was conducted at Tibebe Ghion Specialized Referral Hospital, from November 10 to December 15, 2022. Heterogenous purposive sampling technique was used to select 11 study participants. Data were collected through in-depth interviews guides and observational checklist. The rigor and trustworthiness of the study were maintained by transferability, dependability, credibility, and conformability. Thematic analysis method was used for the development of codes and themes using ATLAS. ti.7 software for analysis.

Result

Five main themes and eleven subthemes were developed that explore the lived experience of adults with heart failure. Impact of heart failure on daily life, psychological and spiritual experiences, financial experiences, experiences related to hospital service, and challenges to getting treatment are major themes. Unavailability of medicine, lab investigations, and the inaccessibility of cardiac centers were the main challenges during their treatment.

Conclusion

This study explored that lived experience of adult HF patients were addressed in in terms of Physical, Psychological and Spiritual, financial, hospital service and challenges to get treatment. Therefore, we recommended providing psychological and economical support for HF patients and in addition to accessing medication and medical care centers.

Protective Buffering: Nurses Facilitating Communication Between Adults With Cancer and Their Adult Family Caregivers Who Overprotect One Another-An Integrative Review

The aim of this study was to explore how nurses can alleviate protective buffering between adult patients with cancer and their adult family caregivers (PROSPERO No. CRD42020207072). An integrative review was conducted. PubMed, CINAHL, Embase, and Cochrane Library were searched for primary research articles published between January 2010 and April 2022. Only research conducted in oncology, hematology, or multiple settings and investigating communication between adult patients with cancer and their adult family caregivers and/or the communication between patients, family caregivers, and nurses was included. The constant comparison method outlined the approach to the analysis and synthesis of the included studies. Titles and abstracts of 7,073 references were screened; 22 articles (19 qualitative and three quantitative studies) were included in the review. Three themes emerged during data analysis: (a) family coping, (b) an isolating journey, and (c) the nurse's role. A study limitation was that "protective buffering" is not a common term in the nursing literature. There is a need for further research on protective buffering in families with cancer, particularly on psychosocial interventions that focus on the whole family across various cancer types.

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE PERSIAN VERSION OF THE FAMILY FUNCTIONING, HEALTH, AND SOCIAL SUPPORT QUESTIONNAIRE IN A SAMPLE OF HEART FAILURE PATIENTS AND THEIR FAMILY MEMBERS

Background and Purpose: Family functioning, family health, and social support have significant roles in the management of heart failure (HF). This study aimed to translate, adapt, and assess the validity and reliability of the Persian version of the Family Functioning, Family Health, and Social Support (FAFHES) questionnaire. Methods: FAFHES questionnaire was translated into Persian, and an expert panel assessed the cross-cultural adaptation. We examined the construct validity by confirmatory factor analysis and internal consistency by Cronbach's alpha coefficients among 576 participants. Results: The Persian FAFHES confirmed the three-factor structure in the social support and the five-factor structure in the family health scales. However, the family functioning scale yielded the three-factor structure versus the four-factor structure in the original scales. The Cronbach's alpha for the three scales varied from 0.85 to 0.94. Conclusions: The adapted FAFHES seems to be valid and reliable to measure family functioning, family health, and social support in families with HF.

Adherence Barriers to Treatment of Patients with Cardiovascular Diseases: A Qualitative Study

Background

Adherence to treatment is highly important in the management of Cardiovascular Diseases (CVD). Barriers to effective and long-term adherence to treatment by the patient make achieving care and treatment goals challenging. The aim of this study was to identify the adherence barriers to the treatment plan in patients with CVD.

Materials and Methods

A qualitative content analysis study was conducted to explore the experience of patients, family caregivers, and healthcare professionals (n = 35) using qualitative content analysis. The study was carried out between 2019 and 2020 in Isfahan, Iran. Purposive sampling was performed. Data collection was conducted through in-depth interviews and semi-structured until data saturation. Graneheim and Landman content analysis was performed simultaneously with data collection.

Results

After data analysis, 3 themes and 6 categories were identified and named. Themes (and categories) include "Patients unreadiness to change" (misunderstanding of conditions and consequences and deterrence cultural practices and beliefs); "gap in healthcare services" (lack of adequate support for patients and discordance between healthcare professionals); and "limited access to healthcare services" (limited physical access and financial burden).

Conclusions

The findings of the present study can provide a framework for healthcare professionals to employ preventive strategies, reduce disease complications, decrease unhealthy behaviours, and increase prolonged adherence to treatment recommendations in patients with CVD.

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.

Coping with chronic cardiovascular disease in Iran: A qualitative study

The effects of chronic cardiovascular disease can challenge the achievement of treatment goals and recovery outcomes. This study explores the ways in which patients cope with the effects of chronic cardiovascular disease, from the perspectives of patients, family caregivers, and health professionals. The qualitative study was conducted from May 2019 to September 2020 in Isfahan, Iran. Thirteen people with chronic cardiovascular disease, 6 family caregivers, and 16 healthcare professionals participated in semi-structured individual interviews. Transcripts were analysed thematically. Findings suggest that people with chronic cardiovascular disease use a range of coping strategies, both positive and negative, to adjust to their conditions. The positive strategies include managing their health-related symptoms, drawing on religious or spiritual beliefs, and accessing social and relational supports. Negative strategies can include over-reliance on family members for support, leading to reduced activity and loss of independence. Understanding the nature of the strategies used by patients provides an important means by which health service providers can support patients to further develop positive coping strategies. This, in turn, will enable patients to achieve higher levels of wellbeing.

Factors associated with family functioning in patients with heart failure and their family members: An international cross-sectional study

AIMS

To describe and compare family functioning, family health, and perceived social support from nurses and to identify the variables that are associated with family functioning in patients with heart failure (HF) and their family members in Denmark, Iran, and Iceland.

DESIGN

An international multi-centre cross-sectional study.

METHODS

A sample of 1382 participants (692 patients and 690 family members) from Denmark, Iceland, and Iran were included from January 2015 to May 2020. Data were collected using the Family Functioning, Health, and Social Support questionnaire.

RESULTS

The significant factors associated with family functioning in patients were country, New York Heart Association classification (NYHA), education level, age, family health, social support, and there was a significant interaction effect between NYHA class and gender. The significant factors associated with family functioning in family members were country, education level, work status, family health, and there was a significant interaction effect between education and work status.

CONCLUSION

This study indicated that the strongest factor associated with higher family functioning was family health for both patients and family members. Women in NYHA class I and younger patients and those with an academic education had a lower level of family functioning. Moreover, unemployed family members with an elementary education and family members with elementary and high school educations who were self-employed or employees had a lower level of family functioning.

IMPACT

This is the first international study to investigate family functioning, family health, and social support and adds to the literature on the factors associated with family functioning in patients with HF and their family members. Our findings may help nurses to identify the most vulnerable families living with HF, thereby being able to provide special support to enhance their family functioning to promote self-management strategies.