Immersion research education: students as catalysts in international collaboration research.

BACKGROUND: This paper describes an international nursing and health research immersion program. Minority students from the USA work with an international faculty mentor in teams conducting collaborative research. The Minority Health International Research Training (MHIRT) program students become catalysts in the conduct of cross-cultural research. AIM: To narrow the healthcare gap for disadvantaged families in the USA and partner countries. METHODS: Faculty from the USA, Germany, Italy, Colombia, England, Austria and Thailand formed an international research and education team to explore and compare family health issues, disparities in chronic illness care, social inequities and healthcare solutions. USA students in the MHIRT program complete two introductory courses followed by a 3-month research practicum in a partner country guided by faculty mentors abroad. The overall program development, student study abroad preparation, research project activities, cultural learning, and student and faculty team outcomes are explored. RESULTS: Cross-fertilization of research, cultural awareness and ideas about improving family health occur through education, international exchange and research immersion. Faculty research and international team collaboration provide opportunities for learning about research, health disparities, cultural influences and healthcare systems. The students are catalysts in the research effort, the dissemination of research findings and other educational endeavours. Five steps of the collaborative activities lead to programmatic success. CONCLUSIONS: MHIRT scholars bring creativity, enthusiasm, and gain a genuine desire to conduct health research about families with chronic illness. Their cultural learning stimulates career plans that include international research and attention to vulnerable populations.

Assessment of strategies in families tested by Finnish families.

The aim of this paper was to describe testing a Finnish version of the assessment of strategies in families (ASF) instrument and its construct validity and reliability in Finnish families. The ASF instrument is based on Friedemann's framework of systemic organization and the version used in this study consists of 25 items, each containing three statements. The instrument was developed to estimate family functioning in reaching the four targets of the framework of systemic organization. It provides sub-scores for the targets, family stability (system maintenance and coherence), family growth (system change and individuation), control (system maintenance and system change) and spirituality (individuation and coherence). Data were collected from patients attending the outpatient clinics of pulmonary and rheumatic diseases (N=196). Questionnaires were given to patients capable of understanding the questions and they returned questionnaires by mail directly to researchers. Construct validity was tested with exploratory factor analysis. Factor analysis was done with 22 items. The four factor solution was best suited. Two items were eliminated because of low factor loadings and crossloading. The total of 20 items were left in the instrument. Crohnbach's alpha was used to measure internal consistency. It was computed for each target separately and the total tool. There were discrepancies in the assignment of process dimensions which were expected because of cultural perceptions. The total instrument had a reliability of 0.85. The result of the analyses was a pretested tool with subscales for stability, growth, control and spirituality that have acceptable reliability and concept validity. Less satisfactory was the small number of items representing individuation. Another weakness is the lack of statistical distinction between system maintenance and coherence. The instrument is also usable in these subscales, but it needs further development and retesting. Items need to be added to express individuation, possibly some others. The new items will be formulated freely, paying attention to culture. However, the tool appears good enough to be used as measurement in various research studies.

Perceived family dynamics of persons with chronic pain.

This qualitative study was conducted to gain an understanding of the experiences of persons with chronic pain and their relationships with family members and the family as a whole. The framework of systemic organization was used to define the areas of investigation guiding the formulation of broad questions relative to family functioning. Thirty persons with chronic pain (age 31-82 years, 73% women, 83% married, 83% European-American, 17% African-American) participated in the study. A semi-structured interview was conducted to elicit narrative descriptions of the participants' perspective of the pain experience and family functioning. The data were analysed using a constant comparison method of analysis described by Strauss. The dominant themes that emerged included: (i) emotional distress, (ii) distancing from family members, (iii) inability to share difficult feelings, (iv) intense mutual involvement with family members and identification with others' problems, (v) family isolation from community, and (vi) attempt at healing. A mid-range theory developed out of the data and explicated with the framework of systemic organization, was one of balancing and counterbalancing connectedness (spirituality) with personal autonomy or separateness (control) in order to find congruence for the family and individuals within. The pain sometimes acted as a mechanism regulating the distance and closeness among family members. Based on this information, nurses can facilitate better understanding among family members, encourage autonomy, assist individuals to express feelings and needs more directly, and facilitate members to respond to each other.

Family involvement in the nursing home.

The focus of this study was the influence of preestablished family behavior patterns, family orientation of nursing home policies, and practices and caregiver and elder characteristics on the family members' expectations for involvement in the nursing home and the actual involvement 6 months later. The conceptual model was based on findings of Montgomery's nursing home study and open systems principles applicable to families. Data were collected through telephone interviews with 216 family members of residents in 24 nursing homes in southern Michigan. Regression analyses revealed that measures of preestablished patterns of family behavior accounted for 19% to 31% of variance in measures of expected family involvement. Expected family involvement, resident activities of daily learning (ADL), and caregiver relationship accounted for 11% to 23% of variance in measures of actual family involvement. Opportunity for family leadership in resident care had a mild effect of moderating the amount of family direct care and learning activities in the nursing home.

Family involvement in the nursing home: family-oriented practices and staff-family relationships.

Staff-family cooperation in caring for elders in nursing homes is recommended but poorly understood. Family involvement and staff-family interactions in nursing homes with differing family orientations were investigated. Friedemann's (1995) system-based family theory guided the study. Of all 208 licensed nursing homes in southern Michigan, 143 completed a survey about their family-oriented practices. Family orientation was ranked accordingly. Twenty-four nursing homes were randomly selected to conduct semistructured telephone interviews with 177 family members. Data were analyzed by thematic interpretation. Findings showed a wide range of involvement patterns that promoted family connectedness, maintenance of control, growth, and learning. Families desired various types of staff cooperation and were given such opportunities in homes with high family orientation.

A triangulation approach to testing a family instrument.

Sequential triangulation was used to test the validity of the Assessment of Strategies in Families (ASF), a screening tool for family effectiveness, and its application to families experiencing chronic pain. First, 30 subjects with chronic pain completed the questionnaire. Next, for the purpose of item validation, the subjects explained their thought process for each choice on the questionnaire. Results showed that they interpreted the items as intended. Subjects then responded to a semistructured interview about their perception about family stability and growth patterns. Thematic analysis suggested a tendency toward isolation from the community, intense involvement in each other's lives, and rigid control of family operations. ASF results reflected the trends by a low family-growth subscore, and a high or low stability score, depending on the success in achieving cooperation of family members. The findings suggest the instrument is valid and appropriate to screen families with chronic pain.

[Do nurse clinicians influence the working climate and the quality of care? 2. Results]. / Beeinflussen Pflegeexpertinnen Arbeitsklima und Pflegequalität? Zweiter Tell: Die Resultate.

The second part of this report contains the most important knowledge and the results gained through the study carried out at the Inselspital Berne, Switzerland, concerning the influence a clinical nurse practitioner has on work environment and patient satisfaction. Nurses who had the support of a clinical nurse practitioners had better guidelines at their disposal and got more feedbacks than the others. There were, however, no great differences between the units with a clinical nurse practitioner and those without one regarding communication, motivation for further education and support in difficult patient situations. The motivation for higher education was remarkably high on all units. However, the nurses on the units with a clinical nurse practitioner showed more interest in psychological and social matters and they had according literature at their disposal. The patients were generally satisfied, although there were differences regarding trust of the patients in nurses. Patients of units with a clinical nurse practitioner addressed nurses more frequently and easily with their problems and questions than patients from other units. This case study showed that clinical nurse practitioners play an active and important role concerning teamwork, particularly by giving feedbacks and helping to create an atmosphere of support regarding personal continuing education, using all available resources, discussing patient situations, evaluating them and finding solutions.

[Do clinical nurse practitioners affect the working environment and the quality of care?]. / Beeinflussen Pflegeexpertinnen Arbeitsklima und Pflegequalität?

This correlational study examined the influence of a new kind of advanced nurse practitioner in Switzerland with the role of providing complex care, consulting with patients and families, fostering the growth of staff, enhancing team functioning and contributing to nursing knowledge through research. Based on systems theory the perception of staff about their work environment and their motivation to engage in continuing education as well as the patients' satisfaction with care and trust in the nurses were measured outcomes. Instruments were constructed for this study, tested and standardized. Data from three hospital units with an advanced practitioner were compared to three units without a practitioner similar in size, staffing, patient acuity and system of nursing care. Staff reported better guidelines for care, more frequent feedback and better professional advice on units with an advanced practitioner while the quality of communication, professional stimulation and support with difficult patients was comparable on all units. Motivation to further one's education was generally high. In units with an advanced practitioner, there was increased interest in psychosocial topics, and the availability of such literature was better. Patients were highly satisfied in all units, but there was a slight difference in patient trust. It was somewhat easier for patients on units with an advanced practitioner to ask the nurses questions. The study suggested that the advanced practitioner should contribute most by strengthening team cohesion through constructive feedback as well as enhancing a climate for continuing learning through better resources, guided case discussions and opportunities for shared problem solving.

Effects of ALANON attendance on family perception of inner-city indigents.

This study investigated the perception of family functioning of rehabilitating inner-city substance abusers and one of their family members. Subjects were 39 residents of a treatment center and 39 family members. The design was compromised experimental, comparing the group who had family members in ALANON (n = 36) with a nonrandomized control group whose family members had no help (n = 42). Data were collected three times: at the beginning of the abuser's treatment, at the end, and one month after treatment. Subjects completed two family functioning instruments: Assessment of Strategies in Families (ASF) and Family APGAR. Repeated-measure MANOVAs yielded significant differences in all family scores between the ALANON and the control groups. An increase in the perception of family effectiveness was most pronounced between time 2 and time 3, after the substance abuse program was completed. Family members changed their perceptions more than the abusers and maintained their favorable family perception, even though five of the abusers had relapsed shortly after discharge. At 3 months after treatment, the relapse rate for addicts in the ALANON group (n = 15) was 39% compared with 61% for addicts in the control group (n = 18). The difference was not of statistical significance due to the small group sizes, however. Evidence suggests the usefulness of ALANON in empowering families and assisting them in reevaluating the family system more positively.

Family health and mental health six years after economic stress and unemployment.

This study is a follow-up of 39 working class couples who were interviewed after suffering economic stress or unemployment and again six years later. Repeated measures related to economics, stress, family functioning, anxiety, and depression were collected and analyzed for couples and for husbands and wives separately. A model of long-term coping was suggested for future testing. Initially stressed families appeared to grow stronger. Mental health correlated negatively to family problems. Depressed wives seemed to maintain their depression over time if they perceived family life as stressful. Irrespective of marital problems, husbands were less likely to stay depressed.

Perceptions of inner city substance abusers about their families.

This study involved 12 in-depth interviews of inner city rehabilitating substance abusers. An exploration of their perception about their families of origin and their families of today was the purpose of this study. The topic outline, coding system, and qualitative analysis was guided by concepts of the framework of systemic organization. Common family characteristics were lack of togetherness, nonexistent or peripheral role of fathers, and underused or overused controlling power with victimization of the weakest. Regenerative strengths were seen in some families. Family integration of addicts seemed more difficult than anticipated by the subjects and demanded major changes in family processes.

Evaluation of the Congruence Model with rehabilitating substance abusers.

The Congruence Model was used with families of indigent substance abusers. Instead of a focus on pathology, this nursing approach advocated ethnically congruent coping of families within their environment. Forty participants worked on individually chosen goals during eight structured sessions. Evaluation included goal attainment analysis and a comparison of the treated families with families in self-help groups and a control group. Treated families made significant progress with personal and family goals. Treatment and support group families reported better family functioning at one month and fewer relapses two to three months after treatment. The Congruence Model seemed particularly effective if families sought help but did not opt for support groups.

Six years after an economic crisis: child's anxiety and quality of peer relationships.

The purpose of this 6-year follow-up study was to determine whether there is a long-term relationship between economic stress and childrens' anxiety and peer-related behaviors. Data were collected from 39 of the 52 families in the original study. Analysis resulted in several interesting findings. Economic stress in 1983 was a moderate predictor of state anxiety, trait anxiety, and peer rejection in girls in 1989. Descriptive evidence was provided to indicate that detrimental effects of economic stressors on the family as a unit continue beyond the initial stress event. Implications for community health nurses (CHNs) are addressed.

Family support and child adjustment in single-parent families.

The complex phenomenon of single parenthood is explored within Roy's (Roy & Roberts, 1981) adaptation framework. Correlation analysis of a large family data set supported the literature and the conceptual framework. Findings suggested that single parents experienced a characteristic set of stressors distinguishing them from two-parent families. The mere availability of help with parenting seemed less important in fostering the children's positive adaptation than the quality of the relationship among the adults involved with the children. Practitioners are advised to address family support and the ability to cope with environmental factors when developing a treatment plan.

The concept of family nursing.

A system-based conceptualization of family nursing is suggested, with family nursing practised on three system levels. The level of individual family members views the family as the context of the individuals. The interpersonal level addresses dyads and larger units and the family system level includes the structural and functional system components interacting with the environment. Intervention on a higher system level includes the lower levels. While family nursing falls within the practice scope of all nurses, intervention aimed at system change requires holistic understanding of the intricate relationships between family system components and the skills of clinical specialists.

Closing the gap between grand theory and mental health practice with families. Part 1: The framework of systemic organization for nursing of families and family members.

This paper proposes a nursing framework for individuals and families that was inductively derived from existing knowledge and the author's personal experience. The framework is based on the premise that all things are organized as systems. Individuals, family systems, and the environment are interrelated and the congruence of patterns and rhythms between systems and subsystems signifies health. Nursing involves assisting individuals and families to reduce anxiety by weighing against each other the two major dimensions of system control and congruence or spirituality with the aim of maintaining a dynamic equilibrium.