Nurse-family Relationship Research Articles

Grief and the experiences of nurses providing palliative care to children and young people at home

To elicit the views of children's nurses with regard to the personal, contextual and interprofessional challenges faced when delivering palliative and end of life care to children and young people in the community. Semi-structured interviews were conducted with seven nurses who provided palliative care to one or more child or young person in the home. Data generated were analysed thematically to define topics. Four themes emerged: service delivery, nurse-family relationships, nurses' grief, funeral rites and bereavement support. Nurses experienced considerable internal and external pressures. Some are inevitable but others, such as organisation of care provision to families and nurses' personal coping, could be improved by adequately resourced workforces, integrated service structures and guidance on reflective practice. Further research is needed.

Listening with care: using narrative methods to cultivate nurses’ responsive relationships in a home visiting intervention with teen mothers

Effective public health nursing relies on the development of responsive and collaborative relationships with families. While nurse-family relationships are endorsed by home visitation programs, training nurses to follow visit-to-visit protocols may unintentionally undermine these relationships and may also obscure nurses' clinical understanding and situated knowledge. With these issues in mind, we designed a home-visiting intervention, titled Listening with Care, to cultivate nurses' relationships with teen mothers and nurses' clinical judgment and reasoning. Rather than using protocols, the training for the intervention introduced nurses to narrative methods and therapeutic tools. This mixed-method pilot study included a quasi-experimental design to examine the effect of the intervention on teen mothers' depressive symptoms, self-silencing, repeat pregnancy, and educational progress compared to teens who received usual care. Qualitative data were collected from the nurses to evaluate the feasibility and acceptability of the intervention and therapeutic tools. The nurses endorsed the therapeutic tools and expected to continue using them in their practice. Despite the lack of statistically significant differences in outcomes between groups, findings suggest that further study of the intervention is warranted. Future studies may have implications for strengthening hidden aspects of nursing that make a difference in the lives of teen mothers.

Descubriendo caminos: la relación enfermera-familia en comunidades rurales en la Amazonía peruana

From the experience lived by one of the authors as a community nurse in Peru, this reflection had as aim to describe and to understand the meaning and sense found in the relationship between nurse and families in rural communities. The Interpretative Interacionism permitted us the analysis of the experience, where “Discovering roads” was the main component of the experience. The valorization of nurse-family relationship, in a comprehensive and humanized way, allowed to carry out the basic actions with the families. The steps followed were: Inserting in their world; Knowing their reality, Perceiving their vulnerability; Understanding their concerns; Perceiving their ways of acting; Sharing the activities. In the description of the meanings attributed to the experience, contextual aspects, actions and intentions of the nurse and the feelings emerged during the implementation of the activities with the families, were explored. This work enabled us to understand the meaning of the experience, rescuing the importance of nurse-family relationship, making appropriate use of communication, observation and interaction, as well as, the use of strategies to achieve walking toward cultural maturity and humanized care, together and, in order to solve some crucial problems and needs that emerge in this context.

Pregnant with possibilities: drawing on hermeneutic thought to reframe home‐visiting programs for young mothers

Although the positive outcomes achieved in home-visiting interventions targeting young, disadvantaged mothers are partly credited to therapeutic relationships, researchers rarely offer philosophical or theoretical explanations for these relationships. This omission is a conspicuous oversight as nurse-family relationships have figured prominently in public health nursing practice since its inception. In this study, I suggest that the contribution of therapeutic relationships to positive outcomes will remain theoretically undeveloped as long as clinical trials and nursing practice models follow the logic of techne. After describing how a scientific-clinical gaze misrepresents teen mothers and contributes to a rational-technical model of clinical practice, I draw on contemporary hermeneutics to describe how dialog and understanding are indispensable for clinical judgment and the judicious use of scientific knowledge. This hermeneutic corrective calls attention to the dialogical nature of truth and the relational skills that disclose meaning, preserve personhood, and support possibilities available in the life-world. Dialogical understanding also disrupts the scientific-clinical gaze by disclosing the social disparities that are implicated in early childbearing and teen mothers' long-term prospects. The implications of this thought for legitimating and supporting the flexibility and clinical know-how that 'strays' from protocol-driven care is addressed.

A família do paciente internado em terapia intensiva: concepções do enfermeiro

This is an investigation about the nurse’s conceptions of the patient’s family relationship when the patient is interned in the intensive therapy. The methodological strategy is based in the phenomenological approach. From the analysis of the speeches we observed that in the patient’s family relationship the nurse’s perception may be classified in the following categories: the family experiences fear, anxiety and insecurity; the family is worried with the patient . In relation to dealing with the family, the individuals manifested perceptions emerging the following categories: the nurse finds it difficult to deal with the family; the nurse takes some actions in order to help the family; the contact with the family can cause pleasant emotions , as well as to facilitate the patient’s attention in intensive therapy. Observing the subjects’ discourses we concluded that the nurses realize the suffering of the family and, at the same time, their own difficulties in working with it.. Thus, the study shows the importance of rethinking nurse-family relationship and its implications for the attendance on critical condition patient

Being family: the family experience when an adult member is hospitalized with a critical illness

The purpose of this qualitative study was to understand and interpret the 'family experience' with an adult member hospitalized with a critical illness. 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. Family systems theory and existential phenomenology provided the frameworks guiding the study. 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. 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. 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. 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.

Development of the Family Nursing Practice Scale

This article describes the development and testing of the Family Nursing Practice Scale (FNPS). This self-report questionnaire is designed to measure perceived changes in family nursing practice including attitudes toward working with families, critical appraisal of their family nursing practice and reciprocity in the nurse-family relationship. Categories were derived from a needs assessment, competence as effective application of knowledge and skill and theoretical foundations for family assessment and intervention. Psychometric testing (content, construct validity, internal consistency, and test-retest reliability) was undertaken with 140 psychiatric nurses in Hong Kong. Practice appraisal and nurse-family relationships accounted for 56.4% of the variance. Cronbach's alpha reliability coefficients were .88 and .73 for the two subscales, respectively, and .86 for the scale overall. Test-retest reliability ranged from .62 to .93 on the individual items. The results provide preliminary evidence of the reliability and validity of the FNPS. The instrument provides quantitative and qualitative evaluation components.

An insight into Australian nurses' experience of withdrawal/withholding of treatment in the ICU.

The success of biotechnology has created moral and ethical dilemmas concerning end-of-life care in the Intensive Care Unit (ICU). Whilst the competent individual has the right to refuse or embrace treatment, ICU patients are rarely able to exercise this right. Thus, decision-making is left to medical professionals and family/significant others. This study aimed to explore the lived experience of ICU nurses caring for clients having treatment withdrawn or withheld, and increase awareness and understanding of this experience amongst other health professionals. Van Manens' (1990) phenomenological framework formed the basis of this study as it provided an in-depth insight into the human experience. A convenience sample of ten ICU Nurses participated in the study. Conversations were transcribed verbatim and analysed using a process of thematic analysis. Five major themes emerged during the analysis. These were: (1) comfort and care, (2) tension and conflict, (3) do no harm, (4) nurse-family relationships and (5) invisibility of grief and suffering. The experience of providing care for the adult having treatment withdrawn or withheld in the ICU represents a significant personal and professional struggle. Improvements in communication between health professionals, debriefing and education about the process of withdrawing or withholding treatment would be beneficial to both staff and families and has the potential to improve patient care and reduce burden on nurses.

Dis/integrated care: family caregivers and in-hospital respite care.

The aim of this study was to explore family caregivers' experiences of in-hospital respite care for people with dementia and the factors that influenced their perceptions of the service. The provision of respite care is based on the assumption that temporary relief from caregiving will relieve caregiver stress and may possibly extend the duration of home care. Research evidence suggests that this is a simplistic perspective which fails to account for families' concerns about the quality of institutional care and the impact of relocation on the person being cared for. Nine family caregivers, using four different hospitals sites were interviewed during a period of 3 years from 1994 to 1997. The research texts were analysed using a critical discourse analysis approach drawing on the work of Foucault. Family caregiver texts were distinguished by difference rather than by homogeneity. Caregivers occupied a range of positions in terms of their ability to take advantage of the respite time intermittent care offered. My reading of these texts has highlighted the aspects of nurse-family relationships that ameliorated, or alternately exacerbated, the tensions felt by caregivers, as they were torn between the necessity to have a break and their anxieties about the impact of in-hospital respite care on the person with dementia. Nurses' practices in this study were a critical element in facilitating, or alternately constraining, family caregivers' ability to relinquish care and to take full advantage of the respite time. The research findings highlight the need for nurses and other formal caregivers to locate themselves in a secondary and supporting caregiving role, to acknowledge the family caregivers as the primary caregiver, and use family caregivers in-depth and intimate knowledge of the needs of their relative to inform care within the institutional setting.

Oncology ward nurses' perspectives of family grief and a supportive telephone call after the death of a significant other.

To improve family nursing in oncology wards, a new nursing intervention was created: a supportive telephone call after the death of the patient. Nurses who participated in the intervention kept diaries after the call (n = 95). Data were collected also from hospital records. The numerical data were analyzed by using descriptive statistical analysis and the qualitative data by using content analysis. In the diaries, nurses described family grief and mourning as well as content of the supportive telephone call after the death of a family member. Multidimensionality described the family member's grief. The funeral was an important part of the culturally dictated mourning. Support for the family during the patient's last days at the hospital was meaningful with regard to the grief and the onset of coping. Closeness of the nurse-family relationship varied from a close relationship to an uncertain one. A supportive atmosphere during the call made it possible for the survivor to ask questions and talk. During the call, nurses were able to evaluate the family's coping. They also got feedback concerning the nursing care delivered. The call served as a finishing analysis of the family nursing process. The implications of these results for supporting the grieving family by a telephone intervention are considered.

Establishing the nurse-family relationship in the intensive care unit.

The nurse-family relationship in the intensive care unit (ICU) may replace the traditional nurse-patient relationship due to the patient's compromised state. As a result, the nurse-family relationship becomes extremely important. Nurses and families may develop a relationship in which they work together to benefit the patient, or an inadequate relationship may develop. In this study, strategies used by nurses and families to either develop or inhibit the development of the nurse-family relationship were identified. Using unstructured interviews with ICU nurses and family members of ICU patients, categories of strategies were identified and behaviors described. Nurses and families perceived that they each displayed only positive behaviors yet identified inhibiting behaviors of the other. Once the behaviors were shown to nurses as secondary informants, they were able to identify with their negative behaviors. An understanding of these strategies will help nurses to reevaluate their practice and enhance their understanding of the behaviors of family members.

The family and critical care nursing: a brief review of the literature

While there is generalised agreement in the literature on the importance of involving family members in critical care practice, there is little in regard to the roles and responsibilities of both nurses and families. There are many factors that can influence the nurse-family relationship, in both positive and negative dimensions, and this relationship can impact significantly on the family member's experience of critical illness. It can also impact on his or her perception of need and need satisfaction. However, the complex nature of critical care practice may be too demanding, both physically and emotionally, for nurses to respond to many of the family's needs and concerns.

Developing Family-Focused Care

Critical care nurses have a responsibility to provide care from a family-systems perspective in which illness is not an isolated, time-limited event, but instead a highly stressful situation that evolves from the family's history and contributes dynamically toward its future. This article discusses nurse-family relationships, strategies to promote family-focused care, and mechanisms to make family-focused care a reality.

The Shining Stranger

Although many nurses and families may develop a spiritual relationship, a review of the literature showed few studies and scant literature addressing this topic. Furthermore, no studies were identified that used methodologies that provide descriptions and understanding of the meaning of this phenomenon. This article describes the application of the phenomenological method in the investigation of the meaning of a spiritual relationship between families and their nurses in a hospice setting. The phenomenological method can be used to uncover the meaning of experience through respondents' descriptions. Transcripts of interviews in which 11 nurses and 12 families were asked to describe their hospice experience were analyzed using Giorgi's approach to Husserlian phenomenology. Descriptions of nurse-family relationships were identified and synthesized into five thematic structures of experience: nurses' ways of being; nurses' ways of doing; nurses' ways of knowing; ways of receiving and giving; and ways of welcoming a stranger. The thematic structures of experience were synthesized into and interpreted as a metaunity of meaning. Through reflection, the unity of meaning was intuited as "The Shining Stranger." Analysis of selected Eastern and Western religious literature provided exemplars and a characterization of the shining stranger. Implications of the application of the phenomenological method are discussed.

Strengthening Nurse-family Relationships in Critical Care

Establishing relationships with families in critical care is an essential part of high quality care. Critical care nurse-family relationships are important to the patient and family and also benefit the nurse. Thus, nurse-family relationships should be started when families first enter the critical care environment. Cooperative and collaborative relationships require negotiation and must consider the needs of the family as well as the nurse. Barriers need to be overcome before critical care nurse-family relationships can develop. Possible barriers include limited time, perceptions that families are stressors, dysfunctional response styles, and premature judgments. Essential qualities of successful relationships include: trust, respect, empathy, warmth, sensitivity, and touching, when appropriate. Each of these qualities is dependent on the verbal and nonverbal skills of the critical care nurse. As with anything worthwhile, relationship skills take practice to develop, involving a commitment to the importance of nurse-family relationships in critical care.

Caring for the family of the critically ill surgical patient

Surgery and the critical illness of a loved one can be a situational life crisis for family members. Establishing a meaningful nurse-family relationship is critical to the success of all other interventions. Close contact with families, and an awareness of the impact of the family on patient outcomes make nurses the ideal professionals to provide care to families during this crisis.

Characteristics contributing to attachment behavior and its outcomes in student nurse-family relationships.

Characteristics contributing to attachment behavior and its outcomes in student nurse-family relationships.

The impact of a therapeutic nurse-family relationship on post graduate public health nursing students

This article reports an evaluation of the subjective reactions of post-basic public health nursing students to an experience in establishing therapeutic relationships with families. Two consecutive groups of students (17 in 1975; 21 in 1976) made home visits for a period of approx 4 1 2 months, to families with health problems, but no need for technical nursing care. Members of both groups completed a written interview at the end of their study periods. These interviews indicate a great deal of stress at the outset, related to fears of intruding on and exploiting clients. This was most pronounced in the first group who experienced all aspects of these relationships (contact with clients, supervision) in a highly personalized fashion. The second group, shared a concern about the ethics of the visits, but was more open to a new experience, and appeared to react somewhat more professionally than personally. Reactions to teaching were favorable for the two classes. Both groups seem to arrive at a common kind of learning: an appreciation of the supportive, non-intrusive aspects of the therapeutic relationship. A reevaluation of teaching is suggested, to better aid students to cope with stress related to their ‘right’ to enter a home without a technical care function.