The non-uniformed TAC member: exploring the impact of tactical team membership on family systems and family well-being

This article investigates the family and child welfare system in Lithuania in terms of social sustainability, with an emphasis on children’s rights. The conceptual framework of Gilbert et al. (2011a) on child welfare was used as the substance of the research, identifying the problem frame, aim and mode of intervention, and parent–state relationship as the main dimensions for analyzing configurations of the child welfare systems. The analysis in this article focuses on how the family and child welfare system is observed in everyday professional practice in Lithuania by linking it with the social sustainability concept. The quantitative research sample comprised 501 respondents from Lithuania, representing different professionals of the family and child welfare system. An online questionnaire was distributed across regional municipal social services departments and to the national service of the State Child Rights Protection and Adoption Service. Explorative factor analysis and multidimensional scaling were used for data analysis. The research demonstrated that family and child welfare dimensions are meaningfully related to the social sustainability concept through the rights of a child such as the child’s best interests, accessibility to services, the right to be heard, protection against violence, child identity, development assurance, and so forth. The research indicates the need for awareness raising, including education and training for professional actors regarding child and family welfare, as an integral part of the concept of social sustainability.

Currently, modern families are coping with different stressful situations. The family studies are focused on the conceptual perspective, political perspective and methodological topic and they leave aside the familiar dynamics and functioning. This paper was interested in describing and comparing indicators of family resilience and family welfare of 442 Colombian families. This study had three hypotheses: The first one is focused on differences in well-being family dimension per location; the second hypothesis was focused on significant differences in family resilience per location, and the third one was interested in significant relations in family resilience and family well-being. The theoretical support to this research is the McCubbin and Patterson’s resilience model called Double ABCX and Family Adaptation and Adjust Response Model by Patterson. The family well-being is considered a result of internal family functioning and is measured by the family member perception about the concern about health problems, fears, anger and sadness. Family resilience is understood as the capacity to recover from adversity. This capacity strengthens families and improves their resources. In this theoretic resilience approach the resilience is a dynamic result to the adaptation phase and the family well-being is the final adjustment. The design was cross-sectional analytical with a convenience sample. The families were interviewed in their homes, from each family both parents and a child between 9 and 17 years old participated. They are located geographically in Bogota (n = 196), Santa Marta (n = 81) and Cali-Palmira (n = 145). Families completed the Family Member Well-being Index (FMWB) and the Family Regeneration and Adaptation Index (FIRA-G) to assess resilience. Families residing in Bogota showed significant differences with those of Cali-Palmira in the dimension of family well-being, family stress and support from friends and family. While families located in Santa Marta showed differences with respect to the families located in Cali-Palmira in family stress and in community and social support. The father correlations between the family resilience index and the well-being family index is strong and inverse with the family stress and the family well-being summarized. The mother well-being family perception is significant associated with family resilience, and these correlations was strongest with family well-being summarized. The family stress index, strains and distress exposed moderate and inverse relations with the positive resilience family summarized. The discussion deals with family resilience as a product of the dynamic interaction in the hole family system and is oriented to the fact that the presence of support from family and friends reduces the burden of family stress, promotes support in the face of crisis and, in general, improves the well-being and family adaptation. In general, the differences reflect varied resilience trajectories that depend on the challenges posed by the close context of the city where they live. An approach to this result leads us to think as a hypothesis not yet widely explored, in the mobility factor of cities, which limits contact with close family networks. In big cities like Bogota, its internal mobility compromises the times and spaces of daily life, and thus allows or prevents families from organizing their relationships in the different areas of their social life. Resilience occurs through positive adaptive family resources that included social support and family coherence and allow families to reduce stress and meet the demands of the environment. On the other hand, the presence of the two parents in families without clinical indicators shows that the burden of shared stress helps family resilience, which is also fed by the presence of external aids to the family nucleus, such as the support of the community, family and friends. https://doi.org/10.16888/interd.2021.38.3.7

Contents. K. Kreppner, R.M. Lerner, Family Systems and Life-Span Development: Issues and Perspectives. R.M. Lerner, Individual Development and the Family System: A Life-Span Perspective. K. Kreppner, Linking Infant Development-in-Context Research to the Investigation of Life-Span Family Development. R.D. Parke, K.B. MacDonald, V.M. Burks, J. Carson, N. Bhavnagri, J.M. Barth, A. Beitel, Family and Peer Systems: In Search of the Linkages. L. Krappmann, Family Relationships and Peer Relations in Middle Childhood: An Exploratory Study of the Associations Between Children's Integration Into the Social Network of Peers and Family Development. C-P. Hwang, M.E. Lamb, A. Br berg, The Development of Social and Intellectual Competence in Swedish Preschoolers Raised at Home and in Out-of-Home Care Facilities. R. Plomin, Nature and Nurture in the Family. R.A. Hinde, Reconciling the Family Systems and the Relationships Approaches to Child Development. D.H. Olson, Y. Lavee, Family Systems and Family Stress: A Family Life Cycle Perspective. K.A. Schneewind, Contextual Approaches to Family Systems Research: The Macro-Micro Puzzle. J. Brooks-Gunn, M. Zahaykevich, Parent-Daughter Relationships in Early Adolescence: A Developmental Perspective. A. von Eye, K. Kreppner, Family Systems and Family Development: The Selection of Analytical Units. S.I. Powers, Family Systems Throughout the Life-Span: Interactive Constellations of Development, Meaning, and Behavior. J. Dunn, C. Stocker, The Significance of Differences in Siblings' Experiences Within the Family. T.C. Antonucci, Understanding Adult Social Relationships. J. Brooks-Gunn, F.F. Furstenberg, Jr., Long-Term Implications of Fertility-Related Behavior and Family Formation on Adolescent Mothers and Their Children. L.N. Richards, V.L. Bengtson, R.B. Miller, The Generation in the Middle: Perceptions of Changes in Adults' Intergenerational Relationships. Y. Sch tze, Adolescents and Their Families. S.E. Harari, M.A. Vinovskis, Rediscovering the Family in the Past.

In all areas of knowledge, research has shown the devastating effects of COVID-19, and the impact on families' financial stress and well-being is one of them. Crises are predictors of families' financial stress as they produce changes in their income and negative feelings, such as fear and demotivation, which affect well-being. This study analyses the financial and social impact of COVID-19 on families, supported by the ABCE-WB model, with data collection being the result of snowball sampling. The results obtained allow the conclusion that the current pandemic crisis has caused financial stress in families, to a greater or lesser degree, and caused feelings of fear and demotivation as consequences of the general lockdown. The empirical evidence also shows that these effects are positively associated with the perception of their level of well-being. The contribution of the study lies in corroborating the model used. Final considerations are presented together with the limitations and suggestions for future research.

Screening-associated distress, or "scanxiety," is a recognized challenge for individuals at risk of cancer diagnosis or recurrence, particularly for those with Li-Fraumeni syndrome (LFS), a cancer predisposition syndrome with high lifetime cancer risks. Despite the benefits of early detection, individuals with LFS report emotional and logistical burdens associated with intense screening. Existing research lacks a relational perspective on how distress manifests or is managed during the process of screening, especially within families affected by inherited cancer syndromes like LFS. Adults enrolled in the National Cancer Institute's longitudinal LFS study completed interviews about screening experiences for themselves and for loved ones (e.g., parents, children, and non-LFS partners). Transcripts were analyzed using team-based thematic analysis. Eighteen participants (89% female, 89% with a cancer history, median = 47years) completed interviews. Approximately half (56%) had children and all except one (94%) had one or more first-degree relatives with a cancer history. Participants reported a range of distress reactions related to pragmatic aspects, and the potential results, of recommended cancer screening that often surpassed concerns about personal results. Participants reported that distress regarding loved ones' screening manifested along two common dimensions; participants expressed concern for family members' screening results, and they attended to family members' emotional distress in response to their own and their loved one's screening. To manage this distress, participants evaluated their family's emotional well-being, masked their own concerns to protect others, and created narratives that normalized cancer screening as a regular feature of daily life.

Patients’ family members are often stressed, and sometimes they get angry with nursing staff. What is the best way to respond to those feelings?Janice Linton, DNP, APRN, ANP-BC, CCRN, ACHPN, replies:Clinicians in hospitals provide medical care and intervention to improve the outcomes of sick and injured patients. Hospitals—especially intensive care units (ICUs)—can, however, be a frightening place that causes anxiety, uncertainty, and stress among patients and their families. Among persons receiving ICU-level care, 1 in 5 will die in the hospital or soon after being discharged.1 Families entering an ICU are often overwhelmed by unfamiliar sights and the sounds of alarms and medical jargon, and they are blindsided by the image of their critically ill loved one receiving life-prolonging care.In these unfamiliar spaces, family members are frequently stressed and sometimes become angry with the nursing staff who approach them for an urgent consent for blood transfusion, for example. Families grapple with the complexity of their loved one’s illness and struggle to make decisions about medical matters they may not understand. Families often lack a basic understanding of their loved one’s medical condition, options for care, and prognosis even after being exposed to the ICU environment for 48 hours.2The action plan set forth in Healthy People 2020 to improve health literacy charges clinicians with the responsibilities of communicating and delivering health information in understandable ways, and assisting patients and families in making informed decisions.3 Nurses are integral to the health literacy initiative. Early, clear, and purposeful communication with families about their loved one’s medical condition and its trajectory, treatment options, and prognosis improve health literacy and reduce family members’ stress and anger as they deal with the acute crisis in the ICU setting.4According to the crisis theory put forth by Erich Lindemann,5 crisis often manifests as disturbed equilibrium. As family members endure the situational crisis of having a loved one in the ICU, they ride the uncertain roller coaster of hovering, seeking information, tracking, and garnering resources.6 Hovering, the initial phase of stress, manifests as worry and anxiety about their loved one’s medical condition and the ICU environment. While seeking information, families ask multiple questions but report that clinicians share limited information, thus amplifying the hovering phase. In the tracking phase the family evaluates the care and the caregivers. Garnering resources is the final phase, during which families seek tangible support to meet their emotional needs.6Studies demonstrate that family members attribute distress and dissatisfaction to low levels of family-clinician communication and poor emotional support from the medical team.7 Researchers used the Family Satisfaction With Critical Care Questionnaire to evaluate the experience of 29 family members whose loved ones received care in a trauma ICU. The study reflected high ratings for overall satisfaction with ICU care and staff competency and skills, but low scores for the frequency of communication from nurses and physicians, and for accessible, understandable information and compassionate family support (see Table). The participants reported anxiety, stress, and a lack of clarity and consistency in communication from clinicians.7 Anxiety and stress often ensue in family members when clinicians report results of quantitative laboratory tests and radiographic scans as “better”: a spouse just sees their partner, swollen, on a ventilator, and unresponsive to the familiar terms of endearment being whispered to them since their admission to the ICU. Who engages in the dialogue—and when and where— to quantify “better”?In the multicenter PARTNER trial (Pairing Re-engineered ICU Teams with Nurse-Driven Emotional Support and Relationship Building), researchers compared data from the intervention—a structured family support protocol implemented by the ICU team— with usual ICU care. Nurses who participated in the PARTNER trial received formal training about communication skills. The training focused on supporting families of critically ill patients and included role-play and structured feedback for quality improvement. The hospital settings also used standard protocols for clinician-family meetings that would occur within 48 hours of a patient’s admission. For the group who received the intervention, the results revealed better surrogate ratings for quality of communication and better patient and family-centered care. Patients whose families were in the intervention group also had shorter ICU stays than patients whose families were in the usual care group.1Skilled clinician communication is a valuable practice in response to a family’s stress and anger.Evidence from a systematic review of interventions to improve clinician-family communication supports the ability of both printed information and structured communication by specialty palliative care providers and trained ICU teams to reduce family stress and improve emotional outcomes.9 Board-certified palliative care providers are skilled at managing refractory symptoms and engaging in complex medical decision-making conversations. All clinicians should have primary palliative care skills such as basic knowledge of how to assess symptoms, how families cope, and how to initiate patient- and family-centered conversations.10Nurses in the ICU perceive their role as coordinators and advocates of family-centered communication, yet despite being vital members of the health care team, they report feeling undervalued and disempowered during family meetings.11 Nurses share vulnerable space with families who endure waves of anger, abandonment, distress, despair, and hope. They hear stories of wellness the patient once enjoyed. They listen to the family’s hopes for their loved one’s recovery and sense the family’s internal conflict as they consent to ongoing interventions that sometimes seem to be more burdensome than beneficial. They are at the forefront of the anger that is sometimes the sole emotion a family is capable of displaying. For patients and families, nurses are accessible, responsive collaborators in the daily delivery of care.In the era of heightened virtual engagement with online courses, nurses have favorable opportunities and multiple platforms through which to participate in asynchronous and synchronous communication skills training. The American Association of Critical-Care Nurses, Center to Advance Palliative Care, End of Life of Nursing Education Center, Hospice and Palliative Nurses Association, and Vital Talk offer online communication skills training courses for clinicians. Synchronous communication skills training would allow participants to engage in virtual role-play, share best practices, and receive, in real time, evaluative feedback from instructors and peers. Educating, training, and empowering nurses to engage in family-centered communication will improve their role as advocates and collaborators in reducing the stress and anger family members direct at nursing staff.

This study investigated the interrelationships between students’ perceptions of their family of origin systems and their reports of family quality and stress in a sample of 118 Australian first-year students taking Psychology at the University of Sydney. The main measure adopted in this study was a new instrument (FACES IV) developed by Judith Tiesel and David Olson (1997) and applied by them to assess dimensions and predictions associated with Olson’s Circumplex Model of Family Systems. In the present study, families classified as generally extreme or unbalanced in their type of family system were found to be significantly lower in family quality and higher in family stress than families classified as balanced. More specifically, multiple regression analyses indicated that family quality was best predicted by family disengagement and family rigidity, and family stress by family chaos. The linear relationships found in this Australian study are consistent with the findings reported in a recent study using FACES IV with a North American sample (Tiesel & Olson, 1997).

This study examined profiles of family functioning, stress, psychological well-being, and social support in families participating in early head start; family characteristics that relate to profile membership; and the relationship of profiles to child social-emotional functioning. Because families' levels of functioning and well-being vary widely within low-income samples, we used a person-centered approach to understand how variations among families are linked with children's social-emotional skills. Our latent profile analysis of a sample of 246 families identified three profiles of family functioning and well-being: low stress, high family functioning (63%); moderate family stress, low family functioning (25%); and high psychological distress and parenting stress (12%). Children's social-emotional functioning, both social competence and problem behavior, related to profile membership. Children in the low stress, high family functioning profile displayed the most optimal social-emotional skills. These results highlight the importance of supporting family functioning and decreasing family stress to influence young children's positive behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Family members' perceptions of surrogate decision-making in the intensive care unit: A systematic review

Whatever Happened to Couples and Family Therapy in Psychiatry?

Many people would like to die at home, but their loved ones can be nervous about looking after them fearing their own lack of clinical knowledge. Family and local health...

Into the red zone: behind the mask of a cardiology nurse fighting COVID-19

Purpose Adjustment disorder (AD) is a maladaptive reaction to psychosocial stressors, with prevalence reaching up to 50% in certain consultation settings. Research on stressors, clinical profiles, and concurrence with ICD-11 criteria in AD is limited. We aim to assess stressor profiles, clinical manifestations, course, and diagnostic concurrence between ICD-10 and ICD-11 criteria in AD. Materials and methods Retrospective review of medical records of adults diagnosed with AD between 2016 and 2020. Stressors were categorized using the Adjustment Disorder New Module 8 (ADNM-8), a validated scale assessing AD symptom severity as per ICD-11 criteria. Data were analysed using PSPP. Results Women comprised 57.8% of 445 patients, with a mean age of 32.24 (±9.97) years. The most common stressor was interpersonal relationship (IPR) issues or familial stressors (50.1%). The illness or death of loved ones was a more common stressor among women, while men noted work-related stress more often (p = 0.001). Those under 40 years predominantly faced interpersonal/familial stress (55%), while those over 40 years more frequently experienced illness or death of loved ones (32%; p = 0.001). Depressive symptoms were the most common presentation. Among ICD-11 criteria, preoccupation with and failure to adapt to the stressor were noted in 97.1% and 93.9% patients, respectively. Amongst patients who followed up, 77% showed significant improvement with 36.5% of them having follow up of 2–6 months. Conclusion IPR issues were the most common stressors, with gender and age influencing stressor types. AD commonly presented with depressive symptoms, showing high concurrence with ICD-11 criteria and favourable outcomes.

Although numerous studies have addressed external factors associated with difficulty in surrogate decision making, intrapersonal sources of tension are an important element of decision making that have received little attention. To characterize key intrapersonal tensions experienced by surrogate decision makers in the intensive care unit (ICU), and explore associated coping strategies. Qualitative interview study. Thirty surrogates from five ICUs at two hospitals in Pittsburgh, Pennsylvania, who were actively involved in making life-sustaining treatment decisions for a critically ill loved one. We conducted in-depth, semi-structured interviews with surrogates, focused on intrapersonal tensions, role challenges, and coping strategies. We analyzed transcripts using constant comparative methods. Surrogates experience significant emotional conflict between the desire to act in accordance with their loved one's values and 1) not wanting to feel responsible for a loved one's death, 2) a desire to pursue any chance of recovery, and 3) the need to preserve family well-being. Associated coping strategies included 1) recalling previous discussions with a loved one, 2) sharing decisions with family members, 3) delaying or deferring decision making, 4) spiritual/religious practices, and 5) story-telling. Surrogates' struggle to reconcile personal and family emotional needs with their loved ones' wishes, and utilize common coping strategies to combat intrapersonal tensions. These data suggest reasons surrogates may struggle to follow a strict substituted judgment standard. They also suggest ways clinicians may improve decision making, including attending to surrogates' emotions, facilitating family decision making, and eliciting potential emotional conflicts and spiritual needs.

Although many military families demonstrate resilience and strength, research highlights that military service may impact the health and wellbeing of families. In comparison with civilian families, military families are embedded within a broader military context and culture which may influence many aspects of family life, including socioeconomic status and social participation. This rapid review utilised a systematic methodology to synthesise the evidence of comparing possible differences of the socioeconomic and social participation of military families with civilian families. Relevant online databases such as Medline, PsycINFO, CINAHL and ProQuest Central were searched for articles published between January 2000 and February 2022. After screening 3057 articles, five studies were included for analysis. The results highlight considerable income, education and employment gaps between current serving military and civilian spouses. An association was found between social, economic status and increased risk of violence or assaults in military families. Specifically, younger age and decline in health status were key predictors of domestic violence assaults in military families. This review highlights emerging evidence and recommends further Australian-based research with military families. Policy, research, and practice implications are discussed with consideration to preventative interventions tailored towards strengthening health, wellbeing, and socio-economic status of military families.