Nurses' attitudes to family importance in nursing care: A two-sited cross-sectional study.

AIM: This study aimed to describe nurses' attitudes and beliefs towards the importance of family in nursing care and explore differences in nurses' attitudes and beliefs towards family-centered care between different healthcare institutions, such as community healthcare centers and hospitals. BACKGROUND: Family significantly affects the well-being and health of individuals. Therefore, nurses should support family engagement in nursing care. In recent years, family nursing research has emphasized the importance of teaching family nursing skills in continued education in healthcare institutions. Research has indicated that nurses who believe that illness concerns the family as a whole are more likely to involve the family in patient care. DESIGN: A cross-sectional research design was used. METHOD: Data were collected at one timepoint between March and September 2019 from 425 nurses working at the Primary Health Care Centers of the Capital Area (n=112) and in clinical settings at the University Hospital in Iceland (n=313). RESULTS: The main findings indicated that nurses working in the women-and-child division at the University Hospital reported significantly more positive attitudes towards family evolvement in patient care than nurses working in the intensive care or surgical units. For nurses working at healthcare centers, a significant difference was also found in the nurses' attitudes towards involving families in patient care. The nurses who were working in home care had significantly more positive attitudes when compared to those working in the infant and young children health promotion units. CONCLUSIONS: Greater collaboration is required between healthcare providers and families to improve the quality of care and health-related outcomes. Therefore, it is crucial to enhance nurses' knowledge about the importance of families during patient care. TWEETABLE ABSTRACT: This study aimed to describe nurses' attitudes and beliefs towards family care. Differences were found between nurse's attitudes by units but not by institutions.

Nursing students' perception of family importance in nursing care during the COVID-19 pandemic: A cross-sectional study.

BACKGROUND: Little is known about nursing students' illness beliefs and attitudes towards the involvement of families in nursing care during the COVID-19 epidemic. Focusing on family nursing throughout an undergraduate nursing education is not only appropriate or critical but also essential for advancing family nursing practice. OBJECTIVES: To evaluate the differences in undergraduate and graduate nursing students' perceptions of illness beliefs and their family nursing practice skills at the time of the COVID-19 pandemic. DESIGN: A cross-sectional study. SETTINGS: The Faculty of Nursing at the University of Iceland. PARTICIPANTS: Of the nursing and midwifery students, 109 participated in 2020 from one university. METHODS: Data was collected regarding illness beliefs and attitudes towards family involvement in nursing care, through questionnaires via the Red Cap software. RESULTS: The main finding indicated that the graduate students reported more confidence or reassurance regarding their knowledge of the cause of an illness, control, effect, suffering and what is the most and the least helpful in coping with an illness/health disorder when compared to the undergraduate students (t-value = -2.50, p-value = 0.014). Additionally, graduate nursing students also reported higher positive attitudes towards family importance in nursing care than undergraduate students (t-value = -2.16, p-value = 0.033). CONCLUSION: Even though the graduate students reported higher illness beliefs than undergraduate students, the undergraduate students reported a reasonably high or over medium high score, on the illness beliefs scale. University nursing educators need to be aware that nursing students' knowledge, skills and attitudes towards family nursing practice at the time of the COVID-19 pandemic shape clinical competence in family nursing within health care settings.

Developing a Health Game to Prepare Preschool Children for Anesthesia: Formative Study Using a Child-Centered Approach.

BACKGROUND: Every year, millions of children undergo medical procedures that require anesthesia. Fear and anxiety are common among young children undergoing such procedures and can interfere with the child's recovery and well-being. Relaxation, distraction, and education are methods that can be used to prepare children and help them cope with fear and anxiety, and serious games may be a suitable medium for these purposes. User-centered design emphasizes the involvement of end users during the development and testing of products, but involving young, preschool children may be challenging. OBJECTIVE: One objective of this study was to describe the development and usability of a computer-based educational health game intended for preschool children to prepare them for upcoming anesthesia. A further objective was to describe the lessons learned from using a child-centered approach with the young target group. METHODS: A formative mixed methods child (user)-centered study design was used to develop and test the usability of the game. Preschool children (4-6 years old) informed the game design through playful workshops (n=26), and usability testing was conducted through game-playing and interviews (n=16). Data were collected in Iceland and Finland with video-recorded direct observation and interviews, as well as children's drawings, and analyzed with content analysis and descriptive statistics. RESULTS: The children shared their knowledge and ideas about hospitals, different emotions, and their preferences concerning game elements. Testing revealed the high usability of the game and provided important information that was used to modify the game before publishing and that will be used in its further development. CONCLUSIONS: Preschool children can inform game design through playful workshops about health-related subjects that they are not necessarily familiar with but that are relevant for them. The game's usability was improved with the participation of the target group, and the game is now ready for clinical testing.

The better sleep better well-being programme: Educating and training community healthcare nurses in developing interventions for families of infants with moderate sleep problems: a pilot study.

The main aim of this pilot study was to evaluate the benefit of the Better Sleep Better Well-being (BSBW) educational and training intervention programme regarding infants sleep problems for Community Health Care (CHC) nurses, on their perceptions on their family nursing practice skills and on their job demand, control and support. There were 6 CHC nurses who participated in the BSBW programme, and 26 nurses in the comparison group. The programme consisted of 4 sessions (8 hours per session) of lectures on the aetiology of infants sleep problems as well as on evidence-based and family relational practices and on 20 sessions of clinical cases, scenarios, discussions and reflections. The main finding indicated that the nurses in the intervention group reported significantly higher family nursing practices skills compared to the nurses in the comparison group. The findings are promising, since they offered additional resources to the CHC nurses, in their clinical practices.

The Impact of Family Strengths Oriented Therapeutic Conversations on Parents of Children with a New Chronic Illness Diagnosis.

A growing number of families with children are dealing with a new diagnosis of chronic illnesses or health problems that are demanding. Nurses are in a prime position to provide support and empowerment to these families. The aim of the study was to evaluate the benefits of two sessions of a Family Strengths Oriented Therapeutic Conversation (FAM-SOTC) intervention, offered by advanced practice nurses (APNs) to mothers (N = 31) of children and adolescents in Iceland with newly diagnosed chronic illnesses/disorders. Families of children with Juvenile Idiopathic Arthritis (JIA), epilepsy, Type 1 diabetes (T1DM), or with sleep disturbance with attention-deficit/hyperactivity disorder (ADHD), reported significantly higher family support, greater conviction about their illness beliefs, increased quality of life, and greater satisfaction with health care services after receiving two sessions of the FAM-SOTC intervention (Time 2) compared to before the intervention (Time 1). The findings emphasize the importance of the APN's role and family nursing expertise in supporting families of children with a new diagnosis of chronic illnesses or disorders who are in active treatment.

The impact of nursing education and job characteristics on nurse's perceptions of their family nursing practice skills.

BACKGROUND: Implementing family system nursing in clinical settings is on the rise. However, little is known about the impact of graduate school education as well as continuing education in family systems nursing (FSN) on nurses' perceptions of their family nursing practice. AIMS: To evaluate the level of nursing education, having taken a continuing hospital educational course in family system nursing (FN-ETI programme), and the impact of job characteristics on nurses' perceptions of their family nursing practice skills. DESIGN AND METHODS: Participants were 436 nurses with either a BSc degree or graduate degree in nursing. The Job Demand, Control and Support model guided the study (R. Karasek and T. Theorell, 1992, Healthy Work: Stress, Productivity, and the Reconstruction of Working Life, Basic Books, New York, NY). Scores for the characteristics of job demands and job control were created to categorise participants into four job types: high strain (high demand, low control), passive (low demand, low control), low strain (low demand, high control) and active (high demand, high control). RESULTS: Nurses with a graduate education who had taken the FN-ETI programme scored significantly higher on the Family Nursing Practice Scale than nurses with an undergraduate education. Nurses who were characterised as low strain or active scored significantly higher on the Family Nursing Practice Scale than the nurses who were characterised as high strain. Further, the interaction of education by job type was significant regarding family nursing practice skills. Hierarchical regression revealed 25% of the variance in family nursing practice skills was explained by job control, family policy on the unit, graduate education and employment on the following divisions: Maternal-Child, Emergency, Mental Health or Internal Medicine. CONCLUSION: Graduate education plus continuing education in FSN can offer nurses increased job opportunities more control over one's work as well as increased skills working with families in clinical settings.

The importance of family support in pediatrics and its impact on healthcare satisfaction.

AIMS: To evaluate predictors of healthcare satisfaction for parents whose children received hospital-based healthcare services at the Children's hospital at Landspitali University Hospital. METHODS: In this cross-sectional study, data on perceived family support, family quality of life, expressive family functioning, coping strategies and healthcare satisfaction were collected from 159 mothers and 60 fathers (N = 177 families) of children and adolescents from 2011 to 2012. RESULTS: Logistic regression analysis revealed that, for mothers, 38.8% of the variance in satisfaction with healthcare services was predicted by perceived family support and their coping strategies, while for fathers, 59.9% of the variance of their satisfaction with healthcare service was predicted by perceived family support, family quality of life and whether the child had been hospitalised before. DISCUSSION: Perceived family support was the one factor that was found to predict both the mothers' and the fathers' satisfaction with healthcare services. Knowing which factors predict satisfaction with health care among parents of hospitalised children with different chronic illnesses and health issues can inform the delivery of effective family-focused interventions and evidence-based practice to families.

Family nursing hospital training and the outcome on job demands, control and support.

The purpose of this study was to evaluate the impact of a family systems nursing hospital training educational program (ETI program) on nurses' and midwives' perception of job demands, control, and/or support. Of the nurses and midwives who were working in the Women's and Children's Services Division at The National University Hospital in Iceland, 479 participated in the study on three time periods from 2009 to 2011. Scores for the characteristics of job demands and job control were created to categorize participants into four job types (Karasek and Theorell, 1990). These four job types are high strain (high demand, low control), passive (low demand, low control), low strain (low demand, high control), and active (high demand, high control). However, when the data were evaluated based on the proportion of job characteristics as reported by the nurses and the midwives, no significant difference was found over time (2009 to 2011) (χ(2)=5.203, p=.518). However, based on the results from the independent t-tests at time 1, a significant difference was found amongst the high strain job group regarding perceived support from administrators and colleagues among the nurses and midwives who had taken the ETI program compared to those who had not taken the program (χ(2)=2.218, p=.034). This indicates that the health care professionals who characterized their job to be of high demand but with low control evaluated the support from their administrators and colleagues to be significantly higher if they had taken the ETI program than did the nurses and midwives who did not take the ETI program. These findings are promising because they might, in the long run, increase the nurses' and midwives' autonomy and control over their own work.

The process of translating family nursing knowledge into clinical practice.

PURPOSE: To report on approaches that were used to assist with implementation of family systems nursing (FSN) at a university hospital level in Northern Europe. DESIGN AND METHODS: A quasi-experimental research design was used for the first phase of the study. For the second phase, a cross-sectional research design was used. Data were collected in the first phase of the study from 457 nurses in all except one of the divisions of the hospital regarding their attitudes towards involving families into their care before and after having participated in the education and training intervention (ETI) program in FSN. Furthermore, in the second phase, data were collected from 812 nurses, after FSN had been implemented in all divisions at Landspitali University Hospital, regarding the nurses' knowledge of FSN and their evaluation of the quality of the ETI program (i.e., theoretical lectures on FSN as well as the benefit of the skill lab training regarding applying FSN into their clinical practices). Graham and colleagues' Knowledge to Action framework was used as the conceptual framework for the research. RESULTS: Nurses who had taken a course in FSN reported a significantly more positive attitude towards involving families in their care after the ETI program compared to those who had not taken such a course. Furthermore, a majority of the nurses who participated in the ETI program reported that the program was a favorable experience and indicated readiness for applying FSN in clinical practice. CONCLUSIONS: Further research is needed regarding the benefits of offering FSN at an institutional level, but focusing international attention on effective strategies to implement FSN into nursing practice may result in better health care for individuals and families around the globe. CLINICAL RELEVANCE: Providing clinically meaningful education and training in family nursing through programs such as the ETI program for practicing nurses at a university hospital is essential in supporting nurses applying new knowledge, when providing evidence-based health care services, to individuals and their family members. Such training can facilitate integration of new and needed information in clinical practice.

The impact of a web-based educational and support intervention on parents' perception of their children's cancer quality of life: an exploratory study.

The purpose of this exploratory study was to (1) describe the development of an evidence-based web educational and support intervention for families of children with cancer and (2) assess the favorability of the website, and whether there was any impact on the cancer communication aspect of the quality of life instrument. In the study, 38 persons participated-15 mothers, 12 fathers, and 11 children. The favorability score of the website was found to be very high. The mothers rated the website most favorable, followed closely by the fathers. Furthermore, even though it was not significant, an increase was found in the mothers' evaluation of cancer communication based on the Pediatric Quality of Life Questionnaire (PedsQL) after the intervention as compared with before. The findings suggest that the use of an evidence-based website is feasible, appears to enhance cancer knowledge and might, in that way, contribute to better management of the cancer situation for the families.

Strengths-oriented therapeutic conversations for families of children with chronic illnesses: findings from the Landspitali university hospital family nursing implementation project.

Psychosocial services have been recommended for families of children with chronic illnesses to assist them in adjusting to the illness experience. However, little is known about the benefit of psychosocial interventions in clinical practice. This study aimed at evaluating the benefits of a two-session family therapeutic conversation intervention (FAM-TCIs) for families of children diagnosed with asthma, cancer, or diabetes. A secondary data analysis was conducted on intervention data from 37 families of children with chronic illnesses. Mothers of the children/teenagers perceived significantly higher family support after the FAM-TCI compared with before; mothers reported significantly higher collaboration and problem-solving abilities on the expressive family functioning scale after the FAM-TCI. However, no significant differences were found on the fathers' perceived family support nor on their expressive family functioning after the FAM-TCI compared with that before the intervention. It is promising that mothers of children with chronic illness perceived the two-session FAM-TCI to be beneficial to them. More attention should be paid to psychosocial interventions for families of children with chronic illnesses.

Benefits of a brief therapeutic conversation intervention for families of children and adolescents in active cancer treatment.

PURPOSE/OBJECTIVES: To test the effectiveness of a two-to-three session family therapeutic conversation intervention (FAM-TCI) for primary and partner caregivers of children and adolescents in active cancer treatment on perceived family support and on expressive family functioning. DESIGN: Quasiexperimental; one group pre- and post-test. SETTING: Inpatient cancer unit and a day treatment cancer unit at the Children's Hospital in Reykjavik, Iceland. SAMPLE: 19 parent caregivers (10 primary, 9 partner) of children in active cancer medical treatment. METHODS: The caregivers completed baseline measure questionnaires and were offered the first sessions of the FAM-TCI. About four to eight weeks later, the second session was administered and then the caregivers were offered a third session, if needed, one week later. When the caregivers had finished all sessions, they answered the same set of questionnaires about one week later. MAIN RESEARCH VARIABLES: The FAM-TCI for primary and partner caregivers, family support, and expressive family functioning. FINDINGS: Primary caregivers perceived significantly higher family support after the intervention compared to before. Those caregivers also reported significantly higher expressive family functioning and significantly higher emotional communication after the intervention. Partner caregivers, however, reported significantly lower verbal communication after the FAM-TCI compared to before. CONCLUSIONS: Shortening hospital stays in pediatric oncology populations has focused attention on effective short-term psychosocial interventions. The FAM-TCI is promising as an effective short-term intervention but requires additional testing. IMPLICATIONS FOR NURSING: The FAM-TCI strengthened pediatric oncology caregivers in their caregiving activities and was found to benefit primary caregivers regarding their perception of family support and expressive family functioning; therefore, the intervention might benefit future families of children and adolescents in active cancer treatment. KNOWLEDGE TRANSLATION: The FAM-TCI was brief, easy to provide, and well fitted. Pediatric oncology nurses can offer brief, beneficial interventions to families of children and adolescents with cancer who are in active treatment. Knowing that primary caregivers experienced support and information may result in more effective evidence-based family care.

Therapeutic conversations intervention in pediatrics: are they of benefit for families of children with asthma?

This article reports a quasiexperimental family level intervention study to measure effectiveness of a theory-based family therapeutic conversation intervention (FAM-TC) for families of children with asthma on perceived family support and asthma-related quality of life (QOL). Perceived family support increased significantly for mothers in the experimental group. The children of the parents in the experimental group reported significantly lower problems with asthma treatment on the treatment problems subscale of the asthma QOL scale after the intervention. These results highlight the benefit of therapeutic conversations for families of children and adolescent with asthma to support or enhance QOL.

Knowledge translation in family nursing: does a short-term therapeutic conversation intervention benefit families of children and adolescents in a hospital setting? Findings from the Landspitali University Hospital Family Nursing Implementation Project.

In an effort to examine translation of family nursing knowledge to practice, the Landspitali University Hospital Family Nursing Implementation Project (2007-2011), was thoughtfully initiated in Reykjavik, Iceland and systematically evaluated. The mission was to implement family nursing in every department of the hospital. This publication is the first formal research report from this landmark project. The purpose of this research was to evaluate the effectiveness of a short-term therapeutic conversation intervention with families who were receiving health care services at the Children's Hospital at Landspitali University Hospital in Iceland related to childhood and adolescent acute and chronic illnesses. The therapeutic conversation was guided by Family Systems Nursing and used the Calgary Family Assessment and Intervention Models (Wright & Leahey, 2005, 2009). Families (N = 76) were randomly assigned to either an experimental group (short-term therapeutic conversation: n = 41) or to a control group (traditional care: n = 35). Parents in the experimental group reported significantly higher family support after the intervention, compared to the parents in the control group. Differences were noted between families experiencing acute versus chronic illnesses. Recommendations are made for conducting and designing intervention research with families experiencing the hospitalization of a child or adolescent.

[Burn injuries in children: admissions at Landspitali University Hospital in Iceland 2000-2008]. / Brunaslys barna: innlagnir á Landspítala 2000-2008.

BACKGROUND: Causes of burn injuries in children are universally associated with social and environmental factors. Epidemiological studies are therefore important in identifying risk factors and for planning preventive interventions. METHODS: Children younger than 18 years with skin burns who were treated as inpatients at Landspitali University Hospital over a 9-year period, 2000 and 2008, were included in this retrospective descriptive study. Data was collected from medical records. RESULTS: Of 149 children included in the study 41.6% were four years old or younger. The average annual incidence of hospital admissions was 21/100,000. Cold water as first aid was applied in 78% of cases. Half of the accidents occurred in the home where a close family member was the caretaker. Risk factors were identified in 11.4% of the accidents and abuse or neglect was suspected in 3.4% of cases. Scalds were the most common type of burn injury (50.3%) followed by burns caused by fire (20.4%) including gas or petrol (14.9%) and fireworks (17.6%). The most common source of scalds was exposure to hot water from hot water mains (12,9%) and heated water (12,9%). The mean time from emergency room admission to the paediatric ward was two hours and 22 minutes. The mean length of stay was 13 days; median 9 days (range 1-97). CONCLUSION: Incidence of hospital admissions for burn injury has decreased when compared with earlier Icelandic studies. Children four years and younger and boys between 13-16 years old are most at risk for burn injuries. Stronger preventive measures as well as better documentation of burn accidents are imperative.

Developing a family-level intervention for families of children with cancer.

PURPOSE/OBJECTIVES: To determine the feasibility and effectiveness of a family-level intervention for parents of children newly diagnosed with cancer. DESIGN: A one-group, pretest and post-test, quasi-experimental design. SETTING: A university hospital in Iceland. SAMPLE: 10 families (19 parents) of children and adolescents newly diagnosed with cancer. METHODS: Parents were asked to answer questionnaires at baseline and then twice after the intervention, at 6 and 12 months. MAIN RESEARCH VARIABLES: Acceptability and short-term effects on parents' well-being, coping behavior, hardiness, and adaptation of an educational and informational home page, support offered on the Internet to parents, and one or two 60- to 90-minute support interviews. FINDINGS: Most of the families indicated that the intervention was important, helpful, and supportive, but the level of usefulness of the intervention varied. Information from the hypotheses testing, that parents' level of well-being increased significantly one month after the intervention and that fathers found it helpful to maintain social support and psychological stability after the intervention, are optimistic indicators and support a possible short-term effect of the intervention. CONCLUSIONS: Offering a family-level educational and support intervention was feasible and may be effective for such families. IMPLICATIONS FOR NURSING: Researchers and clinicians may want to enhance the intervention and test it on bigger samples and with a control group.