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.

Tales of resistance and other emancipatory functions of storytelling.

TITLE: Tales of resistance and other emancipatory functions of storytelling. AIM: This paper is the report of a study to explore how the process of storytelling might facilitate women's emancipatory knowing, using examples from women's breastfeeding stories. BACKGROUND: Storytelling, as an interactive process, can give women a way to explain pivotal life events, justify choices, examine reality and find meaning in experiences. Emancipatory functions of storytelling have been identified as contextual grounding, bonding with others, validating and affirming experiences, venting and catharsis, resisting oppression and educating others. METHOD: Secondary data analysis was conducted in 2008 on breastfeeding stories originally gathered from 13 women from 2002 to 2004 for a feminist hermeneutic study of maternal breastfeeding confidence. The stories were re-examined through the lens of the emancipatory functions of storytelling. Illustrations of contextual grounding, validating and affirming experiences, venting and catharsis and acts of resistance were found in the breastfeeding stories and presented as exemplars of emancipatory knowing. FINDINGS: Women revealed the difficulties they encountered breastfeeding, transforming these experiences as they discovered their meaning. They described collisions that occurred when personal, familial, healthcare professionals' or cultural expectations differed from their experience. The stories suggested possible liberation from old ideologies about breastfeeding as women redefined the difficulties they encountered. CONCLUSION: Storytelling has potential as a simple, yet profound, and powerful emancipatory intervention which nurses can use to help women in their care make sense of and transform experiences of health and illness. Storytelling may have global implications for nursing practice and research.

The breast-feeding conversation: a philosophic exploration of support.

Nurses play a vital role in mothers' early experiences with breast-feeding. Literature enumerates both supportive and nonsupportive behaviors, as well as the "interpersonal" aspect of breast-feeding support, although little direction is given to nurses about how to facilitate the relationship. This article conceptualizes breast-feeding support within Gadamerian hermeneutics as a conversation among nurses, mothers, and their newborns. Hermeneutically, breast-feeding conversation encompasses a text (a particular feeding at the breast), conversational partners (a mother, her newborn, and a nurse), and a dialogue that facilitates effective breast-feeding and maternal breast-feeding confidence through interpretation or understanding of the text. History and language are essential as a partnership is formed.

A study to develop a disclosure to children intervention for HIV-infected women.

One of the most difficult issues for an HIV-infected woman is the task of telling her children that she has HIV. Interventions are needed to support women in the distressing task of disclosing the diagnosis to their children and to give them directions based on the experiences of others. The purpose of this study was to develop an intervention to help and support women in disclosing a diagnosis of HIV to their children. Information was gathered from four sources: (a) women with HIV, some of whom had disclosed to their children and others who had not; (b) nurses, case managers, and counselors in HIV care; (c) the body of literature on knowledge and best practices related to disclosure of sensitive information to others, especially children; and (d) an expert in the psychology of mothering. The outcome of the project was an intervention, part of which was a printed brochure, to help HIV-infected women in the disclosure process.

Understanding maternal breastfeeding confidence: a Gadamerian hermeneutic analysis of women's stories.

Our aim in this Gadamerian hermeneutic study was to understand maternal breastfeeding confidence and its meaning through listening to women's voices describing their experiences within the context of the United States. We asked 13 women, aged 23 to 42 years, who had breastfed a child within the last 2 years to tell us their breastfeeding stories. Women experienced maternal breastfeeding confidence as a dynamic interaction between their expectations, their infant(')s breastfeeding behavior, and sources of support. They described experiences that enhanced or diminished their confidence. Health professionals can use these findings to plan approaches that promote and support maternal breastfeeding confidence.

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.

Burden: the phenomenon of mothering with HIV.

If most mothers continually struggle to comply with perceptions of the "good mother" in the face of fatigue, self-doubt, and overwhelming emotion, what must the experience be like for HIV-infected women with dependent children to live and to mother day-to-day with an increasingly chronic, but still fatal, disease? The purpose of this phenomenological study was to gain an understanding of the mothering and end-of-life issues faced by HIV-infected women with dependent children. Sixteen HIV-infected women reflecting diversity of ethnicity, age, number and ages of children, and health status were interviewed in depth. A phenomenon of mothering with HIV revealed a constitutive pattern of burden. Themes revealed were the burden of the diagnosis and health status, the burden of whether or not to reveal to children, the burden of an unknown future for themselves and their children, and relieving the burden of the diagnosis.

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.