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Purpose Guided by Friedemann's framework, the purpose of this study was to examine the dimensions of new family caregivers’ emotional strain in caring for persons with stroke. Method Seventy‐three caregivers who were new to that role participated in an interview every 2 weeks for a year as part of a NIH project. Of these caregivers, 36 participants were randomly assigned and had access to a Web‐based intervention and its e‐mail discussion. In this secondary data analysis, 2,148 e‐mail discussion messages plus 2,455 narrative interview entries were used to examine dimensions of caregivers’ emotional strain. Rigorous content analysis was applied to these data. Results The majority of these caregivers were white women with an average of 55 years who cared for spouses. Three themes emerged from these data: (1) being worried, (2) running on empty, and (3) losing self. Discussion Caregivers worried about themselves and their care recipient, sharing feelings of being just “plain tired.” The caregivers felt that their lives were lost to giving care. They described in detail the emotional strain that they felt, as they took on new roles in caring for the person with stroke. Conclusion This study informs nurses about new family caregivers’ emotional strain, or incongruence in Friedemann's terms, from their viewpoint and provides direction for supportive education interactions.

Purpose The study purposes were to assess the efficacy of a caregiver problem‐solving intervention (CPSI) on stroke caregiver physical and psychosocial adaptation compared with a wait‐list control (WLC) treatment, and to assess the mediation effects of coping on outcomes. Methods A stress and coping model guided the study design. Outcomes were depression, anxiety, preparedness, life changes, and family functioning. CPSI started during acute rehabilitation and continued 3 months postdischarge. Data were collected at baseline (T1), postintervention (T2), and 6 (T3) and 12 months postdischarge (T4). Results Of 255 caregivers, 75% were depressed at baseline. Repeated measures ANOVA of study completers (n = 121) indicated improved T2 depression, life change, and health (ps < .04) favoring the CPSI group. Improvements faded by 6 months. Although no group differences in outcomes were found in the intention‐to‐treat analysis, growth curve modeling indicated a difference in depression rate of change, favoring the CPSI (p = .04). Perceived health, threat appraisal and rational problem‐solving were significant mediators (ps < .05). Conclusions Findings provide direction for future interventions to promote and sustain healthy caregiver adaptation.

Background The Nurse Family Partnership programme was developed in the USA where it is made available to pregnant young mothers in some socially deprived geographic areas. The related Family Nurse Partnership programme was introduced in England by the Department of Health in 2006 with the aim of improving outcomes for the health, wellbeing and social circumstances of young first-time mothers and their children. Methods / design This multi-centre individually randomised controlled trial will recruit 1600 participants from 18 Primary Care Trusts in England, United Kingdom. The trial will evaluate the effectiveness of Family Nurse Partnership programme and usual care versus usual care for nulliparous pregnant women aged 19 or under, recruited by 24 weeks gestation and followed until the child’s second birthday. Data will be collected from participants at baseline, 34-36 weeks gestation, 6, 12, 18 and 24 months following birth. Routine clinical data will be collected from maternity, primary care and hospital episodes statistics. Four primary outcomes are to be reported from the trial: birth weight; prenatal tobacco use; child emergency attendances and/or admissions within two years of birth; second pregnancy within two years of first birth. Discussion This trial will evaluate the effectiveness and cost effectiveness of the Family Nurse Partnership in England. The findings will provide evidence on pregnancy and early childhood programme outcomes for policy makers, health professionals and potential recipients in three domains (pregnancy and birth, child health and development, and parental life course and self-sufficiency) up to the child’s second birthday. Trial registration Trial registration number: ISRCTN 23019866

To provide preliminary data on a diffusion of psychosocial benefit to women diagnosed with breast cancer when only their partners receive a psychoeducational intervention focused on the breast cancer experience. Single-group, pretest/post-test pilot study; participants served as their own controls. Communities in the Pacific Northwest region of the United States. 9 women with a first diagnosis of breast cancer within the previous six months whose partners received the Helping Her Heal intervention. Data were collected from women pre- and postintervention via standardized questionnaires with established reliability and validity. Confidential exit interviews were conducted after postintervention data were returned. State anxiety (State-Trait Anxiety Inventory Form Y [STAI-Y]), depression (Center for Epidemiologic Studies-Depression scale [CES-D]), and marital quality (Dyadic Adjustment Scale [DAS]; Mutuality and Interpersonal Sensitivity scale). Wilcoxon signed-rank tests showed significant improvements on the CES-D (p = 0.01), STAI-Y (p = 0.01), and DAS affectional expression subscale (p = 0.03) in women from pre- to postintervention. Review of exit interview transcripts indicated that women generally were positive about the impact of the program and viewed their partners' gains in communication skills as the greatest benefit of participating. This study offers preliminary support for a diffusion of psychosocial benefit to women with breast cancer when a psychoeducational intervention is delivered to their partners. Diffusion of benefit should be examined in a large, randomized, clinical trial to provide evidence for focusing some clinical efforts on partners alone, rather than adding to diagnosed women's burden of multiple clinical encounters.

BACKGROUND Families are rarely included in clinical care despite research showing that family involvement has a positive effect on individuals with schizophrenia by reducing relapse, improving work functioning, and social adjustment. OBJECTIVES The VA QUERI study, EQUIP (Enhancing QUality of care In Psychosis), implemented family services for this population. DESIGN At two VA medical centers, veterans with schizophrenia and their clinicians were interviewed separately at baseline and 15 months. A family intervention was implemented, and a process evaluation of the implementation was conducted. PARTICIPANTS Veterans with schizophrenia (n = 173) and their clinicians (n = 29). INTERVENTION Consent to contact family was obtained, mailers to engage families were sent, families were prioritized as high need for family services, and staff volunteers were trained in a brief three-session family intervention. MAIN RESULTS Of those enrolled, 100 provided consent for family involvement. Seventy-three of the 100 were sent a mailer to engage them in care; none became involved. Clinicians were provided assessment data on their patients and notified of 50 patients needing family services. Of those 50, 6 families were already involved, 34 were never contacted, and 10 were contacted; 7 new families became involved in care. No families were referred to the family psychoeducational program. CONCLUSIONS Uptake of the family intervention failed due to barriers from all stakeholders. Families did not respond to the mailer, patients were concerned about privacy and burdening family, clinicians had misperceptions of family-patient contact, and organizations did not free up time or offer incentives to provide the service. If a full partnership with patients and families is to be achieved, these barriers will need to be addressed, and a family-friendly environment will need to be supported by clinicians and their organizations. Applicability to family involvement in other disorders is discussed.

Background We have developed a Family Integrated Care (FIC) model for use in a neonatal intensive care unit (NICU) where parents provide most of the care for their infant, while nurses teach and counsel parents. The objective of this pilot prospective cohort analytic study was to explore the feasibility, safety, and potential outcomes of implementing this model in a Canadian NICU. Methods Infants born ≤35 weeks gestation, receiving continuous positive airway pressure or less respiratory support, with a primary caregiver willing and able to spend ≥8 hours a day with their infant were eligible. Families attended daily education sessions and were mentored at the bedside by nurses. The primary outcome was weight gain, as measured by change in z-score for weight 21 days after enrolment. For each enrolled infant, we identified two matched controls from the previous year’s clinical database. Differences in weight gain between the two groups were analyzed using a linear mixed effects multivariable regression model. We also measured parental stress levels using the Parental Stress Survey: NICU, and interviewed parents and nurses regarding their experiences with FIC. Results This study included 42 mothers and their infants. Of the enrolled infants, matched control data were available for 31 who completed the study. The rate of change in weight gain was significantly higher in FIC infants compared with control infants (p < 0.05). There was also a significant increase in the incidence of breastfeeding at discharge (82.1 vs. 45.5%, p < 0.05). The mean Parental Stress Survey: NICU score for FIC mothers was 3.06 ± 0.12 at enrolment, which decreased significantly to 2.30 ± 0.13 at discharge (p < 0.05). Feedback from the parents and nurses indicated that FIC was feasible and appropriately implemented. Conclusions This study suggests that the FIC model is feasible and safe in a Canadian healthcare setting and results in improved weight gain among preterm infants. In addition, this innovation has the potential to improve other short and long-term infant and family outcomes. A multi-centre randomized controlled trial is needed to further evaluate the efficacy of FIC in the Canadian context.

Background and Objectives: One of the challenges of modern healthcare systems, in terms of economic and organizational sustainability and the impact on patients’ quality of life, is the progressive increase in chronicity and care complexity. In this scenario, hospital–community integration models represent possible strategies to ensure the continuity of care, reduce readmission rates, and improve clinical outcomes. This study aims to map integrated care models for patients with chronic diseases, with active involvement of the family and community nurse, describing their functions and associated clinical, organizational, and economic outcomes, as well as barriers and facilitators to their implementation. Materials and Methods: The review was conducted using the JBI methodology and the PRISMA-ScR protocol and identified 26 studies with a publication range from 2000 to 2025. Results: The emerging results highlight the use of integrated and personalized organizational models in the post-discharge phases, with a leading role for the family and community nurse in the assessment, planning, and coordination of various steps. Conclusions: The interventions are associated with an increase in patient and caregiver satisfaction, a reduction in outcomes such as the rehospitalization rate, and greater continuity of care.

Neonatal intensive care unit (NICU) discharge readiness is defined as the masterful attainment of technical skills and knowledge, emotional comfort, and confidence with infant care by the primary caregivers at the time of discharge. NICU discharge preparation is the process of facilitating comfort and confidence as well as the acquisition of knowledge and skills to successfully make the transition from the NICU to home. In this paper, we first review the literature about discharge readiness as it relates to the NICU population. Understanding that discharge readiness is achieved, in part, through successful discharge preparation, we then outline an approach to NICU discharge preparation.

The Family Nurse Partnership (FNP) is an intensive and structured person-centred home-visiting programme delivered by specially trained nurses, who offer support services to first-time young mothers. The COVID-19 pandemic prompted the quick adoption of telehealth within the FNP, as healthcare services moved rapidly to implement remote delivery systems in line with infection control measures. The aim of this study was 1) to understand the features of telehealth employed to deliver the FNP programme during COVID-19 in Scotland; 2) to examine how FNP nurses and clients responded to the delivery of FNP through telehealth; 3) to evaluate the challenges of delivering the FNP through telehealth during COVID-19 and its implications for future delivery of the programme. The study employed a mixed-methods parallel design, where qualitative (one-to-one interviews and focus groups) and quantitative (survey) data were collected and analysed concurrently. Thirty-one family nurses took part in the focus groups and one-to-one interviews and a further 90 responded to the online survey. Fifteen FNP clients participated in one-to-one interviews. Interview data were analysed using thematic analysis and survey data were analysed by descriptive analysis. Family nurses combined both home visiting and remote delivery such as phone calls, SMS text messaging, emails, video calls to deliver the programme. Family nurses felt well equipped and supported to conduct their work remotely. Clients, particularly those who became isolated during COVID-19, overwhelmingly acknowledged this support and felt their family nurses provided stability, advice and care. However, both family nurses and clients found the rapid move to remote delivery challenging, because it affected both recruitment of clients with complex vulnerabilities to the programme and therapeutic relationship building. Nevertheless, 42% of family nurse respondents in the survey indicated that they would prefer mixed-mode delivery of face-to-face and telehealth as part of future FNP programme delivery. Despite the challenges of delivering the programme remotely during COVID-19, telehealth has the potential to play a valuable role in post COVID-19 FNP programme delivery. A hybrid delivery approach could be appropriate in certain instances, for example clients not deemed to have complex vulnerabilities or those living in remote locations. Future studies could robustly examine the impact of the quality of modes of FNP delivery, for instance home visiting, telehealth and hybrid delivery and how these influence outcomes across different client groups. An economic evaluation of the value for money of different modes of delivery could also be insightful for decision makers.

Nursing is characterised as a profession that provides holistic, person-centred care. Due to the condition of the critically ill, a family-centred care model is more applicable in this context. Furthermore, families are at risk of emotional and psychological distress, as a result of the admission of their relative to intensive care. The families’ experiences of their interactions in intensive care have the potential to enhance or minimise this risk. This paper presents a subset of findings from a broader study exploring families of critically ill patients’ experiences of their interactions with staff, their environment, the patient and other families, when their relative is admitted to an Australian intensive care unit. By developing an understanding of their experience, nurses are able to implement interventions to minimise the families’ distress, while providing more holistic, person- and family-centred care. The study was a qualitative enquiry that adopted the grounded theory approach for data collection and analysis. In-depth interviews with family members occurred between 2009 and 2011, allowing the thoughts on interactions experienced by those families, to be explored. Data were analysed thematically. Twelve family members of 11 patients participated in this study. This study was undertaken in a mixed intensive care unit of a large metropolitan hospital in Australia. Interactions experienced by families of the critically ill primarily revolved around seeking information and becoming informed. Further examination of the interviews suggested that staff interacted in supportive ways due to their communication and interpersonal skills. However, families also experienced unsupportive interactions as a result of poor communication. Facilitating communication and interacting in supportive ways should help alleviate the anxiety and distress experienced by families of the critically ill in the intensive care unit.