Päivi Åstedt-Kurki

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.

School-based drama interventions in health promotion for children and adolescents: systematic review.

AIM The paper is a report of a review of the literature on the effects of school-based drama interventions in health promotion for school-aged children and adolescents. BACKGROUND Drama, theatre and role-playing methods are commonly used in health promotion programmes, but evidence of their effectiveness is limited. The educational drama approach and social cognitive theory is share the assumption that learning is based on self-reflection and interaction between environment and person. However, educational drama also emphasizes learning through the dialectics between actual and fictional contexts. DATA SOURCES A search was carried out using 10 databases and hand searching for the period January 1990 to October 2006. METHODS A Cochrane systematic review was conducted. RESULTS Nine studies met the criteria for inclusion. Their topics included health behaviour (five studies), mental health (two) and social health (two). Actor-performed drama or theatre play followed by group activities was the intervention in five studies, and classroom drama in four studies. Four of the studies were randomized controlled trials and five were non-randomized controlled studies. Four reports gave the theory on which the intervention was based, and in eight studies at least some positive effects or changes were reported, mostly concerning knowledge and attitudes related to health behaviour. The diversity of designs and instruments limited comparisons. CONCLUSION There is a need for well-designed and theory-based studies that address drama interventions in health promotion for children and families. The challenge is to find or develop a theory, which combines educational, drama and health theories with valid and reliable measurements to examine the effects of the intervention.

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.

Family health in everyday life: a qualitative study on well‐being in families with children

Family health in everyday life: a qualitative study on well-being in families with children¶This article describes the subjective health views of young Finnish families with children. The data were collected in unstructured focused interviews with 19 families, most of whom were interviewed twice. Set within a phenomenological-hermeneutic framework, the study applies a qualitative method in order to uncover the meanings attached by the families to different facets of their everyday life. Health is an integral part of the everyday life of families with children, comprising various dimensions of experienced well-being and unwell-being, security and different life-habits. Social networks are crucial to family health: they can either strengthen or undermine experienced health. Professionals working with families in the health care system need to have at least a basic knowledge of the different dimensions of family health: this helps to identify and understand the individual ways in which families work to promote their health and well-being. This knowledge of family health is also important for research purposes. Health care professionals also need to know more about how families cope with their everyday problems and about how client families can be supported. More research is needed on the concepts of family health and on how those concepts are applied to practice in different health care sectors and in education.Family health in everyday life: a qualitative study on well-being in families with children¶This article describes the subjective health views of young Finnish families with children. The data were collected in unstructured focused interviews with 19 families, most of whom were interviewed twice. Set within a phenomenological-hermeneutic framework, the study applies a qualitative method in order to uncover the meanings attached by the families to different facets of their everyday life. Health is an integral part of the everyday life of families with children, comprising various dimensions of experienced well-being and unwell-being, security and different life-habits. Social networks are crucial to family health: they can either strengthen or undermine experienced health. Professionals working with families in the health care system need to have at least a basic knowledge of the different dimensions of family health: this helps to identify and understand the individual ways in which families work to promote their health and well-being. This knowledge of family health is also important for research purposes. Health care professionals also need to know more about how families cope with their everyday problems and about how client families can be supported. More research is needed on the concepts of family health and on how those concepts are applied to practice in different health care sectors and in education.

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.

What is expected of the nurse—client interaction and how these expectations are realized in Finnish health care

The purpose of this paper is to describe what clients using health care services and nurses themselves expect of nursing, the role of patient, and also how these expectations are met. This article is based on qualitative research where both clients and nurses have been interviewed and their own perspectives have been revealed. Expectations expressed by both nurses and clients differ from each other. The clients described a good interactive relationship in a much more diverse and many-sided manner than nurses. Interactive situations seem to be taken for granted by nurses. The results show the starting points of good nursing care and the need to continue nursing development in the client-centred direction.

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.