Nursing students' views on trauma-informed pediatric nursing care and family-centered care.

PURPOSE: We studied the views of nursing students on family-centered care (FCC) and their knowledge, opinions, self-rated competence, current practice, and perceived implementation barriers with regard to trauma-informed pediatric nursing care. METHODS: This survey was a descriptive correlational study. The sample consisted of 261 nursing students, 3rd and 4th years, who had completed the Child Health and Diseases Nursing Course. The data were obtained using the "Student Information Form," "Family-Centered Care Attitude Scale," and "trauma-informed care (TIC) Provider Survey." RESULTS: Nursing students were knowledgeable and held favorable opinions about TIC. The survey showed that students with higher levels and those with a hospitalization experience during childhood had higher scores regarding TIC. A positive relationship was found between the students' TIC to mean score and FCC attitude mean score. CONCLUSIONS: Nursing students are not competent to practice TIC, especially with pediatric patients. Therefore, they need to develop relevant skills for helping pediatric patients. PRACTICE IMPLICATIONS: Efforts to improve nursing students' trauma-informed pediatric care should highlight specific skills related to helping pediatric patients manage emotional responses to difficult medical experiences. By integrating TIC into the baccalaureate curricula, nursing educators can provide the students with appropriate skills and facilities so that they can provide holistic and highly effective care to highly vulnerable patients.

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.

Weight assessment and the provision of weight management advice in primary care: a cross-sectional survey of self-reported practice among general practitioners and practice nurses in the United Kingdom.

BACKGROUND: Although primary care settings provide a large-scale and high-reach opportunity for weight management and obesity prevention, the proportion of adults in the United Kingdom (UK) who report receiving weight management advice is limited. This study examines the self-reported frequency of assessing weight and providing weight management advice by General Practitioners (GPs) and Practice Nurses (PNs) working in primary care in the UK, and differences by practitioner characteristics. METHODS: Cross-sectional survey with GPs and PNs in the UK (n = 2020), conducted January-March 2017. A mock consultation exercise assessed what factors led to calculating a patient's Body Mass Index (BMI) and whether weight management advice was given after determining the patient had an obese BMI. For all patients, practitioners were asked how often they calculated BMI, how often they gave weight management advice to patients with an obese BMI, and how often they utilised different advice or referral options (each: Always/Often vs. Less often/Never). Binary logistic regressions examined whether frequency of assessing weight and providing advice was associated with practitioner characteristics. RESULTS: In the mock consultation, physical cues (40%) were most likely to prompt calculation of BMI, and half of practitioners (56%) provided weight management advice after determining the patient had an obese BMI, with GPs less likely to do so than PNs (Odds Ratio [OR] = 0.59, 95% CI: 0.47-0.75). Half of practitioners (58%) said they calculated the BMI of all patients Always/Often, with GPs less likely to do so than PNs (OR = 0.27, 95% CI: 0.21-0.34). Three quarters (78%) said they provided weight management advice to patients with an obese BMI Always/Often, with GPs less likely to do so than PNs (OR = 0.63, 95% CI: 0.47-0.85). Weight management advice was provided more frequently than referrals, particularly suggesting increased physical activity (93%) and diet modification (89%). CONCLUSIONS: Consistent with previous research, the findings suggest that opportunities to provide weight management advice in primary care, including to patients with an obese BMI, are potentially missed. Future research should test alternative mechanisms to increase weight assessment and advice provision, examine the effectiveness of advice frequently given, and seek solutions to reported barriers for providing weight management advice.

Music therapy and musical stimulation in the context of prematurity: A narrative literature review from 2010-2015.

AIMS AND OBJECTIVES: To examine empirical studies of musical stimulation and music therapy carried out with preterm infants and their parents published from 2010-2015. BACKGROUND: Prematurity constitutes a global health problem that can impact the development of the preterm infant and the well-being of the parents. Music-based interventions may benefit the infant, parents and their relationship. In our review, we distinguished between musical stimulation and music therapy, as we found no previous studies that had made this distinction. DESIGN: This is a narrative literature review. METHODS: A search was undertaken in PubMed, PsycINFO and LILACS using the terms "music," "music therapy," "singing," "prematurity" and "preterm." Thirty studies were included and analysed according to the following categories: (i) aims of the study, (ii) participants, (iii) design, (iv) type of intervention, (v) assessment and measures and (vi) main results. RESULTS: The vast majority of the studies focused on the preterm infants and used an experimental design. Few studies carried out family-centred interventions, despite this having been noted as an important factor in effective interventions. Musical stimulation studies used more recorded music, whereas music therapy studies used more individualised interventions with live music. CONCLUSIONS: Both musical stimulation and music therapy demonstrated significant effects on preterm infants and their parents. However, compared to musical stimulation studies, interventions performed by music therapists provided more individualised care and tended to show greater effects on infants' physiological and behavioural responses. RELEVANCE TO CLINICAL PRACTICE: Our review showed that music therapy interventions may provide individualised, effective and family-centred care. There is a significant need for these types of interventions in the neonatal intensive care unit (NICU).

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.

Brain science and illness beliefs: an unexpected explanation of the healing power of therapeutic conversations and the family interventions that matter.

Paradigm families and paradigm practice moments have shown me that therapeutic conversations between nurses and families can profoundly and positively change illness beliefs in family members and nurses and contribute to healing from serious illness. The integration of brain science into nursing practice offers further understanding of the importance of illness beliefs and the role they may play in helping individual and family healing. Brain science offers explanations that connect how certain family nursing interventions that soften suffering and challenge constraining illness beliefs may result in changes in brain structure and functioning. New illness beliefs may result in new neural pathways in the brain, and therefore, possibilities for a new way of being in relationship with illness and in relationship with others can also develop. Newly acquired practice skills and interventions that have emerged from an understanding of brain science plus the reemphasis of other interventions utilized in the Illness Beliefs Model are offered to enhance our care of families suffering with illness.

Families' experiences of their interactions with staff in an Australian intensive care unit (ICU): a qualitative study.

OBJECTIVE: Nursing is characterised as a profession that provides holistic, person-centred care. Due to the condition of the critically ill, a family-centred care model is more applicable in this context. Furthermore, families are at risk of emotional and psychological distress, as a result of the admission of their relative to intensive care. The families' experiences of their interactions in intensive care have the potential to enhance or minimise this risk. This paper presents a subset of findings from a broader study exploring families of critically ill patients' experiences of their interactions with staff, their environment, the patient and other families, when their relative is admitted to an Australian intensive care unit. By developing an understanding of their experience, nurses are able to implement interventions to minimise the families' distress, while providing more holistic, person- and family-centred care. RESEARCH DESIGN: The study was a qualitative enquiry that adopted the grounded theory approach for data collection and analysis. In-depth interviews with family members occurred between 2009 and 2011, allowing the thoughts on interactions experienced by those families, to be explored. Data were analysed thematically. Twelve family members of 11 patients participated in this study. SETTING: This study was undertaken in a mixed intensive care unit of a large metropolitan hospital in Australia. FINDINGS: Interactions experienced by families of the critically ill primarily revolved around seeking information and becoming informed. Further examination of the interviews suggested that staff interacted in supportive ways due to their communication and interpersonal skills. However, families also experienced unsupportive interactions as a result of poor communication. CONCLUSION: Facilitating communication and interacting in supportive ways should help alleviate the anxiety and distress experienced by families of the critically ill in the intensive care unit.

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.

Family presence during cardiopulmonary resuscitation: using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines.

PURPOSE: To provide advanced practice nurses (APNs) with the best available evidence for implementation of policies and procedures to allow family presence during cardiopulmonary resuscitation (CPR) in the acute care environment. DATA SOURCES: A comprehensive review of research-based articles from Ebsco Host, CINAHL, Pre-CINAHL, and Medline Plus, as well as statement alerts from nursing credentialing bodies, and practice guidelines were reviewed. Kolcaba's Theory of Comfort and Lewin's Three Step Change Theory provide a framework for implementation of formal policies and procedures. CONCLUSIONS: Best available evidence showed more support in favor of allowing families at the bedside during CPR. Implementation of policies and procedures allowing family presence enables facilities to change and grow in a holistic and family-oriented atmosphere. IMPLICATIONS FOR PRACTICE: With this evidence-based knowledge the APN will be able to disseminate information to facilitate collaborative change in current practices surrounding staff education, decision making, and self-governance. The APN can then address controversial changes when developing formal policies and procedures, which will increase patient satisfaction and outcomes.

Data management for intervention effectiveness research: comparing deductive and inductive approaches.

Management approaches are needed to prepare intervention data sets for research. We identified four management approaches and applied them to Omaha System intervention data from 15 home care agencies (621,385 interventions provided to 2,862 patients). Classifying intervention data created differing numbers of distinct groups for deductive approaches labeled as action category (four groups), theoretical (5), and clinical expert consensus (23). One inductive, data-driven approach generated 150 groups of interventions, of which 24 were meaningful and unique. Interventions in deductive groups were mutually exclusive, and approaches mapped readily according to intervention action terms. The novel, overlapping, inductive groups consisted of diverse actions for multiple problems. The four management approaches created meaningful intervention groups to be employed in future outcomes evaluation studies.

Family and staff partnerships in long-term care. A review of the literature.

Working with the family in aged care to provide the best care possible is consistent with modern nursing philosophy, which espouses holistic care. The quality and enjoyment of the experience, however, is frequently fraught with problems and challenges for both the family and the staff involved. In residential aged care, partnerships are a complex mix of interactions among the older adult resident, the family, and the caregiving staff. To understand how family involvement in this environment can be made more meaningful, nurses need to be cognizant of how family members experience the caregiving role and how they are perceived by nursing home staff and residents. The relevant literature of the past 20 years is reviewed and key issues central to an understanding of "family care" in the nursing home from the perspective of the family, the nursing home resident, and the nursing home staff are highlighted in this article.

Family beliefs about diet and traditional Chinese medicine for Hong Kong women with breast cancer.

PURPOSE/OBJECTIVES: To explore beliefs about diet and traditional Chinese medicine related to the breast cancer experience of Hong Kong Chinese women and their families. DESIGN: Interpretive phenomenology. SETTING: Hong Kong, China. SAMPLE: A purposive sample of 20 Hong Kong Chinese women diagnosed with breast cancer at various stages of the illness trajectory and at least one other family member. METHODS: A semistructured, three-hour interview was translated, transcribed, and back-translated. FINDINGS: Many women and their family members believed that diet was responsible for their cancer and recurrence. They integrated their cultural beliefs about diet and traditional Chinese medicine to manage illness symptoms and prevent recurrence. Families were anxious and confused about conflicting messages from various sources about dietary practices to promote their health and prevent recurrence. CONCLUSIONS: Food and diet alternatives should be discussed with the understanding that beliefs about diet and traditional Chinese medicine are embedded in culture and that many Chinese women and their families seek a combination of Eastern Chinese medicine and Western medicine strategies to manage the illness trajectory. IMPLICATIONS FOR NURSING: Many Chinese families have different beliefs about food and diet and the role that food plays in managing the cancer experience. Often, Chinese people will not seek clarification if they do not understand information. If information does not fit with their predominant belief systems, families may not implement it, nor will they discuss a situation if they think the conversation will result in a relationship of conflict with healthcare providers.

Enhancing nursing research with children and families using a developmental science perspective.

Nursing scholarship on children and their families has increased rapidly over the past decades. This research focuses on infants, children, and adolescents and their families facing acute or chronic illness, as well as on promoting health and preventing disease in children. While the amount and scope of research in pediatric nursing has increased, the methods and theories used are diverse and are often not based on the most recent science in the broader fields of developmental research. Developmental science, which evolved over the past two decades into a new interdisciplinary framework for the study of human development, involves an integrated holistic, developmental, and systems-oriented perspective. According to this view, the individual functions and develops through dynamic and complex processes involving the integration of many systems within the individual, including mental, biological, and behavioral systems. In addition, individuals function and develop in a continuously ongoing, reciprocal process of interaction with their environment and, as such, have an influence on that environment. These nonlinear, dynamic processes demand complex conceptualizations and research designs if one is to truly understand human development, including health and illness. Key aspects of developmental science important in conceptualization, design, measurement, and data analysis are identified. By providing a framework for critiquing research and presenting recommendations for future research based on developmental science, we hope to move nursing research with children forward toward more developmentally sound knowledge of nursing practice.

Early support needs of Finnish families with small children.

AIMS: This study describes the early needs for support that families with small children have in the context of their own life situations. The study population consisted of Finnish families (n = 551) who participated in a project titled 'Families with Children' (1996-2001). The project supplemented the existing public services. The information provided by the study was utilized in supporting families and developing family work in seven experimental areas. METHODS: The data were collected between 1997 and 2000 using family service plans and client reports. The data were analysed with inductive content analysis and using the SPSS software (version 7.5). FINDINGS: The families needed support in the areas of parenthood, upbringing and child care, marital problems and social support networks. The need for early support was also connected to health problems of the children or the parents, problems with work or studies, unemployment, problems in economic or living conditions, or family crises. In addition to support, the families searched for help from family workers in disputes over child custody and visitation rights, intoxicant abuse and violence, and problems in adjusting to society. Each family had 4-5 needs for early support. CONCLUSIONS: The results demonstrate that families with small children have many needs for which they seek help when there are available services supplementing the existing public services. The information provided by the study can be utilized in maternity and child welfare clinics, in social services and in family work provided by civic organizations to define the early needs of families for support and to develop services.