Marja-Terttu Tarkka

A systematic review of professional support interventions for breastfeeding

OBJECTIVES The objectives of this systematic review were first, to describe how breastfeeding is professionally supported during pregnancy, at maternity hospitals and during the postnatal period. Secondly, to find out how effective interventions are in supporting breastfeeding. BACKGROUND Breastfeeding is an effective way to promote the health of infants. In many countries, the rates for breastfeeding remain lower than recommended. Many studies have examined breastfeeding promotion interventions; some of them are successful and some fail. It is important to find effective combinations of support. DESIGN Systematic review. METHODS Search of CINAHL, Medline and Cochrane Central Register databases were conducted for data collection. The search was limited to articles published in Finnish, Swedish and English between the year 2000 and March 2006, focusing on breastfeeding and breastfeeding support interventions. Two reviewers independently analysed 36 articles in the final analysis. RESULTS Interventions expanding from pregnancy to the intrapartum period and throughout the postnatal period were more effective than interventions concentrating on a shorter period. In addition, intervention packages using various methods of education and support from well-trained professionals are more effective than interventions concentrating on a single method. CONCLUSIONS During pregnancy, the effective interventions were interactive, involving mothers in conversation. The Baby Friendly Hospital Initiative (BFHI) as well as practical hands off -teaching, when combined with support and encouragement, were effective approaches. Postnatally effective were home visits, telephone support and breastfeeding centres combined with peer support. Relevance to clinical practice. Professionals need breastfeeding education and support of their organisations to act as breastfeeding supporters. The BFHI -programme is effective and it would be wise to include the core components of the programme in breastfeeding promotion interventions. Mothers benefit from breastfeeding encouragement and guidance that supports their self-efficacy and feelings of being capable and empowered, and is tailored to their individual needs.

Fear and anxiety in patients at different time-points in the coronary artery bypass process

The purpose of this study was to examine fear and anxiety of coronary artery bypass patients at different time-points in the coronary artery bypass process and changes between different time-points. Patients (n = 171) from one university hospital completed questionnaires while awaiting surgery at home, in hospital the evening before surgery and 3 months later. The Bypass Grafting Fear scale was developed to measure fear. Anxiety was measured using state-trait-anxiety inventory and HAD. The highest levels of fear and anxiety were measured in the waiting period to coronary artery bypass grafting (CABG). Compared with the waiting period, fear and anxiety levels dropped in hospital and 3 months later. Female gender was related to change in fear and HAD anxiety. Marital status and vocational education were related to changes in STATE-A. Age under 55 years was related to higher TRAIT-A especially in the recovery period. These findings warrant concern for fear and anxiety in patients awaiting CABG, especially women and patients who do not have partner relationship.

Changes in quality of life in patients with breast cancer.

AIM To describe and compare changes in quality of life in two groups of patients with breast cancer and to identify factors predicting negative changes in quality of life within six months. BACKGROUND Women with breast cancer suffer from various treatment side-effects, from psychological and social symptoms as well as decreased quality of life, creating a need for support that may persist throughout the breast cancer experience. DESIGN This six-month longitudinal study involved a sample of 164 women, who were quasi-randomized between intervention (n = 85) and control groups (n = 79) after breast cancer surgery. Intervention group received support and education via telephone one week after the breast cancer surgery and face-to-face support six months after the surgery. Quality of life was estimated one week and six months after breast cancer surgery, using the Quality of Life Index-Cancer Version (QLI-CV) and the European Organisation for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire (EORTC QLQ-BR23). METHOD Data were analysed statistically using descriptive statistics and non-parametric tests. Factors predicting negative changes in quality of life within six months were investigated using logistic regression models with the enter method. RESULTS Significant group difference in the magnitude of changes within six months was found in future outlook. Logistic regression analyses revealed six significant predictors of negative changes in quality of life within six months: education, employment status, having underaged children, chemotherapy, radiotherapy and hormonal therapy. CONCLUSION The results of this study underline the importance of identifying quality of life changes in patients with breast cancer and paying attention to those women with difficulties in adapting to being a cancer survivor. RELEVANCE TO CLINICAL PRACTICE The findings of this study provide evidence which may help to create appropriate supportive interventions for both acute and long-term settings.

Effect of social support on changes in quality of life in early breast cancer patients: a longitudinal study

BACKGROUND Breast cancer diagnosis as well as diversity of the treatment process deteriorates womens quality of life (QOL). Researchers have examined social support and its relations with QOL overall, but less is known about effects of social support on changes in QOL. AIMS The aim of this study was to examine social support received from social network and nurses within 6 months and QOL in women with breast cancer. METHODS Women (N = 164) after breast cancer surgery were quasi-randomized to the intervention (n = 85) and control groups (n = 79). Participants completed two well-known QOL questionnaires, and the questionnaire measuring received social support from network and from nurses both 1 week and 6 months after the breast cancer surgery. Data were analysed using descriptive statistics and nonparametric tests. Logistic regression model with the enter method was employed to identify associations between social support and negative changes in QOL. RESULTS Affect and aid from network decreased in both groups and affirmation in the intervention group within 6 months. No significant changes in received social support from nurses were found within groups. Furthermore, no statistically significant difference in the magnitude of changes over time was found between groups. Received social support had an effect on changes in sexual functioning, global QOL and health and functioning. CONCLUSIONS Received social support decreased in both groups within 6 months. Significant effects of social support on negative changes on QOL were found. Social support tailored to womens individual needs is an essential part of the care in patients with breast cancer. For further research, longitudinal designs for longer period should be established to explore social support and its effects on QOL.

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.

Fear and in-hospital social support for coronary artery bypass grafting patients on the day before surgery

The purpose of this study was to ascertain the amount of in-hospital social support received by coronary artery bypass grafting patients and the impact of this support on their feelings of fear and anxiety. As adapted from Kahns theory, social support was understood as emotional, informational and tangible support. The bypass grafting fear scale was developed to measure the fear, and the hospital anxiety and depression scale and the state anxiety inventory were used to measure the anxiety. Data were collected pre-operatively with a questionnaire from in-patients (N=193) and analysed using logistic regression analysis and one-way ANOVA. The majority of patients received plenty of social support from nurses and a great deal of multiprofessional counselling. When the amount of social support was high, patients experienced lower levels of fear and anxiety. It is concluded that social support from nurses can effectively reduce pre-operative fear and anxiety, but that the amount of support should be high.

The impact of supportive telephone call intervention on grief after the death of a family member.

This study describes the impact of a supportive telephone call on grief 4 months after the death of a family member. The study design involved a quasi-experimental intervention group (n = 70) and a control group (n = 155). The intervention was a supportive telephone call after the death of a family member. Grief reactions were measured with the Hogan Grief Reactions Checklist. Results were completed by content analysis of family members’ experiences of the intervention. Chi-square and t tests were used to compare the associations with demographic data, and logistic regression analysis was used to compare the responses. The results pointed to differences in despair and personal growth between the groups. The participants experienced the supportive telephone call positively for the most part. Negative experiences were associated with promises to call in which the call never reached the participant. Grieving family members’ positive experiences of the call indicate that there is a need for individual support after the death, given by nurses of the wards in which the deceased received care.

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.

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 members grief. The funeral was an important part of the culturally dictated mourning. Support for the family during the patients 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 familys 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.