Family-Oriented Therapeutic Conversations: A Systematic Scoping Review.

There is increasing evidence that highlights the benefits of Family-oriented Therapeutic Conversations (FAM-TC) for the patient and the family; however, studies show variability regarding the content and the way these interventions are offered. This may hamper its further development in clinical practice. This review systematically maps the available literature on nurse-led FAM-TC and offers a solid synthesis of the characteristic, effectiveness, and feasibility of these interventions. A systematic search in PubMed, CINAHL, Cochrane, Web of Science, PsycINFO, Trip (Turning Research Into Practice), BASE (Bielefeld Academic Search Engine), OATD (Open Access Theses and Dissertations), and ProQuest databases identified 37 studies. The interventions varied in interventionist nurses' profile, the intervention content, or the duration of the sessions offered. Most of the interventions showed beneficial effects on perceived family support and family functioning. This review offers suggestions for future studies, such as the inclusion of specific theoretical frameworks for intervention design, targeting both the patient and the family and offered by nurses with family nursing competency.

Nurses' attitudes towards family importance in nursing care across Europe.

AIMS AND OBJECTIVE: To explore differences in nurses' attitudes regarding the importance of family in nursing care and factors associated with nurses' attitudes across 11 European countries. BACKGROUND: Family involvement in healthcare has received attention in many European healthcare systems. Nurses have a unique opportunity to promote family involvement in healthcare; however, their attitudes and beliefs may facilitate or impede this practice. DESIGN: A cross-sectional survey across European countries. METHOD: A broad convenience sample of 8112 nurses across 11 European countries was recruited from October 2017 to December 2019. Data were collected using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire. We used the STROBE checklist to report the results. RESULTS: There were significant differences in nurses' attitudes about families' importance in nursing care across Europe. Country was the factor with the strongest association with the total scores of the FINC-NA. Older age, higher level of education, increased years since graduation, having a strategy for the care of families in the workplace, and having experience of illness within one's own family were associated with a higher total FINC-NA score. Being male and working in a hospital or other clinical settings were associated with a lower total FINC-NA score. CONCLUSION: Nurses' attitudes regarding the importance of family in nursing care vary across 11 European countries. This study highlights multiple factors associated with nurses' attitudes. Further research is necessary to gain a deeper understanding of the reasons for nurses' different attitudes and to develop a strong theoretical framework across Europe to support family involvement in patient care. The inclusion of family healthcare programs in the baccalaureate curriculum may improve nurses' attitudes. RELEVANCE FOR CLINICAL PRACTICE: In clinical practice, the focus should be on identifying influencing factors on nurses' attitudes to enhance families' importance in nursing care across Europe.

Psychometric Evaluation of the Spanish Families Importance in Nursing Care: Nurses' Attitudes Scale Through Classical Test Theory and Rasch Analysis.

Nurses' attitudes toward families play an important role in improving relationships with patients' families. It is essential to have valid and reliable instruments to assess nurses' attitudes toward involving families. The aim of this study was to analyze the psychometric properties of the refined Spanish version of the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) according to classical test theory and the Rasch model (N = 263). Cronbach's alpha values were .73 to .87 and intraclass correlation coefficients ranged from .72 to .86. Rasch analysis results suggested that it was a multidimensional scale with four dimensions and a simpler response scheme than the original scale. Except for one item, the scale was free from bias regarding age and experience time. The FINC-NA is a reliable and valid measure showing a good fit to the Rasch model and is ready to map nurses' attitudes and measure the effectiveness of family nursing educational interventions.

Effectiveness of Nursing Interventions for Patients With Cancer and their Family Members: A Systematic Review.

Cancer diagnosis poses enormous physical and psychosocial challenges for both the affected person and their families. This systematic review identifies the characteristics and effectiveness of nursing interventions offered to adult patients with cancer and their families. Five databases were searched, and 19 studies published from 2009 to 2020 were included. Interventions were categorized as follows: (a) interventions with supporting and cognitive components (n = 3), (b) interventions that included skills training for the caregiver (n = 3), (c) interventions to enhance care through managing symptoms (n = 8), (d) interventions focusing on the dyad or family-patient relationship (n = 4), and (e) interventions targeted to the patient's condition (n = 1). The results of this review offer an overview from which to carry out new studies and are useful for providing future directions within family nursing practice, taking into account the impact that the family has on the disease and the consequences the condition may bring to the whole family.

Personal and Contextual Factors to the Successful Implementation of a Family Nursing Approach in Oncology Care.

The aim of this study was to explore nurses' attitudes and beliefs about the importance of families in nursing care, as well as the barriers and facilitators within the clinical context that influence the implementation offamily nursing in an in-patient oncology service. A cross-sectional study design, incorporating quantitative and qualitative measurements, was used with a sample of nurses in Spain from an oncology service (N = 39). In general, oncology nurses reported positive attitudes and beliefs about the importance of family in nursing care. However, they did not effectively involve the family in their daily clinical practice. This was due to the nurses' lack of clinical skills and competence to work with families as well as contextual factors such as the lack of time and workload that acted as barriers to the implementation of family-oriented care. This study identified areas of improvement that are needed to promote the effective and sustainable implementation of family nursing knowledge in clinical practice settings.

Nurses' knowledge, skills and personal attributes for competent health education practice: An instrument development and psychometric validation study.

AIM: To develop and psychometrically test the Nurse Health Education Competence Instrument for assessing nurses' knowledge, skills and personal attributes concerning competent health education practice. DESIGN: A psychometric instrument development and validation study. METHODS: A four-step approach was used: Step 1) operational definition based on an up-to-date concept analysis and experts' judgement; step 2) item generation and content validation by expert panel and target population; step 3) item analysis based on acceptability, internal consistency and face validity; and step 4) psychometric evaluation based on construct validity, criterion validity, internal consistency and stability, conducted from January -February 2019 with 458 hospital-care nurses. RESULTS: The operational framework and expert groups showed good content validity, resulting in the first version. From the initial 88-item pool, 58 items were retained after item analysis. Exploratory factor analysis revealed three scales concerning the cognitive (three-factor solution with 23 items), psychomotor (two-factor solution with 26 items) and affective-attitudinal (one-factor solution with nine items) competency domains, which respectively accounted for 58%, 53% and 54% of the variance. Known-group study demonstrated significant differences by years working in the service and training received in health education, providing evidence for the measure's sensitivity. The three scales correlated positively with the criterion variable. Overall Cronbach alphas for the cognitive, psychomotor and affective-attitudinal scales were 0.95, 0.95 and 0.90, respectively. Intraclass correlation coefficients were >0.70. CONCLUSIONS: The newly developed Nurse Health Education Competence Instrument is an original and tested self-reporting psychometric tool, being the first to identify nurses' knowledge, skills and attributes necessary for planning and assessing health education practice competency. IMPACT: The instrument permits measurable insights into nurses' perceptions regarding their health education competence and related educational needs. This study provides a valid and specific learning tool that is appropriate to use both in clinical practice and in nursing education programmes.

Translation and psychometric validation of the Spanish version of the Demand-Control-Support Questionnaire (DCSQ) for nursing professionals.

AIM: To translate and psychometrically validate the Demand-Control-Support Questionnaire for nurses in Spain. BACKGROUND: Nurses are one of the groups most affected by work-related stress. The combination of high job demands and low control is identified as the main source of stress among nurses. The Demand-Control-Support Questionnaire is a valid and reliable tool for assessing psychosocial stress in the workplace. METHODS: A two-phase cross-sectional descriptive study. The instrument was translated according to Sousa and Rojjanasrirat guidelines, including forward and backward translations, consensus meetings, pilot testing and expert committee. Structural validity, convergent and discriminative validity, internal consistency and test-retest reliability were assessed in a sample of 247 nurses. RESULTS: Exploratory factor analysis verified a three-factor solution with good internal consistency (Cronbach's α values ranged from 0.62 to 0.87) and test-retest reliability (intraclass correlation coefficients ranged from 0.65 to 0.85). CONCLUSIONS: The Spanish version of the Demand-Control-Support Questionnaire seems to be a brief, valid and reliable instrument to measure psychosocial stress in the workplace in nurses. IMPLICATIONS FOR NURSING MANAGEMENT: The use of the Demand-Control-Support Questionnaire can be of value to inform the design and implementation of appropriate management strategies to foster a more favourable work environment that promotes the well-being of professionals.

Family Dynamics and the Alzheimer's Disease Experience.

Using constructivist grounded theory, this study explored how family groups respond to Alzheimer's disease in its early stages. Seven family units (N = 22) participated in a series of 26 longitudinal interviews and 14 other family caregivers took part in three focus groups at a later stage for refinement and verification of the findings. Data analysis revealed four types of family dynamics: close dynamics at the start that were maintained throughout the experience, close dynamics at the start which became conflicting, conflicting dynamics at the start which remained problematic, and conflicting dynamic at the start which became closer over time. Factors such as prior relationships and family history, motivation to care, family organization, communication, and the family vision for future shaped the development of these dynamics. This theory of family dynamics in Alzheimer's disease has the potential to inform the development of more adequate early interventions for families living with the illness.

Effectiveness of Educational Programs for Clinical Competence in Family Nursing: A Systematic Review.

Evidence shows that applying family nursing theory to practice benefits the patient, the family, and nursing professionals, yet the implementation of family nursing in clinical practice settings is inconsistent and limited. One of the contributing factors may be related to insufficient or inadequate educational programs focused on family nursing. This article presents a systematic review of the research that has examined the effectiveness of family nursing educational programs aimed at promoting clinical competence in family nursing. Six databases were systematically searched and 14 studies met the inclusion criteria, generating three themes: general study characteristics, educational program components, and outcome measures. These educational programs reported effectiveness in developing family nursing knowledge, skills, and attitudes, but did not evaluate the nurses' actual acquisition and implementation of family nursing clinical competencies. This review offers relevant implications for research and for family nursing education, especially when designing and evaluating future educational programs. Future research must more closely address the process and outcomes of best educational practices in family nursing education and how these are applied and evaluated in actual practice settings.

Cross-Cultural Adaptation and Psychometric Testing of the Spanish Version of Iceland Health Care Practitioner Illness Beliefs Questionnaire.

The beliefs of nursing professionals who care for families experiencing illness are fundamental to the quality of the nurse-family relationship and the level of the nurse's involvement in the therapeutic process of Family Systems Nursing. It is essential to have valid and reliable instruments for assessing nurses' illness beliefs, especially in the Spanish context where no instruments have been identified to date. The Iceland Health Care Practitioner Illness Beliefs Questionnaire (ICE-HCP-IBQ) is a reliable and valid measure of professionals' beliefs about their understanding of the meaning of the illness experience of families. The purpose of this study was to adapt and psychometrically test the Spanish version of the ICE-HCP-IBQ (N = 249 nurses). The exploratory factor analysis showed one-factor solution with good internal consistency (Cronbach's α = .91) and test-retest reliability (r = .72, p < .01). This questionnaire is a promising tool for mapping nurse's illness beliefs and monitoring the effectiveness of family nursing educational interventions in the Spanish context.

Systematic review of measurement properties of instruments assessing nurses' attitudes towards the importance of involving families in their clinical practice.

AIMS: To identify, appraise and describe the characteristics and measurement properties of instruments assessing nurses' attitudes towards the importance of involving families in their clinical practice. DESIGN: Psychometric systematic review. DATA SOURCES: The PubMed, CINAHL, PsycINFO, Web of Science, and Cochrane Library databases were searched from their time of inception to June 2018. REVIEW METHODS: Two reviewers independently assessed the eligibility of studies, extracted data, and appraised the methodological quality of the studies using the COSMIN checklist. RESULTS: A total of 19 studies representing 5 instruments were included. Two instruments-a revised version of the Families' Importance in Nursing Care: Nurses' Attitudes scale (FINC-NA-R) and the Family Nurse Practice Scale (FNPS)-obtained higher scores for most of their properties. The instruments used in the remaining eight studies require further assessment of their psychometric properties. CONCLUSION: This psychometric review offers a synthesis of the quality of the available instruments and gives a better understanding of nursing theory-based tools. The FNPS and FINC-NA-R instruments seem to be the most suitable measures of nurses' attitudes towards the importance of involving families in their clinical practice. IMPACT: The growing emphasis on improving nurse-family relationships and the quality of care provided makes it necessary to have valid and reliable instruments for assessing nurses' attitudes towards the importance of involving families in their clinical practice. This paper provides evidence that will help clinicians and researchers make decisions about the most suitable instrument based on a critical appraisal and comparison of the measurement properties according to a rigorous methodology.

Peer-led interventions to reduce alcohol consumption in college students: A scoping review.

Risky alcohol consumption among college students is a significant public health issue. In the college setting, students can collaborate in the implementation of peer-led interventions. To date, evidence of peer-led programmes in reducing harmful alcohol consumption in this population is inconclusive. The aim of the current scoping review is to provide a broad overview by systematically examining and mapping the literature on peer-led interventions for preventing risky alcohol consumption by college students. The specific aims were to (1) identify the underlying focus of the interventions and assess their (2) effectiveness and (3) feasibility. A comprehensive search was conducted in PubMed, PsycINFO, CINAHL, Cochrane Library, Web of Science, DART-Europe, RCAAP, Trove and ProQuest. The inclusion criteria were peer-led interventions that exclusively addressed alcohol consumption, college students as the target population and interventional studies (randomised controlled trials, quasi-experimental studies, systematic reviews and meta-analyses of interventions). The methodological quality of the articles was evaluated. From 6654 potential studies, 13 were included. Nine interventions were described within these studies: Voice of Reason programme, Brief Advice sessions, Peer Theatre, Alcohol Education programme, Perceptions of Alcohol Norms intervention, Motivational Intervention, Alcohol Skills Training programme, Lifestyle Management Class and the Brief Alcohol Screening and Intervention for College Students. Only the last showed significant reductions in three of the four outcome measures: quantity and frequency of drinking, estimated peak blood alcohol concentration and alcohol-related consequences. It did not significantly decrease the number of heavy-drinking episodes. Peer interventions may be effective in preventing alcohol use among college students, although the evidence is weak and scarce. Further research is needed to strengthen the findings about peer-led interventions.

Health education: A Rogerian concept analysis.

OBJECTIVES: The concept of health education has traditionally focused on enabling people to change unhealthy behaviours and lifestyles. Although, at the theoretical level, there exist definitions of the concept, it remains complex and ambiguous. Furthermore, nurses often confuse the concept with other related terms, such as health information or health promotion. The aim here is to report a concept analysis of health education and elucidate a current definition. DESIGN: Rodgers' evolutionary concept analysis. DATA SOURCES: A systematic search was conducted using PubMed and CINAHL for articles written in English or Spanish, published between 1986 and 2017. A manual search was performed, and grey literature was also reviewed. A pre-determined template of study inclusion-related questions assisted the process. REVIEW METHODS: Rodgers' evolutionary method guided the narrative analysis. The attributes of health education, as well as its antecedents, consequences, related terms and contextual bases were extracted and synthesized. RESULTS: Based on the review of 31 studies on health education, the attributes are a learning process, health-oriented, multidimensional, person-centred and partnership. The antecedents are professional awareness of health education, training of health professionals, available resources, individual's willingness to act, and health as an individual's priority in life. The consequences are the increase in knowledge, skills and/or attitudes; change in health-related behaviours, individual capability and empowerment; positive health outcomes; and positive social/economic impact. The related terms are health information, patient education, counselling, health coaching and health promotion. Health education is defined as a continuous, dynamic, complex and planned teaching-learning process throughout the lifespan and in different settings that is implemented through an equitable and negotiated client and health professional 'partnership' to facilitate and empower the person to promote/initiate lifestyle-related behavioural changes that promote positive health status outcomes. Health education takes into account individuals'/groups' internal and external factors that influence their health status through potentially improving their knowledge, skills, attitudes and beliefs in relation to their health-related needs and behaviour, within a positive health paradigm. CONCLUSIONS: The theoretical definition and conceptual framework provided in this study contribute to and extend the current knowledge base among nurses and other health care providers. The findings elucidate the clinical role of health educators, enabling them to identify the realities of its practice, building a common reference point, and highlighting the main recommendations for its use at the clinical, education, policy and research interface.

Understanding how a smoking cessation intervention changes beliefs, self-efficacy, and intention to quit: a secondary analysis of a pragmatic randomized controlled trial.

Although beliefs, self-efficacy, and intention to quit have been identified as proximal predictors of initiation or quitting in young adults, few studies have studied how these variables change after a smoking cessation intervention. To evaluate the changes in the beliefs, self-efficacy, and intention to avoid smoking and determine if these are potential mediators in quitting, following a smoking cessation intervention, aimed at tobacco-dependent college students. Single-blind, pragmatic randomized controlled trial with a 6-month follow-up. A total of 255 smoker students were recruited from September 2013 to February 2014. Participants were randomly assigned to intervention group (n = 133) or to control group (n = 122). The students in the intervention group received a multicomponent intervention based on the Theory of Triadic Influence (TTI). The strategies of this program consisted of a 50 min motivational interview conducted by a nurse and online self-help material. The follow-up included a reinforcing e-mail and group therapy. The smoking-related self-efficacy, belief, and intention scale was used to assess outcomes. Intention to quit smoking is partial moderator explaining 36.2% of the total effects in smoking cessation incidence. At 6 month follow-up, the differences in the mean scores of self-efficacy and intention related to stopping smoking were significantly higher in the intervention than in the control group. A multicomponent intervention based on the TTI, tailored to college students, positively increased the self-efficacy to avoid smoking and the intention to quit, suggesting intention as potential mediator of quitting.

Keeping Things in Balance: Family Experiences of Living With Alzheimer's Disease.

Background and Objectives: Historically, research, practice, and policy on Alzheimer's family care has been largely focused on dyadic relationships and the experience of burden and stress, often failing to capture the complex caring dynamics as they unfold over time. This study sought to develop a more nuanced understanding of how people with Alzheimer's disease (AD) and their families are affected by the disease and how they respond to the challenges AD poses. Research Design and Methods: Using constructivist grounded theory, the study explored the experiences of living with AD for native Spanish families residing in Navarra. Data were collected from a series of 26 interviews with seven family units living with early stage AD and further validated with three focus groups with 14 caregivers of people with mid/advanced AD. Data were analyzed to capture the main processes involved and charted how these evolved over time. Results: Keeping things in balance describes the way family works to preserve a balance between caring and their lives before the onset of AD. Three main temporal stages to the experience of early AD, along with their associated processes, were identified: (a) what's going on here and the processes of noticing, suspecting, and confirming; (b) our life is changing underpinned by the processes of watching and redefining; and (c) keeping things together and its associated balancing process. These reinforced the dynamic nature of living with AD over time. Discussion and Implications: This study was novel in its design as it included the person with AD as part of the functioning family unit. The temporal stages and the key social processes identified have the potential to inform the development of "stage-specific" interventions for the support of the whole family at various points in time.

Intervention study for smoking cessation in Spanish college students: pragmatic randomized controlled trial.

AIM: To evaluate the effectiveness of a nurse intervention aimed at helping college student smokers quit smoking. DESIGN: Single-blind, pragmatic randomized controlled trial which compares a multi-component intervention, tailored specifically to college students, with a brief advice session with a 6-month follow-up. SETTINGS: This study was conducted at the University of Navarra, Spain. PARTICIPANTS: A total of 255 college student smokers (age range = 18-24 years) were randomized to an intervention group (n = 133) or to a control group (n = 122). INTERVENTION: A multi-component intervention based on the Theory of Triadic Influence of Flay was developed. The intervention consisted of a 50-minute motivational interview conducted by a nurse and online self-help material. The follow-up included a reinforcing e-mail and group therapy. MEASUREMENTS: The primary outcome was self-reported abstinence, with biochemical verification at 6 months. The secondary outcomes consisted of the mean number of cigarettes smoked per day, self-reported attempts to quit smoking and stage of change at 6 months. FINDINGS: At the 6-month follow-up, the smoking cessation incidence was 21.1% in the intervention group compared with 6.6% in the control group (difference = 14.5 confidence interval = 6.1-22.8; relative risk = 3.41, 95% confidence interval = 1.62-7.20). The difference in the mean number of cigarettes at 6 months was significantly different (difference = -2.2, confidence interval = -3.6 to -0.9). CONCLUSIONS: A multi-component intervention tailored to college students and managed by a nurse is effective in increasing smoking cessation among college students.