Marie-Luise Friedemann

Family involvement in the nursing home: family-oriented practices and staff-family relationships.

Staff-family cooperation in caring for elders in nursing homes is recommended but poorly understood. Family involvement and staff-family interactions in nursing homes with differing family orientations were investigated. Friedemanns (1995) system-based family theory guided the study. Of all 208 licensed nursing homes in southern Michigan, 143 completed a survey about their family-oriented practices. Family orientation was ranked accordingly. Twenty-four nursing homes were randomly selected to conduct semistructured telephone interviews with 177 family members. Data were analyzed by thematic interpretation. Findings showed a wide range of involvement patterns that promoted family connectedness, maintenance of control, growth, and learning. Families desired various types of staff cooperation and were given such opportunities in homes with high family orientation.

Two Sides to the Caregiving Story

Abstract Purpose: This descriptive study examined problems and successes that a sample of 73 adult caregivers new to the role expressed in the first year of caring for stroke survivors. Data were collected from May 2002 to December 2005. Method: Bimonthly, trained telephone interviewers asked the participants open-ended questions to elicit their experience in caregiving. Guided by Friedemann’s framework of systemic organization, we analyzed the data using Colaizzi’s method of content analysis. Results: There were 2,455 problems and 2,687 successes reported. Three themes emerged from the problems: being frustrated in day-to-day situations (system maintenance in Friedemann’s terms), feeling inadequate and turning to others for help (coherence), and struggling and looking for “normal” in caring (system maintenance vs. change). Three themes were attributed to the successes: making it through and striving for independence (system maintenance), doing things together and seeing accomplishments in the other (coherence), and reaching a new sense of normal and finding balance in life (individuation and system maintenance). Conclusion: These findings provided an in-depth, theorybased description of the experience of being a new caregiver and can help explain how caring can be a difficult yet rewarding experience. Knowledge of the changes over time allows health care professionals to tailor their interventions, understanding, and support.

Family Involvement in the Nursing Home

The focus of this study was the influence of pre established family behavior patterns, family orientation of nursing home policies, and practices and caregiver and elder characteristics on the family members’expectations for involvement in the nursing home and the actual involvement 6 months later. The conceptual model was based on findings of Montgomery’s nursing home study and open systems principles applicable to families. Data were collected through telephone interviews with 216 family members of residents in 24 nursing homes in southern Michigan. Regression analyses revealed that measures of pre established patterns of family behavior accounted for 19% to 31% of variance in measures of expected family involvement. Expected family involvement, resident activities of daily learning (ADL), and caregiver relationship accounted for 11% to 23% of variance in measures of actual family involvement. Opportunity for family leadership in resident care had a mild effect of moderating the amount of family direct care and learning activities in the nursing home.

Caregivers dealing with stroke pull together and feel connected

Changes that can accompany stroke may create considerable stress for individuals caring for the affected person. This study explored the coping process for nine rural-dwelling caregivers of persons with stroke and the responses of these caregivers to a Web-based support program. The qualitative data management program QSR N 5 was used to analyze quotes from telephone interviews and computer entries. Stories of how caregivers came together and supported one another emerged from the data collected as part of a larger study that examined the experience of caring. Friedemanns framework of systemic organization guided data analysis and interpretation. Actions demonstrated by the caregivers illustrated the process of crisis resolution through family togetherness in which nurses were included. The findings of this study aided in understanding this process and gave direction for nurses working with such clients.

Family Caregiver Role and Burden Related to Gender and Family Relationships

This study described and contrasted family caregivers and explored the effect of gender and family relationship on the caregiver’s role perception, workload, burden, and family help. Home care agencies and community organizations assisted with the recruitment of 533 multicultural, predominantly Latino caregivers who were interviewed at home. The Caregiver Identity Theory guided the study. Survey instruments were standardized tools or were constructed and pretested for this study. Descriptive statistics and t-test analyses assisted in describing the sample, and multivariate analyses were used to contrast the caregiver groups. Findings suggested a gendered approach to self-appraisal and coping. Men in this predominantly Latino and Caribbean sample felt less burden and depression than women who believed caregiving is a female duty. Family nurses should pay attention to the most vulnerable groups—older spouses resistant to using family and community resources and hard-working female adult children—and assess each family situation individually.

Girls in Detention The Results of Focus Group Discussion Interviews and Official Records Review

This study examined the risk factors related to delinquency in an effort to describe the problem of rising female juvenile delinquency. It also examined the context of family environments in which female juvenile delinquents live. Using a triangulated methods approach, the data collected via focus group discussions with 30 female residents in a Regional Detention Center and 100 official intake records revealed that childhood maltreatment, parental incarceration, and school discipline problems were significant risk factors associated with delinquency. Focus group results also indicated that most female delinquents were victims of sexual and physical abuse. Many had family members who engaged in violence and alcohol and other substance use, and the girls themselves engaged in these activities at a young age. To address the growing problem of female delinquency and develop more effective intervention and prevention programs for girls, it is necessary to understand the importance of the family environment in which girls grow. Prevention and intervention programs should provide gender-specific services for girls as well as adequate services for their families.

Strategies to engage clinical staff in subject recruitment

Purpose. In many countries, meeting subject recruitment goals is challenging for researchers relying on clinical staff members (CSMs) to identify or recruit subjects. This paper describes research strategies that improved staff engagement in three different studies conducted in US clinical settings. Method. The recruitment strategies described in this paper were identified during the process of consultation among three US researchers recruiting via CSMs. Strategies which successfully engaged CSMs are described. Results. Our approach improved engagement with CSMs in three different US studies. Early engagement strategies included establishing trust, gathering input from CSMs, and using succinct training procedures as well as a study logo. Middle phase strategies included assigning recruitment, publishing a study newsletter, giving the CSMs compensation and appreciation for their participation, and expanding the subject pool. Completion strategies included closing with an appreciation meeting and adding merit letters to personnel files. Conclusion. Recruitment of an adequate number of subjects is often challenging, even within clinical settings where subject populations are abundant. CSMs have rightly prioritised clinical care over directing subjects to research studies. It is therefore critical that researchers recruiting in such clinical settings anticipate recruitment challenges and plan to implement appropriate engagement strategies in all phases of research.

A triangulation approach to testing a family instrument

Sequential triangulation was used to test the validity of the Assessment of Strategies in Families (ASF), a screening tool for family effectiveness, and its application to families experiencing chronic pain. First, 30 subjects with chronic pain completed the questionnaire. Next, for the purpose of item validation, the subjects explained their thought process for each choice on the questionnaire. Results showed that they interpreted the items as intended. Subjects then responded to a semistructured interview about their perception aboutfamily stability and growth patterns. Thematic analysis suggested a tendency toward isolation from the community, intense involvement in each others lives, and rigid control offamily operations. ASF results reflected the trends by a low family-growth subscore, and a high or low stability score, depending on the success in achieving cooperation offamily members. Thefindings suggest the instrument is valid and appropriate to screen families with chronic pain.

Family health and mental health six years after economic stress and unemployment.

This study is a follow-up of 39 working class couples who were interviewed after suffering economic stress or unemployment and again six years later. Repeated measures related to economics, stress, family functioning, anxiety, and depression were collected and analyzed for couples and for husbands and wives separately. A model of long-term coping was suggested for future testing. Initially stressed families appeared to grow stronger. Mental health correlated negatively to family problems. Depressed wives seemed to maintain their depression over time if they perceived family life as stressful. Irrespective of marital problems, husbands were less likely to stay depressed.

Strategies to teach family assessment and intervention through an online international curriculum.

A Web-based certificate program for international health professionals to acquire understanding of family health and strategies to implement culturally sensitive health care of families is outlined. In four Web courses and a project, students progress interactively to apply culture, family, and interdisciplinary health system theories to assessments and clinical interventions with families in the interdisciplinary setting. Four online educational strategies to facilitate student success from the virtual classroom to actual clinical care are described: adjusting to the technology, communicating the learning progress openly, giving mutual feedback, and implementing evidence-based family care. Outcomes addressing student learning and skill enhancement, family interaction, and student and faculty experiences in the virtual learning environment are explored. Overall, students learned to work successfully with families in health care, experienced increasing comfort and competency in challenging situations, introduced family care in their work setting, and emerged as leaders while working in interdisciplinary teams.