Refinement and psychometric reevaluation of the instrument: Families' Importance In Nursing Care--Nurses' Attitudes.

The instrument Families' Importance in Nursing Care--Nurses' Attitudes (FINC-NA) was developed to measure nurses' attitudes toward the importance of families in nursing care. The low variations in item responses, which affect the discrimination ability and unstable internal consistency, have been considered as limitations. The aim of this study was to refine and revalidate FINC-NA regarding score distribution, homogeneity, dimensionality, differential item functioning for gender, stability, and internal consistency. There were 246 registered nurses studying at advanced levels who answered the revised FINC-NA. The FINC-NA had five response alternatives. The findings showed that although some subscales still deviated from a normal distribution, the variability of the scores and the homogeneity was improved. In addition, the dimensionality was reproduced and minor problems with differential item functioning for gender were detected. All FINC-NA scales showed good reliability. The results allow the use of the revised FINC-NA in studies where an assessment of nurses' attitudes toward families' importance in nursing care is desired.

Family adaptation in relation to a family member's stay in ICU.

OBJECTIVES: To describe and interpret the family adaptation during the ICU hospitalisation and up to 18 months after discharge. RESEARCH METHODOLOGY/DESIGN: A qualitative design was chosen. MAIN OUTCOME MEASURES: Individual and family interviews with eight families including 31 family members. A hermeneutical analysis was performed and paradigm cases were constructed. RESULTS: The result is presented in three themes: striving for endurance, striving for consolation and striving to rebuild life under new conditions. The family adaptation started at the onset of the critical incident and continued during the ICU stay and after discharge. The family members metaphorically went through peaks and valleys during the whole process of adaptation. CONCLUSION: Adaptation is an issue for the whole family and is facilitated by being able to stay close to the patient and receive supportive unambiguous information from the staff both during the ICU stay and after discharge.

Nonattendance in a cervical cancer screening program - what happens if women's requirements are met?

In this study we focus on women who have no registered cervical smear during the previous 5 years, their requirements for attendance, and promotive efforts performed. Of the 400 women randomly selected to answer a telephone-based questionnaire about future attendance at cervical cancer screening (CCS), 120 would consider having a cervical smear taken, and 50 of them wanted help to accomplish that. When meeting the women's requirements, such as being assured friendly treatment and a suitable appointment time, the numbers of registered cervical smears were higher for the study group compared with a control group. Still, the most highly resistant women did not attend.

Reasons for non-attendance at cervical screening as reported by non-attendees in Sweden.

PURPOSE: To describe reasons for non-attendance at cervical screening, as reported by non-attendees, in Sweden. METHODS: Four hundred women were randomized from a population-based register, of which 133 non-attendees answered the Cervical Screening Questionnaire (CSQ) in telephone interviews. Pearson's Chi2 and Mann-Whitney U-test were used to analyze differences between groups. Logistic regression was used to study the relationship between explanatory variables and a binary response variable. RESULTS: The most common reasons for non-attendance were: feeling healthy, lack of time, and feelings of discomfort with the gynecologic examination. Non-attendees, who reported non-attendance due to experiences of discomfort associated with the gynecologic examination, estimated great discomfort at their latest examination. A history of sexual abuse was reported by 16.5%, but there were no differences regarding non-attendance due to experiences of discomfort associated with the gynecologic examination, between non-attendees who had no history of sexual abuse and those who had. CONCLUSION: It seems as though non-attendees did not attend cervical screening as they felt healthy, and thereby did not give time to preventive efforts. Earlier negative experiences such as discomfort during earlier gynecologic examinations seem to guide their decision not to attend.

'I do not need to... I do not want to... I do not give it priority...'--why women choose not to attend cervical cancer screening.

OBJECTIVE: To describe and interpret why women with no cervical smear taken during the previous 5 years choose not to attend a cervical cancer screening (CCS) programme. BACKGROUND: CCS programme is a service for early detection of cervical cancer. Today, some women choose not to attend the programme. DESIGN: Data were collected by tape-recorded interviews and analysed by qualitative inductive content analysis. SETTING AND PARTICIPANTS: Purposive sample of 14 women in southeast Sweden, who had chosen not to attend CCS during the previous 5 years. FINDINGS: The following themes were revealed: I do not need to..., I do not want to... and I do not give it priority.... The women had a positive attitude to CCS but as long as they felt healthy, they chose not to attend. A negative body image, low self-esteem, feelings of discomfort when confronted with the gynaecological examination and fear of the results also influenced their non-attendance. The women prioritized more important things in life and reported various degrees of lack of trust in health-care. CONCLUSION: Women's choice not to attend CCS were complex and influenced by present and earlier intra- and inter-personal circumstances. They had a positive attitude to CCS, but other things in life were more important. Health-care professionals have to facilitate a co-operative discussion with the women in order to contribute to a mutual understanding for the perspectives of the women and the professionals.

Promotion of cervical screening among nonattendees: a partial cost-effectiveness analysis.

Measures to increase attendance rate in cervical screening programmes have been suggested, but few have been evaluated in terms of value for money. The aim of this study was to describe the cost-effectiveness of a resource-intensive intervention to promote attendance at cervical screening among women with no registered cervical smear during the last 5 years. Among all 56 644 women (28-65 years) in Kalmar County, January 2004, a total of 6565 women had no registered cervical smear during the last 5 years. From this population, 400 women were randomly selected to a study group and another 400 women to a control group. The intervention was composed of a variety of efforts intended to promote attendance at cervical screening. We included, for example, all costs for identifying the women, sending out invitation letters, making phone calls and helping to make arrangements. Data on registered cervical smears at follow-up were collected from a data register within 1 year. In the study group, 118 women had a registered cervical smear compared with 74 in the control group (P=0.000). In the study group, the cost per cervical smear taken was 66.87 euro compared with 16.63 euro in the ordinary screening programme. The incremental cost per additional registered cervical smear was calculated at 151.36 euro in an area with high coverage, efforts to promote attendance at cervical screening were related to high costs per extra cervical smear gained and is not considered as reasonable from a cost-effectiveness perspective.

The first pelvic examination.

PURPOSE: To describe adolescents' experiences of their first pelvic examination. METHODS: Data were collected by tape-recorded interviews with 15 adolescents, who had had their first pelvic examination (PE) performed by a midwife at a Youth Clinic. Data were analyzed by qualitative latent content analysis. RESULTS: The result is presented in terms of the themes: Emotional ambivalence, Being in control and A step into women's world. The adolescents generally believed that PE was beneficial to their health and they were curious to see how they would manage. On the other hand they also felt embarrassed about getting undressed. They described several factors which contributed to feelings of being in control of the situation, e.g., when the examiner shared the process of decision making, thoroughly explained the PE procedure in advance, and assured them that the PE could be discontinued at any time. They considered their first PE as a step into a women's world. It seems important that the examiners perform the first PE in a manner that empowers the adolescents so they can enter womanhood with a positive attitude to their bodies. Furthermore, this empowering process may lay the foundation for subsequent PEs to be educational events for the adolescents.

Being a family in the midst of living and dying.

The aim of this study was to illuminate the way of being a family when one family member is in the midst of living and dying. A family systems frame and a life world perspective were used in interviews with five families. A qualitative analysis inspired by Giorgi revealed dialectic and dynamic processes in constant motion within and between the continua being in affinity-being in loneliness, being in power-being in helplessness, and being in continuity-being in disruption. When families were moving in the direction of being in affinity, power, and continuity, these seemed to be prerequisites for enduring their challenged life situation and for giving them a kind of repose. When the movements were in the opposite direction, existential and emotional suffering were manifested as individual embodied experiences such as depression and anxiety.

Nursing students' beliefs about families in nursing care.

Caring for families is a growing part of nurses' professional work in various health care settings and consequently an important issue for nursing education. One way to determine the readiness for nursing students to meet families is to reveal their beliefs about families. Beliefs can be uncovered through interpretation of conversations, as beliefs are embedded in our stories. The aim of this study was to explore nursing students' beliefs about families in nursing care. Nine nursing students, three from each year of a three-year programme, were interviewed individually. The interviews were tape-recorded and transcribed verbatim. First, a manifest content analysis was performed followed by a latent content analysis in order to reveal underpinning beliefs. The results demonstrate beliefs about families and nurses and their relationship, for example, if family members are close to each other and when the patient is cared for in his/her own home, it reduces suffering for the whole family, and if nurses create a trusting relationship and atmosphere, it fosters the families' well-being. Although the beliefs uncovered are seen as facilitative ones, educational efforts are essential to implement family nursing both theoretically and practically in curricula throughout the nursing education.

The level of and relation between hope, hopelessness and fatigue in patients and family members in palliative care.

Hope, hopelessness and fatigue are important experiences for patients and family members in palliative care. The aim of the study was to describe the level of and relation between hope, hopelessness and fatigue in patients and family members in palliative care. Eighty-five participants completed the Herth Hope Index, Beck's Hopelessness Scale and rated their level of fatigue from none to severe. The level of hope proved to be significantly lower among the family members than among the patients. For the family members, correlations were found between hope and age (-0.358*), fatigue and hope (-0.439*), hopelessness and age (0.484**), age and fatigue (0.403**) and between hope and hopelessness (-0.723**). For the patients, correlations were found between age and hopelessness (0.555**) and between hopelessness and hope (-0.580**). Efforts to increase the experience of hope and decrease hopelessness and fatigue must include not only the patient but also the family members. (* =P <0.5, ** =P <0.01)