Family theoretical perspectives and implications for nursing practice

Health care professionals have focused for the most part on individuals within families as they provide care in acute care settings. The lack of a theoretical perspective to permit observing the family as a unit with interacting parts has contributed to this practice. This article presents an overview of trends and of four theoretical frameworks that have contributed to family practice and research, both for other disciplines and for nursing. Symbolic interactionism, systems, developmental, and social exchange theories are promising frameworks for considering family relationships now and into the future. The purpose, major concepts, and implications for nursing practice of each theory are presented.     

Families living with severe mental illness: a literature review

Schizophrenia is a severe mental illness, which is stressful not only for patients, but also for family members. Numerous studies have demonstrated that family caregivers of persons with a severe mental illness suffer from significant stresses, experience moderately high levels of burden, and often receive inadequate assistance from mental health professionals. Effective family functioning in families with schizophrenia may be influenced by a variety of psychosocial factors. The purpose of this article was to present a review of the social science literature related to families living with schizophrenia that has been published during the last three decades. There is general agreement in the literature that a multitude of variables affect families with a severe mental illness, such as schizophrenia. Therefore, this literature review examined the most frequently investigated variables (coping, psychological distress and caregiver burden, social support, caregiver resiliency and depression, and client behavioral problems) as they are related to families and schizophrenia.     

Families Living with Severe Mental Illness: A Literature Review

Schizophrenia is a severe mental illness, which is stressful not only for patients, but also for family members. Numerous studies have demonstrated that family caregivers of persons with a severe mental illness suffer from significant stresses, experience moderately high levels of burden, and often receive inadequate assistance from mental health professionals. Effective family functioning in families with schizophrenia may be influenced by a variety of psychosocial factors. The purpose of this article was to present a review of the social science literature related to families living with schizophrenia that has been published during the last three decades. There is general agreement in the literature that a multitude of variables affect families with a severe mental illness, such as schizophrenia. Therefore, this literature review examined the most frequently investigated variables (coping, psychological distress and caregiver burden, social support, caregiver resiliency and depression, and client behavioral problems) as they are related to families and schizophrenia.     

Supporting one another: the nature of family work when a young adult has cancer

Families, and the support they provide, are one of the most important resources of the informal health care delivery system As nurses we are called upon to enable clients to maximize their use of family resources and to enable families to cope with illness-related events While research has clearly documented the important role of support in enabling persons to cope effectively with illnesses and illness related events, further research to understand the processes of providing support within families has been called for With such information we may be more effective in our efforts to guide and support families as they cope with illness in a family member This paper was developed from a qualitative study with young adults with cancer that examined social relationships in order to understand the nature of interactions perceived as supportive and the context within which they occurred In-depth interviews conducted with young adults provided detailed data regarding the nature of support young adults received from and offered to their families in order to maintain family functioning The processes of offering and receiving support have been conceptualized into five categories of 'family work' The nature of the work is described and the roles of family members in accomplishing the work are addressed The findings are discussed in relation to current issues in practice     

An experience nursing an intravenous drug user(IDU) with AIDS: applying the family stress model

There is prejudice and fear in society about AIDS, causing the families of AIDS patients to be stigmatized. The number of patients infected with HIV has increased substantially in the past two years as presumably a result of an increase in the sharing of syringes. Intravenous drug users (IDUs) are often isolated from their families, with whom they usually have poor relationships. If they are infected with HIV, it becomes all the more difficult for them to be accepted by their family. The article describes the stress experienced by a family as a result of hospitalization of an IDU with AIDS. The findings from this case report demonstrate three main problems identified from the assessment of Boss's family stress management. These three health-related problems were that the primary caregiver felt exhausted, that communication between parents and children was poor, and that the family's coping ability was compromised. Encouraging positive communication between the client and his mother throughout the period of care enhanced the closeness and harmoniousness of their relationship, as well as the client's sense of security as he approached death. Furthermore, we consulted with social workers in order to facilitate the joint provision of social resources and to assist the family during its crisis.     

Family social support: toward a conceptual model

Nursing clinical assessment and empirical investigations of the social support resources available to families are hampered by the lack of theoretical bases regarding the family social support process. This article presents a preliminary conceptual model of family social support in the interest of stimulating discussion and further development. Assumptions of the model are presented, family characteristics and interaction processes are identified, and propositional statements are derived from the model. The model proposes that social support is not an outcome or a resource but a process of interaction through which the family develops versatility and resourcefulness in identifying and using resources available in its environment. The conceptual model presents family social support as a process of relationships between the family and its social environment.     

Elder care in Japan

The social and health care issues surrounding the elderly in Japan have been described focussing on the long-term care issues and the LTCI System. Because the Japanese have traditionally held a strong sense of family, they have believed that the family should look after a family member. The burden of caregiving had become so serious to many families that the situation has been called "caregiving hell". In those situations, the LTCI System seems to be succeeding in releasing the families from the unbearable burden of caregiving. However, there are many problems associated with the LTCI System. The system adopted the social insurance system because of its clearly defined relationships between the provision of services and the insured persons' share of the costs of services. Keeping with the system's principle, the insured persons' rights must be respected and the system must continually be improved so that they could choose the necessary and the most appropriate services to meet their needs. Japan has been experiencing the aging of its society at an unprecedented rate, which no other nation in the world has experienced. The world is watching Japan with interest to see how it responds to the grave issues of an aged society. The necessary systems and services should not be provided because the funding is available. Rather, the funding should be arranged so that the necessary systems and services can be provided. It is said that some countries intend to study the merit of Japan's strong sense of family ties and to utilize the strength of family ties to enhance their elder care. Considering such an idea it is hoped that, with collective efforts, the health care and the social welfare services for the elderly in Japan will continue to improve in the future.     

In-hospital social support for families of heart patients

Chronic illness in one family member influences all aspects of family life. Research has documented the positive contributions of social support in an unexpected and stressful event such as a family member's heart disease. The aim of the study was to describe in-hospital social support provided by nurses to families of heart patients and to identify factors related to social support. Data were collected using a mailed questionnaire to family members of heart patients (n = 161) receiving treatment on two medical wards of a university hospital in southern Finland. The results show that the family members were not very satisfied with the social support from nurses, because about 40% were dissatisfied with the concrete aid and affirmation they received and about 30% with emotional support. According to regression analysis the most important predictors of social support were family structure, patient's age, gender of family member and whether the patient had been hospitalized for cardiac symptoms. This report shows that supporting families of cardiac patients need development according to the family nursing practice.     

Family presence during resuscitation

The concept of allowing families in during invasive procedures and resuscitation is rapidly growing and receiving more attention and acceptance. Health care organizations that have been traditionally bound by the practice of family exclusion are now being challenged by the increasing volume of research and public attention surrounding the family presence movement. In an ironic turn of practice, the health care arena that long ago permitted fathers and family members to be present at the beginning of life, is now beginning to recognize the value of family presence at the end of it. Allowing family members to be present validates the unique personhood of the patient while recognizing his integral position within a larger family unit. The documented benefits have exceeded the perceived risks for families permitted to be present during resuscitation. Families as well as patients view family presence during resuscitation as a right. In addition, health care providers who initially had resisted permitting families in during resuscitation are now conceding to families this opportunity and, not surprisingly, an opportunity that they would choose for themselves. The family presence program will continue to evolve as new research is conducted and variables are examined to assess their impact on patients, families and health care providers. With increased knowledge and awareness of the benefits and limitations of family presence, the practice of allowing families in to comfort and support loved ones at the end of life can only enhance and strengthen the hallowed bond between patients and health care providers.     

Patient-reported family distress among long-term cancer survivors

Two quality of life studies at the University of Nebraska Medical Center and 3 similar studies in the nursing literature were compared regarding family distress to illness scores as reported by long-term cancer survivors. All studies were cross-sectional mail surveys and used City of Hope National Medical Center questionnaires. Participants represented a broad range of survivorship in terms of diagnosis and length of survival (range of means 3Y8 years). Single-item scores were compared among participants regarding the item "How distressing has your illness been for your family?" Significant levels of patient-reported family distress to illness were reported in all 5 studies. Patient survivors may have been able to recall past levels of significant family distress despite prolonged survival or they may have reported significant ongoing family distress as a result of their disease and treatment. Longitudinal assessment of patients' and families' quality of life is essential throughout survivorship. Future studies should identify and compare the types distress experienced by patient survivors and families over time and also measure the intensity of their distress. Interventions designed to meet their individual and collective needs, thereby decreasing their distress, are needed to improve quality of life for survivors and families.     

Early support needs of Finnish families with small children

AIMS: This study describes the early needs for support that families with small children have in the context of their own life situations. The study population consisted of Finnish families (n = 551) who participated in a project titled 'Families with Children' (1996-2001). The project supplemented the existing public services. The information provided by the study was utilized in supporting families and developing family work in seven experimental areas. METHODS: The data were collected between 1997 and 2000 using family service plans and client reports. The data were analysed with inductive content analysis and using the SPSS software (version 7.5). FINDINGS: The families needed support in the areas of parenthood, upbringing and child care, marital problems and social support networks. The need for early support was also connected to health problems of the children or the parents, problems with work or studies, unemployment, problems in economic or living conditions, or family crises. In addition to support, the families searched for help from family workers in disputes over child custody and visitation rights, intoxicant abuse and violence, and problems in adjusting to society. Each family had 4-5 needs for early support. CONCLUSIONS: The results demonstrate that families with small children have many needs for which they seek help when there are available services supplementing the existing public services. The information provided by the study can be utilized in maternity and child welfare clinics, in social services and in family work provided by civic organizations to define the early needs of families for support and to develop services.     

Living with a young person who wets the bed: the families' experience

After allergic disorders, bed-wetting is the most common chronic condition of childhood. It can seriously diminish the quality of life of young people and their families, having an impact on day-to-day activities, family holidays and the young person's willingness and ability to stay away from home with friends and wider family. In this ethnographic study, family members describe the practical and social consequences of bed-wetting, both for themselves and for the family, and the methods that they have employed to encourage the bed-wetting to stop. Most of these methods have little chance of success. Many families' feelings of helplessness and isolation are reinforced by lack of help from healthcare professionals, although the professional's intention to be helpful is rarely questioned. The nature of the families' experiences illustrates the urgent need for adopting a new professional approach to the support of these families, which is based on the principles of 'family nursing'.     

Family and staff perceptions of the role of families in nursing homes

Family and staff perceptions of the role of families in nursing homes Admission to a nursing home is generally regarded as the termination of family care and the commencement of institutional care. Research suggests that following placement families are often expected to relinquish their dependent older relative to the bureaucracy of the institution. The aim of this study was to investigate family and nursing home staff perceptions of the role of families caring for residents in nursing homes. A convenience sample of 44 family carers and 78 nursing home staff completed questionnaires, and interviews were conducted with 10 family carers and 10 nursing home staff. The results suggest that family carers perceived themselves to have a greater role in caring for relatives than that perceived by the nursing home staff. Either families overestimated their involvement, or staff underestimated family involvement in caring for residents in nursing homes. Families were mostly satisfied with their role and with the care provided in nursing homes. They perceived nurses as providers of technical care and they perceived themselves as having an important role in providing social and emotional care. Families trusted the clinical judgement of the staff but the staff were reluctant to trust family carers, especially in situations where care involved an element of risk. Family roles were limited by members' own ability to care and the dependency of the resident, while professional responsibility and accountability discouraged nurses from sharing some caring roles. The results indicate that families in this study were more willing to help in nursing home care and were perhaps under-valued as a resource within the nursing home setting.     

Opinions and Expectations of Fathers of Young Families of Family Counselling

Opinions and experiences of fathers of young families were studied from questionnaires distributed through maternity welfare centres (MWC) and child welfare centres (CWC) in the provinces of Turku and Pori, southwestern Finland. The first phase of the Finnish Family Competence Study included a total of 1 414 fathers of families expecting their first baby. Of these, 1 279 responded to the first survey questionnaire. Afters the baby's birth, 1 134 responded to a second questionnaire. The present study used results obtained from these two inquiries. Special attention was paid to factors associated with fathers' participating in family counselling. The conventional methods of family training used in MWCs and CWCs do not always seem to be suitable for the Finnish man. Industrial employees and young fathers were irregular attendants of the family training sessions, although young fathers found them useful, especially for combating anxiety in novel family situations. They would have liked to receive more information on social support available to young families. Despite the apparently positive results, these subgroups clearly did not realize that they were expected to ask for more information during the training sessions, due to their low base of knowledge. The heaviest criticism of the training system was presented by fathers belonging to the professional subgroup. The fathers specifically complained that they had not been sufficiently informed about the possible psychological changes which they might experience during the wife's pregnancy and the birth of the child.     

Family stress,perceived social support and coping following the diagnosis of a child's congenital heart disease

BACKGROUND: Congenital heart disease (CHD) is now estimated to be the second most prevalent chronic illness. A child's chronic illness may have effects that have pervasive consequences for family life. Recently, attention has focused on resiliency variables, especially social support and coping strategy, regulating the impact of stress. In the resiliency model of family stress, adjustment and adaptation, social support is viewed as one of the primary moderators or mediators between stress and well-being. AIMS: The purpose of this study was to explore the relationships of family stress, perceived social support, and coping and determine the resiliency factor associated with coping by families who have a child with chronic illness. DESIGN: In a secondary analysis of a large longitudinal study, the sample consisted of 92 families who had a child under age 12 who was newly diagnosed with CHD within the last 3-4 months. FINDINGS: Results from regression analysis revealed that perceived social support operated as a resiliency factor between family stress and both parental and family coping. Child and family characteristics appeared to be the important predictors of perceived social support and parental coping. Although perceived social support appeared to be an important predictor of parental and family coping, neither the moderating nor mediating model was supported in full but partial causal relations were confirmed. CONCLUSIONS: Findings provided evidence for the theoretical and empirical significance of perceived social support as a predictor of family coping. Further, these findings suggest that perceived social support is a factor influencing the resiliency of relatively high-risk groups of families who have a child with chronic illness.     

The caregiving experience: how much do health professionals understand?

Legal, social and economic factors have changed the delivery of care to people who have a mental disorder. Many of these people are now treated in the community and they live with or in close proximity to their family. The aim of this paper is to provide health professionals with an insight into the experience of being a caregiver to a person with a person with a mental disorder. For these families caregiving becomes an integral part of everyday life. Positive outcomes for both the caregiver and the ill family member are more likely to occur when effective levels of collaboration exist between health professionals and caregivers. Collaboration is enhanced when caregivers and health professionals value each other's contribution to the ill family member's care. Often the burden, stress, and socio-economic effects on the family caring for a person with mental illness is not sufficiently appreciated and further increases this burden. A review of the literature from the caregiver's perception is presented. An increased understanding of the caregiving experience will enable health professionals to develop and implement strategies that facilitate positive outcomes for the caregiver and the ill family member.     

A holistic intervention programme for families with a child with a disability

BACKGROUND: The birth of a child with a disability may cause serious stress for the parents and affect each member of the family. Parents need support to deal with such a situation; however, health care professionals themselves are not always well equipped to help them and often adopt an attitude of withdrawal. AIM: The aim of this paper is to describe a family intervention programme developed in collaboration with families who were adapting to the birth of a child with a disability. DISCUSSION: The primary purpose of the programme is to help family members adapt to the situation in which they suddenly find themselves, primarily by reducing stress. The family's autonomy and competencies in providing care for the child are promoted and called into action. The programme encompasses different aspects of family relations: the individual, marital, parental, family, extended family and non-family sub-systems. Its theoretical foundations, clinical experience with families of a child with a health problem, and our previous research have enabled a remodelled vision of the way individuals and families adapt to such a situation. CONCLUSION: The symbioses of the design of the programme, training in its application, and intervention itself have transformed families of a child with a disability as well as the nurses themselves. The key element of this transformation has been the mutual recognition of relevant skills and authority by families and health care professionals that has led to new competencies, self-determination and an individuality that may change their lives.     

Families: a link or a liability?

Hospitalization in a critical care setting has multiple effects on patients and their families. For patients, it can be a frightening and dehumanizing experience, while families are confronted with stressors that can disrupt normal family functioning. The nurse is the pivotal figure in the health care system who can positively affect family coping through the support offered. With family needs met, they are then strengthened and able to support their family member. This article examines the roles and relationships of families, social support systems, and nurses. Through the framework of social support, nurses provide emotional, instrumental, spiritual, and appraisal assistances to families. This can potentially positively affect the family's adaptation to a stressful situation, and thus the family's ability to provide support to the patient. A case study analysis is described to illustrate the interactions and interventions through a model of family support.     

Are nurses respecting and upholding the human rights of children and young people in their care?

Children's nurses may assume that the care they provide for children and their families is family centred and meets their holistic needs. However, very little objective evaluation has been undertaken with children and young people regarding the health services and nursing care they receive. In this study, data were collected from 18 young ventilator-dependent people and their families in order to evaluate their experiences of health and social care. The UN Convention and other policy documents advocating client-focused services were used as benchmarks for analysis, demonstrating that the needs and aspirations of the young people are not being addressed and raising questions for nurses and other professionals.     

A study of three measures of expressed emotion in a sample of Chinese families of a person with schizophrenia

Emotional climate or expressed emotion (EE) has been examined in families of white descent who have a family member with schizophrenia but few studies have been conducted in Asian or Chinese families. This study tested the utility of the five-minute interview (FMI), adjective checklist (ACL) and family attitude scale (FAS) in a sample of Chinese family members in Beijing, in an attempt to introduce useful measures of EE into practice. A sample of 51 family members were interviewed and administered the three instruments. A total of 29.4% of families were found to be high-EE critical and 13.7% high-EE emotional over involvement using the FMI. The FAS and ACL prove internally consistent and were significantly correlated but not with the FMI. Cultural explanations for the discrepancies are offered. The measures have applicability in terms of understanding family relationships but further research and replication is necessary to deepen our understanding of EE in Chinese families.