Parent-nurse interactions: care of hospitalized children

BACKGROUND: An essential component of quality nursing care is nurses' ability to work with parents in the hospital care of their children. However, changes in the health care environment have presented nurses with many new challenges, including meeting family-centred care expectations. AIM OF THE PAPER: To report a research study examining the experiences of parents who interacted with nurses in a hospital setting regarding the care of their children. METHODS: A qualitative approach was employed for this study. In-depth audiotaped interviews were conducted with eight parents representing seven families. Data collection was completed over a 7-month period in 2001. FINDINGS: Parents characterized their experiences with nurses caring for their children as interactions, and identified the elements of establishing rapport and sharing children's care as key to a positive perception of the interactions. These elements were influenced by parental expectations of nurses. Changes in nurses' approach were reported by parents as the children's conditions changed. CONCLUSION: Nurses were able to work with families in the hospital care of their children in ways that parents perceived as positive. However, in parents' views, their interactions with nurses did not constitute collaborative relationships. A deeper understanding of these interactions may provoke new thinking about how to promote an agency's philosophy, and how nurses enact this philosophy in practice.     

Family systems nursing: a guide to mental health care in Hong Kong

In Hong Kong, mental health care has traditionally focused on the individual and the concept of considering the family as the unit of care is relatively new. The purpose of this article is to describe the process of planning, implementing, and evaluating a family systems nursing project in a psychiatric setting in Hong Kong. Psychiatric nurses (N = 110) participated in seminars focusing on family systems nursing concepts and individuals and families suffering from mental illness. The Calgary Family Assessment Model and the Calgary Family Intervention Model formed the framework for practice. Significant changes were found both in the nurses' critical appraisal of their clinical practice related to family systems nursing and in their reflections on the reciprocity in their nurse/family relationships. In addition, hospital-wide systems outcomes were noted. This project appears to demonstrate that a family systems nursing approach is relevant for psychiatric nurses caring for Chinese individuals and their families suffering from mental illness.     

Parent-nursing student communication practice: role-play and learning outcomes

Parents accompanying their child's hospitalization can experience stress associated with the child's illness, treatments, and major alterations in family life. Nurses often serve as the primary communicator and cultural broker because of their constant presence at the child's bedside. Nursing students may not have essential parent-nurse communication competencies. In an innovative method of teaching nursing students about communicating with parents, 64 undergraduate nursing students participated in a parent-led postconference with a nursing instructor. The parents provided background and led role-play activities and debriefing sessions with students. Feedback provided by students before and after the parent session included requests for additional parents' experiences, appreciation and exceeded expectations of hands-on experience, recognized value of information provided, and the recommendation that all students attend. We demonstrate that empathy is a teachable skill, nursing students are apprehensive about communicating with parents, and nursing students do not understand how much families rely on nurses.     

Teaching family nursing: strategies and experiences

The traditional hospital-based approach to Australian nurse education curricula was primarily based on the medical model and directed towards the preparation of nurses who were able to give care to individual clients The major focus was on the needs of the individual A notable absence in curricula was any consideration of the role or importance of families to individual and family health This was despite the continuing involvement that nurses have in their practice with the families of their clients This paper describes the experiences of introducing a family nursing subject in an undergraduate, preregistration nursing programme which focuses on the family as a unit of care Educational strategies, clinical experiences, and evaluation of the unit of study are discussed     

Predictors and enablers of mental health nurses’ family‐focused practice

Family‐focused practice improves outcomes for families where parents have a mental illness. However, there is limited understanding regarding the factors that predict and enable these practices. This study aimed to identify factors that predict and enable mental health nurses’ family‐focused practice. A sequential mixed methods design was used. A total of 343 mental health nurses, practicing in 12 mental health services (in acute inpatient and community settings), throughout Ireland completed the Family Focused Mental Health Practice Questionnaire, measuring family‐focused behaviours and other factors that impact family‐focused activities. Hierarchical multiple regression identified 14 predictors of family‐focused practice. The most important predictors noted were nurses’ skill and knowledge, own parenting experience, and work setting (i.e. community). Fourteen nurses, who achieved high scores on the questionnaire, subsequently participated in semistructured interviews to elaborate on enablers of family‐focused practice. Participants described drawing on their parenting experiences to normalize parenting challenges, encouraging service users to disclose parenting concerns, and promoting trust. The opportunity to visit a service user's home allowed them to observe how the parent was coping and forge a close relationship with them. Nurses’ personal characteristics and work setting are key factors in determining family‐focused practice. This study extends current research by clearly highlighting predictors of family‐focused practice and reporting how various enablers promoted family‐focused practice. The capacity of nurses to support families has training, organizational and policy implications within adult mental health services in Ireland and elsewhere.     

Implementing child-focused family nursing into routine adult psychiatric practice: hindering factors evaluated by nurses

Aims and objectives. The aim of this study is to describe nurses’ evaluations of factors that are hindering implementation of child‐focused family nursing (CF‐FN) into adult psychiatric practice. In addition, it explains the nurses’ evaluations of the hindering factors related to the hospital organizational structure, the individual nurse, nursing and family. Background. There is an increasing amount of families with dependent children in adult psychiatry. Although these families have long‐term benefits from preventive family interventions, implementation of CF‐FN is not routine mental health practice. Design and methods. Data were collected via a questionnaire‐survey completed by Registered Psychiatric Nurses (n = 223) and practical Mental Health Nurses (n = 88) from 45 adult psychiatric units in five Finnish university hospitals. The response rate was 51%. Results. Family‐related factors, such as families’ fears and lack of time, were considered as ‘most hindering’ to CF‐FN. Nurses who used a family‐centred approach and had further family education considered most of the factors as ‘less hindering’ in comparison to other nurses. Conclusion. To meet the needs of the families in mental health services, it is essential to develop nursing intervention methods such as CF‐FN. There is a need for further education and use of family‐centred care to develop this preventive approach. Relevance to clinical practice. The results of this study could be considered when developing mental health services and family interventions for families with parental mental illness.     

Intercountry adoption and nursing care

AIMS AND OBJECTIVES: This paper is based on a Norwegian study that addressed the importance of nurses understanding adoptive families' particular needs. The study aimed to provide a diverse picture of adoptive families' challenges and resources. It addressed adoptive families' experiences with welfare professions, particularly public health nurse services, and explored their need for support before and after adoption. This paper focuses particularly on challenges confronting 'transracial' families. PARTICIPANTS AND METHOD: The qualitative research interview was used as the methodological approach. Nine couples of adoptive parents, four adoptive mothers, three public health nurses and four adult adoptees were interviewed. The analysis process was an ad hoc generation of meaning, and the data were systematically reviewed and categorized through an intuitive analysis style. RESULTS: The study indicates that adoptive families manage their 'most common' challenges on their own, but the informants also spoke about a need for professional support and assistance in many cases. Recurring themes in the study were challenges linked to 'attachment difficulties', 'external categorization', 'grief' and 'the meaning of biological heritage and roots'. Findings indicate that there is a substantial demand for increased knowledge of adoptive families' special needs, not least in the public health nurse services; there is also limited knowledge within other welfare professions. Nurses particularly need to strengthen their understanding on how external categorization affects transracial adoptive families. CONCLUSIONS: The study recommendations call for improved follow-up after adoptions. This can be met by establishing a special programme for adoptive families at maternity and child health centres. In addition, public health nurses can support adoptees in their teenage years through individual consultations.     

Family-nurse co-construction of meaning: a central phenomenon of family caring

The purpose of the study was to understand and interpret caring in the family health experience by exploring the interactional phenomenon of family-nurse co-construction of meaning in the paediatric intensive care unit (PICU). A hermeneutic phenomenological method within a framework of existentialism and symbolic interactionism was used in the investigation. The convenience sample for this study was four family-nurse dyads, that is four families of critically ill children (all with positive outcomes) and the four nurses assigned to their care who were participating in a larger study. Data were derived from semi-structured interviews regarding significant interactions throughout the child's illness and subsequent significant interactions of families with other nurses and nurses with other families. Trustworthiness of the study was addressed through the criteria of credibility, dependability, transferability and confirmability. Co-construction of meaning in the family health experience was found to have two dimensions: interdependent and independent. Both families and nurses described being like family as an essential component of the interdependent experience. Independent dimensions for families were journeying through troubled waters of learning the meaning of the illness event and sensing family comfort through the nurse's care. Independent dimensions described by nurses were journeying through troubled waters of learning to care for families and living with another's fear. The family-nurse interaction, the relational connection and the evolution of meanings that families and nurses construct, was affirmed as the major vehicle in the co-construction experience. Family caring is influenced by the existential meaning constructing, process-oriented, interactional nature of the family health experience. Caring in the family health experience is enhanced through actions the nurse performs on behalf of, and with, the family while understanding the family's unique situation. Caring enacted by nurses in participation with families holds abundant potential for enhancing the family health experience and honor the ethic of caring as central to nursing.     

'Being appropriately unusual': a challenge for nurses in health-promoting conversations with families

This study describes the theoretical assumptions and the application for health-promoting conversations, as a communication tool for nurses when talking to patients and their families. The conversations can be used on a promotional, preventive and healing level when working with family-focused nursing. They are based on a multiverse, salutogenetic, relational and reflecting approach, and acknowledge each person's experience as equally valid, and focus on families' resources, and the relationship between the family and its environment. By posing reflective questions, reflection is made possible for both the family and the nurses. Family members are invited to tell their story, and they can listen to and learn from each other. Nurses are challenged to build a co-creating partnership with families in order to acknowledge them as experts on how to lead their lives and to use their own expert knowledge in order to facilitate new meanings to surface. In this way, family health can be enhanced.     

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.     

Do nurses working in adult psychiatry take into consideration the support network of families affected by parental mental disorder?

The aim of this study was to gain information about registered and practical mental health nurses' activities concerning support network of families affected by parental mental illness. Data were collected using a structured questionnaire distributed to all 608 practical and registered mental health nurses working in adult psychiatric units in five Finnish university hospitals. A total of 311 nurses returned completed questionnaires (response rate 51%). Sixty per cent (n = 222) of registered nurses and 36% (n = 88) of practical mental health nurses responded. Information about family relationships and socio-economic situation was gathered regularly by all nurses. The nurses' individual characteristics, such as being a parent, further family education and use of family-centred care, were significantly related to their activeness in discussing the family's support network with the parents. Discussing family relationships and families support networks forms part of patient care in adult psychiatric nursing with families with dependent children (under 18 years of age). Nurses can work directly with the parents to aid them to strengthen their support network for themselves and their children.     

Family nursing telesimulation: Teaching therapeutic communication in an authentic way

BackgroundA nurse's skill in establishing therapeutic communication is central to family nursing. Using a family-centered approach, nurses can facilitate relationship building with members of a family unit. Through authentic learning activities such as simulation, students can practice the competencies required to provide effective family nursing care.DesignOne hundred and one nursing students participated in a two-part family nursing telesimulation. Students were sent an online evaluation about their simulation experience immediately afterwards.ResultsFifty-six percent (n = 57) of the 101 students completed the online evaluation. Students overwhelmingly appreciated the opportunity to apply theory in a real-world manner, engaging in family nursing in an authentic way.ConclusionThe telesimulation strongly supported students’ ability to practice their clinical decision-making skills and respond to changing family needs. Telesimulation is a promising teaching strategy that allowed students to practice their therapeutic communication in the context of family nursing.     

Developing resilient children and families when parents have mental illness: a family-focused approach

There is substantial evidence supporting the need for effective intervention for children and families living with parental mental illness. However, translation of this knowledge into mental health workforce practice remains variable, with a range of clinical practices and models of care evident. Nurses, who constitute the majority of the mental health workforce, are in prime positions to support children and families and provide preventative measures, identify those at risk, and intervene early. In this paper, we provide a framework for practice for nurses working with consumer parents. We contend that traditional models of nursing practice concentrating on the consumer are insufficient in meeting the needs of children and families living with parental mental illness. A focus on families needs to be core business for mental health nurses. A family-focused approach can be used to prevent problems for children and their families, and identify their strengths as well as vulnerabilities. Family-focused care is a useful framework from which to support families and address the challenges that might arise from parental mental illness, and to build individual and family resilience.     

Nurses'' experiences of caring for culturally and linguistically diverse families when their child dies

Nurses experience the care of a dying child and their family as a challenging but distressing event. In a paediatric intensive care unit (PICU), Melbourne, Australia, nurses expressed a concern that they may not be providing the most appropriate care when a cultural disparity exists between nurses and families experiencing the death of their child. A critically informed study was undertaken with six PICU nurses to explore their experiences of caring for a culturally and linguistically diverse family whose child had died. Three consecutive focus group interviews were conducted with the nurses to identify issues in this area of their nursing practice and to contemplate how their practice might be changed. The focus of this paper is on one particular finding of the study about the nurses' use of controlling practices to ensure families conformed to the established routines and values of the PICU staff.     

Family Nursing Practice in Public Health: Finland and Utah

Abstract This exploratory study of family nursing practice in public health care was conducted in Finland and Utah. Staff nurses were interviewed in focus groups and asked to describe their practice of family nursing, the factors promoting and restraining practice, and the impact of the changes in health care delivery on practice. Thirty-six Finnish and 30 Utah nurses participated. Pressure to do more activities with fewer nurses and resources, changes in family problems, and skill level of the nurses were common themes. However, differences were evident. Finnish public health nurses used emotional support and information to help families empower themselves to use resources and to strengthen their family unit. Utah nurses focused first on individual level goals and then family cohesion and health. Nurseinitiated referrals and direct physical care were the primary intervention strategies of Utah nurses. Unlike the U.S. health care system, access for all in maternal and child health care and school health allowed Finnish nurses to develop long-term relationships with families, thus advancing family nursing practice. This study identifies several potential variables for further study particularly related to the organization of health care and nurse-family relationships.     

Towards relational recovery: Nurses’ practices with consumers and families with dependent children in mental health inpatient units

Facilitating parent–child and family connections during parental hospitalization provides important opportunities for mental health services to support individual and family recovery. Nurses are often the primary point of contact for families in the inpatient context. They play an integral role in the care provision of consumers and families and in supporting consumers’ recovery. The aim of the present qualitative study was to explore nurses’ practice with families in inpatient mental health settings in the context of designated family rooms. Three themes were derived from the thematic analysis of semistructured interviews with 20 nurses from four mental health inpatient units. Nurses experienced tensions within their roles in balancing safety and risk, a lack of confidence in family‐focused practices in relation to role expectations, and challenges in juggling nursing care ideals with the contemporary realities of inpatient practice. A family‐centred relational recovery approach is recommended for mental health services, which is underpinned by family‐focused policies and processes, and supported at an organizational, managerial, and local‐unit level. At an individual level, nurses need professional development on the models of care they practice in, explicit role clarity on their practice with families, and education on evidence‐based brief family interventions.     

Self-care operations and nursing interventions for children with cancer and their parents

As individuals assume more responsibility for their healthcare, nurses need to explore methods to support families' self-care practices. The purpose of this qualitative study was to: (a) determine what self-care and dependent-care operations children and parents perform to address self-care requisites, and (b) explore nursing interventions to promote operations. Orem's theory of self-care, theory of self-care deficit, and theory of nursing system were employed. Twenty-seven participants were interviewed about their cancer experiences. Results were that children and parents performed estimative, transitional, and productive operations to meet self-care requisites. Various nursing interventions that promoted these operations were identified. Recommendations were made for further interventions to support families.     

Evaluation of a multischool collaborative COVID-19 vaccination project

To describe experiences of student nurses and faculty who participated in COVID-19 vaccine delivery through a multischool collaboration. Cross-sectional survey. Student nurses and faculty members from five university schools and colleges of nursing who participated in one or more COVID-19 vaccination or education events in 2021. Surveys were designed for students and faculty to document process and outcome experiences associated with project participation. Surveys were administered through an online survey platform. Overall, 648 students and 68 faculty members participated in the project. The evaluation survey was completed by 115 students (18%) and 58 faculty members (85%). Students valued increasing their clinical skills and reported the experience influenced their perspectives on nursing, fueling their passion and informing future career choices. Students reported that it was personally important to contribute to the vaccination effort. Few students reported challenges in participating in the project. Faculty reported positive experiences including gaining knowledge about public health and their communities, fueling their passion for nursing education, feeling a deeper connection with students, and experiencing personal satisfaction from contributing to the pandemic response. This project resulted in meaningful student learning opportunities, enhanced capacity for the public health emergency response, and strengthened partnerships among nursing programs and between academia and public health community partners.