Implementing family nursing: how do we translate knowledge into clinical practice?

Implementation and efficacy of knowledge translation frameworks in family focused nursing care: A scoping review

AIM

To provide an overview of the characteristics, variety and outcomes of knowledge translation (KT) strategies used in nursing care involving adult patients and their family members.

BACKGROUND

The gap in providing family nursing practice could be due to a lack of explicit KT frameworks and understanding of ways to translate evidence-based knowledge into clinical practice.

DESIGN

A scoping review conducted according to the Joanna Briggs Institute.

METHODS

The review is reported according to PRISMA-ScR. Relevant studies were searched in MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL Complete, ProQuest Nursing & Allied Health Premium, PsycINFO, Social Work Abstracts, Social Services Abstracts and Scopus. Grey literature was searched in ProQuest Dissertations & Theses Global. Search results were imported into the web-based programme Covidence. Studies describing concepts of KT, strategies of implementation, involvement of families and nurses/family caregivers in adult health care and conducted within the last 15 years were included.

RESULTS

Eight studies met the inclusion criteria. Three studies used the KTA Framework to guide the implementation process. The remaining five studies used different frameworks/guidelines to translate a variety of family focused interventions into their clinical practice. Translation strategies were often targeted towards nurse education. Reported outcomes included nurses' attitudes towards and acceptance of involving families in health care. The outcomes were conceptualized and measured differently, showing inconclusive results on effectiveness on family focused care and family health.

CONCLUSION AND IMPLICATIONS FOR CLINICAL PRACTICE

The application of KT frameworks to implement evidence-based family nursing into clinical practice is limited. The process of KT mainly targets at nurses' adoption of family focused interventions with limited information about short-, intermediate- and long-term efficacy on family health. Clinical leaders should consider time and resources needed to implement family focused care KT strategies before putting it into practice.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. Data were obtained from other's literature.

The Implementation of Evidence-Informed Family Nursing Practices: A Scoping Review of Strategies, Contextual Determinants, and Outcomes

There is a lack of knowledge about the successful implementation of family nursing practices. This scoping review maps current knowledge about the implementation of evidence-informed family nursing practices across settings and populations. A systematic search (CINAHL, PubMed, Medline) identified 24 publications, published between 2010 and 2020. We found nurses' implementation experience to be one of disruption, learning, and moving to new ways of practicing. The implementation resulted in benefits to families and self but was marked by fluctuation and partial integration of evidence-informed family nursing practices into care delivery. Uptake was shaped by various contextual determinants, with barriers mainly at the team and organizational levels. We identified low-quality, tentative evidence that capacity-building strategies coupled with dissemination-educational strategies may enable family nursing practice skills and increase the quality of family care. More rigorous research is needed to build further knowledge about effective implementation. Future implementation endeavors should utilize the evolving knowledge base in family nursing and tailor implementation strategies to contextual barriers.

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

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

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.

Drawing forward family strengths in short therapeutic conversations from a psychiatric nursing perspective

PURPOSE

The aim of the narrative is to describe the therapeutic process and experience from a psychiatric nursing perspective, in therapeutic communication, with a father and his son in acute psychiatry.

METHODS

In this case scenario, the Family Strength-Oriented Therapeutic Conversation Intervention (FAM-SOTC Intervention) was used.

FINDINGS

The FAM-SOTC Intervention was found to be beneficial for the father-son relationship.

PRACTICE IMPLICATION

It is encouraging for nurses in acute psychiatry to know that three short therapeutic conversations can make a difference within the family system. FAM-SOTC seemed to offer cognitive and emotional support to the father-and-son dyad.

Feasibility and short-term impact of the "case study in-house group training program for family nursing" at medical facilities

The aim of this study was to evaluate the feasibility and short-term impact of case study training in family nursing care targeting midlevel nursing professionals. The intervention group participated in four 90-minute case study training sessions over 6 months, while the control group participated in two 90-minute lectures. Using primary outcome variables as evaluation indexes, we measured the participants' total scores on the Family Importance in Nursing Care Scale and 4 subitems 3 times (before, immediately after and 1 month after training) from May 2014 to March 2015 and then conducted 2-way repeated-measure analysis of variance. We asked the participants and training planners/managers to provide feedback on their evaluation and then performed content analysis on their responses. Although the primary impact due to the different measurement times was significant, no significant difference was observed in the interaction between measurement time and training differences. Of the 4 subitems, significant interactions because of measurement time and training differences were observed only in Fam-B. Feedback data showed all participants felt that their understanding of the importance of family nursing care was strengthened, and participants in the intervention group specifically described how they were utilizing what they had learned from training in practice.

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.

Waiting to return to normal: an exploration of family systems intervention in childhood cancer

The illness suffering of families in childhood cancer is characterized in part by a loss of family normalcy. Hermeneutic phenomenology and family process research methods were used to analyze videotaped family intervention sessions and post-intervention family/clinician interviews. Within this article, some of the findings from the larger doctoral study that focused on the illness suffering of family members and relational, family systems intervention based on the Illness Beliefs Model are described. Although the larger study included findings of family interventions that addressed several aspects of the illness suffering experienced, this article details specific findings related to the theme of the loss of family normalcy and a longing to return home. Family systems intervention practices which facilitated a lessening of illness suffering included the following: offering new interpretations of suffering within a reflecting team, articulating family strength, sensitively acknowledging the illness suffering, and eliciting the experiences of family members in a shared therapeutic conversation.

Contextual barriers to the successful implementation of family-centered practice in mental health care: a Hong Kong study

This article presents findings from an exploratory study to identify nurses' perspectives on factors that hinder the implementation of family-centered practice in mental health settings in Hong Kong. Thirty-four nurses participated in the study by completing the pre- and post-questionnaires. Ten nurses were invited to participate in focus group and case interviews. The analysis identified knowledge-practice gap, role of psychiatric nurses, professional identity of psychiatric nurses, and management support as negatively affecting the nurses in implementing a family-centered approach to mental health care. Suggestions about facilitating the implementation of the family-centered approach into clinical practice are offered.

The 15-minute family interview: a family health strategy tool

The 15-minute family interview is a condensed form of the Calgary Family Assessment and Intervention Models (CFAM and CFIM) that aims to contribute to the establishment of a therapeutic relationship between nurses and family and to implement interventions to promote health and suffering relief, even during brief interactions. This study investigated the experience of nurses from the Family Health Strategy (FHS) who used the 15-minute interview on postpartum home. The qualitative research was conducted in three stages: participants' training program, utilization of the 15-minute family interview by participants, and interviews with nurses. The data were collected through semistructured interviews with eight nurses. The thematic analysis revealed two main themes: dealing with the challenge of a new practice and evaluating the assignment. This work shows that this tool can be used to deepen relationships between nurses and families in the Family Health Strategy.

Strengths-oriented therapeutic conversations for families of children with chronic illnesses: findings from the Landspitali university hospital family nursing implementation project

Psychosocial services have been recommended for families of children with chronic illnesses to assist them in adjusting to the illness experience. However, little is known about the benefit of psychosocial interventions in clinical practice. This study aimed at evaluating the benefits of a two-session family therapeutic conversation intervention (FAM-TCIs) for families of children diagnosed with asthma, cancer, or diabetes. A secondary data analysis was conducted on intervention data from 37 families of children with chronic illnesses. Mothers of the children/teenagers perceived significantly higher family support after the FAM-TCI compared with before; mothers reported significantly higher collaboration and problem-solving abilities on the expressive family functioning scale after the FAM-TCI. However, no significant differences were found on the fathers' perceived family support nor on their expressive family functioning after the FAM-TCI compared with that before the intervention. It is promising that mothers of children with chronic illness perceived the two-session FAM-TCI to be beneficial to them. More attention should be paid to psychosocial interventions for families of children with chronic illnesses.

Does a therapeutic conversation intervention in an acute paediatric setting make a difference for families of children with bronchiolitis caused by respiratory syncytial virus (RSV)?

AIMS AND OBJECTIVES

To measure the benefit of a short-family therapeutic conversation (STC) intervention in an acute paediatric unit.

BACKGROUND

Studies of children with bronchiolitis caused by respiratory syncytial virus (RSV) have shown that this virus may have an impact on their respiratory system in the form of a wheezing disorder, asthma and even allergy during their childhood. Studies of the parents of these children indicate that they experience distress, vulnerability and anxiety through the illness period and therefore need support from healthcare professionals. However, little is known about what intervention is of most benefit for these parents.

DESIGN

Quasi-experimental.

METHOD

Data were collected from a convenience sample from February throughout April 2009 at an acute unit at a children's hospital in Iceland. Parents of infants diagnosed with bronchiolitis caused by RSV were invited to attend. In total, there are 41 participants: 21 in the intervention group (n = 21) and 20 in the control group (n = 20). Parents in both groups answered questionnaires about perceived support and family expressive functioning both before the intervention and on an average of 11 days after the intervention.

RESULTS

The main findings showed that mothers in the intervention group perceive significantly higher support after the intervention compared with the control group. The findings also showed a significant difference between the genders (mothers and fathers) in the intervention group. The mothers perceived higher cognitive support than the fathers.

CONCLUSIONS

Despite the often chaotic environment in an acute care setting, the research findings give paediatric nurses reason to conclude that a STC intervention benefits mothers of infants with bronchiolitis caused by RSV.

RELEVANCE TO CLINICAL PRACTICE

A STC intervention offered by a nurse within an acute paediatric unit can support families in handling the illness experience.

Comparative standards of evidence in social work

In this article the authors analyze relevant and reliable evidence on the effects of the preferable treatment customized to each social work client. In doing so, the authors look at four major standards of evidence: (1) evidence-based practice, (2) collaboration models (i.e., the Cochrane Collaboration and the Campbell Collaboration), (3) knowledge translation, and (4) the Social Work Article Club. The ultimate goal of these standards of evidence is to successfully transfer research into practice. Currently, there is a gap between research and practice as a result of a lack of collaboration. Most social workers do not possess the skills to implement change in practice based on research evidence. The authors' objective is to increase understanding by instilling, in part, positive feelings toward research.

Study of Nurses' Knowledge about Palliative Care: A Quantitative Cross-sectional Survey

CONTEXT

Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in palliative care. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and knowledge related to pain and palliative care.

AIMS

The objective of this paper was to assess the knowledge about palliative care amongst nursing professionals using the palliative care knowledge test (PCKT).

SETTINGS AND DESIGN

Cross-sectional survey of 363 nurses in a multispecialty hospital.

MATERIALS AND METHODS

The study utilized a self-report questionnaire- PCKT developed by Nakazawa et al., which had 20 items (statements about palliative care) for each of which the person had to indicate 'correct', 'incorrect', or 'unsure.' The PCKT had 5 subscales (philosophy- 2 items, pain- 6 items, dyspnea- 4 items, psychiatric problems- 4 items, and gastro-intestinal problems- 4 items).

STATISTICAL ANALYSIS USED

Comparison across individual and professional variables for both dimensions were done using one-way ANOVA, and correlations were done using Karl-Pearson's co-efficient using SPSS version 16.0 for Windows.

RESULTS

The overall total score of PCKT was 7.16 ± 2.69 (35.8%). The philosophy score was 73 ± .65 (36.5%), pain score was 2.09 ± 1.19 (34.83%), dyspnea score was 1.13 ± .95 (28.25%), psychiatric problems score was 1.83 ± 1.02 (45.75%), and gastro-intestinal problems score was 1.36 ± .97 (34%). (P = .00). The female nurses scored higher than their male counterparts, but the difference was not significant (P > .05).

CONCLUSIONS

Overall level of knowledge about palliative care was poor, and nurses had a greater knowledge about psychiatric problems and philosophy than the other aspects indicated in PCKT.

Psychometric development of the Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ)

Instruments that are able to capture changes related to an intervention are of great value to the scientific as well as to the clinical community. The Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ) measures expressive emotions, collaboration, problem solving, communication, and behavior in families experiencing a chronic or an acute illness. The conceptual framework of the Calgary Family Assessment Model (Wright & Leahey, 2009) was used to construct the original questionnaire of 45 items and 10 subcategories. A total of 557 family members with a recent illness experience of a close relative answered the ICE-EFFQ in three different studies. Principal component factor analysis reduced the original questionnaire to 22 items with five factors emerging and a total Cronbach's alpha coefficient of α = 0.912 accounting for 60.3% of the total variability. Confirmatory factor analysis from two studies produced the final version of the questionnaire consisting of 17 items and four factors.

Knowledge translation in family nursing: does a short-term therapeutic conversation intervention benefit families of children and adolescents in a hospital setting? Findings from the Landspitali University Hospital Family Nursing Implementation Project

In an effort to examine translation of family nursing knowledge to practice, the Landspitali University Hospital Family Nursing Implementation Project (2007-2011), was thoughtfully initiated in Reykjavik, Iceland and systematically evaluated. The mission was to implement family nursing in every department of the hospital. This publication is the first formal research report from this landmark project. The purpose of this research was to evaluate the effectiveness of a short-term therapeutic conversation intervention with families who were receiving health care services at the Children's Hospital at Landspitali University Hospital in Iceland related to childhood and adolescent acute and chronic illnesses. The therapeutic conversation was guided by Family Systems Nursing and used the Calgary Family Assessment and Intervention Models (Wright & Leahey, 2005, 2009). Families (N = 76) were randomly assigned to either an experimental group (short-term therapeutic conversation: n = 41) or to a control group (traditional care: n = 35). Parents in the experimental group reported significantly higher family support after the intervention, compared to the parents in the control group. Differences were noted between families experiencing acute versus chronic illnesses. Recommendations are made for conducting and designing intervention research with families experiencing the hospitalization of a child or adolescent.

Psychometric development of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ)

Valid and reliable instruments are needed to measure how family members perceive support from nurses when a family member is experiencing serious illness. The purpose of this article is to describe the development and psychometric testing of a new instrument, the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ). The concepts in the original version of the ICE-FPSQ (suggesting 24 items and 4 categories) were developed from the Calgary Family Intervention Model. In the first phase of the instrument construction, 179 family members answered the original ICE-FPSQ, and 236 answered the questionnaire in the second phase of testing. Principal Component Analysis (PCA) reduced the original questionnaire to 21 items. Cronbach's α = .959 explained 68% of the total variance, with three factors emerging: (a) emotional support (α = .925), (b) recognition of families' strengths (α = .926), and (c) cognitive support (α = .841). Confirmatory Factor Analyses (CFA) resulted in a final version of the questionnaire containing 14 items with total alpha of .961 and two factors: (a) cognitive support (α = .881) and (b) emotional support (α = .952). The instrument measures family's perceptions of support provided by nurses and will be helpful in examining the usefulness of family nursing interventions.

Intervention fidelity: ensuring application to practice for youth and families

PURPOSE

Limited information on intervention fidelity is available in published studies with youth and families. The components of intervention fidelity, the complexity of measurement in these studies, and strategies for measuring intervention fidelity are described.

CONCLUSIONS

Strategies for ensuring intervention fidelity according to the Treatment Fidelity Workgroup of the Behavior Change Consortium in the areas of study design, provider training, treatment delivery, treatment receipt, and treatment enactment provide guidance for evaluating or developing intervention fidelity plans.

PRACTICE IMPLICATIONS

Ensuring the quality of intervention fidelity in evidence-based reviews or when developing new interventions is essential for translating findings into practice.

Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program

This study measures the attitudes of the psychiatric nurses, after having received an education and training intervention program (ETI-PROGRAM) in family systems nursing, towards the importance of the families in their care. Nurses' knowledge of the impact that family nursing intervention can have on family members may increase positive attitudes towards families. However, little is known about the impact that education and training intervention can have on nurses' attitudes, towards families in clinical practice. Quasi-experimental design was used to assess the change in nurses' attitudes towards families in psychiatric care after the intervention, which included a one-day seminar on the Calgary family nursing conceptual frameworks and skills training with clinical vignettes of families from psychiatry. The Families Importance in Nursing Care - Nurses' Attitude questionnaire was used to evaluate nurses' attitudes. A total of 81 nurses (65%) working in psychiatric care responded to the questionnaire. Nurses with more than 15 years of work experience were significantly more supportive of families in their care compared with less experienced nurses. Out of the 81 nurses, 52 (64%) answered the questionnaire again 14 months later. Furthermore, psychiatric nurses saw families significantly less burdensome after having participated in the ETI-PROGRAM.

Return of the "intimate outsider": current trends and issues in family nursing research revisited

This article reviews family nursing research published from 1996 to 2011. This is a follow-up to a review published in the Journal of Family Nursing in 1995. Findings from the first review are compared with this one, trends in family nursing scholarship are identified, and predictions and suggestions for future directions are offered. The latest generation of family nursing scholarship is conceptually and methodologically sound, and there is evidence of more multidisciplinary and interdisciplinary research conducted by family nursing researchers. Scholars are paying more attention to issues of diversity and family context at present than in the past, although there are still aspects of diversity that need more attention. Strong research programs in family nursing exist worldwide; an international synergism has helped promote rapid expansion of family nursing research and theory development. A vigorous movement to promote research to practice initiatives and greater attention to family interventions are exciting developments.

Do family interventions improve health?

The central aim of this article is to examine the evidence that family interventions improve health in persons with chronic illness and their family members, across the life span. The review focuses on recent meta-analyses of randomized controlled trials of family intervention research. In adults, evidence supports the salutary effects of family interventions versus usual medical care for patient health and mental health, and for family member health. In children, robust evidence supports family-based multimodal interventions for obesity treatment. Reasonable evidence supports family approaches to type 1 diabetes treatment in children. Nurses led the research or were members of interdisciplinary research teams in several of these literatures, representing one quarter to one third of the research cited, but were absent in other literatures, such as family treatment of childhood obesity.

The essence of the family critical illness experience and nurse-family meetings

Nursing care of families is essential to strong family support and maintenance of family health during a critical illness. Secondary data analysis of interviews conducted with 11 families with a family member in the intensive care unit revealed two essences: the family critical illness experience and the family vision for the kind of care families required and desired from nurses. The purpose of this article was to explicate the essence of these phenomena and their implications for family nursing practice. Findings affirm the need for a family intervention described in the literature, that of regularly scheduled nurse-family meetings. Although developed for work with families experiencing a chronic illness, bringing families together and inviting meaningful conversation about their experiences is appropriate for families experiencing critical illness. Nurse-family meetings acknowledge suffering and vulnerability of families when a loved one is critically ill and afford families an opportunity for honest sensitive communication with nurses.

Family nursing research for practice: the Finnish perspective

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