Patricia Short Tomlinson

Family–nurse co‐construction of meaning: a central phenomenon of family caring

The purpose of the study was to understand and interpret caring in the family health experience by exploring the interactional phenomenon of family–nurse co-construction of meaning in the paediatric intensive care unit (PICU). A hermeneutic phenomenological method within a framework of existentialism and symbolic interactionism was used in the investigation. The convenience sample for this study was four family–nurse dyads, that is four families of critically ill children (all with positive outcomes) and the four nurses assigned to their care who were participating in a larger study. Data were derived from semi-structured interviews regarding significant interactions throughout the childs illness and subsequent significant interactions of families with other nurses and nurses with other families. Trustworthiness of the study was addressed through the criteria of credibility, dependability, transferability and confirmability. Co-construction of meaning in the family health experience was found to have two dimensions: interdependent and independent. Both families and nurses described being like family as an essential component of the interdependent experience. Independent dimensions for families were journeying through troubled waters of learning the meaning of the illness event and sensing family comfort through the nurses care. Independent dimensions described by nurses were journeying through troubled waters of learning to care for families and living with anothers fear. The family–nurse interaction, the relational connection and the evolution of meanings that families and nurses construct, was affirmed as the major vehicle in the co-construction experience. Family caring is influenced by the existential meaning constructing, process-oriented, interactional nature of the family health experience. Caring in the family health experience is enhanced through actions the nurse performs on behalf of, and with, the family while understanding the familys unique situation. Caring enacted by nurses in participation with families holds abundant potential for enhancing the family health experience and honor the ethic of caring as central to nursing.

Clinical nurse specialist participation on a collaborative research project. Barriers and benefits.

Clinical nurse specialists are expected to contribute to the development of new nursing knowledge through research activities. Competing demands require constant juggling of time and priorities, and activities, such as research, often do not receive the attention they deserve. Research requires specific skills and knowledge and significant time expenditure. Collaborative research is an appropriate way for the clinical nurse specialist to both contribute to research and improve his or her research skills. This article discusses two pediatric critical care clinical nurse specialists’ participation in a collaborative research team led by university faculty. The study was designed to reduce family uncertainty and stress and to increase staff nurse competency in providing family care. The ability of the clinical nurse specialists to contribute to the research team was enhanced by knowledge of the research process, good communication skills, and clinical expertise in the specific population of interest. Challenges for the clinical nurse specialists included limited experience in conducting clinical research and balancing clinical and research priorities. Both clinical nurse specialists and the university faculty benefited from this collaboration. The clinical nurse specialist, with expertise in a clinical specialty, is able to bridge the gap between the academic and clinical sites, making clinical research more likely. At the same time, working with expert researchers allows the clinical nurse specialist to increase his or her research skills.

Identification of nurse-family intervention sites to decrease health-related family boundary ambiguity in PICU.

The most common explanation of parental stress associated with hospitalized children is based on individual stress theory. Using a family stress and family systems approach with an emphasis on examining family integrity, this qualitative study selected families in the Pediatric Intensive Care Unit (PICU) with high boundary ambiguity in the caregiving environment and identified potential sites for nursing actions that impede or assist families in maintaining family integrity. Within three days of admission of their child to a major tertiary childrens hospital PICU, 29 families were recruited and screened with a Health-Related Family Boundary Ambiguity Scale. High scoring families (n = 11) were interviewed using an open-ended method. Data were analyzed using a content analysis method, and results were interpreted within a family systems framework. The following three potential areas of intervention to encourage family integrity during acute illness of a child were identified: fostering family normalcy, respecting family rights, and strengthening the family boundary. Implications for initiating or improving family centered care in the PICU are discussed.

Caregiver Mental Health and Family Health Outcomes Following Critical Hospitalization of a Child

Changes in caregiver and family health and in family health behavior patterns were examined 9 weeks after the hospitalization of a child for an acute, first-time illness in a pediatric intensive care unit (PICU). Family and caregiver health included reports of physical, mental, role, and social functioning as well as perceptions of health, pain, and changes in health behavior patterns at 3-7 days after admission to PICU and 9 weeks later. A convenience sample of 20 primary caregivers (all mothers) of children aged 2 days to 17 years served as subjects for the study. Results showed a decrease in mental health scores of all subjects over the 9-week period. Further, those caregivers whose child was rated as having a greater potential for chronicity had a significantly greater decline and were in the range of poor mental health at the 9-week posttest. Seventy percent of subjects reported new health problems in the family posthospitalization, and 43% reported at least one change in family health behavior patterns. Implications for testing the efficacy of mental health nursing consultation and case management during and after critical childhood illness are discussed.

Development of the Family Nurse Caring Belief Scale (FNCBS)

Measurement of family nursing practice phenomena needs particular attention. This study develops a new instrument, Family Nursing Caring Belief Scale (FNCBS), that measures nurse attitudes regarding provision of family-sensitive care to families in crisis and establishes initial psychometric properties. Classical test theory was used to construct a discriminative, summative instrument for measuring nurse attitudes. Internal consistency reliability in a randomly selected sample (N = 163) of pediatric intensive care unit and neonatal intensive care unit nurses was estimated at .81 (Cronbachs α) and .78 (Guttman split half). A four-factor structure was revealed: ethical caring practices, systems orientation to family, child advocacy, and normalizing milieu. The FNCBS demonstrated concurrent (r = .57) and criterion-related validities. The FNCBS demonstrated sound psychometric properties with a child-rearing population of families and has the potential for future use in family nursing research, education, and practice. It requires further assessment before testing with an adult population.

Graduate Nursing Education: Developmental Disabilities and Special Health Care Needs

As children and adults with developmental disabilities and special health care needs are integrated into home, school, and community life, nurses are being required to provide leadership, advocacy, and training in community settings to a much greater extent than in the past. To assess the school and community need for formal graduate preparation for nurses who work with individuals with developmental disabilities and/or special health care needs, 25 nurses in leadership positions representing urban and rural health agencies throughout Minnesota took part in a 5-hour focus group discussion. Analysis of data summarized from this process shows five features of the recommended curriculum necessary for advanced practitioners in this specialty area: (a) discipline-specific core competencies, (b) discipline-specific specialty competencies, (c) genetic competencies not specific to nursing but necessary to function in nursing roles, (d) interdisciplinary and intradisciplinary learning experiences, and (e) clinical experiences with preceptors. The authors recommend the development of interdisciplinary graduate programs designed to prepare nurses to assume leadership roles in school health, public health, home health care, and systems management that will affect public policy and, ultimately, promote change in the systems charged with responsibility to serve this population.

BEHAVIORAL INTERACTION OF FATHERS WITH INFANTS AND MOTHERS IN THE IMMEDIATE POSTPARTUM PERIOD

This study describes paternal behaviors of first-time fathers with their partner and newborn immediately after birth and identifies a progression of behaviors with the infant within the first 15 minutes after birth. Videotapes were made of 24 first-time fathers observed at birth a traditional delivery room setting. Utilizing an ethological approach to define behavioral codes, episodes of paternal behavior were measured with time interval sampling. Using a modified frequency method, behaviors were identified in four main categories: proximity, gaze, touch, and movement. The analysis showed that proximity and gaze were high-frequency behaviors and touch and movement were low-frequency behaviors. A progression of behaviors was identified, with gaze starting out high and diminishing, proximity and movement increasing over time, and touch remaining low but constant. Limitations of the setting and implications for clinical practice and research are discussed.