Marie L. Lobo

A conceptual review of family resilience factors.

Family resilience is the successful coping of family members under adversity that enables them to flourish with warmth, support, and cohesion. An increasingly important realm of family nursing practice is to identify, enhance, and promote family resiliency. Based on a review of family research and conceptual literature, prominent factors of resilient families include: positive outlook, spirituality, family member accord, flexibility, family communication, financial management, family time, shared recreation, routines and rituals, and support networks. A family resilience orientation, based on the conviction that all families have inherent strengths and the potential for growth, provides the family nurse with an opportunity to facilitate family protective and recovery factors and to secure extrafamilial resources to help foster resilience.

Voices not heard: A systematic review of adolescents' and emerging adults' perspectives of health care transition

BACKGROUND A better understanding of the needs of adolescents and emerging adults with special health care needs (AEA-SHCNs) is essential to provide health care transition services that represent best practices. The purpose of this systematic review was to evaluate the research on health care transition for AEA-SHCNs from their perspectives. METHODS A comprehensive literature review of research publications since 2005 was performed using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and EBSCO databases. Thirty-five studies met the final review criteria. RESULTS The process of transition from child to adult for AEA-SHCNs is complex. Individuals experiencing the transition desire to be a part of the process and want providers who will listen and be sensitive to their needs, which are often different from others receiving health care at the same facility. CONCLUSIONS More research that considers the voice of the AEA-SHCNs related to transition from pediatric to adult care is needed.

Reducing parenting stress in families with irritable infants.

Background: Caring for an infant with unexplained, persistent crying is one of the most stressful events for new parents. Infant irritability, also referred to as infantile colic, occurs in 10-25% of all infants and is the most common parental concern reported in the first year of life. Objective: The aim of this study was to evaluate the effectiveness of a home-based nursing intervention in reducing parenting stress in three groups of families with irritable infants, using data from a larger evaluation study. Methods: A two-site, randomized clinical trial was conducted with 121 infants and their parents. Infants were randomized to a treatment or a control group. A third group of infants (n = 43) was added as a posttest-only comparison. The level of parenting stress was measured by the Parenting Stress Index (PSI) at baseline, after the 4-week intervention, and at the 8-week follow-up visit. Results: A repeated measures analysis of variance (ANOVA) was used to compare the two groups across the three time points (baseline, immediately after the 4-week intervention, and at the 8-week follow-up visit). The results revealed a reduction in total parenting stress over time for both the treatment and control groups. Mothers in the treatment group reported reduced parenting stress on the parent-child dysfunctional interaction subscale (p = .04). Total parenting stress scores were found to be significantly higher for mothers in the posttest-only group (p = .009). Conclusion: Initial parenting stress levels were high in all participants. Parent feedback at the exit interview indicated that the nurse visits for data collection were also viewed as helpful in reducing the stress level associated with parenting these irritable infants. This home-based program was perceived as helpful in improving the interactions between parents and their irritable infants.

Effectiveness of an Intervention for Colic

An intervention for infant irritability or colic was evaluated in a randomized clinical trial. A total of 121 full-term irritable infants (2 to 6 weeks old) were randomized to routine care or the home-based intervention program. A third group (n=43) of irritable infants were entered into a post-test-only group. Following the 4-week intervention, the treatment group infants cried 1.7 hours less per day than the infants in the control group (p=0.02). The findings support the emerging view of infant colic as a behavioral pattern that is responsive to environmental modification and structured cue-based care.

Uncharted Territory: Systematic Review of Providers' Roles, Understanding, and Views Pertaining to Health Care Transition

BACKGROUND Health care transition (HCT) for adolescents and emerging adults (AEA) with special health care needs is an emerging field of interdisciplinary field of practice and research that is based upon an intergenerational approach involving care coordination between pediatric and adult systems of health care. Informed understanding of the state of the HCT science pertaining to this group of providers is needed in order to develop and implement service programs that will meet the comprehensive needs of AEA with special health care needs. METHODS The authors conducted a systematic review of the literature on the transition from child to adult care for adolescents and emerging adults (AEA) with special health care needs from 2004 to 2013. Fifty-five articles were selected for this review. An adaptation of the PRISMA guidelines was applied because all studies in this review used descriptive designs. RESULTS Findings revealed lack of evidence due to the limitations of the research designs and methodology of the studies included in this systematic review. Study findings were categorized the following four types: adult provider competency, provider perspectives, provider attitudes, and HCT service models. The discipline of medicine was predominant; interdisciplinary frameworks based upon integrated care were not reported. Few studies included samples of adult providers. CONCLUSIONS Empirical-based data are lacking pertaining to the role of providers involved in this specialty area of practice. Evidence is hampered by the limitations of the lack of rigorous research designs and methodology.

Transition Needs of Parents of Adolescents and Emerging Adults With Special Health Care Needs and Disabilities

The period of health care transition (HCT) for adolescents and emerging adults with special health care needs and disabilities involves a complex realignment of the parent–child relationship, including alterations in role responsibilities and decision making. The purpose of this systematic review was to analyze the research designs, methodology, and findings reported in studies of parents during this transition period to provide new insights for research and clinical practice. Results showed that parents were unable to clearly envision what the future held for their children and were not well prepared by the service system to anticipate future prospects. These parents have a myriad of needs that are not yet fully understood, as HCT research is in the early stages of development.

An intervention program for families with irritable infants.

Purpose:To describe and evaluate a home-based nursing intervention program, the REST routine, which incorporates the use of infant behavior assessment, pattern recognition, individualized infant schedules, specific management strategies, and parent education and support. Study Design and Method:A two-site clinical trial was conducted on 164 healthy full-term infants with excessive unexplained irritability or colic. Infants between the ages of 2 to 6 weeks were randomized to routine care or a home-based intervention program (n = 121). A third group (n = 43) of infants too old at entry for randomization (mean age = 10.4 weeks) were entered into a posttest-only group. Results:Infants in the REST routine treatment group cried 1.3 hours per day on average following the intervention program as compared to the control group crying 3 hours per day (p = .02). Infant irritability was resolved (<1 hour) in 62% of the treatment group while only in 29% of the control group at the time of the 8-week follow-up visit (p = .04). Clinical Implications:Families in both the treatment and control groups reported benefiting from a nurse visiting in their home to inquire about their infant and their well-being. Options for individualizing the program for those most in need of intensive home visiting and other delivery modes for the intervention are areas for further investigation

Recovery from Serious Mental Illness: A Concept Analysis

This paper examines the concept of recovery in the context of serious mental illness. The analysis uses literature from multiple health care disciplines and different uses of “recovery” in every- day language, technical applications, and popular culture. This iterative process concludes with a definition of recovery from serious mental illness: a nonlinear process of self-organization and adaptation that offsets the personal disintegration of mental illness and enables the individual to reconceive his or her sense of self and well-being on all biopsychosocial levels. The relevance of the concept is reevaluated with this definition for potential usage in the mental health care setting.

Systematic review: Health care transition practice service models

BACKGROUND Nearly 750,000 adolescents and emerging adults with special health care needs (AEA-SHCN) enter into adulthood annually. The linkages to ensure the seamless transfer of care from pediatric to adult care and transition to adulthood for AEA-SHCN have yet to be realized. PURPOSE The purpose of this systematic review was to investigate the state of the science of health care transition (HCT) service models as described in quantitative investigations. METHODS A four-tier screening approach was used to obtain reviewed articles published from 2004 to 2013. A total of 17 articles were included in this review. DISCUSSION Transfer of care was the most prominent intervention feature. Overall, using the Effective Public Health Practice Project criteria, the studies were rated as weak. Limitations included lack of control groups, rigorous designs and methodology, and incomplete intervention descriptions. CONCLUSION As the findings indicate, HCT is an emerging field of practice that is largely in the exploratory stage of model development.

Disclosure: a concept analysis

AIM This article is a report of a concept analysis of disclosure. BACKGROUND Disclosure of health concerns is often delayed or incomplete, resulting in a lack of appropriate care or inability to avoid complications. Disclosure is a poorly understood phenomenon in nursing, however, an understanding of the concept is critical to providing effective nursing care. DATA SOURCES Literature from the humanities, social sciences, business, law, nursing and allied health fields in five search engines was reviewed for insight into a patients decision to disclose health information to a healthcare provider. REVIEW METHODS Wilsons method of concept analysis guided this study into the meaning of disclosure from the point of view of a patient seeking healthcare. Inclusive years of search ranged from 1991 to 2010. RESULTS Disclosure is defined as the act of seeking care by revealing personally significant information that exposes the bearer to the risk of rejection or negative judgment. Attributes of disclosure are identified as: holding significant health-related information, assistance needed to cope, tolerance for unpredictable result, divulgence and expectation of serious response. Consequences of disclosure include resolution, reassurance or assistance gained, but may also include suffering rejection or negative repercussions. CONCLUSION Implications for nursing practice are explored and include focused questioning, providing for safety concerns, acknowledging significance and sensitivity of disclosed information and acting on the disclosure.