Eija Paavilainen

Interrelation between adult persons with diabetes and their family: a systematic review of the literature.

Diabetes mellitus is a common chronic disease all over the world. Self-management plays a crucial role in diabetes management. The purpose of this systematic review was to summarize what is known about the interactions between adult persons with diabetes, their family, and diabetes self-management. MEDLINE, CINAHL, PSYCHINFO, LINDA, and MEDIC databases were searched for the years 2000 to 2011 and for English language articles, and the reference lists of the studies included were reviewed to capture additional studies. The findings indicate that family members have influence on the self-management of adult persons with diabetes. The support from family members plays a crucial role in maintaining lifestyle changes and optimizing diabetes management. Diabetes and its treatment also affect the life of family members in several ways, causing, for example, different types of psychological distress. More attention should be paid to family factors in diabetes management among adult persons.

Identification of child maltreatment while caring for them in a university hospital.

The purpose of the study was to look at how nurses and physicians of a university hospital rated their ability to identify child maltreatment while caring for those children. In this study, child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child under the age of 18 by parents or caregivers. The total population of staff caring for children (N=513) in a university hospital were surveyed. Data were collected with a questionnaire developed for this study with reference to the literature. Altogether 317 questionnaires were returned, which yielded a response rate of 62%. The data were analysed using statistical methods and quantitative content analysis. Forty per cent of the respondents estimated that they had never cared for a maltreated child. Two-thirds of the respondents believed that they would be able to identify a child maltreatment case. The most distinct signs by which maltreatment could be identified were fractures, multiple bruises and the fact that the child had frequent injuries. The childs or parents behaviour often aroused suspicion of maltreatment. Seventy-one per cent of the respondents rated the identification of maltreatment as rather difficult or difficult. Awkwardness of the phenomenon, the staffs pressure of work and relative unfamiliarity with the phenomenon were assessed as things that make the identification difficult. The fact that no jointly agreed guidelines were available for handling the matter was seen as a particular weakness. The respondents had fairly much theoretical knowledge about child maltreatment. However, child maltreatment is a multi-dimensional phenomenon that calls forth emotions. The development and improvement of practical nursing and medical care and of staff collaboration require that education be provided to different occupational groups and parties caring for children and that jointly agreed hospital-specific and regional models for operation be developed.

Interaction between Family Members and Health Care Providers in an Acute Care Setting in Finland

The purpose of the study was to ascertain health care providers’ perspectives about interaction with patients’ family members. Data were collected by questionnaire from health care providers who worked in a Finnish acute care hospital (N = 320). The response rate was 51%. The hospital staff perceived the interaction with the patient’s family to be important. Family members were primarily seen as informants of the patient’s condition and family situation, and the interaction was marked by dissemination of information. The support provided by family members to the patient was also seen as important. The interaction with hospital staff was mainly initiated by a family member. Further research should explore family members’ perceptions of the interaction with health care providers to enable comparisons between perceptions. Application of qualitative study methods would also deepen the existing knowledge of the family-health care provider interaction.

Nursing intervention studies on patients and family members: a systematic literature review

The development of evidence-based practice is a major current challenge in the fields of nursing practice and nursing research. A concerted effort is needed to develop and test interventions and to assess their impacts. The illness of one family member inevitably affects other family members and the whole family. Nursing interventions should be so designed that they support and enhance the life situation of both patients and their families. The aim of this study is to undertake a systematic review of nursing intervention studies on patients and family members published in international databases in 2001-2006. The main focus was on the targets, methods and impacts of interventions. The articles for the review were searched from Medline and Cinahl (n = 31) and analysed by content analysis and the RE-AIM evaluation model. The results showed that the interventions were targeted at patients with chronic diseases and individual family members. In addition to support components, the interventions included elements of teaching, counselling and education. The preliminary evidence indicated that the interventions were effective in relieving the burden of care and depressive symptoms of family members of Alzheimer, cancer, stroke and schizophrenia patients as well as in promoting their quality of life and coping. Nursing interventions are still in the development and testing phase. The challenge for the future is to broaden the scope and application of interventions in different nursing environments. Assessments of the efficacy of interventions should also consider their adaptation, implementation and maintenance in practical nursing.

Development and testing of a family nursing scale.

A methodological study was conducted to test the psychometric properties of the Family Functioning, Health, and Social Support (FAFHES) Instrument to be used with families of heart patients. A total of 109 initial items were developed based on knowledge generated by three Finnish academic dissertations concerning family functioning, health, and social support provided by nurses. Data were collected from family members of 161 heart patients. Principal component analysis was performed in each of three total scales: family functioning, family health, and social support. The scales had acceptable reliability (alpha coefficients ranged from .73 to .95). Internal consistency reliability and content validity of the FAFHES have initial support. Results obtained from this study support that this instrument is ready for use in research in which the investigator wishes to measure social support associated with family functioning and the health of families of heart patients.

The burden of inflammatory bowel disease on health care utilization and quality of life

Abstract Objective. The aim of this study was to explore the utilization of health services by Finnish adults with inflammatory bowel disease (IBD) and to assess the associated demographic and health-related quality of life (HRQoL) factors. Material and methods. 556 Finnish IBD patients eligible for reimbursement for IBD medication according to the Social Insurance Institution in Finland answered our postal cross-sectional survey. The study questionnaire included questions about demographic characteristics of the patients, health care resource use, and HRQoL. The number of doctor visits was compared with those of irritable bowel syndrome patients. Results. During the previous year, more than three quarters of the respondents reported disturbing IBD symptoms. The majority (64%) had seen a doctor due to their IBD, women more often than men (p < 0.001). The use of health services did not differ between diagnostic (Crohns disease or ulcerative colitis) or age groups, marital status, education, or time elapsed since diagnosis. Women were absent from work more frequently than men (p = 0.01). The amount of physician visits, work absenteeism, and a higher amount of undergone procedures were related to impaired HRQoL (p < 0.001 on all accounts). Conclusions. Despite comprehensive public health services and specialized care for IBD patients in Finland, a majority expressed disturbing IBD symptoms. Since the amount of physician visits, work absenteeism and a higher amount of procedures were related to a diminished HRQoL, the patients who are most often met by professional caregivers are often those whose HRQoL needs to be more adequately addressed.

Further testing of a family nursing instrument (FAFHES)

BACKGROUND Cardiac illness in one family member affects the well-being and health of the whole family. When a family member falls ill, life may change for the whole family in many ways. Family members expect nursing staff to provide more support when their family situation changes. OBJECTIVES To describe further development and testing of a family nursing instrument for assessing the association between social support for the family of an adult cardiac patient and family functioning and perceived family health. SETTINGS The study was conducted in two university hospitals and in two central hospitals in Finland. METHODS AND PARTICIPANTS Questionnaires were given to family members of heart patients. Patients themselves defined who their closest adult relative was. Data were collected from family members of 509 heart patients. RESULTS Good internal reliability in this further testing of a new instrument was demonstrated. Principal component analysis (PCA) with varimax rotation was performed in each of the three total scales: family functioning, family health and social support. PCA supported the previously proposed theoretical framework. A final scale consisted of 62 items. All the total scales and subscales had acceptable validity and reliability, alpha coefficients ranged from .76 to .98. CONCLUSIONS The Family Functioning, Health and Social Support (FAFHES) provides a reliable and valid instrument when the investigator wishes to measure social support associated with family functioning and the health of families of heart patients.

Family Functioning Assessed by Family Members in Finnish Families of Heart Patients

Background: The role of family is central to the wellbeing and health of individuals. Family attitudes, habits and routines affect the way individuals promote their health. Family functioning and family health are threatened when one family member develops heart disease. Aims: The aim of the study was to describe family functioning and to ascertain factors related to family functioning of families with heart patient as assessed by family members. Methods: Data collection was done using a questionnaire (FAFHES) in 2000. The sample consisted of 161 family members of patients receiving treatment on two medical wards. The data were analysed by means and tested by parametric and non-parametric tests. The multivariate method used was stepwise regression analysis. Results: The better the family values were materialized and the greater the familys contribution to family health, the better the familys functioning is. Concrete aid was also related to family health. The more concrete aid the family received from nurses, the better family functioning is. When the background variables were included, values and activities remained in the model, but two new variables explained family functioning: family members age and knowledge of health issues. The older the family member is and the better the knowledge in the family is, the better is family functioning. Conclusion: Family functioning of families with heart patients can be supported and developed by family nursing, e.g. concrete aid from nurses. Other aspects of support, e.g. consideration of family members age and knowledge of health issues also need to be further considered and studied as the basis of care.

COPD, chronic bronchitis and capacity for day-to-day activities: Negative impact of illness on the health-related quality of life:

The aim of this study was to investigate the negative impact of illness on health-related quality of life (HRQoL) of people with chronic obstructive pulmonary disease (COPD) or chronic bronchitis. The study population consisted of the participants (N = 8028) of a health examination survey conducted in Finland. The sample in the present substudy was composed of 4718 participants who had complete information about spirometry. Variables age, gender, body mass index (BMI), illnesses, smoking in lifetime, education, FEV1% and incomes were entered in blockwise bivariate regression analysis to examine the relationships between capability for day-to-day activities (physical, psychological and social functioning) of those with COPD. Also, COPD (n = 277) and chronic bronchitis (n = 630) were compared with the general population (n = 3817). Study results showed that women with COPD had worse HRQoL than men, regarding the activities in daily living (ADL; odds ratio [OR] 2.63, 95% confidence interval [Cl] 1.15—5.99), instrumental activities of daily living (IADL; OR 4.23, 95% Cl 1.92—9.29) and exercise (OR 2.66, 95% Cl 1.21—5.84). Compared with the general population, people with chronic bronchitis were associated with poor ADL, IADL and exercise, (OR 1.58, 95% Cl 1.32— 1.92). Those with COPD, had difficulties managing in ADL (OR 4.02, 95% Cl 2.98—5.44), IADL (OR 3.27, 95% Cl 2.43—4.39), exercise (OR 3.35, 95% Cl 2.47 to 4.53). In this representative population-based sample, COPD and chronic bronchitis mean a significantly poor capability in physical functioning. People with chronic bronchitis experienced their daily life to be worse compared with the general population. Reductions in physical functioning for women and especially with COPD were also noteworthy.

Risk factors of child maltreatment within the family: towards a knowledgeable base of family nursing

The purpose of this study was to compare family dynamics in child maltreating families (n=42) with that in ordinary families with children (n=77), and to ascertain risk factors of child maltreatment within the family. Child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child by a parent. Data were collected using questionnaires (Family Dynamics Measure 2, FMD 2) (N=119) basing on Barnhills conceptual framework of healthy family systems and analysed by forming sum variables and logistic regression. The study results indicate that family functioning in child maltreating families is lower on all dimensions of family dynamics (individuation, mutuality, flexibility, stability, communication and roles) than that in ordinary families with children. Furthermore, it seems that specific risk factors, detected with logistic regression analysis, are related to whether child maltreatment occurs in the family or not. These include the parents low educational background, many children in the family, unemployment of a parent, low individuation of the family members, and poor stability and security within the family. The results of this study provide guidelines for detecting and preventing child maltreatment as well as for recognising its existence, although no generalizations can be made due to the small sample size and complexity of the phenomenon under study.