A school-based health centre partnership: Faculty practice, nursing student learning and wellness in youth, families and community.

AIMS AND OBJECTIVES: This paper describes the development of a SBHC with an innovative model of care that grew out of a partnership between a public-school district and a university nursing programme in the midwestern region of the United States. BACKGROUND AND PURPOSE: Persistent barriers to health and health care experienced by youth are well documented. School-based health centres (SBHCs) can improve educational and health outcomes, positively impacting health equity. Academic systems are positioned to address health care needs of the school-aged population, yet educators face challenges of accessing quality learning placements for students and faculty practice sites. METHODS: A community-based collaborative methodology guided the planning phases that were driven by priority needs identified by families and stakeholders. With the mission of "partnering with students, families, and communities in the promotion of health and wellness through engagement in practice, education, and research," an ongoing dialogue over a two-year period led to articulating a vision, designing a plan and implementing a nurse-managed SBHC. The Standards for Reporting Qualitative Research (SRQR) checklist was considered in the preparation of this paper. RESULTS: In three years, this SBHC has addressed and identified priority needs and served individual youth and families. The SBHC provides opportunities for the faculty to fulfil a practice requirement for certification and accreditation. Nursing students engage with youth and families in health education and health promotion while strengthening their technical and relational skills. Family nurse practitioner students gain valuable clinical experience. Faculty with expertise in family nursing guide family assessments, support family resiliency and direct therapeutic conversations with family units. CONCLUSION: SBHCs serve youth, families, and community. This academic-practice partnership has the added benefit of providing faculty practice opportunities and nursing student experiential learning. RELEVANCE TO CLINICAL PRACTICE: SHBCs provide practice opportunities that address needs in individuals, families, and communities. Partnerships should be considered at academic nursing programmes to support their needs and fulfil commitments to address health equity gaps.

Early Career Nurses' Experiences of Providing Family Nursing Care: Perceived Benefits and Challenges.

Faculty at Minnesota State University, Mankato (USA) developed a family-focused baccalaureate curriculum to address gaps between evidence and practice with families that have been linked to undergraduate nursing education. The purpose of this study was to understand the perceptions of new graduate nurses in providing family-focused nursing care in practice settings. A descriptive design focused on narrative data was used to identify the nurses' perceived benefits and challenges of caring for families in their current nursing practice. Data were collected from three cohorts of new graduate nurses who were currently employed in health care settings (N = 109) through a five-contact procedure and examined using a content analysis method. Nine perceived benefit categories, subcategories, and summary statements were identified. Seven challenge categories were identified. The early career graduate nurses' ability to translate family-focused knowledge to their practice was a significant finding. The benefits and value of developing interactions with families were evident in a number of categories. Education and practice systems can implement educational innovations and partner to support new career graduates' ability to offer skilled family nursing practice.

An Educational Intervention Incorporating Digital Storytelling to Implement Family Nursing Practice in Acute Care Settings.

This project describes implementation of an educational intervention designed to initiate practice changes that support families and nurses during acute illness. An academic-practice partnership and digital storytelling methodology provided a foundation. A quasi-experimental research design included quantitative and qualitative measurement before and after the educational intervention. Themes identified in digital stories of nurse experiences caring for families provided direction for the educational intervention including the digital stories, empirical evidence, and proposed changes in nursing practice focused on families. Nurse participants (n = 160) in the educational intervention reported positive responses on a qualitative questionnaire. Comparing pretest and posttest results of the Family Nurse Practice Scale reflected positive, though not significant change. Family members (n = 49) reported significantly improved perceptions of support on 7 of the 14 items on the Iceland Perceived Family Support Questionnaire. This project highlighted digital storytelling's power to promote family interventions and move family nursing knowledge into practice.

Measuring Family Members' Experiences of Integrating Chronic Illness Into Family Life: Preliminary Validity and Reliability of the Family Integration Experience Scale:Chronic Illness (FIES:CI).

Measures of family members' experiences of integrating chronic conditions (CC) or chronic illnesses (CI) into family life are needed to optimize family care. This article reports development and psychometric testing of the Family Integration Experience Scale: Chronic Illness (FIES:CI), a measure of family member perceptions of integrating CC or CI into evolving family life. Family Systems Nursing (FSN), the Reintegration Within Families in the Context of Chronic Illness Model, and measurement theory guided the study. Participants were those (N = 328) managing a CC or CI. Concurrent validity (r = +.629; p < .001) and discriminant validity, F(1, 155) = 7.09; p < .05, were demonstrated. Exploratory factor analysis revealed a two-dimensional model explaining 63.8% variance. Scale internal reliability was α = .70 and .785, and factor reliabilities were α = .798 (Factor 1) and α = .847 (Factor 2). Test-retest item and subscale correlations, while accounting for intra-family correlation, were acceptable. The FIES:CI contributes a valuable new measure of family integration in the context of CC or CI with preliminary validity and reliability as tested in these samples.

Adjusting to sex and intimacy: Gynecological cancer survivors share about their partner relationships.

This study describes what gynecological (GYN) cancer survivors relate about their intimate partners and adjustments in their sexual lives following diagnosis and treatment. Conventional descriptive content analysis was used to examine participant responses about partner relationships following their diagnosis. Responses revealed three clusters and 15 codes of data. Findings report the influence of cancer treatment on sexual activity and functioning, women's sex lives, and their relationships. Health-care providers have a vital role in supporting women and their partners during the cancer care trajectory and should include both the survivor and the partner in conversations focused on sexual concerns and sexual well-being.

Reducing Digital Storytelling Implementation Barriers in Nursing Education Workshops.

Digital stories have the potential to transform health care systems by cultivating understanding and compassion; however, limited research explores the use of this innovative strategy in continuing education. This article describes how a collaborative partnership of an Academic Team and Translational Partners (n = 15) implemented a four-phase study that included a continuing education workshop with digital stories as the central strategy. The study's guiding questions focused on adapting approaches to creating digital stories to reduce logistic concerns and overcome implementation challenges yet empower nurses in their practice with families. Numerical and narrative responses from workshop participant evaluations (n = 160) affirmed storytelling as the most valuable component, and reflection increased understandings to influence their thinking and actions. This study affirms using digital stories as an implementation strategy in health care systems has the potential to transform nursing education, supports the transfer of family nursing practice knowledge, encourages reflection, and develops empathy for families and nurse peers. [J Contin Educ Nurs. 2019;50(9):411-416.].

Development and Implementation of a Family-Focused Undergraduate Nursing Curriculum: Minnesota State University, Mankato.

Nurse educators have the responsibility to create learning experiences centered on the scientific and praxis foci of the nursing discipline to advance nursing practice with families. Although the nursing profession has ample knowledge about the importance of family nursing and the value of family-focused actions, there is a lack of curricular and teaching models that address nursing practice with families in numerous courses and learning experiences. This article describes the development of a family-focused undergraduate curriculum and teaching-learning practices at Minnesota State University, Mankato in the United States. A vision and mission centered on the nursing of families, a family care teaching model, a framework of family constructs, and taxonomy of significant learning strategies guided faculty in creating learner-centered experiences. Course objectives, competencies, and teaching-learning practices in this curriculum are described. This manuscript may guide the development of innovative teaching-learning practices that integrate family nursing constructs and family nursing actions from a variety of family nursing models and theories. Initial evaluation suggests that this curriculum can increase students' knowledge of family and instill a passion for family care in undergraduate programs.

A family nursing educational intervention supports nurses and families in an adult intensive care unit.

The family experience of critical illness is filled with distress that may have a lasting impact on family coping and family health. A nurse can become a source of comfort that helps the family endure. Yet, nurses often report a lack of confidence in communicating with families and families report troubling relationships with nurses. In spite of strong evidence supporting nursing practice focused on the family, family nursing interventions often not implemented in the critical care setting. This pilot study examined the influence of an educational intervention on nurses' attitudes towards and confidence in providing family care, as well as families' perceptions of support from nurses in an adult critical care setting. An academic-clinical practice partnership used digital storytelling as an educational strategy. A Knowledge to Action Process Framework guided this study. Results of pre-intervention data collection from families and nurses were used to inform the educational intervention. A convenience sample of family members completed the Iceland Family Perceived Support Questionnaire (ICE-FPSQ) to measure perception of support provided by nurses. Video, voice, and narrative stories of nurses describing their experiences caring for family members during a critical illness and family members' experiences with a critically ill family member also guided education plans. When comparing the pre and post results of the Family Nurse Practice Scale (FNPS), nurses reported increased confidence, knowledge, and skill following the educational intervention. Qualitative data from nurses reported satisfaction with the educational intervention. Findings suggest that engaging nurses in educational opportunities focused on families while using storytelling methods encourages empathic understandings. Academic-clinician teams that drive directions show promise in supporting families and nurses in critical care settings. Plans are moving forward to use this study design and methods in other critical care settings.

Using Simulation Pedagogy in the Formation of Family-Focused Generalist Nurses.

BACKGROUND: Nursing practice with families is essential because a family member's illness affects the family and, reciprocally, the family influences health outcomes. Yet, nurses often report a lack of confidence in their ability to meet the needs of families, whereas family members often describe troubling experiences with nurses. These challenges may have beginning roots in nursing education. This article explores the use of simulation in the formation of family-focused generalist nurses. METHOD: Simulation pedagogy was used to guide students in developing an understanding of the importance of family nursing care, gaining confidence in family practices, and developing family competencies. RESULTS: Innovative simulation learning experiences in an undergraduate nursing curriculum helped students to learn how to develop nurse-family relationships and gain humanistic skills of family nursing practices. Students and faculty reported that simulation guides students to achieve meaningful outcomes. CONCLUSION: In this curriculum, faculty consistently directs attention to the family in simulation learning experiences, and students value this pedagogy.

The essence of the family critical illness experience and nurse-family meetings.

Nursing care of families is essential to strong family support and maintenance of family health during a critical illness. Secondary data analysis of interviews conducted with 11 families with a family member in the intensive care unit revealed two essences: the family critical illness experience and the family vision for the kind of care families required and desired from nurses. The purpose of this article was to explicate the essence of these phenomena and their implications for family nursing practice. Findings affirm the need for a family intervention described in the literature, that of regularly scheduled nurse-family meetings. Although developed for work with families experiencing a chronic illness, bringing families together and inviting meaningful conversation about their experiences is appropriate for families experiencing critical illness. Nurse-family meetings acknowledge suffering and vulnerability of families when a loved one is critically ill and afford families an opportunity for honest sensitive communication with nurses.

Expanding simulation to teach family nursing.

Caring for families during an illness experience is increasingly recognized as a core of nursing practice. Yet research reports deficiencies in the current state of family nursing care. It is possible that these deficiencies are rooted in a lack of integrating family care throughout nursing education and a focus on the biomedical science paradigm. As a relational skill, family care requires different pedagogical approaches to effectively teach family nursing. Simulation is one such approach. Even though simulation is rapidly moving into nursing education, the primary focus is teaching psychomotor nursing skills, rather than caring and family nursing.

Being family: the family experience when an adult member is hospitalized with a critical illness.

AIMS AND OBJECTIVES: The purpose of this qualitative study was to understand and interpret the 'family experience' with an adult member hospitalized with a critical illness. BACKGROUND: Nursing practice in critical care settings has traditionally focused on individual patient needs with only tangential recognition of family needs. Investigation to describe the family experience to illuminate family nursing practice has been lacking. The majority of studies thus far related to critical illness and family are quantitative and reveal constraints to family care and problematic nurse-family interactions. The logical next step is a new kind of family research to enhance nursing of the family as a whole. DESIGN: Family systems theory and existential phenomenology provided the frameworks guiding the study. METHODS: Semi-structured 'family as a group' interviews were performed with 11 families. Data were analysed using Van Manen's hermeneutic method. Rigor was addressed with trustworthiness criteria. RESULTS: The family experience was analysed within Van Manen's framework of lived space, lived relation, lived body and lived time. A constitutive pattern of being family was revealed. CONCLUSIONS: Being family bonds families and makes them exceedingly strong during the critical illness experience. Being a family unit is what gives most families the ability to endure the emotional upheaval and suffering that come with the critical illness experience. RELEVANCE TO CLINICAL PRACTICE: Nurses have profound power to help families bear this experience. Family caring is enhanced with the presence of nurses who recognize the importance of 'Being Family' for the family, acknowledge the significance of the nurse-family relationship and act on a commitment to be with and for the family.

Family interviews as a method for family research.

AIM: This paper is a description of the experience of conducting family interviews in a study to come to understand from families their experience of the hospitalization of a critically ill family member. BACKGROUND: Traditional family research has been done quantitatively, with a focus on the needs of individual family members rather than the family as a whole. The limited amount of qualitative family research has been done primarily by interviewing individual family members rather than the family as a group. METHOD: The original study was conducted within a framework of phenomenology and 11 families, for a total of 41 individuals, were interviewed about their experiences. Family groups from two to seven members, some including adolescents and young adults, participated in semi-structured interviews. FINDINGS: Findings revealed that gathering families together, even early in the critical illness experience, is not only feasible but beneficial for them and opens the door to dialogues that have a therapeutic effect on the family and help them manage the critical illness experience. Although daunting and challenging, family interviews are feasible and provide rich family-level data that contribute knowledge to family science and family caring. Strategies for family recruitment, conduct of family interviews and family-level data analysis are presented. CONCLUSION: Families want to tell their stories and clearly have a need for nurses to develop relationships with them while caring for their ill loved ones. Family interviews both affirm the family and give nurses greater understanding of family issues, concerns and meanings.

Culturally competent nursing care: listening to the voices of Mexican-American women.

Mexican-Americans represent the fastest-growing minority population group in the United States. Gaining a cultural perspective of health care in the Mexican-American population necessitates listening to the voices of women because they assume primary responsibility for maintaining family health. The Transcultural Assessment Model developed by Giger and Davidhizar (2004) provides the framework for this exploration of Mexican-American women's health care views. From this model the investigators developed an interview guide based on social organization and environmental control. Thematic analysis of interviews with six Mexican-American women revealed the importance of the family, religion, and locus-of-control in the health beliefs, attitudes, and lifestyle practices of this culture. Using the voices of Mexican-American women the investigators seek to promote an understanding of the culture as a guide for nursing care. The purpose of this article is to increase awareness of the Mexican-American cultural phenomena of social organization and environmental control which can guide the nurse to provide culturally competent care that meets the needs of Mexican-American women and their families.

Artificial hydration and nutrition in advanced Alzheimer's disease: facilitating family decision-making.

BACKGROUND: As Alzheimer's disease progresses to its final stages of dementia and dysphagia, whereby patients can no longer swallow food and fluids, families suffer with difficult decisions regarding initiation of artificial hydration and nutrition. AIMS AND OBJECTIVES: Through the use of a hypothetical family scenario, this theoretical article presents the ethical principals of beneficence and autonomy as a framework for use by nurses to hear and inform family decision-makers of the physiology of death in the advanced stages of Alzheimer's and examines the current literature related to benefits and burdens of artificial hydration and nutrition. CONCLUSIONS: While a beneficial consideration, ethical principles are critiqued for their inability to provide an absolute answer and relieve family suffering in this clinical situation. RELEVANCE TO CLINICAL PRACTICE: A nurse-lead consensus building process is proposed to guide family decision-making regarding artificial hydration and nutrition with advanced Alzheimer's disease.

Family caring strategies in neutropenia.

Aggressive chemotherapy protocols result in neutropenia in approximately half of all patients receiving chemotherapy. Thus, neutropenia continues to be a significant and potentially life-threatening side effect of treatment, even with use of colony-stimulating factors. Families of patients with neutropenia often provide the primary healing environment because most chemotherapy protocols are managed on an outpatient basis. To learn about the family's experience of managing chemotherapy-induced neutropenia (CIN), a grounded-theory methodology was used to analyze data from seven families. The central theme revealed by these families was "turbulent waiting with intensified connections." This meant that when families had a sense of greater vulnerability in response to the waiting after diagnosis of CIN, they connected intensely with each other and healthcare providers. Families reported that connections with nurses became more significant when neutropenia interrupted chemotherapy. Families also developed family caring strategies to manage this period of waiting for the chemotherapy to resume. These strategies included family inquiry, family vigilance, and family balancing. Nurses need to be aware of approaches to support the family's ability to manage CIN. Interventions and approaches constructed from the perspective of a family-professional partnership will enhance the family cancer experience as well as ongoing family growth and function.