Validity and reliability of the brazilian version of the instrument the assessment strategies in families-effectiveness (asf-e) / Validez y confiabilidad de la versión brasileña del instrumento the strategies in families-effectiveness asf-e/brasil / Validade e confiabilidade da versão brasileira do instrumento the strategies in families-effectiveness asf-e/brasil

ABSTRACT Objective: to test the psychometric validity of an instrument to assess family effectiveness strategies and its reliability for use with Brazilian families. Method: this is a methodological study, content validation, construct, criterion, which used exploratory and Confirmatory Factor Analysis and reliability. The sample consisted of 100 families. Data were collected from October 2017 to March 2018. Results: the percentage of agreement among family health experts was 100%, with a perfect Content Validity Index and reliability (1.00). For the target audience (pre-test), 89.3% of agreement and Content Validity Index of 0.89 were obtained. Construct validity had a total explained variance of 73.8%. The concurrent criterion validity presented a correlation coefficient (ρ) of 0.75 (p = 0.004). Reliability had a Cronbach's α coefficient of 0.82 for the full scale and a range of 0.62 to 0.82 in the instrument's goals. Conclusion: the instrument proved to be valid and reliable to assess the effectiveness of the functioning of Brazilian families.

RESUMEN Objetivo: probar la validez psicométrica del instrumento para evaluar las estrategias de efectividad familiar y su confiabilidad para su uso con familias brasileñas. Método: estudio metodológico, validación de contenido, constructo, criterio, mediante análisis factorial exploratorio y confirmatorio y confiabilidad. La muestra estuvo formada por 100 familias. Los datos se recopilaron desde octubre de 2017 hasta marzo de 2018. Resultados: el porcentaje de concordancia entre los especialistas en Salud de la Familia fue del 100%, con un perfecto Índice de Validez de Contenido y confiabilidad (1,00). Para la población objetivo (pre-test), se obtuvo 89,3% de acuerdo y un Índice de Validez de Contenido de 0,89. La validez de constructo tuvo una varianza explicada total del 73,8%. La validez del criterio concurrente presentó un coeficiente de correlación (ρ) de 0,75 (p = 0,004). La confiabilidad tuvo un coeficiente α de Cronbach de 0.82 para la escala completa y un rango de 0.62 a 0.82 en las metas del instrumento. Conclusión: el instrumento demostró ser válido y confiable para evaluar la efectividad del funcionamiento de las familias brasileñas.

RESUMO Objetivo: testar a validade psicométrica do instrumento de avaliação das estratégias de efetividade familiar e a confiabilidade para uso com famílias brasileiras. Método: estudo metodológico, de validação de conteúdo, construto, critério, pela Análise Fatorial Exploratória e confirmatória e confiabilidade. A amostra foi composta por 100 famílias. Os dados foram coletados no período de outubro de 2017 a março de 2018. Resultados: o percentual de concordância entre os especialistas em Saúde da Família foi de 100%, com Índice de Validade de Conteúdo e confiabilidade perfeitos (1,00). Para a população-alvo (pré-teste), obtiveram-se 89,3% de concordância e Índice de Validade de Conteúdo de 0,89. A validade de construto apresentou variância total explicada de 73,8%. A validade do critério concorrente apresentou coeficiente de correlação (ρ) de 0,75 (p=0,004). A confiabilidade apresentou coeficiente α de Cronbach de 0,82 para a escala total e variação de 0,62 a 0,82 nas metas do instrumento. Conclusão: o instrumento mostrou-se válido e confiável para avaliar a efetividade do funcionamento das famílias brasileiras.

Uso do modelo teórico da organização sistêmica na avaliação familiar / Use of the framework of systemic organization in family assessment

Objetivo: produzir um levantamento de estudos sobre a aplicação do modelo teórico da organização sistêmica na avaliação da eficácia do funcionamento familiar e construir o estado da arte. Método: trata-se de estudo bibliográfico, descritivo, do tipo revisão integrativa, entre 2001 a 2017, nas bases de dados MEDLINE, LILACS, Google Scholar e na Biblioteca Virtuais SciELO, com consulta a especialistas via ResearchGate. Resultados: apresentaram-se 21 estudos desenvolvidos por enfermeiros em seis países, nos quais se evidenciaram a validade e a confiabilidade do instrumento ASF-E, avaliando a eficácia do funcionamento familiar, principalmente, em condições crônicas ou de vulnerabilidade. Utilizaram-se metodologia adequada e nível de evidência IV. Conclusão: conclui-se que o modelo teórico da organização sistêmica tem sido utilizado por ser considerado uma ferramenta válida para avaliar a saúde da família na em diferentes contextos de atuação da Enfermagem de famílias.(AU)

Objective: to produce a survey of studies on the application of the Framework of Systemic Organization to evaluate the effectiveness of family functioning and build the state of the art. Method: this is a descriptive bibliographic study, integrative review, from 2001 to 2017, in the databases MEDLINE, LILACS, Google Scholar and the Virtual Library SciELO, with consultation with experts via ResearchGate. Results: 21 studies developed by nurses in six countries were presented, showing the validity and reliability of the ASF-E instrument, assessing the effectiveness of family functioning, especially in chronic or vulnerable conditions. Appropriate methodology and level of evidence IV were used. Conclusion: it is concluded that the Framework of Systemic Organization has been used as it is considered a valid tool to evaluate family health in different contexts of family nursing.(AU)

Objetivo: producir una encuesta de estudios sobre la aplicación del modelo teórico de la organización sistémica para evaluar la efectividad del funcionamiento familiar y construir el estado del arte. Método: este es un estudio bibliográfico descriptivo, tipo revisión integradora, de 2001 a 2017, en las bases de datos MEDLINE, LILACS, Google Scholar y SciELO Virtual Library, con consulta con expertos a través de ResearchGate. Resultados: se presentaron 21 estudios desarrollados por enfermeros en seis países, que muestran la validez y confiabilidad del instrumento ASF-E, evaluando la efectividad del funcionamiento familiar, especialmente en condiciones crónicas o vulnerables. Se utilizó la metodología apropiada y el nivel de evidencia IV. Conclusión: se concluye que el modelo teórico de la organización sistémica se ha utilizado porque se considera una herramienta válida para evaluar la salud familiar en diferentes contextos de Enfermería familiar.(AU)

Proposta de adaptação transcultural e validação de um instrumento / Proposal for cross-cultural adaptation and validation of the instrument

Objetivos: apresentar uma proposta de um protocolo para a adaptação transcultural do instrumento The Assessment of Strategies in Families-Effectiveness (ASF-E) para o idioma português do Brasil e validar para uso com famílias brasileiras. Método: estudo quantitativo, transversal. Para o desenvolvimento do processo de adaptação transcultural serão seguidos os padrões metodológicos recomendados para uso em outro contexto cultural. Este estudo será realizado em Unidades Básicas de Saúde, que serão selecionados os participantes por indicação dos agentes comunitários de saúde para em visita domiciliar: a) Avaliação qualitativa do instrumento com 15 participantes; b) Realizar o pré-teste do instrumento com 30 participantes e c) Validar o instrumento com 200 participantes. Serão utilizados dois instrumentos, um formulário para caracterização sociodemográfica e instrumento que avaliará a eficácia familiar. Para a análise dos dados será utilizado o programa Statistical Package Social Science. Para a análise do teste de confiabilidade serão aplicados os "coeficientes de Alpha Cronbach". O modelo teórico da organização sistêmica para entender a partir desta perspectiva a eficácia familiar. Resultados esperados: O instrumento adaptado apresentará consistência interna alta (0,70) tanto entre os itens quanto entre os itens e os domínios.(AU)

Family Caregiver Role and Burden Related to Gender and Family Relationships.

This study described and contrasted family caregivers and explored the effect of gender and family relationship on the caregiver's role perception, workload, burden, and family help. Home care agencies and community organizations assisted with the recruitment of 533 multicultural, predominantly Latino caregivers who were interviewed at home. The Caregiver Identity Theory guided the study. Survey instruments were standardized tools or were constructed and pretested for this study. Descriptive statistics and t-test analyses assisted in describing the sample, and multivariate analyses were used to contrast the caregiver groups. Findings suggested a gendered approach to self-appraisal and coping. Men in this predominantly Latino and Caribbean sample felt less burden and depression than women who believed caregiving is a female duty. Family nurses should pay attention to the most vulnerable groups-older spouses resistant to using family and community resources and hard-working female adult children-and assess each family situation individually.

Use of adult day care service centers in an ethnically diverse sample of older adults.

Our nation is aging and unprepared to meet the needs of community-dwelling seniors and their caregivers. This study explored the perceived need for and use of adult day care services (ADS) in a low-income population. A random sample of 537 patient-caregiver dyads were recruited in home care agencies, and separate in-home surveys were conducted. Patients and caregivers were primarily women and 50.2% were of Hispanic origin. Although half (n = 267/537, 49.7%) of the caregivers had a perceived need for using ADS, only 19.1% of these caregivers used these services, mostly in the context of severe patient cognitive impairment. There were no racial or ethnic differences among ADS users and nonusers. The overall low use of ADS in a growing ethnically diverse senior population with a perceived need for services warrants further investigation and action as states seek to decrease nursing home placement and find solutions for our looming caregiving crisis.

Linking theory with qualitative research through study of stroke caregiving families.

PURPOSE: This theoretical article outlines the deliberate process of applying a qualitative data analysis method rooted in Friedemann's Framework of Systemic Organization through the study of a web-based education and support intervention for stroke caregiving families. METHODS: Directed by Friedemann's framework, the analytic method involved developing, refining, and using a coding rubric to explore interactive patterns between caregivers and care recipients from this 3-month feasibility study using this education and support intervention. Specifically, data were gathered from the intervention's web-based discussion component between caregivers and the nurse specialist, as well as from telephone caregiver interviews. FINDINGS AND CONCLUSIONS: A theoretical framework guided the process of developing and refining this coding rubric for the purpose of organizing data; but, more importantly, guided the investigators' thought processes, allowing them to extract rich information from the data set, as well as synthesize this information to generate a broad understanding of the caring situation.

Resource need and use of multiethnic caregivers of elders in their homes.

AIMS: The aim of this study was to predict South Florida family caregivers' need for and use of informal help or formal services, specifically, to explore the predictive power of variables suggested by the Caregiver Identity Theory and the literature and develop and test a structural model. BACKGROUND: In the USA, most of the care to older adults is given by family members. Caregivers make economic and social sacrifices that endanger their health. They feel burdened, if they receive no assistance with their tasks; however, services available are not sufficiently used. DESIGN: This cross-sectional correlational study was a survey of family caregivers in their home, using standardized and/or pre-tested scales and a cognitive status test of their patients. METHODS: A random sample of 613 multiethnic caregivers of frail elders were recruited in home care and community agencies. The interviews were held between 2006-2009. Analyses involved correlation and regression analyses and structural equation modelling. Outcome measures were need and use of family help and formal services. RESULTS/FINDINGS: The model yielded excellent fit indices replicated on three random samples of 370. The patients' functional limitations yielded the strongest predictive coefficients followed by caregiver stress. Cultural indicators played a minor role. CONCLUSION: The lack of a link between resource need and use suggested access barriers. Important for policy makers and service providers are the delivery of high-quality services and the use of a personal and individualized approach with all ethnicities. Quality service includes understanding the caregiving situations and requires a trusting relationship with family caregivers.

Patterns of caregiving of Cuban, other Hispanic, Caribbean Black, and White elders in South Florida.

Caregivers in Miami, Florida (185 Cubans, 108 other Hispanics, 229 non-Hispanic Whites, and 73 Caribbean Blacks) were described and compared along demographic and health variables, cultural attitudes, and caregiving behaviors. Participants were recruited at random through Home Health Services (61 %) and convenience sampling in the community (39 %), and interviewed at their home. Standardized instruments and measures constructed for this study were pretested. Multivariate analyses showed that the ethnic groups differed in age, education, income, and number of persons giving care, while caregiver health and patient functioning were similar. Controlling for demographics, differences in cultural variables were small. The sense of obligation, emotional attachment, openness about who should give care, spirituality, use of family help or community services were comparable in all groups. Commitment to caregiving was high, driven mainly by patient needs. Cubans had the greatest family stability, and worked the hardest, with the lowest sense of burden. Caribbean Black caregivers lived in bigger families, were youngest, and their patients had the lowest cognitive status. Burden was felt most by White caregivers who were older than the others. Professionals need to understand complex belief systems and behavior patterns to assist caregivers in mobilizing appropriate resources.

Strategies to engage clinical staff in subject recruitment.

PURPOSE: In many countries, meeting subject recruitment goals is challenging for researchers relying on clinical staff members (CSMs) to identify or recruit subjects. This paper describes research strategies that improved staff engagement in three different studies conducted in US clinical settings. METHOD: The recruitment strategies described in this paper were identified during the process of consultation among three US researchers recruiting via CSMs. Strategies which successfully engaged CSMs are described. RESULTS: Our approach improved engagement with CSMs in three different US studies. Early engagement strategies included establishing trust, gathering input from CSMs, and using succinct training procedures as well as a study logo. Middle phase strategies included assigning recruitment, publishing a study newsletter, giving the CSMs compensation and appreciation for their participation, and expanding the subject pool. Completion strategies included closing with an appreciation meeting and adding merit letters to personnel files. CONCLUSION: Recruitment of an adequate number of subjects is often challenging, even within clinical settings where subject populations are abundant. CSMs have rightly prioritised clinical care over directing subjects to research studies. It is therefore critical that researchers recruiting in such clinical settings anticipate recruitment challenges and plan to implement appropriate engagement strategies in all phases of research.

Data collectors' field journals as tools for research.

With rising numbers of families giving care to elderly loved ones, novel methods and sources of data need to be used to obtain comprehensive information about family caregiving patterns. The purpose of this paper is to present the interviewers' reflective journals as a source of rich data. Data collectors interviewed Hispanic family caregivers as part of a quantitative study of caregiving patterns. The stories derived from the personal journals brought to life three themes: caregiving as responsibility; creativity in giving care; and resistance to delegating tasks. Well-written journals have the potential of enhancing the interpretation of data collected by other means and of raising the quality of interviews and data through introspection and cultural understanding of the caregiving reality.

Strategies to teach family assessment and intervention through an online international curriculum.

A Web-based certificate program for international health professionals to acquire understanding of family health and strategies to implement culturally sensitive health care of families is outlined. In four Web courses and a project, students progress interactively to apply culture, family, and interdisciplinary health system theories to assessments and clinical interventions with families in the interdisciplinary setting. Four online educational strategies to facilitate student success from the virtual classroom to actual clinical care are described: adjusting to the technology, communicating the learning progress openly, giving mutual feedback, and implementing evidence-based family care. Outcomes addressing student learning and skill enhancement, family interaction, and student and faculty experiences in the virtual learning environment are explored. Overall, students learned to work successfully with families in health care, experienced increasing comfort and competency in challenging situations, introduced family care in their work setting, and emerged as leaders while working in interdisciplinary teams.

The workings of a multicultural research team.

PURPOSE: Transcultural nurse researchers are exposed to the challenges of developing and maintaining a multiethnic team. With the example of a multicultural research study of family caregivers conducted in the Miami-Dade area, the authors guide the readers through steps of developing a culturally competent and effective team. DESIGN: Pointing out challenges and successes, the authors illustrate team processes and successful strategies relative to recruitment of qualified members, training and team maintenance, and evaluation of team effectiveness. METHOD: With relevant concepts from the literature applied to practical examples, the authors demonstrate how cultural team competence grows in a supportive work environment.

Two sides to the caregiving story.

PURPOSE: This descriptive study examined problems and successes that a sample of 73 adult caregivers new to the role expressed in the first year of caring for stroke survivors. Data were collected from May 2002 to December 2005. METHOD: Bimonthly, trained telephone interviewers asked the participants open-ended questions to elicit their experience in caregiving. Guided by Friedemann's framework of systemic organization, we analyzed the data using Colaizzi's method of content analysis. RESULTS: There were 2,455 problems and 2,687 successes reported. Three themes emerged from the problems: being frustrated in day-to-day situations (system maintenance in Friedemann's terms), feeling inadequate and turning to others for help (coherence), and struggling and looking for "normal" in caring (system maintenance vs. change). Three themes were attributed to the successes: making it through and striving for independence (system maintenance), doing things together and seeing accomplishments in the other (coherence), and reaching a new sense of normal and finding balance in life (individuation and system maintenance). CONCLUSION: These findings provided an in-depth, theorybased description of the experience of being a new caregiver and can help explain how caring can be a difficult yet rewarding experience. Knowledge of the changes over time allows health care professionals to tailor their interventions, understanding, and support.

[Verification of a family assessment instrument based on the framework of systemic organisation]. / Uberprüfung eines Familien-assessment- Instruments auf der Grundlage der Theorie des systemischen Gleichgewichts.

The verification of the Assessment of Strategies in Families Effectiveness (ASF-E) for use in German-speaking Europe is described. The ASF-E is a screening instrument for family health defined according to the Framework of Systemic Organization (Friedemann, 1991). It was first translated and adjusted to cultural differences in Switzerland in the early 1990s. This testing was the first in Germany and the second in Switzerland. The instrument had 26 initial items, each containing three statements expressing family strategies of which respondents are asked to select the one most like their family. The statements are rated from 1 to 3 with 3 expressing optimal health. In Germany, a group of 343, in Switzerland, a group of 209 people from the community with diverse ages and economic backgrounds completed the instrument. A Principal Component Analysis with Varimax rotation yielded 4 factors with Eigenvalues > 1. Eight items had to be eliminated due to skewed distribution or weak factor loadings. The final instrument had 18 items with acceptable reliability (Cronbach Alpha). The ASF-E can be used in Germany and Switzerland to conduct research with families and to estimate family health in conjunction with nursing interventions.

Planning for long-term care: concept, definition, and measurement.

PURPOSE: This study explores the development and testing of an instrument to measure long-term-care planning behavior. DESIGN AND METHODS: Researchers operationalized proposed constructs and response styles as statements in a questionnaire. A telephone survey involved 150 randomly selected residents of Miami-Dade County, Florida who were between the ages of 55 and 70. Responses underwent exploratory and confirmatory factor analyses and reliability testing. RESULTS: The trimmed long-term-care planning instrument of 23 items had five subscales with high internal reliability (coefficients >.70), a comparative fit index of.987, and a root mean square error of approximation of.050. Responses involved making choices about housing, readiness to use help from family and friends, maintaining one's health, saving and investing money, and not accepting the need to ask for help. IMPLICATIONS: Future research of long-term-care planning behaviors can use the instrument. Practitioners may use the instrument as a diagnostic inventory, alone or in combination with personalized educational interventions aimed at increasing awareness of and planning for future dependency and long-term-care assistance.

Caregivers dealing with stroke pull together and feel connected.

Changes that can accompany stroke may create considerable stress for individuals caring for the affected person. This study explored the coping process for nine rural-dwelling caregivers of persons with stroke and the responses of these caregivers to a Web-based support program. The qualitative data management program QSR N 5 was used to analyze quotes from telephone interviews and computer entries. Stories of how caregivers came together and supported one another emerged from the data collected as part of a larger study that examined the experience of caring. Friedemann's framework of systemic organization guided data analysis and interpretation. Actions demonstrated by the caregivers illustrated the process of crisis resolution through family togetherness in which nurses were included. The findings of this study aided in understanding this process and gave direction for nurses working with such clients.

Development of a family assessment instrument for transcultural use.

PURPOSE: The article describes challenges related to the transfer of a family assessment instrument, the Assessment of Strategies in Families-Effectiveness (ASF-E), and its theoretical basis to another culture. DESIGN: Instrument development encompassed translation and discussion of theoretical and cultural relevance of the items. Patients from two clinics in Tampere, Finland (N = 196) completed the ASF. Psychometric tests involved factor and reliability analysis. RESULTS: The theoretical constructs of stability, growth, control and connectedness/spirituality were represented in the factor structure, and reliability ranged from .65 to .83. DISCUSSION: There were cultural differences in the interpretation of certain items. Characteristics of Finnish culture with impact on instrument validity were homogeneity and family emphasis on conflict resolution. Insights contributed to further instrument development and broader understanding of culture.

Nursing the spirit: the Framework of Systemic Organization.

AIMS: To elucidate the concept of spirituality as an essential and integrated dimension of the functioning of individuals and families through the Framework of Systemic Organization (Friedemann 1995) and to demonstrate with a case example, how a nurse can integrate spirituality in the care of a terminally ill patient. BACKGROUND: Spirituality is the focus of discussion in nursing and other health professions in the United States of America, but whether or not it should be generally included in patient care is heavily debated. Also unanswered is the question about how spirituality should be addressed. The Framework of Systemic Organization (Friedemann 1995) is introduced here as an organizing structure to guide nurses in caring for the spiritual needs of patients. IMPLEMENTATION OF THE THEORETICAL FRAMEWORK: Spirituality is defined as connecting to systems such as God, nature or other people, and thus finding meaning through relationships. Key to spiritual care is the establishment of a balance between control and spirituality that is tailored to an individual patient's history, values and needs. A case example is used to show how a nurse intervenes with a patient who faces death. FINDINGS: The example shows that control remains important in a patient's life process until death arrives. Nevertheless, a dying patient benefits from an increasing focus on spirituality to gain self-acceptance, reconciliation with the family and restoration of emotional health. Nurses are instrumental in finding the balance between control and spirituality that a patient desires. CONCLUSION: Nurses who have explored and reconciled their own spiritual beliefs can learn to address their patients' unique needs within the broad context of family and environment. Nursing the spirit by using the Framework of Systemic Organization is a client-directed and intimate process that leads to growth of both patient and nurse.