Cross-Cultural Adaptation and Psychometric Testing of the Spanish Version of Iceland Health Care Practitioner Illness Beliefs Questionnaire

The beliefs of nursing professionals who care for families experiencing illness are fundamental to the quality of the nurse-family relationship and the level of the nurse's involvement in the therapeutic process of Family Systems Nursing. It is essential to have valid and reliable instruments for assessing nurses' illness beliefs, especially in the Spanish context where no instruments have been identified to date. The Iceland Health Care Practitioner Illness Beliefs Questionnaire (ICE-HCP-IBQ) is a reliable and valid measure of professionals' beliefs about their understanding of the meaning of the illness experience of families. The purpose of this study was to adapt and psychometrically test the Spanish version of the ICE-HCP-IBQ (N = 249 nurses). The exploratory factor analysis showed one-factor solution with good internal consistency (Cronbach's α = .91) and test-retest reliability (r = .72, p < .01). This questionnaire is a promising tool for mapping nurse's illness beliefs and monitoring the effectiveness of family nursing educational interventions in the Spanish context.

A Multilevel Modeling Approach to Examine Incongruent Illness Appraisals in Family Care Dyads Over Time

Over the past two decades, there has been movement toward a dyadic perspective of the illness experience. Although multilevel models have led to great insights into how dyads are affected by illness as family units, these models are still underutilized for understanding incongruent illness appraisals. Such incongruent appraisals can have implications for how the dyad collaborates to manage illness, the health of the dyad, and clinical outcomes. The focus of this article is to describe and promote the application of multilevel models to longitudinal dyadic data to understand incongruent illness appraisals over time. In particular, we present a data exemplar so researchers can apply these models to their own data and clinical questions to understand the ways care dyads converge and diverge in their appraisals and determine factors associated with such variability. We comment on the implications and extensions of these models for family nursing research and practice.

Mothers' Experiences in the NICU Before Family-Centered Care and in NICUs Where It Is the Standard of Care

BACKGROUND

Family-centered care (FCC) in neonatal intensive care units (NICUs) was initiated in 1992 to promote a respectful response to individual family needs and support parental participation in care and decision-making for their infants. Although benefits of FCC have been reported, changes in the maternal experience in the NICU are unknown.

PURPOSE

The purpose of this study was to compare mothers' experiences in NICUs where FCC is the standard of care and to compare these with the experiences of mothers 2 decades ago.

METHODS

In this qualitative descriptive design, mothers of infants born under 32 weeks postconceptional age were asked to describe their experiences with their infant's birth and hospitalization. Open-ended probing questions clarified maternal responses. Saturation was reached after 14 interviews. Iterative coding and thematic grouping was used for analysis.

RESULTS

Common themes that emerged were: (1) visiting; (2) general caregiving; (3) holding; (4) feeding; and (5) maternal ideas for improvement. Findings indicated important improvements in privacy, mother-nurse relationship, ease of visiting, and maternal knowledge and participation in infant caregiving.

IMPLICATIONS FOR PRACTICE

Mothers suggested improvements such as additional comforts in private rooms, areas in the NICU where they can meet other mothers, and early information on back-transport. Better recognition and response for mothers without adequate social support would provide much needed emotional assistance.

IMPLICATIONS FOR RESEARCH

Future research addressing benefits of webcams, wireless monitors, back-transport, maternity leave, and accommodations for extended visiting for siblings would address other needs mentioned by mothers.

Creating a Social Media Assessment Tool for Family Nursing

The use of social media (SM) is contributing to an unprecedented state of global connectivity and occupying an increasingly prominent position in the lives of individuals and families. The more integrated these media become into society the more likely they are to play a role in overall health and family functioning, be it positively or negatively. Family systems theory provides an ideal lens through which to examine the effects of SM in today's family life. This article introduces a new SM assessment tool aligned with the principles of this foundational theory. Family nurses can use the proposed Social Media Assessment Package (SMAP) to gain an initial picture of usage patterns within a family as well as identify and support positive future SM choices. Practitioners may also use the SMAP in a personal evaluation of their practice as a means to maximize SM use in ongoing professional development.

Nurse Family Partnership: Comparing Costs per Family in Randomized Trials Versus Scale-Up

The literature that addresses cost differences between randomized trials and full-scale replications is quite sparse. This paper examines how costs differed among three randomized trials and six statewide scale-ups of nurse family partnership (NFP) intensive home visitation to low income first-time mothers. A literature review provided data on pertinent trials. At our request, six well-established programs reported their total expenditures. We adjusted the costs to national prices based on mean hourly wages for registered nurses and then inflated them to 2010 dollars. A centralized data system provided utilization. Replications had fewer home visits per family than trials (25 vs. 31, p = .05), lower costs per client ($8860 vs. $12,398, p = .01), and lower costs per visit ($354 vs. $400, p = .30). Sample size limited the significance of these differences. In this type of labor intensive program, costs probably were lower in scale-up than in randomized trials. Key cost drivers were attrition and the stable caseload size possible in an ongoing program. Our estimates reveal a wide variation in cost per visit across six state programs, which suggests that those planning replications should not expect a simple rule to guide cost estimations for scale-ups. Nevertheless, NFP replications probably achieved some economies of scale.

Levels of reduction in van Manen's phenomenological hermeneutic method: an empirical example

AIM

To describe reduction as a method using van Manen's phenomenological hermeneutic research approach.

BACKGROUND

Reduction involves several levels that can be distinguished for their methodological usefulness. Researchers can use reduction in different ways and dimensions for their methodological needs.

DATA SOURCES

A study of Finnish multiple-birth families in which open interviews (n=38) were conducted with public health nurses, family care workers and parents of twins.

REVIEW METHODS

A systematic literature and knowledge review showed there were no articles on multiple-birth families that used van Manen's method. Discussion The phenomena of the 'lifeworlds' of multiple-birth families consist of three core essential themes as told by parents: 'a state of constant vigilance', 'ensuring that they can continue to cope' and 'opportunities to share with other people'.

CONCLUSION

Reduction provides the opportunity to carry out in-depth phenomenological hermeneutic research and understand people's lives. It helps to keep research stages separate but also enables a consolidated view. Social care and healthcare professionals have to hear parents' voices better to comprehensively understand their situation; they need further tools and training to be able to empower parents of twins.

IMPLICATIONS FOR RESEARCH/PRACTICE

This paper adds an empirical example to the discussion of phenomenology, hermeneutic study and reduction as a method. It opens up reduction for researchers to exploit.

White-black disparities in family-centered care among children with autism in the United States: evidence from the NS-CSHCN 2005-2006

OBJECTIVES

The aim of this study was to compare the reported receipt of family-centered care between parents of white and black children with autism spectrum disorders (ASD) in the United States, and to disentangle the associations of race and ASD on different aspects of family-centered care.

METHODS

Parents of 35,386 children, aged 0 to 17 years, were surveyed by the National Survey of Children with Special Health Care Needs (NS-CSHCN) 2005-2006. Autism was defined by the question, "To the best of your knowledge, does [child] currently have autism or autism spectrum disorder, that is, ASD?" Family-centered care was measured with 5 key indicators on a 4-point Likert scale. Univariate and multivariate analyses were used, with adjustment for the complex sampling design.

RESULTS

The prevalence of autism in this sample was 5.4% (n = 1869). We found that, among children with SHCN but no ASD, more white parents than black parents reported receiving family-centered care. Further, fewer parents of both white children and black children with ASD reported receiving family-centered care compared with those with a child who had special needs other than ASD. Lastly, among parents with a child with ASD, being black was associated with lower reporting of family-centered care for 3 of 5 items. In multivariate analyses, black parents with a child with ASD had 2 to 5 times greater odds of not reporting family-centered care on each item compared with white parents without a child with ASD.

CONCLUSION

Targeted efforts are needed to improve family-centered care for parents with a child with ASD, and particularly for black families.

The prevalence and risk factors for percutaneous injuries in registered nurses in the home health care sector

BACKGROUND

Patients continue to enter home health care (HHC) "sicker and quicker," often with complex health problems that require extensive intervention. This higher level of acuity may increase the risk of percutaneous injury (PI), yet information on the risk and risk factors for PI and other types of exposures in this setting is exceptionally sparse. To address this gap, a large cross-sectional study of self-reported exposures in HHC registered nurses (RNs) was conducted.

METHODS

A convenience sample of HHC RNs (N=738) completed a survey addressing 5 major constructs: (1) worker-centered characteristics, (2) patient-related characteristics, (3) household characteristics, (4) organizational factors, and (5) prevalence of PIs and other blood and body fluid exposures. Analyses were directed at determining significant risk factors for exposure.

RESULTS

Fourteen percent of RNs reported one or more PIs in the past 3 years (7.6 per 100 person-years). Nearly half (45.8%) of all PIs were not formally reported. PIs were significantly correlated with a number of factors, including lack of compliance with Standard Precautions (odds ratio [OR], 1.72; P=.019; 95% confidence interval [CI]: 1.09-2.71); recapping of needles (OR, 1.78; P=.016; 95% CI: 1.11-2.86); exposure to household stressors (OR, 1.99; P=.005; 95% CI: 1.22-3.25); exposure to violence (OR, 3.47; P=.001; 95% CI: 1.67-7.20); mandatory overtime (OR, 2.44; P=.006; 95% CI: 1.27-4.67); and safety climate (OR, 1.88; P=.004; 95% CI: 1.21-2.91) among others.

CONCLUSION

The prevalence of PI was substantial. Underreporting rates and risk factors for exposure were similar to those identified in other RN work populations, although factors uniquely associated with home care were also identified. Risk mitigation strategies tailored to home care are needed to reduce risk of exposure in this setting.

One size does not fit all: parents' evaluations of a support program in a newborn intensive care nursery

As intensive care nursery personnel increasingly seek to provide comprehensive care to families, there is a renewed emphasis on offering family support programs.

PURPOSE

The purpose of this study was to identify parents' utilization and evaluation of a support program based in a newborn intensive care unit (NICU) that offered a combination of formats for support services: group support, one-to-one support, and telephone support.

METHODS

Program records and a survey developed by the author documented parental use and evaluation of services. Data analysis consisted of descriptive statistics and qualitative content analysis of demographic data, survey results, and parental comments.

RESULTS

Of the total 477 participants, 78% utilized 1 support service format exclusively. Eighteen percent utilized 2 support formats concurrently. A subsample of 48 parents completed an evaluation survey. Continuity of care was a critical component of the program overall. Group support offered more opportunities for families to problem-solve communication issues with nursery personnel and provide information that assisted parents' involvement in their babies' care.

CONCLUSIONS

Parent support programs that utilize only one type of format may not be optimal for providing the range of support needed by many NICU families. Parent support programs offer an important mechanism to assess provider approaches to facilitate family-centered care.

[Verification of a family assessment instrument based on the framework of systemic organisation]

The verification of the Assessment of Strategies in Families Effectiveness (ASF-E) for use in German-speaking Europe is described. The ASF-E is a screening instrument for family health defined according to the Framework of Systemic Organization (Friedemann, 1991). It was first translated and adjusted to cultural differences in Switzerland in the early 1990s. This testing was the first in Germany and the second in Switzerland. The instrument had 26 initial items, each containing three statements expressing family strategies of which respondents are asked to select the one most like their family. The statements are rated from 1 to 3 with 3 expressing optimal health. In Germany, a group of 343, in Switzerland, a group of 209 people from the community with diverse ages and economic backgrounds completed the instrument. A Principal Component Analysis with Varimax rotation yielded 4 factors with Eigenvalues > 1. Eight items had to be eliminated due to skewed distribution or weak factor loadings. The final instrument had 18 items with acceptable reliability (Cronbach Alpha). The ASF-E can be used in Germany and Switzerland to conduct research with families and to estimate family health in conjunction with nursing interventions.

Outcomes of managed care of dually eligible older persons

PURPOSE

To assess changes in various functional and satisfaction measures between older persons enrolled in Minnesota Senior Health Options (MSHO), a managed care program for older persons eligible for both Medicare and Medicaid.

DESIGN AND METHODS

We used two sets of matched controls for MSHO enrollees and their families and matched controls living in the community and in nursing homes: Persons in the same county who were eligible to enroll but did not enroll in MSHO and persons in other metropolitan areas where MSHO is not available. For the community sample, we used questionnaires to measure functional status (activities of daily living), pain, unmet care needs, satisfaction, and caregiver burden. Approximately 2 years after the first survey, we resurveyed respondents who lived in the community at the time of the first survey. For the nursing home residents, we used annual assessments to calculate case mix to compare changes in functional levels over time.

RESULTS

There were few significant differences in change over time between the MSHO sample and the two control groups. Out-of-area controls showed greater increases in pain but in-area controls showed less interference from pain. Compared with out-of-area controls, MSHO clients showed greater increase in homemaker use, meals on wheels, and outpatient rehabilitation. Compared with in-area controls, they showed more use of meals on wheels and less help from family with household tasks. There were few differences in satisfaction, but the MSHO families showed significantly lower burden than controls on five items.

IMPLICATIONS

The analyses show only modest evidence of benefit from MSHO compared with the two control groups. The model represented by MSHO does not appear to generate substantial differences in outcomes across function, satisfaction, and caregiver burden.

Nurse practitioners' treatment of febrile infants in Utah: comparison to physician practice nationally

PURPOSE

To determine nurse practitioners' (NPs') knowledge of published guidelines involving the treatment of infants with fever without a source and to compare the practice of NPs in Utah to physicians nationally.

DATA SOURCES

Using a comparative descriptive design, a survey was sent to 450 NPs in Utah replicating the methodology of a 1998 survey of physicians. The NPs were asked about their evaluation decisions and management strategies for various ages of infants/toddlers with fever without a source.

CONCLUSIONS

The practice decisions of NPs in Utah and physicians nationally were similar. Family NPs' clinical decisions aligned more closely with family practice medical doctors and pediatric NPs' with pediatricians. Overall, the younger the patient, the more likely were NPs to order labs and antibiotics or to hospitalize/refer to a physician. The fact that management decisions were not based upon existing protocols may account for the practice variation seen among NPs.

IMPLICATIONS FOR PRACTICE

Management of a febrile infant is a common clinical scenario for the primary care provider. Although evidence-based protocols exist, the treatment of febrile infants remains controversial. Overall, NPs' evaluation and management of these infants were not shown to differ from physicians. Further studies are needed to determine why clinical guidelines are not being followed.

A computerized system for tracking practice and prescriptive patterns of family nurse practitioner students

Decisions about the fit between advanced practice nursing curricula and the real world of primary care practice should be based on data and not on intuition. The purpose of this article is to describe a computerized database system that can be used to: 1) track practice (including prescribing) patterns of nurse practitioner (NP) students; 2) address data issues that commonly arise; and 3) describe NP students' practice during their education to prospective employers. The database system uses both the Family Nurse Practitioners Log (FNPLOG), a faculty-developed software program, and Epi Info, a companion public domain software program. Variables are categorized as being related to sociodemographic, diagnostic, or prescriptive components of primary care. The system provides a simple, efficient, and feasible way of computerizing, analyzing, and evaluating students' clinical experience and practice patterns. The implications for advanced practice nursing education will be illustrated along with other potential uses of the database system.