Setting new priorities for nursing research: The updated Swiss Nursing Research Agenda-a systematic, participative approach

AIM

To identify current key areas for nursing research in Switzerland, we revised the Swiss Research Agenda for Nursing (SRAN) initially published in 2008.

BACKGROUND

By developing a research agenda, nursing researchers internationally prioritize and cluster relevant topics within the research community. The process should be collaborative and systematic to provide credible information for decisionmakers in health care research, policy, and practice.

SOURCES OF EVIDENCE

After a participative, systematic, and critical evaluation within and outside of the Swiss Association for Nursing Science, the updated SRAN 2019-2029 defines four research priorities (new models of care, nursing care interventions, work and care environment, and quality of care and patient safety) and four transversal themes (organization of research, research methodologies, research in health care policy and public health perspectives).

CONCLUSION

Adding to other national nursing research agendas, the categories are organized in a framework of key research priorities and transversal themes. They relate to the importance of global and local foci of research as well as challenges in health care services and policy systems. The agenda is an important prerequisite for enhancing the influence of nursing research in Switzerland and provides guidance for the next decade.

IMPLICATIONS FOR NURSING PRACTICE

The revised agenda ensures that research projects target key knowledge gaps and the discipline's core questions in respective countries.

IMPLICATIONS FOR HEALTH POLICY

Nursing research should inform and influence health policy on all institutional and political levels. Therefore, the integration of public health perspectives in research is one of the most important new aspects of SRAN 2019-2029.

Implementing Buurtzorg-derived models in the home care setting: a Scoping Review

Background

Buurtzorg is a pioneering healthcare organization founded in the Netherlands. Buurtzorg has established independent, self-managing teams of nurses and promises high-quality home care at a lower cost through person-centered care, continuity of care, building trusting relationships, and networks in the neighborhood. Traditional home care services are increasingly reorganized according to the Buurtzorg-principles.

Objectives

This review aims to describe the experiences gathered during the implementation of the Buurtzorg-derived model outside the Netherlands. It further outlines their potential effects.

Design

Scoping Review.

Methods

Several electronic databases were searched for relevant articles, supplemented by hand-searching and internet searches for gray literature. Various publication types that described the implementation of the Buurtzorg model or its outcomes in countries other than the Netherlands were included. The data were analyzed using qualitative content analysis. Two authors coded the data in several cycles and created categories and subcategories.

Results

The review identified 25 publications reporting the experiences or outcomes of Buurtzorg-derived models outside the Netherlands. Upon implementing elements of Buurtzorg, the home care organizations adopted a person-centered care approach, with improved communication with patients and family caregivers, and could establish new networks with other services. The main challenges were related to the self-managed working culture, the organizational framework, or national healthcare policies, which hindered the implementation process.

Conclusions

The implementation of Buurtzorg-derived models is complex, challenging, and requires adaptations on several levels: upskilling of networking and staffing competencies in teams, leadership and IT requirements in the organization, and policy changes in the healthcare system. Individualized approaches and solid conceptual preparation are required for implementation.

Tweetable abstract

Experiences with the implementation of Buurtzorg in home care services outside the Netherlands. A scoping review @HegeduesAnna.

[Civilian Service to Support Informal/Family Caregivers at Home: Acceptance and Need in Switzerland]

BACKGROUND

There is an unmet and increasing need for informal/family care for older adults, the sick, and those with disabilities living in private households. Alternative civilian services provided by so-called "zivis" could make an important contribution to supporting informal caregivers. However, its acceptance and the actual demand by informal caregivers and care recipients are not well understood.

METHOD

A total of 314 informal caregivers and 78 care recipients were surveyed about their potential demand for a zivi and their preferences regarding qualifications of zivis, kind of service expected, working time, service duration, as well as willingness to pay. We used descriptive and inferential statistical methods for the analysis.

RESULTS

Informal caregivers (87%) and care recipients (90%) deemed zivis beneficial in private households, and acceptance increased with the general need for care. For most respondents, the qualifications of the zivis were not their first priority, but rather a "pleasant personality". Help with household chores and transportation assistance were a important for the vast majority of respondents, help with personal hygiene for 40% (caregivers) and 35% (care recipients), respectively.

CONCLUSION

Zivis could serve as an important pool of carers for persons in private households with impaired ability to carry on with activities of daily life caused by ill health, especially cognitive and physical decline. They can offer help in many areas of living, but continued and reliable assistance is important.

[Alternative civilian service as a "helping hand" in private households - potentials for reconciling work and informal care]

Alternative civilian service as a "helping hand" in private households - potentials for reconciling work and informal care Abstract. Background: Informal caregivers (or family caregivers) are considered as the backbone of unpaid care in private households. As they are increasingly often employed, new sources of aid in domestic long-term care settings are needed. The Swiss Federal Council therefore mandated the Swiss Federal Office of Civilian Service to commission a study of how civil servants would be accepted as aids by informal caregivers and which services the latter would use. Aim: The results contribute to the development of alternative civilian services in Switzerland based on empirical evidence from informal caregivers who are employed at the same time. Methods: 158 informal caregivers from three language regions of Switzerland who were employed at the time answered a standardized quantitative survey. Their data was analyzed by descriptive and inferential statistical methods (hypothesis testing, regression). Results: Situations in which the cared-for person had cognitive limitations (29 %) constituted for the majority of the working time of civil servants as desired by informal caregivers (56 %) and were associated with increased willingness to pay. Support with caregiving tasks of personal hygiene and transport services were frequently desired, and the underlying settings required above-average intensity of support. Conclusions: There is a need for aid along the entire span of informal caregivers' working life. Reconcilability of employment and informal long-term care is dependent on a well-functioning, flexible network, which cannot be ensured by the labor market alone.

Gut leben zuhause mit Multimorbidität

Living well at home with multimorbidity - A project on the contribution of advanced practice nursing in home health care Abstract. Background: Multimorbidity has increased among the elderly, leading to loss of autonomy, lower quality of life, complex treatment plans and higher rates of complications and hospitalisations. Functional impairment and challenging therapy management make the use of home health nursing services essential. Experience in primary care and in hospitals has shown that Advanced Practice Nurses (APN) lead to a better quality of care for patients with multimorbidity. However, there is no data yet regarding the potential contribution of APNs to the care of these patients in home healthcare settings. Aim: To develop the role of the APN in a home health nursing organisation for patients with multimorbidity, applying internationally established APN core competencies. Methods: Characteristics of referred clients were collected and presented in case studies in an APN practice development project based on the PDCA-cycle. Benefits for clients, family caregivers, the nursing team, and for interprofessional collaboration were elaborated. Results: During the project period, a total of 40 clients were assigned to APN-care. An increase in stability in complex situations and higher confidence of clients and family caregivers in their individual health management were achieved. Discussion: The key factors were the APN's leadership role in best practice development and interprofessional collaboration. The APN played an important role in coordinating the numerous parties involved. Limits and transfer: This role must be further established. Empirical research is required to show the effect on quality of care.

Experiences of relatives with outpatient palliative care: a cross-sectional study

AIM

The authors aimed to evaluate the experiences of the relatives of dying people, both in regard to benefits and special needs, when supported by a mobile palliative care bridging service (MPCBS), which exists to enable dying people to stay at home and to support patients' relatives.

DESIGN

A cross-sectional survey.

METHODS

A standardised survey was performed, asking 106 relatives of dying people about their experiences with the MPCBS (response rate=47.3%). Descriptive statistics were analysed using SPSS 23.

FINDINGS

Many relatives (62.5%) reported that their dying relations when discharged from a facility to stay at home were not symptom-free. The MPCBS helped relatives maintain home care, and this was reported to be helpful. Support provided by the MPCBS made it easier for 77.6% of relatives to adjust care as soon as situations changed, and helped ensure that symptoms could be better controlled, at least for 68.2% of relatives. Younger relatives felt more encouraged by the MPCBS to care for their relatives dying at home.

Nurse Practitioners in Swiss Family Practices as Potentially Autonomous Providers of Home Visits: An Exploratory Study of Two Cases

In Swiss primary care, general practitioner (GP) home visits have decreased due to impending GP shortages particularly in rural areas. Nurse practitioners (NP) are newly introduced in family practices and could potentially offer home visits to the increasing number of multimorbid elderly. We analysed consultation data from two pilot projects (Practice A and Practice B) with the goal to measure the frequency and patient characteristics of NP consultations both in the practice and on home visits, and to determine the NPs’ autonomy based on the required GP supervision. In Practice A, 17% of all NP consultations were home visits, in Practice B 51%. In both practices, the NPs saw older patients and reported higher autonomy on home visits compared to consultations in the practice. In Practice A, the NP encountered a higher share of multimorbid patients on home visits than in the practice, and the NP’s proportion of autonomously conducted consultations increased from 0% in the first month to 19% after 13 months of GP supervision. In Practice B, the NP was autonomous in about three-quarters of consultations after 2 years on the job. These first cases provide some evidence that NPs could reach a relatively high degree of autonomy and might pose a potential solution for the decreasing numbers of GP home visits to multimorbid elderly in Swiss primary care.

Zwischen Himmel und Hölle: Erfahrungen von Eltern mit einem kritisch kranken Kind mit extrakorporaler Membranoxygenierung (ECMO) - Eine qualitative-explorative Studie mit Paarinterviews

Between Heaven and Hell: Experiences of parents with a critically ill child with extracorporeal membrane oxygenation (ECMO) - A qualitative-explorative study with couple interviews Abstract. Background: It is a traumatic experience for parents when their child's severe illness necessitates a period of intensive care. This situation becomes even more challenging for parents if a highly technical therapy such as extracorporeal membrane oxygenation (ECMO) in the Pediatric Intensive Care Unit is required. Aim: The study explores the experiences of parents of critically ill children undergoing ECMO therapy with the aim of better understanding their needs and identifying courses of action for healthcare professionals. Method: The qualitative-explorative study was based on interviews with six couples whose critically ill child is or has been receiving ECMO during the last year, which were used to examine their experiences. The analysis of six such interviews was performed using intensive paraphrasing and inductive coding. Results: The parents' situation can be best characterised as ambivalent with simultaneous feelings of hope and fear. They recognize the danger to their child's life, leading to intense feelings of helplessness with strong emotional reactions. It becomes apparent that there is too little fit between the emotional world of the parents and the action patterns of the health care professionals. Conclusions: The health care professionals thinking logic is based on professional criteria, such as the life threat and risks of ECMO, which ignores the emotional needs of the parents. For this reason, it is important to be more sensitive to the parents and to share positive little signs about their child' s state of health and ability to suffer with them.

Das Potenzial neuer Technologien zur Unterstützung von Pflege über eine räumliche Distanz - Literaturstand und qualitative Befunde

The potential of technological assistance to support distance caregiving - literature review and empirical results Abstract. Background: Due to demographic change, increasing labour mobility and changing family patterns, social relationships often exist over long distances. Supporting relatives over a distance is therefore a highly topical issue but still little discussed, also in Germany and Switzerland. Aim: The project "DiCa" (2016 - 2019) with an interdisciplinary research team from Germany (EH Ludwigsburg) and Switzerland (Careum School of Health, Zurich) aims to investigate different dimensions of "Distance Caregiving". This paper deals with the possible use of new technologies to support these care arrangements. Methods: Based on a literature review, qualitative interviews were conducted with "Distance Carers" and partner companies in Germany to investigate the use of new technologies in the context of "Distance Caregiving". Results: There are initial approaches concerning technical solutions in home care and in companies. So far communication options via telephone and smartphone and flexible working time and workplace regulations have played an important role. However, the potential of new technologies does not seem to be fully explored. Conclusions: In order to make the most of the various possibilities of innovative technologies in the context of "Distance Caregiving" for those affected but also for companies, well-researched information and independent advice and counseling are required for all parties involved in the care process.

„Wachsam? Aber sicher!“

Zusammenfassung. Hintergrund: Der Beitrag von Angehörigen zur Patientensicherheit ist bislang kaum untersucht. Pflegefachpersonen können als pflegende Angehörige auf spezifisches Fachwissen zurückgreifen. Fragestellung: Wie erleben Pflegefachpersonen unerwünschte Ereignisse bei der Gesundheitsversorgung ihrer Nächsten und wie gehen sie damit um? Methode: In der ersten Phase eines übergeordneten Forschungsprojekts mit sequenziellem Mixed Methods Design wurden insgesamt 30 leitfadengestützte Interviews mit Gesundheitsfachpersonen, die eine nahestehende Person unterstützen, geführt. Dabei waren 20 Pflegefachpersonen. Alle Interviews wurden theoretisch kodiert. Im Analyseprozess wurden die Herausforderungen von Pflegefachpersonen bei unerwünschten Ereignissen als Schlüsselkategorie bedeutsam. Ausgehend von ihrem Erleben und ihrem situativen Handeln wurde ein Modell entwickelt. Ergebnisse: Das Modell veranschaulicht ein Dilemma der Befragten, sich bei unerwünschten Ereignissen als Angehörige und als Pflegefachperson zu positionieren. Sie beobachteten als fachkundige Angehörige die Versorgung ihrer Nächsten besonders wachsam und erkannten riskantes Verhalten und Schwachstellen im Versorgungssystem rasch. Bei unerwünschten Ereignissen mussten sie entscheiden, ob sie sich als Fachperson zu erkennen geben. Vor einem Eingreifen wägten sie Vor- und Nachteile sorgfältig ab. Schlussfolgerungen: In der Gesundheitsversorgung ihrer Nächsten nutzen Pflegefachpersonen ihr Fachwissen besonders bei sicherheitsrelevanten Ereignissen, die sie als risikoreich einschätzen, um möglichen Schaden abzuwenden bzw. zu minimieren.

A tool for the consensual analysis of decision-making scenarios

The authors believe there is a need for novel ways of enhancing professional judgment and discretion in the contemporary healthcare environment. The objective is to provide a framework to guide a discursive analysis of an ongoing clinical scenario by a small group of healthcare professionals (4–12) to achieve consensual understanding in the decision-making necessary to resolve specific healthcare inadequacies and promote organisational learning. REPVAD is an acronym for the framework’s five decision-making dimensions of reasoning, evidence, procedures, values, attitudes and defences. The design is set out in terms of well-defined definitions of the dimensions, a rationale for using REPVAD, and explications of dimensions one at a time. Furthermore, the REPVAD process of application to a scenario is set out, and a didactic scenario is given to show how REPVAD works together with a sample case. A discussion is fleshed out in four real life student cases, and a conclusion indicates strengths and weaknesses and the possibility of further development and transferability. In terms of findings, the model has been tried, tested and refined over a number of years in the development of advanced practitioners at university healthcare faculties in two European countries. Consent was obtained from the four participating students.

Employed family caregivers in health care: from a logic of care to a logic of reconciliation / Berufstätige Angehörige im Gesundheitswesen: Von der Versorgungslogik zur Vereinbarkeitslogik

Introduction: In the context of illness, disability, and longevity, reconciliation of employment and family caregiving is evolving - in Switzerland termed „work & care“. Due to time, local, and personal restrictions, employed family caregivers need an organizational culture in health care which acknowledges their specific needs for reconciliation in order to remain employed and secure their financial situation.

Aim: To identify how organizational cultures in health care institutions influence reconciliation of employment and family caregiving.

Method: Within a larger study, case studies in three Swiss health care institutions were conducted within acute, long-term and homecare settings. Data triangulation included document analysis, expert interviews (N=13), field observations, and group discussions (N=5 each with 4-5 participants). The latter are focused in the analysis of this article.

Results: Three core categories are discussed: employed family caregivers providing care and receiving care, and how they are perceived physically present and absent, either employed or not employed. Employment of family caregivers was only marginally identified.

Discussion: Across all core categories, family caregivers are dominated by institutional rules in all care settings. This can foster or hinder reconciliation. Specific approaches, e. g. care coordination, enhance a sense of reconciliation within the health care system. Hence, health professionals can develop strategies that positively affect employment of family caregivers.

Conclusion: Health care institutions focus primarily on patients or residents. Thus, they follow predominantly a logic of care. This primacy should be complemented by a logic of reconciliation, in order to reinforce the lived reality of employed family caregivers.

Co-nonsolvency of PNiPAM at the transition between solvation mechanisms

We investigate the co-nonsolvency of poly-N-isopropyl acrylamide (PNiPAM) in different water-alcohol mixtures and show that this phenomenon is due to two distinct solvation contributions governing the phase behavior of PNiPAM in the water-rich and alcohol-rich regime respectively. While hydrophobic hydration is the predominant contribution governing the phase behavior of PNiPAM in the water-rich regime, the mixing contributions governing the phase behavior of classical polymer solutions determine the phase behavior of PNiPAM in the alcohol-rich regime. This is evidenced by distinct scaling relations denoting the energetic state of the aqueous medium as a key parameter for the phase behavior of PNiPAM in the water-rich regime, while the volume fractions of respectively water, alcohol and PNiPAM become relevant parameters in the alcohol-rich regime. Adding alcohol to water decreases the energetics of the aqueous medium, which gradually suppresses hydrophobic hydration, while adding water to alcohol decreases the solvent quality. Consequently, PNiPAM is insoluble in the intermediate range of solvent composition, where neither hydrophobic hydration nor the mixing contributions prevail. This accounts for the co-nonsolvency phenomenon observed for PNiPAM in water-alcohol mixtures.

Hydrophobic hydration of poly-N-isopropyl acrylamide: a matter of the mean energetic state of water

The enthalpically favoured hydration of hydrophobic entities, termed hydrophobic hydration, impacts the phase behaviour of numerous amphiphiles in water. Here, we show experimental evidence that hydrophobic hydration is strongly determined by the mean energetics of the aqueous medium. We investigate the aggregation and collapse of an amphiphilic polymer, poly-N-isopropyl acrylamide (PNiPAM), in aqueous solutions containing small amounts of alcohol and find that the thermodynamic characteristics defining the phase transitions of PNiPAM evolve relative to the solvent composition at which the excess mixing enthalpy of the water/alcohol mixtures becomes minimal. Such correlation between solvent energetics and solution thermodynamics extends to other mixtures containing neutral organic solutes that are considered as kosmotropes to induce a strengthening of the hydrogen bonded water network. This denotes the energetics of water as a key parameter controlling the phase behaviour of PNiPAM and identifies the excess mixing enthalpy of water/kosmotrope mixtures as a gauge of the kosmotropic effect on hydrophobic assemblies.

[Hospital discharge preparation: enhancing self-care competence of patients after minimally invasive hip arthroplasty]

Increasing numbers of hip replacement implant surgeries in Switzerland today are minimally invasive. Patients undergoing such procedures become mobile faster and are discharged from hospital to home within an average of four days. Using a qualitative descriptive design, this study examined how post-operative self-care is taught to patients in the orthopaedic department of a rehabilitation hospital after a minimally invasive hip arthroplasty and explored ways to optimise such teaching methods. Data were collected by conducting three focus groups with nine nursing professionals and expert interviews with the chief surgeon and the assigned physiotherapist. Data were analysed by using qualitative content analysis procedures. Results showed that teaching to enhance self-care competence of patients was not carried out systematically. Instead, the primary focus was to inform and prescribe rather than empower patients. Empowerment, however, would be necessary to assure adherence to the treatment regime. Hospital discharge often takes place surprisingly early and prevents assessment-based counselling of patients. The researchers concluded that the introduction of the minimally invasive surgical technique requires that the multidisciplinary rehabilitation team adapts its teaching methods. Self-care confidence in patients should be enhanced by following participatory clinical pathways. This demands modification in discharge and rehabilitation teaching plans to make them patient-oriented, and the plans should be supported by the entire team and the management.

Interviewing Sub-Saharan migrants in Switzerland about HIV/AIDS: critical reflections on the interview process

Although research underpinnings for the interview process are often discussed in the scholarly community, reports of explicit experiences about this step are often insufficient or lacking in research publications on migrant health and in the context of HIV/AIDS. The authors highlight the challenges they encountered in conducting qualitative interviews in a multilingual, transcultural setting with Sub-Saharan migrants on HIV prevention and care. The authors discuss challenges and solutions during the conduct of interviews. They particularly highlight strategies on interview conduct, participant focus, and interviewer's behavior, which supported good quality in their research interviews. The main aim of the article is to critically reflect experiences and to suggest successful methods during interview phases with regard to the migrant setting and the sensitivity of the research topic.

["work & care" - Combining employment and care: a literature analysis on challenges for family caregivers, companies, and nursing]

In German speaking Europe, concepts on combining family care and employment are widely lacking. However, due to increased participation of women in the labour market, women have less time to engage in traditional family care giving. For nurses, working caregivers are challenging because they are even more in need of integrated care models than non-caregivers. In the literature analysis, the current situation on "work & care" and its relevance for nursing in German-speaking countries is discussed. After presenting the relevance and the chosen research method, identified prevalence data are listed. Focusing on risks and resources resulting from combining employment and care, strategies and services used by companies are analysed. Based on this analysis, concepts will be presented which enable nurses to become involved in solutions for family caregivers and the development of innovative nursing services.

[Gaining access--recruitment phase as a challenge]

Due to the increased HIV-incidence, there has been recently a lively discussion in Switzerland about the issue of HIV/AIDS and Sub-Saharan migration. In addition to a pilot intervention project about HIV/AIDS prevention among Sub-Saharan migrants in Switzerland, in-depth interviews aimed at revealing insight from the migrants' perspectives and providing information for effective HIV prevention. It is important to mention that HIV prevention in this research project is also understood as secondary and tertiary prevention. HIV positive persons from this population group should be given a voice, since discussion has recently focused on the increased incidence amongst migrants from Sub-Saharan Africa. This article will address the question of how we accessed interviewees from this target group, and we will describe the many challenges met and overcome in this part of the research process.

Das Arbeitsprofil der Angehörigen von Menschen mit HIV/Aids

In den letzten beiden Jahren wurde in der Schweiz die angestiegene HIV-Inzidenz in den Medien und im Gesundheitswesen mit Besorgnis kommentiert. Dabei standen die Angehörigen nicht im Blickpunkt, obwohl ihre Zahl ebenfalls und exponentiell ansteigt. Schweizer ForscherInnen haben in den letzten Jahren etwas Licht auf ihre Situation geworfen. In dieser Untersuchung steht nun die Frage im Zentrum, welche familiale Arbeit die Angehörigen leisten, unter welchen Bedingungen sie diese Arbeit erbringen, und welche Konsequenzen daraus erwachsen. Die Datenauswertung aus den elf leitfadengestützten Interviews mit Angehörigen orientierte sich an einer qualitativen Inhaltsanalyse. Die Ergebnisse zeigen, dass die befragten Personen äußerst vielfältige und umfangreiche Arbeiten übernehmen, und zwar nicht nur für die HIV-positiven Menschen, sondern auch für sich selbst und weitere Angehörige und Bekannte. Dabei erzielen sie eine vorwiegend stabilisierende Wirkung auf den HIV-positiven Menschen. Zu diskutieren gilt es zum einen die Dynamik der familialen Arbeit. Diese zieht kontinuierliche Anpassungsanforderungen nach sich. Zum andern muss die oft unspektakuläre, aber nicht weniger wichtige Arbeit der Angehörigen wahrgenommen und symbolisch, sozial und finanziell anerkannt werden. Zum Schluss werden Implikationen für die Pflegepraxis aufgezeigt.

[Developing and establishing an expanded and more comprehensive HIV/AIDS nursing practice]

Developing and establishing an advanced nursing practice is an essential step toward future-oriented nursing care. An action research process was initiated to establish advanced nursing practice at the HIV clinic of the outpatient department at the University Hospital Basel with the goal to offer advanced nursing care to patients. Participatory action research allows generating knowledge about a social system while at the same time tempts to promote social change. The most important goal is to constantly analyse, improve, and evaluate nursing care for patients and family caregivers. Advanced nursing practice in HIV/AIDS is based on solid knowledge regarding the illness and current therapies. Central concepts are caring, clinical experiences, evidence based practice, and patient preferences. Through a systematic step-by-step process, the nurses at the HIV clinic are being better educated and more experienced in these concepts. An essential aspect of advanced nursing practice is the specialization of each nurse in a self selected topic within HIV/AIDS care. These nurses now offer new services such as medication management and adherence support, health maintenance and prevention, and symptom management. This ongoing process of learning while establishing advanced nursing practice in HIV/AIDS, enables the nurses to face future changes in health care in a proactive way.

[Families living with HIV and Aids--review of the literature]

This article presents the current state of the art regarding the concept of families living with HIV and Aids. The literature reflects a comprehensive view including families of origin, families of choice and partnerships. It is evident that family networks of homosexual men are most systematically described in the literature; to a lesser extent families with hemophilia and i.v. drug users and even fewer studies are found regarding families with a heterosexual transmission background and especially female family caregivers. This paper also focuses on the wide range of support offered by these family systems. The acute and mostly terminal infectious disease Aids, as observed in the 80 Dies, has now become a predominantly chronic-progressive illness. Since the mid 90 Dies, the new antiretroviral therapies have further decreased morbidity and mortality, leading to less personal care, high-tech nursing requirements and household support. This development places families in a position of providing more emotional and advocatory support and companionship over a considerably longer time span. The discussion identifies strengths and weaknesses of the current literature in order to define deficits in the Anglo-American as well as in the German speaking area. From a nursing science point of view, the characteristics of HIV/Aids care must be further acknowledged, described and systematically studied, and results must be made accessible. This is important because the knowledge acquired by studying families affected by HIV and Aids is of interest for other family systems dealing with chronically ill family members. Finally, research recommendations are listed regarding family-oriented care and future study designs.