Effect of family nursing therapeutic conversations on patients with heart failure and their family members: Secondary outcomes of a randomised multicentre trial.

AIMS AND OBJECTIVES: This study evaluates the short-term (3 months), medium-term (6 months) and long-term (12 months) effect of family nursing therapeutic conversations added to conventional care versus conventional care on social support, family health and family functioning in outpatients with heart failure and their family members. BACKGROUND: It has been emphasised that increased social support from nurses is an important resource to strengthen family health and family functioning and thus improve the psychological well-being of patients with heart failure and their close family members. DESIGN: A randomised multicentre trial. METHODS: A randomised multicentre trial adhering to the CONSORT checklist was performed in three Danish heart failure clinics. Consecutive patients (n = 468) with family members (n = 322) were randomly assigned to either the intervention or control group. Participants were asked to fill out family functioning, family health and social support questionnaires. Data were measured ahead of first consultation and again after 3, 6 and 12 months. RESULTS: Social support scores increased statistically significant both at short-term (p = 0.002) medium-term (p = 0.008) and long-term (p = 0.018) among patients and their family members (p = <0.001; 0.007 and 0.014 respectively) in the intervention group in comparison with the control group. Both patients and their family members reported increased reinforcement, feedback, decision-making capability and collaboration with the nurse. No significant differences between the intervention and control groups were seen in the family health and family functioning scales among patients and family members. CONCLUSIONS: Family nursing therapeutic conversations were superior to conventional care in providing social support from nurses. RELEVANCE TO CLINICAL PRACTICE: Family nursing therapeutic conversations are suitable to improve the support from nurses among families living with heart failure.

The lived experiences of emotionally insecure nursing students: A qualitative study.

Research shows that students who feel emotionally insecure are at risk of dropping out of nursing educational program. It is, therefore, important to support student resilience in the international nursing education. The aim of this study was to investigate the lived experiences of undergoing a nursing education as an emotionally insecure student. The method was conducted within a phenomenological-hermeneutic approach, inspired by the French philosopher Paul Ricoeur's theory of narrative and interpretation, which is conducted in a three-phased structure: Naïve reading, structural analysis and critical interpretation and discussion. Seven participants were included in the study. The findings show that feeling emotionally insecure can be linked to not feeling good enough and feeling misunderstood - yet, with hidden resources. Nurse educators must be aware that emotionally insecure students can easily feel shame, must be willing to help clear up potential misunderstandings and should be curious about resources that might be hidden, such as competence awareness. Hidden resources might be related to protective factors and resilience. The study points to ways in which the relation between nurse educators and students can affect resilience, and that students are not solely either resilient or emotionally insecure; resilience may exist within vulnerability.

Translation and field testing of the family functioning, family health and social support questionnaire in Danish outpatients with heart failure.

BACKGROUND: Valid and reliable instruments to assess family functioning, health and social support in families with heart failure constitute a cornerstone in the detection of the families' needs, in improving their functioning and in evaluating the effects of nursing interventions. AIM: To translate the three scales of the Family Functioning, Family Health and Social Support (FAFHES) questionnaire from Finnish into Danish, to test validity and reliability of the Danish version among outpatients with heart failure and to add to previous studies by reconstructing scales using confirmatory factor analysis. METHODS: A cross-sectional design was used to study a sample of 330 patients with heart failure who completed the FAFHES. The validity (dimensionality) and reliability (internal consistency and test-retest) were assessed for each of the three scales. The scales were constructed using confirmatory factor analysis. RESULTS: Patients were primarily men (76%) with a mean age of 66.5 (SD 12.5), categorised as New York Heart Association (NYHA) classification II (80%) and NYHA III (20%) for clinical severity of symptoms. In all three modified scales, construct validity was supported by the analysis. There were strong correlations within the factors, with Cronbach's alpha ranging from 0.73 to 0.95 across the three scales, and significant, though weak, correlations between most of the factors. None of the revised scales showed good model fit according to the goodness-of-fit indices used. The test-retest showed interclass correlation coefficients ranging between 0.69 and 0.86, indicating acceptable test-retest reliability. CONCLUSION: The Danish version of the FAFHES is an instrument that can be used to measure family functioning, family health and social support from the perspective of the patient with heart failure. Further testing is recommended.