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.     

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.     

The diversity of family health: constituent systems and resources

The purpose of this study was to explore changes in family health associated with child's chronic illness and hospitalization. The aim was to answer the following questions: (i) What kind of changes do families experience when a child in the family is afflicted by a chronic illness; and (ii) What kind of changes do families experience when their child is admitted to hospital? The data were collected in 2002 in interviews with 29 such families whose children were receiving treatment or who had previously received treatment on the paediatric wards of two hospitals in Finland. Data were collected until reaching theoretical saturation, in which no additional data are found. Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Family health was formed out of two different dimensions: the constituent systems and the resources of family health. The constituent systems describe the impact of the child's chronic illness and period of hospitalization at the level of both individual family members and the family as a whole. These systems were described by five categories: (i) ill child at the centre of family attention, (ii) siblings in a minor role, (iii) the child's illness governs parental well‐being, (iv) the roller coaster of the couple relationship and (v) the whole family is ill. The resources promoting and maintaining family health were divided into six different categories: (i) creative and maintaining mental images, (ii) active involvement, (iii) internal coping means, (iv) reinforcement of coping means, (v) awareness and change of values and (vi) social network shares emotional burden and responsibility for care. The results of the study show that family health is highly vulnerable when a child has to be admitted to hospital because of a chronic condition. They should help nursing staff gain a clearer picture of the depth and diversity of family health and support the resources that promote family health. Future research should study the methods of family nursing used in the care of families with children with chronic conditions.     

Parents’ experiences of a Family Support Program when a parent has incurable cancer

Aims and objectives. The Family Support Program was created to support children and parenting when one of the parents has incurable cancer. We chose a family‐based approach to support parent’s coping and to help families pull together, identify strengths in the family and learn how to seek help. Background. Cancer is usually a new experience for young families. In most cases, parents do not have the necessary knowledge about their children’s need for information and support about their parent’s serious illness and impending death. Design. A qualitative evaluation study based on data collected through in‐depth interviews focusing on parent’s experiences with the Family Support Program. Methods. Participants were patients with incurable cancer and their partners and ex‐partners with children aged between 5–18 years. Thirteen parents were in‐depth interviewed. Results. Parents described how the Family Support Program helped them gain greater insight into their children’s thoughts and reactions and into how the situation affected their daily living. Parents reported that conflicts were reduced, they could talk more openly about the situation in the family and that they were shown how to support their children’s coping. Conclusion. The Family Support Program met the parents in the study’s needs for more information and support about how to cope with their children during the patient’s terminal illness. Relevance to clinical practice. The Family Support Program is described in detail in a manual that makes it easy for other health workers to use the same programme. The Family Support program was in use in outpatient clinics, oncology wards and palliative care units and was provided both from nurses and social workers trained in cancer care. Parent’s in the study would like the Family Support Program to be available to all patients who receive the poor prognosis that their cancer cannot be cured.     

Family dynamics of postnatally depressed mothers - discrepancy between expectations and reality

Background. The birth of a new family member always brings changes to family dynamics. The family has to adjust to a new situation and, although the time after childbirth is happy for most families, postnatal depression affects 10–15% of mothers annually. Aims and objectives. The purpose of this study was to ascertain families’ experiences of family dynamics when the mother suffers from postnatal depression. Design. Nine families (nine mothers, five fathers) where the mother had displayed symptoms of postnatal depression took part for the study. Methods. Data were collected through interviews with nine families where the mother had scored 13 or more on the Edinburgh Postnatal Depression Scale, completed 6–8 weeks after childbirth. Families were offered the opportunity to volunteer for the interview while taking part in a follow‐up study of postnatal depression in Finland. Interviews were analysed using the principles of grounded theory. Results. The findings showed that there was great discrepancy between expectations and reality in the depressed mothers’ families. Parents, especially mothers, strove for perfection, perceived the infant to tie them down and had high expectations of family life. Conclusions. Everyday family life and human relationships change, the depression and the parents’ attitudes towards the infant manifest themselves in different ways, and support is of great importance. Relevance to clinical practice. Women, especially those expecting their first child need a great deal of information about mood changes after childbirth and the opportunity to discuss the changes brought about by the birth of a child.     

Family–school nurse partnership in primary school health care

Scand J Caring Sci; 2013; 27; 195–202 Family–school nurse partnership in primary school health care Background: The foundation of the health and well‐being of a child in primary school age is the family. To promote the child’s comprehensive health, we must develop the cooperation between the family and the primary school nurse. Aim: The aim of the study was to develop a family nursing oriented substantive theory of cooperation between primary school nurses and families. Method: The study used grounded theory based on Straussian principles. Data were collected from sixth‐graders (N = 22) using group discussions. Interviews were conducted with parents (N = 19), and the views of school nurses (N = 20) on their cooperation with families were obtained via free form essays. Findings: The core concept of the theory describing cooperation between primary school nurses and families is problem‐based communication. As a result of the analysis, nine‐2‐dimensional concepts were formed to describe this cooperation. The theory is structured further by four dimensions, which contain concepts explaining them and which also describe the relationships between the different concepts. These dimensions are the meeting between the school nurse and the family, mutual exchange of information, attending to the child’s health monitoring and being at school for the child and family. The substantive theory describing cooperation between the primary school nurse and family entails the concepts formed in the analysis, their interrelationships, as well as, the core concept. Conclusions: Primary school nurses can apply the resulting theory while working with families and while developing this cooperation. This theory can also be implemented in developing nursing education.     

Stress-point intervention for parents of repeatedly hospitalized children with chronic conditions

Little is known about how to assist children with chronic conditions and their families cope with repeated hospitalizations. A two-group, pretest–posttest study was done to determine whether a community-based, stress-point nursing intervention for parents could decrease distress and improve child and family functioning. Fifty participants were randomly assigned to intervention or usual care control groups. The intervention focused on specific, parent-verified child and family issues. Three months after hospitalization, intervention parents had better coping and family functioning than those in the usual care group. Intervention parents' anxiety was initially higher and then lower. There were no child behavior differences between the groups after hospitalization. Intervention children had no developmental regression at 2 weeks and better developmental gains 3 months after discharge than the usual care children. Stress-point intervention for families and their children with chronic conditions improved family coping and functioning, and eliminated hospitalization-induced developmental regression. © John Wiley & Sons, Inc. Res Nurs Health 20: 475–485, 1997     

Living as a family in the midst of chronic illness

Aims and objectives

The aim of the study was to illuminate the meaning of lived experience of living as a family in the midst of chronic illness.

Background

Chronic illness implies a change for both the individual and the family. In this changed situation, all family members seem to benefit from sharing experiences and receiving support. Current research highlights the individual patient's or family member's perspectives on chronic illness, but family systems nursing (FSN) studies are warranted.

Design

A qualitative design with a FSN approach was chosen.

Method

Repeated qualitative narrative interviews with seven families living with chronic illness were performed. A phenomenological hermeneutic analysis, inspired by Ricoeur, was used to interpret the data.

Results

The phenomenon can be described as an ongoing movement towards well‐being. The results included two themes and five sub‐themes. The first theme was ‘Co‐creating a context for living with illness’ with the subthemes; ‘learning to live with the expressions of illness’ and ‘communicating the illness within and outside the family’. The second theme was ‘Co‐creating alternative ways for everyday life’ with the subthemes; ‘adapting to a new life rhythm’, ‘altering relationships’ and ‘changing roles and tasks in the family’.

Conclusions

Living as a family in the midst of chronic illness can be described as an ongoing process where the family members co‐create a context for living with illness. They also co‐create a context for alternative ways of everyday life.

Relevance to clinical practice

Knowledge about lived experience of living as a family in the midst of chronic illness can help nurses to adopt a FSN care perspective. This can increase the chances of taking advantage of the ways family members manage situations together, as well as highlight resources within the family.     

Promoting health in families of children with type 1 diabetes mellitus

de Oliveira IR, Nascif‐Júnior IA, Rocha SMM. International Journal of Nursing Practice 2010; 16 : 106–111
Promoting health in families of children with type 1 diabetes mellitus This paper presents a study of families of children with type 1 diabetes mellitus, emphasizing the identification of social supports and networks to strengthen interventions aimed at health promotion. The approach selected was a qualitative research, using a case study design. Four families of children with diabetes type 1 were studied, totalling seven participants. Data were collected between April and June 2007, through in‐depth interviews and the construction of a genogram and an ecomap. The results presented the families' characterization and testimonies grouped in the following categories: social support, social networks and family roles. To promote care in practice, there is a need to identify the characteristics of each family and resources available that provide better living conditions. We concluded that identifying supports and social networks allows for more personalized care delivery to each family with a view to health promotion.     

Caregivers' experiences of interaction with families expecting a fetally impaired child

Background. On the basis of earlier research, caregivers’ actions when interacting with clients should be developed. However, nursing research has focused little attention on the interaction between caregivers and families expecting a fetally impaired child. Aim. The study aimed at generating a practical family nursing theory of caregivers’ interaction with families expecting a malformed child. Methods. A grounded theory study was undertaken at Tampere University Hospital in Finland in 1999–2000. Data consisted of semi‐structured interviews with 22 (n = 22) nurses and doctors. The data were analysed using the constant comparative method. Results. The interaction process starts when a caregiver informs the parents of the fetal impairment. The process is influenced by caregivers’ attitude towards issues related to the family's life situation. Caregivers’ views of their job, and of human coping and cultural attitudes towards these issues are also of importance. These factors account for their goals in the interaction, which, in turn, underlie their actions. When the caregiver's interpretation is that the family accepted the help provided, the outcome of the interaction is satisfaction with having been able to help. Correspondingly, in the case of an opposite interpretation, the caregiver experiences strain caused by inadequacy of the help he/she is providing. The core of interaction consists of two dimensions: gaining strength and losing strength in relation to impairment issues. Conclusions. Caregivers’ views of helpful interaction were consistent with earlier research on the subject, but the findings of this study showed that more attention should be focused on the family as a whole. Furthermore, caregivers rarely criticized their own actions, thus their interaction skills should be upgraded by focusing on systematic self‐assessment through training. Nursing research deepening our understanding of why interaction fails is warranted. Relevance to clinical practice. The study results can be used in the family nursing practice as tools in reinforcing the caregivers’ ability to helpful interaction with families expecting a fetally impaired child. The results may enhance caregivers’ systematic self‐evaluation and conscious use of the self.     

Research Article: Empowerment process for families rearing children with developmental disorders in Japan

The understanding of developmental disorders and the support that is offered to families rearing a child with developmental disorders always have been limited in Japan. To clarify the empowerment process for families rearing a child with developmental disorders, we interviewed 20 mothers of children who lived in the wider Tokyo area, Japan. To analyze the data, we adopted the modified grounded theory approach. The results identified three stages in the empowerment process: confusion over caring for the child, confrontation with the child with the disorder, and expectations of a valuable life for the child. The empowerment process showed step‐by‐step progress: families that were originally ill‐equipped to deal with their child's disorders were able to deal with them in collaboration with professionals through approaching the local administration and were able to shift their stance on child‐rearing along with their child's growth. To promote the family empowerment process, cross‐jurisdictional and cross‐occupational collaboration among local care teams is needed. The members of the teams should understand the experiences and feelings of the families that are rearing children with developmental disorders in the context of the family's empowerment process.     

Interaction between caregivers and families expecting a malformed child

BACKGROUND: Earlier research has shown that the care of families expecting a malformed child should be intensified and that the topic is understudied. AIM: This study aimed at generating a practical nursing theory of interaction between caregivers and families expecting a malformed child, as experienced by families. METHODS: A grounded theory study was undertaken at a university hospital, Finland. Data consisted of semi-structured interviews with 29 mothers and fathers, analysed using the constant comparative method. FINDINGS: The interaction process starts with the confirmation of the diagnosis. It usually comes as a shock to the parents, and gives rise to questions about the nature of the malformation, family members' relationship with themselves, family relationships and relationships with people outside the family. These questions are crucial to the family's coping and form the core of interaction. Families' own coping strategies are either reinforced or undermined by caregivers' actions and are reflected in parents' expectations about caregivers, which in part account for their actions and experiences of interaction. The care system as an interactive environment is part of a process which results in the experiences of being helped or being left without help. The core of the interaction process comprises two dimensions: gaining strength and losing strength in relation to malformation issues. CONCLUSIONS: The findings of the study are consistent with earlier research and complement it by providing a detailed delineation of the interaction from the perspective of the family. They can be used to formulate recommendations for improving caregivers' interactive skills and awareness of the topic through training. The care system should be developed to ensure that families receive psychological support and that the family as a whole receives proper care. Consideration of the viewpoint of siblings is a challenge for further research.     

Maternal experiences making a decision about heart surgery for their young children with congenital heart disease

Aim. The aim of this study was to investigate the essence of the experience of mothers during the decision‐making process when facing their less than three‐year‐old child undergoing heart surgery due to congenital heart disease (CHD). Methods. In this phenomenological study in Taiwan nine mothers were interviewed in their homes. They were invited to share their experience of family interactions and relationships while facing a decision about their child's heart surgery. The interviews were recorded and transcribed for further analysis according to Colaizzi's phenomenological methodology. Results. The essence of the maternal experience themes during the decision‐making process included (i) understanding the surgery step by step, (ii) role pressure, (iii) constructing care‐taking ability, (iv) endeavouring to maintain family functioning while preparing for surgery and (v) deliberate consideration to make the correct decision. Conclusions. When parents face their child having CHD and plan heart surgery, the whole family is living through a stressful decision‐making process. According to the results of this study, it is obvious that the caregivers and their whole families experience psychological distress, role reorganization and remodelling of family functioning. Relevance to clinical practice. The results of this study provide evidence‐based essential knowledge that will assist the management of such decision‐making processes and help to prepare the child and the family to have confidence in the heart surgery.     

Functioning of child maltreating families: lack of resources for caring within the family

The purpose of this study was to develop a preliminary theoretical model of functioning of child maltreating families. Child maltreatment was defined as physical, psychological or sexual abuse or neglect caused by the child's primary caregivers. The aim was to generate knowledge needed in developing understanding and the care of these families. Data were collected using interviews with open-ended questions from child maltreating families (n = 20). Transcribed interviews were analysed by using grounded theory and its constant comparative method. The categories of family functioning included structural factors of the family, relationships between family members, relationships outside the family, family strengths, and risk factors and manifestations of maltreatment. The relationships that emerged between these categories included conflicts and negative circles of family life and the effects of child maltreatment on the family. Lack of resources for caring within the family emerged as the core category which described the phenomenon in general and was connected to all other categories of family functioning. The findings can be useful in developing the care of child maltreating families, in nursing education and in preventing child maltreatment.     

Impact of eating disorders on family life: individual parents' stories

Aims and objectives. The aim of this study was to consider the impact that an eating disorder had on the family, particularly the parents. The objective was to give a voice to parents in order to develop new understandings of their experience leading to more appropriate clinical decision‐making. Background. The impact of an eating disorder on family life has not been well‐documented in the published literature. There are numerous articles from the sufferer's perspective and treatment modalities. The following paper describes a component of a larger study that explored the parent's perspective of having a child with an eating disorder. Design. Nineteen mothers and three fathers from Sydney, Australia, volunteered to be interviewed as the result of advertizements placed in parent support organization newsletters and by using the snowballing technique. Methods. A qualitative approach using semi‐structured interviews was used to explore parents’ experiences of having a child/adult child with an eating disorder. Themes were identified through in depth analysis. Results. Themes that were extrapolated from this research included, family unification or disintegration, parent's inability to cope, inconsiderate comments from significant others, social isolation and financial impacts. Conclusions. This study reports five overarching effects on family life. The authors conclude that one way in which the life of parents and families could be improved would be increased involvement and integration into the treatment process. For this to happen, health professionals would need to acknowledge the family as a resource. Relevance to clinical practice. This research documents the family struggle and highlights the current omissions concerning the family's role. The need for changes to clinical practice is substantiated. It requires health professionals to scrutinize their own clinical practice and consider modification of the treatment process.     

The perceptions of Taiwanese families who have children with learning disability

Aims and objectives. To explore the perceptions of families in Taiwan of living with a child who have learning disability and the parents perspectives on the cultural influences on their spiritual experiences. Background. Traditionally, the family is the most important unit of society, family functioning is a key field of interest among helping professionals who provide family interventions. Design. This study adopted qualitative research with semi‐structured interviews. The study analysis used content analysis which was a process of identifying, coding and categorizing the themes in the data. Methods. Semi‐structured interviews were conducted with 117 parents in their homes and were interpreted by using content analysis to extract key conceptual themes from the transcribed interview texts. Results. The findings revealed that the perceptions of families with learning disability children were wide‐ranging. The stressors did not occur in a fixed order, they were different in degree and importance from one family to another. Conclusions. The results showed that the experience of analysing qualitative data was extremely valuable for parents in that it aided their own understanding of the real‐life experiences of the parents and in coming to know the parents in a richer, more meaningful way. In doing so, nurses need to be aware of their own thoughts and environment without letting it influence others. Relevance to clinical practice. The nurse should demonstrate knowledge and understanding of the family's culture and be able to show respect for cultural difference to assess and identify culturally acceptable health‐care interventions.     

Negotiation of parental roles within family-centred care: a review of the research

Aims and objectives. To review research published in the past 15 years about how children's nurses’ negotiate with parents in relation to family‐centred care. Background. Family‐centred care is a basic tenet of children's nursing and requires a process of negotiation between health professionals and the family, which results in shared decision‐making about what the child's care will be and who will provide this. The literature highlights inconsistencies in the degree to which nurses are willing to negotiate with parents and allow them to participate in decisions regarding care of their child. There is need to explore further the extent to which nurses communicate and negotiate shared care with children and their parents. Conclusions. Three themes emerged from this review of the literature relating to whether role negotiation occurred in practice, parental expectations of participation in their child's care and issues relating to power and control. Parents wanted to be involved in their child's care but found that nurses’ lack of communication and limited negotiation meant that this did not always occur. Nurses appeared to have clear ideas about what nursing care parents could be involved with and did not routinely negotiate with parents in this context. Relevance to clinical practice. For family‐centred care to be a reality nurses need to negotiate and communicate with children and their families effectively. Parents need to be able to negotiate with health staff what this participation will involve and to negotiate new roles for themselves in sharing care of their sick child. Parents should be involved in the decision‐making process. However, research suggests that a lack of effective communication, professional expectations and issues of power and control often inhibit open and mutual negotiation between families and nurses.     

Family‐focused practice with EASE: A practice framework for strengthening recovery when mental health consumers are parents

This paper provides a framework for essential family‐focused practices (EASE: Engage, Assess, Support, Educate) for clinicians to support parents with mental illness in the context of their family. The framework is underpinned by relational recovery as the parent/consumer's recovery is considered within the context of their relationships, including the relationship between clinician and parent/consumer. The central aim is to strengthen nurses’ and other clinicians’ capacity to address key psychosocial needs of parents and to strengthen relational recovery in families where parents have mental illness. The EASE framework is a theory and evidence‐informed family practice approach to relational recovery within healthcare provision. The EASE practice components are defined and illustrated with practice exemplars that operationalize the framework within adult service settings. Potential applications and outcomes of using EASE are also described. The framework is intended as a practical guide for working with parents and families in inpatient and community mental health settings and may also be relevant for clinicians in a range of contexts including child welfare and primary health care.