Naohiro Hohashi

Validity and Reliability of the Chinese Version of the Feetham Family Functioning Survey (FFFS)

A Chinese version of the Feetham Family Functioning Survey (Chinese FFFS) was developed and psychometrically tested using a sample of 317 child-rearing mothers in Hong Kong. The Chinese FFFS is a self-administered questionnaire consisting of 25 items from which an instrument discrepant score (d score) can be extracted. The results from the confirmatory factor analysis and exploratory factor analysis confirm that the Chinese FFFS has a five-factor structure based on the family ecological model, thereby affirming its construct validity. Cronbachs alpha for d scores was .91, indicating a high internal consistency. In the test—retest study of 39 mothers, the correlation coefficient for “total d score” over a 2-week period was .82, which showed high test—retest reliability. The highest discrepant scores in family functioning were at the level of the marital relationship, which requires family nurses to be skilled at assessing and intervening at this family subsystem.

Fatigue and quality of life in citrin deficiency during adaptation and compensation stage

Citrin-deficient children and adolescents between adult-onset type II citrullinemia and neonatal intrahepatic cholestasis by citrin deficiency do not have clear clinical features except for unusual diet of high-fat, high-protein, and low-carbohydrate food. The aims of the present study are to characterize fatigue and quality of life (QOL) in citrin-deficient patients during adaptation and compensation stage, and to define the relationship between fatigue and QOL. The study subjects were 55 citrin-deficient patients aged 1-22years (29 males) and 54 guardians. Fatigue was evaluated by self-reports and proxy-reports of the PedsQL Multidimensional Fatigue Scale. QOL was evaluated by the PedsQL Generic Core Scales. Both scale scores were significantly lower in child self-reports (p<0.01 and p<0.05, respectively) and parent proxy-reports (p<0.01 and p<0.01, respectively) than those of healthy children. Citrin-deficient patients with scores of 50 percentile or less of healthy children constituted 67.5% of the sample for the Fatigue Scale and 68.4% for the Generic Core Scales. The PedsQL Fatigue Scale correlated with the Generic Core Scales for both the patients (r=0.56) and parents reports (r=0.71). Assessments by the patients and their parents showed moderate agreement. Parents assessed the condition of children more favorably than their children. The study identified severe fatigue and impaired QOL in citrin-deficient patients during the silent period, and that such children perceive worse fatigue and poorer QOL than those estimated by their parents. The results stress the need for active involvement of parents and medical staff in the management of citrin-deficient patients during the silent period.

Development of the Concentric Sphere Family Environment Model and Companion Tools for Culturally Congruent Family Assessment

The article presents development of a nursing model for holistically understanding the family environment that acts on family well-being as well as of tools based on this model to assess family well-being. These were constructed by using qualitative, quantitative, and literary approaches, such as the Delphi technique, a literature review, semistructured interviews with families, and ethnographic studies in Japan, Hong Kong, and the United States. In the “Concentric Sphere Family Environment Model,” a three-dimensional logical space is formed by the three assessment axes of relationships (structural distance, functional distance, and temporal distance) and five systems (supra system, macro system, micro system, family internal environment system, and chrono system) located therein. The “Family Environment Assessment Index” comprises 37 items for assessing the family well-being, and for each of their specifications useful sample questions are provided to conduct the culturally congruent family assessment.

Interrelations between siblings and parents in families living with children with cancer.

Having a child diagnosed with cancer is a stressful event for the family. This exploratory multimethod study utilized both quantitative and qualitative multiinformant methodologies to investigate the relationships between parental family functioning and siblings’ health-related quality of life (HRQOL) and to describe interrelations between the experiences of parents and siblings of children with childhood cancer. A total of 14 Japanese families participated in the quantitative study, and 4 families of the 14 participated in the qualitative study. In-depth, semistructured interviews revealed three family-unit stages during the time course of the ill child’s treatment that included particular parent–sibling interrelations. We also found strong correlation between parental family functioning and siblings’ HRQOL in the quantitative study. The results suggest the importance of family nursing interventions directed to individual family members and the family unit that focus on strengthening the parent–sibling relationship and supporting families who are experiencing childhood cancer.

Development and testing of the Survey of Family Environment (SFE): a novel instrument to measure family functioning and needs for family support.

Background and Purpose: Hohashi’s Concentric Sphere Family Environment Model (CSFEM; Hohashi & Honda, 2011) is a newly proposed family nursing theory for holistically understanding the family environment that acts on family well-being. The purpose of this article is to develop and psychometrically test the Japanese version of the Survey of Family Environment (SFE-J), grounded in the CSFEM, for measuring family’s perceived family functioning and family’s perceived needs for family support. Methods: The SFE-J is a 30-item self-administered instrument that assesses five domains (suprasystem, macrosystem, microsystem, family internal environment system, and chronosystem) and has been subjected to rigorous reliability and validity investigations among paired partners in child-rearing families (N of family = 1,990). Results: Internal consistency reliability was high as measured by Cronbach’s alpha coefficients. Temporal stability over a 2-week interval was supported by high (substantial or perfect) and significant intraclass correlation coefficients. The total score for the SFE-J was significantly correlated with the Japanese version of the Feetham Family Functioning Survey (FFFS-J), indicating an acceptable concurrent validity. Construct validity was supported by a confirmatory factor analysis that evaluated the five-factor structure to measure the concept of CSFEM. Results also demonstrate that the SFE-J family functioning scores show no significant differences between paired partners. Conclusions: The SFE-J is a reliable and valid instrument to assess not only intrafamily functioning but also interfamily functioning and, by identifying items/domains with high requirements for family support, serves to facilitate the providing of appropriate support to families.

Family functioning of child-rearing Japanese families on family-accompanied work assignments in Hong Kong.

Although the number of employees on overseas assignments accompanied by their families has increased steadily, little is known about the effects of this experience on family functioning. Japanese families on family-accompanied assignments living in Hong Kong were compared with families living in Japan (consisting of 135 and 248 paired partners, respectively). Applying an ecological framework, family functioning was examined using the Feetham Family Functioning Survey–Japanese (FFFS-J). Japanese wives living in Hong Kong rated family functioning lower, particularly in the area of “relationship between family and family members.” Between paired marital partners living in Hong Kong, the level of satisfaction in the area of “relationship between family and society” was significantly lower for wives than for husbands. This study provides application of the family ecological framework in families in a multicultural environment and identifies potential areas for family assessment and intervention that may of interest to health care professionals who care for families living away from their home countries.

Family Care/Caring Based on Family Belief Systems Theory:

Dear Colleagues, Coming to the end of spring, for me, translates into thoughts of a relaxing vacation with a good book or two in hand. For some of us the setting is the Jersey Shore, for others backpacking in the Sierras of California or bringing in the salmon in Alaska; and what about that quiet little lake in Wisconsin, Michigan, or Minnesota that beckons us to its shores. Each provides time away—time to recharge our batteries. It transports us away from the demands of the everyday, encourages us to be with our thoughts, and to consider future possibilities. We all need that time to rejuvenate physically, mentally, and spiritually. Similarly, with our family—the Transcultural Nursing Society—we need to take that time to reflect on future endeavors such as becoming an associate member with the United Nations, creating online educational opportunities, and including more ethnicities to the Cultural Perspectives app, which are three areas that communicate our commitment to the Transcultural Nursing Society mission and goals. Similar to every organization, we need to see movement and growth, energy, and enthusiasm. We are consistently moving in a forward direction. So take time this summer to rest and rejuvenate. Reflect on your many, and I am sure there are many, accomplishments over the past year. You have met challenges in unexpected ways. You have inspired others to join in the movement toward providing cultural care that as our founder said “fits with and is beneficial to the patient, family, and community.” Join us as we venture forward to achieve our goals and objectives. You are unique. There is no one like you. We need your participation. Together we are creative and visionary. The path before us beckons! Namasté

Development and Validity Testing of an Assessment Tool for Domestic Elder Abuse

Background: The older adult population is increasing in number, and elder abuse is expected to become a more pressing problem. Developing tools to assess the presence and severity of elder abuse is important to both effectively prevent this abuse and provide increased support for families. Purpose: This study was intended to test the validity of an Assessment Tool for Domestic Elder Abuse (ATDEA). The items that constitute this tool were derived from a literature review. Methods: Two rounds of self-administered questionnaire surveys were conducted with nurses working at home-visit nursing stations. Round 1 was used to evaluate the face validity, and Round 2 was used to test the content using the content validity index (CVI). Results: Two hundred forty nurses participated in the two studies. In Round 1, 56 nurses evaluated 38 items derived from a literature review, resulting in the development of a 36-item ATDEA. In Round 2, 184 nurses evaluated the content validity of the 36-item ATDEA. The Item-CVI (I-CVI) scores ranged from .61 to 1. Twenty-eight of the items met or exceeded the I-CVI threshold of .78, whereas the eight items assessing self-neglect did not. The overall Scale-CVI score for the assessment tool was .90, which met the threshold of .90. Conclusions/Implications for Practice: The results of validity testing established the preliminary validity of this assessment tool. In addition, as self-neglect is known to damage the well-being of older adults, six of the eight items assessing self-neglect were retained in the ATDEA despite their failure to meet the threshold I-CVI of .78. The remaining two self-neglect items were not included in the ATDEA because of excessively low I-CVI scores (< .70). Thus, the final version of the ATDEA includes 34 items. The authors recommend that nursing professionals use the ATDEA as a checklist to assess the presence of elder abuse and to discern the subtypes and severity of this abuse. When evaluating elder abuse, the higher the degree of severity, the greater the urgency to provide support.

A Comparison Study of Single-Parent Families Living on Remote, Rural Islands and in Urban Settings in Japan.

Background: Nursing interventions that aim to enhance the family environment are necessary to help single-parent families with children to improve family functioning. The cultural and social factors that are unique to Japan’s remote islands should be considered to assess the influence of this unique setting on family functioning. Purpose: The objectives of this study were to evaluate the family functioning of child-rearing single-parent families living in different environments and to investigate the association between family demographics and family functioning. Methods: A self-administered questionnaire, the Japanese version of the Survey of Family Environment, was used to evaluate the sufficiency of family functioning. The participants were families with children enrolled in nurseries and kindergartens who were either living in remote, rural islands or in an urban city on the mainland in Japan. Results: Family functioning was significantly higher for single-parent families living on the islands than for those living in the city in terms of media use, participation in community activities, and the collaboration of family members in child-rearing. Family functioning of single-parent families correlated significantly with household income, the parent’s gender, family members’ health, and family life cycle. Conclusions/Implications for Practice: Single-parent families living on Japanese offshore islands maintained family functioning through mutual support and the effective use of information technology. Nevertheless, single-parent families require additional support to improve their healthcare and financial situations.

The Environment and Support Needs of Japanese Families on Temporary Work Assignments in the United States

Purpose: This study aimed to describe the environment and the family support needs of families of Japanese nationals rearing children who are temporarily working in the Southwestern United States. Design: Mixed methods were utilized based on the Concentric Sphere Family Environment Model. Data collection occurred over 132 days, with 25 families participating in formal interviews and 40 families completing a written questionnaire survey. Findings/Results: “Mutual support from relatives and friends in Japan, and with local Japanese peers,” and other themes, six in all, were extracted. Japanese families require intervention for measures related to the global environment in their daily lives. Discussion and Conclusions: The common factor for those families with high intervention needs was the inability to access family external resources that were usually available in Japan. Implication for Practice: The building of peer support and intervention to promote their participation in the community are necessary.