A Shifting Paradigm Toward Family-Centered Care in Neuro-Oncology: A Longitudinal Quasi-Experimental Mixed-Methods Feasibility Study.

Family-centered intervention can help families facing illness-related issues. We investigated the feasibility of Family and Network Conversations (FNCs) in high-grade glioma patients and their families. Quasi-experimental feasibility study with longitudinal mixed-methods design. Patients and families were invited to three FNCs over 1 year. They completed questionnaires at four time points and expressed their perspectives on the intervention through telephone interviews. Nurses' perspectives were collected in a focus group. Twenty-one patients and 47 family members were included. On average, patients were 66 years old, mainly male, married, living with caregivers, with unifocal cancer. On average, caregivers were 47 years old, mainly female, being spouses or children of the patient. Quantitative and qualitative data did not always match and expanded each other. Nurse-delivered FNCs holistically addressed families' needs while strengthening family's dialogue and union. Nurses felt empowered, underling that advanced competencies were required. Nurse-delivered FNCs are feasible to provide family-centered care, but they should be tailored to each family's needs.

Analysis of the Effect of Nursing Intervention for Thyroid Diseases Based on Family Nursing Methods.

Patients with thyroid disease must take long-term antithyroid drugs and go to the outpatient clinic for regular check-ups. This requires patients to have good compliance behaviors in order to better control their thyroid hormone levels. In order to improve patients' compliance behavior and seek effective family care interventions, this paper combines family care methods to evaluate the nursing effect of thyroid disease and combines investigation and analysis and experimental methods to verify the effectiveness of the method proposed in this paper. In addition, this paper compares family nursing methods with conventional methods under the guidance of family philosophy and objectively analyzes and evaluates the application value of accelerated rehabilitation surgery concepts and methods in thyroid surgery. Finally, this paper sets up a control group and a test group to carry out the nursing effect of home nursing in thyroid diseases. Through comparative experiments, it can be seen that the nursing intervention for thyroid diseases based on home nursing in this paper has a good nursing effect.

Palliative and Hospice Care in Correctional Facilities: Integrating a Family Nursing Approach to Address Relational Barriers.

BACKGROUND: The need for palliative and hospice care for persons with life-limiting conditions who are incarcerated is increasingly common in correctional facilities worldwide. OBJECTIVE: Through a family nursing lens, we critically analyze the unique challenges experienced by those requiring palliative care while incarcerated. Key concerns and implications for nursing are illustrated through the discussion of a representative case scenario. METHODS: The case scenario was developed based on the findings of a scoping review of academic and gray literature (such as policy documents and editorials) about palliative, hospice, and end-of-life care in corrections. RESULTS: The case scenario highlights multilevel barriers that were identified, including the individual, relational, institutional, and sociocultural contexts of palliative care in correctional facilities. Evidence is presented of how integration of a family nursing perspective can enhance specialized palliative and hospice care services in correctional settings. CONCLUSIONS: By applying a family nursing approach, nurses practicing with correctional populations can ensure persons with life-limiting illnesses are not denied their right to appropriate end-of-life care by playing a key role in addressing barriers to palliative and hospice care access in corrections. Specific attention to relational issues and holistic care can contribute to enhanced palliative and hospice care, greater dignity in dying, and improved family and peer outcomes, which have benefits for individuals, families, communities, and society. IMPLICATIONS FOR PRACTICE: Through the case scenario, we illustrate real issues emerging in correctional contexts and offer evidence of how family nursing relational principles can be applied to promote adequate palliative and hospice care.

Knowledge and health promotion practice of Family Health Strategy nurses / Conocimiento y práctica de promoción de la salud de las enfermeras de la Estrategia de Salud Familiar / Conhecimento e prática de promoção da saúde de enfermeiros da Estratégia Saúde da Família

ABSTRACT Objectives: to analyze the knowledge and health promotion practice carried out by Family Health Strategy nurses. Methods: a descriptive study and qualitative approach. The study was conducted with 18 Family Health Strategy nurses from the city of São Carlos. Data were collected through semi-structured interviews and analyzed through thematic analysis. The study was approved by the Research Ethics Committee. Results: the data revealed that nurses had difficulties to conceptualize health promotion, and it is common to describe the definition of disease prevention. Nurses also reported developing group activities for health promotion; however, individual actions and consultations were still predominant. Final Considerations: it is necessary to develop sustainable strategies for collective health-promoting activities, in addition to strengthening multidisciplinary work and Continuing Education actions.

RESUMEN Objetivos: analizar el conocimiento y la práctica de la promoción de la salud llevada a cabo por enfermeras de Estrategias de Salud Familiar. Métodos: estudio descriptivo y enfoque cualitativo. El estudio se realizó con 18 enfermeras de Estrategias de Salud Familiar de la ciudad de São Carlos. Los datos fueron recolectados a través de entrevistas semiestructuradas y analizados a través de análisis temáticos. El estudio fue aprobado por el Comité de Ética en Investigación. Resultados: los datos revelaron que las enfermeras tenían dificultades para conceptualizar la promoción de la salud, y es común describir la definición de prevención de enfermedades. Las enfermeras también informaron el desarrollo de actividades grupales para la promoción de la salud; sin embargo, las acciones y consultas individuales seguían predominando. Consideraciones Finales: es necesario desarrollar estrategias sostenibles para las actividades colectivas de promoción de la salud, además de fortalecer el trabajo multidisciplinario y las acciones de Educación Continua.

RESUMO Objetivos: analisar o conhecimento e a prática de promoção de saúde realizada por enfermeiros de Estratégias Saúde da Família. Métodos: estudo descritivo e de abordagem qualitativa. O estudo foi realizado com 18 enfermeiros de Estratégias Saúde da Família do município de São Carlos. Os dados foram coletados por meio de entrevista semiestruturada e analisados por meio da análise temática. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: os dados revelaram que os enfermeiros apresentaram dificuldades para conceituar a promoção de saúde, sendo comum descrever a definição de prevenção de doenças. Os enfermeiros também relataram desenvolver atividades grupais para a promoção de saúde; porém, as ações de caráter individual e em forma de consultas ainda eram predominantes. Considerações Finais: torna-se necessário o desenvolvimento de estratégias sustentáveis para a realização de atividades coletivas de promoção em saúde, além do fortalecimento do trabalho multidisciplinar e das ações de Educação Permanente.

Oncology Nurses' Knowledge, Confidence, and Practice in Addressing Caregiver Strain and Burden

OBJECTIVES: To describe nurses' practices, confidence, and knowledge of evidence-based interventions for cancer caregiver strain and burden and to identify factors that contribute to these aspects. 
. SAMPLE & SETTING: 2,055 Oncology Nursing Society members completed an emailed survey.
. METHODS & VARIABLES: Pooled analysis of survey results. Variables included the baseline nursing assessment, intervention, confidence, knowledge, strategies used, and barriers encountered. 
. RESULTS: Nurses tend to overestimate the strength of evidence for interventions not shown to be effective and have moderate confidence in assessing and intervening with caregivers. Having been an informal caregiver and having received care from an informal caregiver were associated with higher reported practice and confidence. Major strategies used were referral to social workers and others. Barriers reported were financial, caregiver emotional responses, and distance. 
. IMPLICATIONS FOR NURSING: An opportunity exists to increase nurses' knowledge and confidence in assessment and intervention with caregivers. Greater use of technology may help nurses overcome some barriers to working with caregivers. Findings can be used to plan continuing education, develop clinical processes, and identify resources nurses need to address strain and burden among informal caregivers.

Family-centred care for families living with cystic fibrosis in a rural setting: A qualitative study.

AIMS AND OBJECTIVES: To explore experiences of family-centred care among parents of children with cystic fibrosis living far from tertiary treatment centres and to understand what such distances mean to their care. BACKGROUND: Australia is a large continent. However, many families with a child with cystic fibrosis live in regional areas, often thousands of kilometres away from the primary treatment centres located in Australia's coastal capital cities. DESIGN: A qualitative, phenomenological design using a Van Manen () approach. METHODS: Individual, semi-structured interviews were conducted with parents (n = 7) of a child with cystic fibrosis who lived in regional Australia. Thematic content data analysis was used. RESULTS: The essence of the participants' experience was their seeking certainty and continuity in the changeable realm of cystic fibrosis while negotiating a collaborative approach to their child's care. Five core themes and two subthemes were identified: "Daily care: a family affair," including the subtheme "Accessing expert care"; "Family-centred care: seeking inclusion"; "Control versus collaboration: seeking mutual trust," with the subtheme "The team who grows with you"; "Future projections"; and "The CF circle." CONCLUSION: Some concerns are not unlike those of their city counterparts, but can be intensified by their sense of distance and isolation. RELEVANCE TO CLINICAL PRACTICE: Insight into this unique milieu from the parents' perspective is requisite so that care is appropriate to such a challenging environment and incorporates the whole family.

Why adolescents need their parents during admission to hospital for elective surgery.

The literature about adolescence and healthcare tends to focus on the quest for independence and the importance of peer support. This article discusses the continuing importance of parental support during adolescence, especially when young people are admitted to hospital for surgery. It discusses why adolescents who are admitted to hospital for elective surgery will have different needs to young people who are admitted regularly for long-term conditions or those who are admitted due to risk-taking behaviour or mental health problems. It is suggested that elective admissions for surgery in otherwise fit and well young people may create a temporary change in developmental level, resulting in the need for parental support, rather than independence and peer support as recommended in the literature.

Effectiveness of a nurse-led preadmission intervention for parents of children with profound multiple disabilities undergoing hip-joint surgery: A quasi-experimental pilot study.

PURPOSE: The aim of this study was to assess the effectiveness of a family-centered care (FCC) intervention provided by an advanced practice nurse (APN) for parents of children with profound disabilities undergoing surgery. DESIGN AND METHODS: In a quasi-experimental design, we used the MPOC-20 to assess satisfaction with FCC and interviews to identify potential mechanisms for improving satisfaction. RESULTS: There was a positive effect on the MPOC-20 domain "general information," albeit with a small effect size (Cohen's d = 0.35). The interviewed parents expected additional support. PRACTICE IMPLICATIONS: Emphasis should be placed on providing comprehensive care coordination by an experienced APN. Shared care management is crucial in improving FCC.

"A stressful and frightening experience"? Children's nurses' perceived readiness to care for children with cancer following pre-registration nurse education: A qualitative study.

BACKGROUND: In the UK children with cancer are cared for by children's nurses in a variety of settings, specialist and non-specialist. Whilst post-registration specialist education is available to some nurses, many nurses rely solely on pre-registration education to competently care for these children. This study explores whether nurses perceive that this adequately prepares them. OBJECTIVES: To explore the extent to which qualified nurses perceive that pre-registration nurse education prepares them to care for children with cancer; to consider the implications for children's nursing pre-registration curricula. DESIGN: A small-scale qualitative study was undertaken using an interpretivist approach. METHODS: Semi-structured interviews were conducted with six qualified children's nurses in two clinical areas - a specialist children's cancer inpatient ward, and a general children's ward where inpatients included children with cancer. RESULTS: Findings are discussed in relation to three emergent themes: Learning in Theory and Practice, Care of the Child and Family, and Resilience. Participants attached significance to the quantity and quality of practice experience. They reflected on barriers to specific and transferable theoretical learning and stressed the importance of integrating theory and practice. Understanding of family-centred care formed a significant part of their preparation. Preconceptions, communication with families and the emotional impact of this speciality were stressful. Improved pre-registration preparation may have developed participants' resilience. CONCLUSION: The complexities of caring for children with cancer and their families require well-prepared nurses. Participants' perceptions of preparedness were influenced by aspects of pre-registration education. Their experiences suggest that curricula should be practice-focused and include a range of placements. Specialist theoretical content must be integrated with practice and transferability of knowledge and skills made explicit. Reflection and problem-based learning may foster coping mechanisms and resilience that will equip them to care for children with cancer.

Estratégias para identificação e enfrentamento de situação de violência por parceiro íntimo em mulheres gestantes / Estrategias para identificar y enfrentar situaciones de violencia de parte de la pareja en mujeres gestantes / Strategies for identification and coping with the violence situation by intimate partners of pregnant women

RESUMO Objetivo Conhecer as estratégias utilizadas por enfermeiros de Unidades de Estratégias de Saúde da Família para identificação e enfrentamento de situação de violência por parceiro íntimo em mulheres gestantes. Método Estudo descritivo com abordagem qualitativa, com entrevista semiestruturada direcionada a 23 enfermeiros da atenção básica, no período de setembro de 2015 a abril de 2016. Utilizou-se a análise de conteúdo do tipo temática. Resultados Emergiu a categoria: "É bem complexo" - ações de identificação e enfrentamento da violência por parceiro íntimo em mulheres gestantes. As lesões físicas foram o principal indicativo de violência identificada na consulta pré-natal. As estratégias de enfrentamento foram os encaminhamentos a serviços especializados e discussão conjunta com a equipe de saúde. Conclusão Aponta-se a necessidade de organização de um protocolo de enfermagem que auxilie na identificação e classificação de risco à exposição à violência, educação permanente destes profissionais e fortalecimento das ações intersetoriais.

RESUMEN Objectivo Conocer las estrategias utilizadas por enfermeros de Unidades de Estrategias de Salud de la Familia para identificación y enfrentamiento de situación de violencia por compañero íntimo en mujeres gestantes. Método Estudio descriptivo con abordaje cualitativo, con entrevista semiestructurada dirigida a 23 enfermeros de la atención primaria, en el periodo de septiembre de 2015 a abril de 2016. Se utilizó el análisis de contenido del tipo temático. Resultados Surgió la categoria: "Es muy complejo" - acciones de identificación y enfrentamiento de la violencia de parte del compañero íntimo en mujeres gestantes. Las lesiones físicas fueron el principal indicativo de violencia identificada en la consulta prenatal. Las estrategias de enfrentamiento fueron los encaminamientos a servicios especializados y discusión junto al equipo de salud. Conclusión Se apunta la necesidad de organización de un protocolo de enfermería que auxilie en la identificación y clasificación de riesgo a la exposición a la violencia, educación permanente de estos profesionales y fortalecimiento de acciones intersectoriales.

ABSTRACT Objective To know the strategies used by nurses of Units of Family Health Strategies to identify and cope with the violence situation by intimate partners of pregnant women. Method Descriptive study with a qualitative approach, in which semi-structured interviews were conducted with 23 primary care nurses from September 2015 to April 2016. Thematic content analysis was used. Results The category "It's very complex" has emerged - actions to identify and cope with the violence situation by intimate partners of pregnant women. Physical injuries were the main violence indicative identified at prenatal care. The coping strategies were the referrals to specialized services and joint discussion with healthcare team. Conclusion There's a need to organize a nursing protocol that helps in the identification and classification of risk exposure to violence, permanent education of these professionals and strengthening of intersectoral actions.

Village Voices: Lessons about Processes for Disease Prevention from a Qualitative Study of Family Health Leaders in a Community in Northeastern Thailand.

BACKGROUND: Cancer is a primary source of concern in Thailand and other countries around the world, including the Asian-Pacific region. Evidence supports that an important contributing cause of cancer and other chronic illnesses such as stroke, diabetes, and hypertension is excessive alcohol consumption. Studies conducted in Thailand reveal a worrisome rise in the number of new and regular drinkers in communities. Therefore, actions for primary, secondary and tertiary prevention of problem drinking are necessary. In recent years nurses in North East Thailand have been developing and implementing the Khon Kaen Family Health Nursing model to embed disease prevention in communities through the actions of family health nurses and local family health leaders. AIM: The aim of this qualitative research was to better understand the experiences of the local family health leaders using this model and to synthesize lessons learned. MATERIALS AND METHODS: As part of a participatory action research approach involving analysis of focus group discussions and individual interviews, the experiences of 45 family health leaders were synthesized. RESULTS: Four main themes were identified, namely: i) Family first: role modeling beginning at the personal and family level. ii) Local leverage: using village community forums to reduce alcohol drinking. iii) Gentle growth: making the first step and treading gently; and iv) Respect, Redemption, Rehabilitation: valuing the person to re-integrate them in the village society. CONCLUSIONS: As alcohol consumption in the village declined significantly following the prevention program, these findings illuminate how low-tech integrated prevention approaches may be very useful, particularly in rural communities. The lessons learned may have relevance not only in Thailand but in other countries seeking to prevent and mitigate behavior that conduces to diseases such as cancer.

Challenges in providing culturally-competent care to patients with metastatic brain tumours and their families.

Being diagnosed with a metastatic brain tumour can be devastating as it is characterized by very low cure rates, as well as significant morbidity and mortality. Given the poor life expectancy and progressive disability that ensues, patients and family members experience much turmoil, which includes losses that bring about changes to family roles, routines and relationships. Crisis and conflict are common during such major disruptions to a family system, as individual members attempt to make sense of the illness experience based on cultural and spiritual beliefs, past experiences and personal philosophies. It is imperative health care providers strive towards increased awareness and knowledge of how culture affects the overall experience of illness and death in order to help create a mutually satisfactory care plan. Providing culturally-competent care entails the use of proper communication skills to facilitate the exploration of patient and family perspectives and allows for mutual decision making. A case study will illustrate the challenges encountered in providing culturally-competent care to a woman with brain cancer and her family. As the patient's health declined, the family entered into a state of crisis where communication between family members and health care professionals was strained; leading to conflict and sub-optimal outcomes. This paper will address the ethical dilemma of providing culturally-competent care when a patient's safety is at risk, and the nursing implications of upholding best practices in the context of differing beliefs and priorities.

Effects of nursing intervention models on social adaption capability development in preschool children with malignant tumors: a randomized control trial.

OBJECTIVES: The objectives of this study are to compare the effects of two nursing intervention models on the ability of preschool children with malignant tumors to socialize and to determine if these interventions improved their social adaption capability (SAC) and quality of life. METHODS: Inpatient preschool children with malignant tumors admitted to the hospital between December 2009 and March 2012 were recruited and randomized into either the experimental or control groups. The control group received routine nursing care, and the experimental group received family-centered nursing care, including physical, psychological, and social interventions. The Infants-Junior Middle School Student's Social-Life Abilities Scale was used to evaluate SAC development of participants. RESULTS: Participants (n = 240) were recruited and randomized into two groups. After the intervention, the excellent and normal SAC rates were 27.5% and 55% in the experimental group, respectively, compared with 2.5% and 32.5% in the control group (p < 0.001). After the intervention, SAC in experimental group was improved compared with before intervention (54.68 ± 10.85 vs 79.9 ± 22.3, p < 0.001). However, no differences in SAC were observed between baseline and after intervention in the control group (54.70 ± 11.47 vs. 52 ± 15.8, p = 0.38). CONCLUSION: The family-centered nursing care model that included physical, psychological, and social interventions improved the SAC of children with malignancies compared with children receiving routine nursing care. Establishing a standardized family-school-community-hospital hierarchical multi-management intervention model for children is important to the efficacy of long-term interventions and to the improvement of SAC of children with malignancies.

Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

BACKGROUND AND PURPOSE: The purpose of this statement is to delineate basic expectations regarding primary palliative care competencies and skills to be considered, learned, and practiced by providers and healthcare services across hospitals and community settings when caring for patients and families with stroke. METHODS: Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were chosen to reflect the diversity and expertise of professional roles in delivering optimal palliative care. Writing group members were assigned topics relevant to their areas of expertise, reviewed the appropriate literature, and drafted manuscript content and recommendations in accordance with the American Heart Association's framework for defining classes and level of evidence and recommendations. RESULTS: The palliative care needs of patients with serious or life-threatening stroke and their families are enormous: complex decision making, aligning treatment with goals, and symptom control. Primary palliative care should be available to all patients with serious or life-threatening stroke and their families throughout the entire course of illness. To optimally deliver primary palliative care, stroke systems of care and provider teams should (1) promote and practice patient- and family-centered care; (2) effectively estimate prognosis; (3) develop appropriate goals of care; (4) be familiar with the evidence for common stroke decisions with end-of-life implications; (5) assess and effectively manage emerging stroke symptoms; (6) possess experience with palliative treatments at the end of life; (7) assist with care coordination, including referral to a palliative care specialist or hospice if necessary; (8) provide the patient and family the opportunity for personal growth and make bereavement resources available if death is anticipated; and (9) actively participate in continuous quality improvement and research. CONCLUSIONS: Addressing the palliative care needs of patients and families throughout the course of illness can complement existing practices and improve the quality of life of stroke patients, their families, and their care providers. There is an urgent need for further research in this area.

The effectiveness and cost-effectiveness of the Family Nurse Partnership home visiting programme for first time teenage mothers in England: a protocol for the Building Blocks randomised controlled trial.

BACKGROUND: The Nurse Family Partnership programme was developed in the USA where it is made available to pregnant young mothers in some socially deprived geographic areas. The related Family Nurse Partnership programme was introduced in England by the Department of Health in 2006 with the aim of improving outcomes for the health, wellbeing and social circumstances of young first-time mothers and their children. METHODS / DESIGN: This multi-centre individually randomised controlled trial will recruit 1600 participants from 18 Primary Care Trusts in England, United Kingdom. The trial will evaluate the effectiveness of Family Nurse Partnership programme and usual care versus usual care for nulliparous pregnant women aged 19 or under, recruited by 24 weeks gestation and followed until the child's second birthday. Data will be collected from participants at baseline, 34-36 weeks gestation, 6, 12, 18 and 24 months following birth. Routine clinical data will be collected from maternity, primary care and hospital episodes statistics. Four primary outcomes are to be reported from the trial: birth weight; prenatal tobacco use; child emergency attendances and/or admissions within two years of birth; second pregnancy within two years of first birth. DISCUSSION: This trial will evaluate the effectiveness and cost effectiveness of the Family Nurse Partnership in England. The findings will provide evidence on pregnancy and early childhood programme outcomes for policy makers, health professionals and potential recipients in three domains (pregnancy and birth, child health and development, and parental life course and self-sufficiency) up to the child's second birthday. TRIAL REGISTRATION: Trial registration number: ISRCTN23019866.

Family caregiver burden, skills preparedness, and quality of life in non-small cell lung cancer.

PURPOSE/OBJECTIVES: To describe burden, skills preparedness, and quality of life (QOL) for caregivers of patients with non-small cell lung cancer (NSCLC), and describe how the findings informed the development of a caregiver palliative care intervention that aims to reduce caregiver burden, improve caregiving skills, and promote self-care. DESIGN: Descriptive, longitudinal. SETTING: A National Cancer Institute-designated comprehensive cancer center in southern California. SAMPLE: 163 family members or friends aged 18 years or older and identified by patients as being a caregiver. METHODS: All eligible caregivers were approached by advanced practice nurses during a regularly scheduled patient clinic visit. Informed consent was obtained prior to study participation. Outcome measures were completed at baseline and repeated at 7, 12, 18, and 24 weeks. Descriptive statistics were computed for all variables, and one-way repeated-measures analysis of variance was used to test for change over time for all predictor and outcome variables. MAIN RESEARCH VARIABLES: Caregiver burden, skills preparedness, psychological distress, and QOL. FINDINGS: Caregivers were highly functional. Caregiver burden related to subjective demands increased significantly over time. Perceived skills preparedness was high at baseline but decreased over time. Psychological distress was moderate but increased in the study period. Overall QOL was moderate at baseline and decreased significantly over time. Psychological well-being had the worst QOL score. CONCLUSIONS: Caregivers experienced high levels of caregiver burden and reported deteriorations in psychological well-being and overall QOL. IMPLICATIONS FOR NURSING: Oncology nurses need to ensure that caregivers receive information that supports the caregiving role throughout the cancer trajectory. KNOWLEDGE TRANSLATION: Although family caregivers are profoundly impacted by a loved one's lung cancer diagnosis, the literature about caregiver burden, skills preparedness, and QOL is limited. Current evidence suggests that family caregivers can be negatively impacted by a loved one's cancer diagnosis. Caregiver-specific support interventions are needed to eliminate the burden of caregiving in lung cancer.

Caracterización de la salud familiar de una localidad para orientar un plan de cuidado / Characterization of the family health in a locality aimed at preparing a care program

Antecedentes: para gestionar el cuidado del grupo familiar resulta útil conocer cuál es su situación de salud y la estratificación de las familias según tal condición. Objetivos: determinar la situación de salud de las familias inscritas en el CESFAM Lorenzo Arenas de Concepción, Chile y determinar la aceptación de la intervención familiar por parte del jefe de hogar y del grupo familiar. Métodos: diseño transversal y descriptivo. El universo estuvo constituido por 5591 familias inscritas en el CESFAM Lorenzo Arenas y la muestra correspondió a 204 familias seleccionadas mediante muestreo probabilístico. Se trabajó con un 95 por ciento de confianza y un intervalo de confianza del 5 por ciento. Se utilizó como instrumentos de recolección de datos un cuestionario de antecedentes biodemográficos, la prueba de percepción de funcionamiento familiar (FF-SIL), el inventario de características familiares de riesgo y la matriz de salud familiar. Se aplicó a los jefes de familias previo consentimiento informado. El procesamiento de datos se realizó con el programa SPSS 17.0 y para su análisis se utilizó estadística descriptiva. Resultados: el 75 por ciento de las familias clasificó en la zona de elevada criticidad y buen funcionamiento intrafamiliar, el 22 por ciento presentó ajuste familiar, el 3 por ciento presentó afección de extrema gravedad, con elevada criticidad y disfuncionalidad. No se presentaron casos de relaciones intrafamiliares disfuncionales con baja criticidad. El 74 por ciento de los jefes de hogar declararon que aceptarían la intervención familiar y el 42 por ciento declararon que todo el grupo familiar la aceptaría. Conclusiones: predominan las familias con afección grave dada por la criticidad familiar, de ellas un alto porcentaje aceptaría la intervención del equipo de salud. Esta información orienta la gestión del cuidado y la elaboración de un plan de cuidado para las familias de esta localidad(AU)

Background: to manage the family group care, it is useful to know the health situation and the stratification of the families according to their conditions. Objectives: to determine the health situations of families registered at CESFAM Lorenzo Arenas de Concepcion in Chile and to determine the acceptance of family intervention by the head of the household and the family group. Methods: cross-sectional and descriptive design. The universe of study was formed by 5591 families registered at CESFAM Lorenzo Arenas and the final sample consisted of 204 families selected by the probabilistic sampling. The confidence index of 95 percent and the confidence interval was 5 percent. The instruments of data collection were a questionnaire on biodemographic antecedents, the family functioning perception test, the inventory of risky family characteristics and the family health matrix. It was all applied to the heads of households after informed consent. SPSS program 17.0 served to process data which were analyzed through summary statistics. Results: in the group, 75 percent of families classified into the highly critical condition area and good intrafamily functioning, 22 percent presented family adjustment, 3 percent had extremely severe problems, highly critical conditions and dysfunctionality. There was no case of dysfunctional intrafamily relationships with low critical conditions. In this study, 74 percent of the heads of households stated that they would accept family intervention and 42 percent said that the whole family group would also do it. Conclusions: predominance of families with serious illnesses due to highly critical conditions in the family, a high percentage of which would accept the health team intervention. This information is useful to direct the care management and the preparation of a care program aimed at the families living in this locality(AU)

Caregivers' understanding of dementia predicts patients' comfort at death: a prospective observational study.

BACKGROUND: Patients with dementia frequently do not receive adequate palliative care which may relate to poor understanding of the natural course of dementia. We hypothesized that understanding that dementia is a progressive and terminal disease is fundamental to a focus on comfort in dementia, and examined how family and professional caregivers' understanding of the nature of the disease was associated with patients' comfort during the dying process. METHODS: We enrolled 372 nursing home patients from 28 facilities in The Netherlands in a prospective observational study (2007 to 2010). We studied both the families and the physicians (73) of 161 patients. Understanding referred to families' comprehension of complications, prognosis, having been counseled on these, and perception of dementia as "a disease you can die from" (5-point agreement scale) at baseline. Physicians reported on this perception, prognosis and having counseled on this. Staff-assessed comfort with the End-of-Life in Dementia - Comfort Assessment in Dying (EOLD-CAD) scale. Associations between understanding and comfort were assessed with generalized estimating equations, structural equation modeling, and mediator analyses. RESULTS: A family's perception of dementia as "a disease you can die from" predicted higher patient comfort during the dying process (adjusted coefficient -0.8, 95% confidence interval (CI): -1.5; -0.06 point increment disagreement). Family and physician combined perceptions (-0.9, CI: -1.5; -0.2; 9-point scale) were also predictive, including in less advanced dementia. Forty-three percent of the families perceived dementia as a disease you can die from (agreed completely, partly); 94% of physicians did. The association between combined perception and higher comfort was mediated by the families' reporting of a good relationship with the patient and physicians' perception that good care was provided in the last week. CONCLUSIONS: Awareness of the terminal nature of dementia may improve patient comfort at the end of life. Educating families on the nature of dementia may be an important part of advance care planning.