The impact of a chronic condition on the families of children with asthma

As the incidence and severity of asthma continues to escalate, many families will encounter complex issues related to condition management and family coping. Nurses must understand the impact that a chronic condition can have upon the family in order to assist parents in developing their ability to manage their child's care. The use of an assessment tool, such as Hymovich's Parent Perception Inventory (HPPI) can assist nurses in this effort. Several research studies have demonstrated that common child and family concerns include time away from school and work; social restrictions; fear of exacerbations; and anxiety over treatment protocols. A preliminary study on a small convenience sample of families showed that parents had greatest concerns about time management, financial strain, and family relations (see Figure 1). Important nursing interventions related to family management of asthma include assessing family perceptions and coping abilities; encouraging expression of feelings and concerns; educating the child and family about the disease and condition management; supporting positive coping behaviors; and securing resources to help families manage their child's condition.     

Transition to home from the newborn intensive care unit: applying the principles of family-centered care to the discharge process

Increasingly newborn intensive care units (NICUs) are embracing family-centered care principles. Family-centered newborn intensive care requires that families are welcomed as partners in caregiving and decision making. Traditionally, discharge planning has been done without significant family involvement. In fact, parent participation in caregiving may still be limited until discharge is imminent. By increasing parental involvement in caregiving throughout hospitalization and working with families to facilitate the discharge process, parents may emerge from the NICU experience with increased competence and confidence in infant caregiving. This article reviews common discharge practices and processes in the NICU and offers strategies to assist nurses in integrating a family-centered approach into discharge planning.     

Family interaction and treatment adherence after stroke

Caregivers of 60 stroke patients were assessed five months after patient discharge from a stroke care unit to determine the relationship between family function and poststroke treatment adherence. Areas of family interaction which were significantly related to ratings of treatment adherence included problem solving, communication, and affective involvement. Better functioning families were consistently high on signs of treatment adherence. Findings suggest that families with specific dysfunction may not be as capable of helping patients comply with rehabilitation efforts as families who function more effectively. Thorough family assessment to identify which areas of family interaction are most problematic in relation to adherence issues is recommended.     

Psychiatric patients and families: moving from a catastrophic event to long-term coping

The families of psychiatric patients struggle throughout their member's illness with the change it brings and their own feelings about the illness. In the past, families were blamed for many of the problems that mentally ill people experienced, and although this perception of fault has changed, families still experience a catastrophic event when mental illness occurs. Coping will vary among families, and all experience grief as a result of their losses. Psychiatric home care can help families learn new and adaptive coping skills. Careful family assessment can be an important part of the patient's treatment, forming a partnership to reintegrate the ill person into the family and home.     

Parent views of infant pain and pain management in the neonatal intensive care unit

It is well established that infant pain is an important concern of parents, but little is known about the knowledge and expectations of parents regarding their infant's pain or about parents' involvement in their infant's care and satisfaction with pain management by neonatal intensive care unit (NICU) staff. Parents have an important role to play in helping health care professionals understand their child's pain and in providing comfort to their child. Neonatal nursing has been at the forefront of family-centered care, but family involvement in pain care has lagged behind other aspects. New guidelines and standards emphasize the importance of the family's role in pain management. This article examines the rationale for supporting parent involvement in infant pain care and discusses the importance of understanding parent views on infant pain in light of the new standards for pain management set forth by the Joint Commission on Accreditation of Healthcare Organizations. Findings from a survey to determine parent understanding of and involvement in infant pain care in one NICU are presented. A continuous-quality-improvement approach for enabling the involvement of parents in their infant's pain care is proposed, and specific strategies are suggested. Copyright © 2001 by W.B. Saunders Company     

Different perspectives: the effect of heart disease on patients and spouses

Nurses working in critical care units play an important role in helping patients and their families cope with illness. In this article, heart disease is used as a paradigm for discussion of the coping processes of patients and families as they adapt to an acute event. Patients and spouses demonstrate different but equally important responses that may increase marital conflict and impede recovery. The denial frequently used by patients is in direct contrast to the oversolicitousness demonstrated by spouses. Early assessment of potential family dysfunction is essential in order to plan and implement interventions that promote family coping. In this article, the interventions available to nurses working with families in an acute care setting are reviewed. Interview data from one study of cardiac patients and their spouses is used to illustrate the family dynamics seen in the acute and chronic phase of recovery and to provide examples of the couples' differing perspectives on the helpfulness of various interventions.     

Care managers’ view of family influence on needs assessment of older people

Scand J Caring Sci; 2011; 25; 243–252
Care managers’ view of family influence on needs assessment of older people Research has shown that families experience poor involvement in needs assessment of older people while little is known about municipal care managers’ views of family participation. The aim was to explore how municipal care managers view families’ participation in and influence on needs assessment of older people receiving public home help. Individual interviews (n = 26) were conducted with care managers (n = 5) about their previously conducted needs assessments (n = 5–6). As a complement, a focus group interview with care managers (n = 9) from nine different municipalities was conducted. All interviews were analysed using a qualitative content analysis. The results revealed the overarching category, ‘Having to establish boundaries towards family influence and at the same time use them as a resource’, which encompassed five principal categories. How family participation was viewed and handled during the needs assessment process seemed determined by the way care managers set boundaries for their professional responsibility. Their views revealed both distancing and strengthening attitudes. The distancing attitude dominated, in particular towards family members who were not perceived as having any legal rights to be considered, even though their participation was an important resource. To follow legislation and municipal guidelines of allocation of public home help to avoid reprimands caused a need for self‐protection. The care managers seemed pressed by demands from organizations and families, and in this competition, the family lost out. Adherence to organizational developed patterns of handling legislation and guidelines were prioritized. Because family members often are older and assist in providing care, family participation in the needs assessment of older help recipients needs further societal support.     

Caring for adolescents and families in crisis

Nurses are likely to see adolescents and their families in a variety of practice settings. Recognizing the youth and family at risk is significant in helping them resolve a stressful situation by mobilizing resources and strengthening coping and problem-solving skills. This article has focused on several areas, including suicide and depression, sex-related issues, substance abuse, and poor academic performance. Helping the youth and family in crisis challenges the nurse to use astute assessment skills that support a patient-centered crisis intervention model. During a time when cost-effective mental health care is a necessity, this model offers nurses an opportunity to provide quality health care.     

Facilitating nurturant fathering behavior in the NICU

Many of the roles required of the father of a NICU infant are new and unfamiliar, difficult to carry out, unrehearsed, and yet called for in an unexpected crisis. At a time when they too need nurturing, fathers of high-risk infants are expected to adapt readily and be models of self-control. It is apparent from this investigation that the primary nurse is in a strategic position to assist the new father in his acquaintance with and early adjustment to his infant. Although some of the fathers will become actively involved with their children, others prefer less involvement in infant care taking and display minimal nurturant behaviors. A nurse must be able to recognize these differences and support a father's (and mother's) choice. A couple's sociocultural ideology and perceptions of the father's role, as well as the family dynamics and values, need to be given primary consideration in planning nursing care. In order for the nurse to fulfill an important teaching role for the fathers (parents) of NICU infants, the nurse must meet the needs of each individual father in relation to the family system. This requires systematic and nonjudgmental assessment and caring facilitation of paternal role development and early father-infant and father-mother-infant interactions.     

Management of Alzheimer's disease. A family affair

The various approaches to the patient with Alzheimer's disease are receiving much attention, but relatively little has been written about the important role physicians can serve in helping the patient's family deal with the disease. In managing Alzheimer's disease, the physician's relationship with family members may be as important as or even more important than his or her relationship with the patient. Establishing and maintaining a successful relationship involve early assessment of family function, periodic home visits, coordination of available community resources, regular assessment of caregivers' coping skills, and regular discussions about the limits of home care and the possibility of placement in a nursing home. When nursing home care is chosen, the physician can, by continuing his or her involvement, help assure provision of the highest quality care possible.     

Living with major depression: experiences from families' perspectives

The aim of this study was to describe the ways of living with major depression in families. Seven families with an adult member who suffered major depression participated, in all 18 participants. Data were collected from seven narrative group interviews, one with each family. A qualitative thematic content analysis was used and the text was coded according to its content and further interpreted into themes. Findings consist of five themes: 'Being forced to relinquish control of everyday life'; during depression the family members lost their energy and could not manage everyday life. 'Uncertainty and instability are affecting life'; everyday life in the families was unstable and emotions influenced the atmosphere. 'Living on the edge of the community': the families periodically lived in seclusion. 'Everyday life becomes hard'; everyday life was demanding for everyone in the family and the responsibility shifted between family members. 'Despite everything a way out can be found'; the families as a unit as well as individually had their own ways of coping and finding some kind of satisfaction within the bounds of possibility. The families' experiences were demanding. Children were aware of their parent's depression and were involved in managing everyday life and emotionally affected by the situation. This legitimates the need for nurses and other healthcare professionals to have a family's perspective on the whole situation and to include partners as well as children and take their experiences seriously when supporting and guiding a family. It is important to develop strategies which in particular include children in the planning, provision and receiving of care as well as unburden them with the responsibility. It is also important to support the family in their own coping strategies with a major depressive episode.     

The many roles of family members in "family-centered care"--part II. Interview by Deborah Dokken

This article highlights the role parents can play as advocates for their own children. A mother who is interviewed describes a nurse's support in helping her claim her baby as her own in the midst of the NICU environment and how that claiming led her to become involved in his care and a strong advocate for his needs. She shares advice for parents and health care providers. A physician who is interviewed discusses working with this mother and other parents, and describes ways health care professionals can support parents as advocates.     

Case study of an educational intervention to favor siblings’ adaptation during the hospitalization of a preterm infant in the neonatal intensive care unit

Hospitalization of a preterm infant in the Neonatal Intensive Care Unit (NICU) places additional strain on the family and influences the siblings' adaptation. Although it is essential to support the siblings’ adaptation and provide family-centered care in the NICU, sibling involvement is rarely integrated into nursing care. An evidence-based intervention was therefore developed in a level-III NICU and its impact on sibling adaptation was evaluated using a Case study in which three families with a hospitalized infant and siblings between 3 and 12 years old participated. The parents were asked to consult a website and attend a 30-min educational session on issues related to sibling adaptation, and the siblings received a structured introduction to the NICU and visited the preterm infant. All three families were satisfied with the activities, although two parents felt neutral about whether the intervention met their expectations. Overall, the intervention seems to have the potential to facilitate sibling adaptation during the experience of a NICU hospitalization.     

Potential for alterations in family process: when a family has a child with cystic fibrosis

Cystic Fibrosis (CF) is a disease that has profound consequences on a family unit. As a genetically transmitted, chronic illness, it influences every aspect of family life, including time constraints, finances, and relationships among family members. The purpose of this article is to demonstrate the cumulative effect of the nursing diagnoses related to the pathophysiology of CF on the nursing diagnosis, Potential for Alterations in Family Process, when a family has a child with cystic fibrosis. This nursing diagnosis was first recognized by the North American Nursing Diagnosis Association (NANDA) in 1982. It is vital that nurses be able to differentiate between a family having difficulty coping with a child with CF in the home, and one that is coping well on its own. The children of families that are not coping well tend to be hospitalized more than those of families that are coping well. The families use the hospitalizations as rest periods for themselves. By recognizing the cues identified by NANDA of a family having problems, early intervention can be initiated before the family is in a crisis. The family must live with CF on a daily basis for the remainder of the child's life; therefore it must be able to function at its optimum level. It is nursing's responsibility to be able to recognize and assist the family in need. A knowledge of the nursing diagnosis, Alterations in Family Process, will assist nurses in fulfilling this obligation to the family.     

Potential for alterations in family process: when a family has a child with cystic fibrosis

Cystic fibrosis (CF) is a disease that has profound consequences on a family unit. As a genetically transmitted, chronic illness, it influences every aspect of family life, including time constraints, finances, and relationships among family members. The purpose of this article is to demonstrate the cumulative effect of the nursing diagnoses related to the pathophysiology of CF on the nursing diagnosis, Potential for Alterations in Family Process, when a family has a child with cystic fibrosis. This nursing diagnosis was first recognized by the North American Nursing Diagnosis Association (NANDA) in 1982. It is vital that nurses are able to differentiate between a family having difficulty coping with a child with CF in the home, and one that is coping well on its own. The children of families that are not coping well tend to be hospitalized more than those of families that are coping well. The families use the hospitalizations as rest periods for themselves. By recognizing the cues identified by NANDA of a family having problems, early intervention can be initiated before the family is in a crisis. The family must live with CF on a daily basis for the remainder of the child's life; therefore it must be able to function at its optimum level. It is nursing's responsibility to be able to recognize and assist the family in need. A knowledge of the nursing diagnosis, Alterations in Family Process, will assist nurses in fulfilling this obligation to the family.     

Children's adaptation to insulin dependent diabetes mellitus: a critical review of the literature

A preventive health care context is important in managing children with insulin dependent diabetes mellitus (IDDM). Specific risk factors can make adaptation to IDDM more difficult. These include older age, female gender, family stress, and non-intact family structure. Factors which enhance child adaptation, also called resistance factors, include family cohesion and adaptability, positive coping strategies, younger age, and social support. Children having a chronic illness face many challenges, including changes in lifestyle, such as regimented scheduling of everyday life, readjustment of roles in the family, and potential activity alterations. An important role of health care professionals is to guide and counsel both children who are newly diagnosed with a chronic illness and their families about ways to normalize their lives as much as possible, even while realizing that their lives will never be the same as before diagnosis. Throughout the course of an illness, children and families rely on nurses to provide information about health promotion and illness management. Nurses coordinating the care of children adapting to insulin dependent diabetes mellitus (IDDM) must recognize the significance the diagnosis has on the child. Furthermore, identification of those factors that place the child at risk for poor adaptation is critical so that the nurse can assist with the process of adaptation and recruit other psychological or social support resources as early as possible.     

Parents' views about infant pain in neonatal intensive care

OBJECTIVE: The purpose of this study was to describe parents' perceptions and feelings about their infant's pain experience and pain care in the neonatal intensive care unit. METHOD: Thematic content analysis was used to encode the qualitative information contained in parents' written comments on a questionnaire about their views on infant pain and pain care. The questionnaire was completed by 257 parents from 9 neonatal units in the United Kingdom (n = 196) and 2 neonatal units in the United States (n = 61). RESULTS: Parents' comments indicated that they saw medical procedures as the major source of their infant's pain, wanted more information, and generally desired more involvement in this aspect of their infant's care. Parents' comments indicated that their infant's pain affected them emotionally and that they worried about their future relationship with their infant. Parents also articulated specific ways in which health care professionals could assist them and their infants in coping with neonatal intensive care unit-related pain. DISCUSSION: The findings from this study expand knowledge about how parents understand and respond to the difficult situation in which their newborn infant is subjected to essential but painful procedures. The findings provide direction for research and clinical practice interventions aimed at: 1) helping parents to gain knowledge and correct their misperceptions; 2) engaging parents in meaningful dialog about their concerns and preferences for involvement; and 3) helping parents to develop effective coping strategies to reduce psychologic distress related to their infant's pain.     

Men's perspectives on individual and family coping with their wives' breast cancer and chemotherapy

Little research has examined the impact of cancer and chemotherapy treatment for breast cancer from men's perspectives as partners, fathers, and caregivers. This research, part of a larger study describing women's, partners', and children's perspectives, aims to describe men's perspectives on their experiences and how their wives' breast cancer and chemotherapy impacted them and their families, to describe what facilitated and hindered their coping, and to suggest interventions to assist men and their families to manage the experience with less stress. This participatory action study used qualitative naturalistic inquiry methods. Semistructured interviews were conducted with 11 male partners. Two major themes were identified: focusing on a wife's illness and care, and focusing on the family to keep life going. Nine sub-themes cut across the major themes: being there, relying on health care professionals, being informed and contributing to decision making, trying to keep patterns normal and family life going, helping out and relying on others, being positive, putting self on hold, adapting work life, and managing finances.     

Coping processes of Taiwanese families during the postdischarge period for an elderly family member with hip fracture

The purposes of this study were to develop a conceptual framework explaining the coping processes of Taiwanese families after hospital discharge of an elderly family member with hip fracture and to use the Roy adaptation model to examine their interdependence relationships. In-depth, face-to-face interviews were tape-recorded and transcribed verbatim. Data were analyzed by grounded theory method. Findings revealed that a harmony between receiving and giving relationships was maintained by care receivers and caregivers during the postdischarge period to achieve an outcome of adaptation in their relationships. By understanding these coping processes, nurses can assist families to enhance adaptation.     

Addressing the Needs of Mothers with Infants in the Neonatal Intensive Care Unit: A Qualitative Secondary Analysis

PurposeMothers of infants hospitalized in neonatal intensive care units (NICUs) need to be recognized as essential partners of the care team as their presence and involvement are key to infants' health and developmental outcomes. Addressing mothers' perceived needs is beneficial for the improvement of supportive nursing care; however, little qualitative research on their unmet needs has been conducted in South Korea. This study assessed mothers' perspectives on their NICU experiences and their unmet needs within the South Korean cultural context.MethodA cross-sectional, multicentered, secondary analysis study was conducted using the written responses to an open-ended questionnaire. Of the 344 NICU-experienced mothers, 232 throughout South Korea (seven cities and five provinces) voluntarily completed the questionnaire via smartphone-based or web-based surveys. Their narrative responses were analyzed using thematic content analysis guided by the critical incident technique.ResultsFour themes emerged. NICU-experienced mothers of preterm infants referred to the “family-friendly environment” (16.4%) as a positive experience. The greatest unmet need was “relationship-based support” (58.2%), followed by “information and education-based support” (20.0%) and “system-level challenges” (5.4%).ConclusionThe importance of creating a family-friendly NICU environment should be emphasized by ensuring 24-hour unrestricted access and encouraging active parental involvement in infant care, as well as actively supporting NICU families through supportive words and actions. The assurance of antiinfection management and better staffing levels should be fundamentally guaranteed to NICU staff.