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Background: Informal caregiving by family members is the most common way of caring for sick people at home. However, the number of care arrangements, in which both formal (nurses) and informal (family members) caregivers are involved, is considerable and increasing. Despite implicit assumptions in research that the involvement of nurses in home care arrangements is inherently beneficial, there is evidence that their involvement may have a destabilising effect., Aims: The purpose of this study was to investigate the relationship between nurses and family caregivers and its impact on the actual care that is provided., Method: Eighty-eight interviews with family caregivers (n = 57) and nurses (n = 31) were conducted in Germany and analysed according to the Grounded Theory methodology., Findings: The relationship between formal and informal care is an encounter of two quite different perspectives that is focused on a negotiation process about caregiving work and the helpfulness of the actions taken and the interventions used. For family caregivers, it is determined by the goal of facilitating work and care for their sick family member. The nurses' work is characterised by a process of shaping different realities in different homes. The results reveal the processes that lead to the involvement of nurses into home care arrangements and offer a deeper understanding of the negotiation processes between formal and informal caregivers., Conclusions: To provide sufficient support in home care, nurses need the ability to engage in negotiation processes that take the whole home care arrangement into account. Developmental work is needed to design services that are helpful for family caregivers., (© 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.)

Prevalence of mental health problems among adolescents varies from 10 to 30%. Therefore, mental health promotion in school has risen as a very important developing area in public health services. The need is international. Despite the large number of projects and recommendations on the promotion of schoolchildren's mental health, the literature does not offer a comprehensive theoretical description of what mental health work with people of this particular age really is as a whole. The theory can be constructed by combining and comparing the viewpoints of the different parties--the employees, the schoolchildren and their families--as well as previous knowledge of the subject. The purpose of this research was to produce a description of the concepts used by employees when addressing the subject of promoting mental health in the upper level of comprehensive schools (grades 7-9). The description has been produced by analysing interviews with nine people who work with schoolchildren, as well as workgroup memos related to the development work. The respondents work in the fields of primary healthcare, specialised healthcare, the education authority and social services. The analysis was conducted by applying the grounded theory method. The research target was a Finnish upper-level comprehensive school with 446 pupils. Four key concepts were found: The concept of a school environment comprises the physical and social conditions in the school, the curricula and other instructions. Human resources comprise representatives of various organisations, their competencies and time-consumption opportunities. The schoolchildren and their families and also their friends are key operators and partners. The concept of work to promote mental health is related to enhancing the school's conditions, recognising problems and offering help, co-operation and joint agreement. The produced description clarifies the overall picture of mental health work in schools and facilitates the finding of key development areas., (© 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.)

Objective: The aim of the study was to describe the experiences of different types of domestic violence among adolescents and associations between the family background and different types of domestic violence., Methods: The survey included 1393 ninth-graders from one Finnish municipality., Results: Domestic violence is fairly common in the lives of adolescents. Sixty-seven percent of respondents had experienced parental symbolic aggression, 55% mild violence and 9% severe violence during their childhood. Twelve percent of adolescents had witnessed parent-to-parent violence. Witnessing domestic violence and exposure to parental violence is associated with a number of adolescents' background factors such as self-perceived health, satisfaction with life, family relationships, parenting practice, school bullying and sexual activity., Conclusions: The findings stress the relevance of corporal punishment and witnessing domestic violence as a risk factor for more severe domestic violence and sexual abuse. Different types of domestic violence have a major effect on adolescent well-being and risk behaviours. To break the negative cycle, nurses and other professionals working with adolescents in different settings should pay attention to all forms of violence, including the milder ones., (© 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.)

Background: In the acute trauma caused by intimate partner violence (IPV), the emergency department (ED) and its staff are often the first contact for women. The failure to intervene in IPV situations may contribute to further injury and health problems for women, as well as to frequent visits to the ED., Aims: The aims of this study is to describe the history of IPV with its health consequences for women when seeking care for their acute injuries and what kinds of care experiences had the women had when visiting EDs., Methods: Data were collected via questionnaires from 35 women and after that seven semi-structured interviews were conducted. The data were analyzed using quantitative and qualitative methods., Results: Among the women the lifetime prevalence of physical IPV was 94%. Ninety-seven percent of past and 56% of acute cases of physical violence were accompanied by psychological violence. The surveyed women highlighted individual needs for care, including appropriate medical care of injuries, and psychological and tangible support. The women worried about their children and partners and regarded supporting the whole family as important., Conclusion: There is a need for ED professionals to develop family-oriented services, and a need for further training and research on how to deal with women exposed to IPV., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Intimate partner violence (IPV) is seen as a serious health risk factor for women with significant acute and long-term health consequences and it affects women from all ethnic and socioeconomic groups. Knowledge of these consequences of IPV may help emergency department (ED) professionals to identify these women and provide them with appropriate care, including information on a variety of community services, and refer those women to such services if necessary. The study aimed to describe the frequency of ED visits by women exposed to physical intimate partner violence as estimated by ED professionals (nurses, practical nurses, emergency medical technicians) and identification of acute IPV. In this study 'partner' is defined as a woman's husband, former husband, current or former cohabitant or partner. This design was used as part of a larger, descriptive, cross-sectional multi-centre and multi-method study. Data were collected from 28 EDs in 13 Finnish hospital districts. Altogether 488 questionnaires were returned, which yielded a response rate of 51%. The data were analysed using descriptive statistics and quantitative content analysis. Findings showed that 48% (n = 231) of the ED professionals reported that they encountered women in IPV relationships at least once a month. Over one-fifth of the ED professionals reported having repeatedly encountered the same women visiting the ED for IPV related injuries. Over half of the participants reported having problems 'often' or 'now and then' when identifying women exposed to IPV. Those with training on IPV estimated that they had identified women exposed to IPV more often. To conclude, the research suggests that improvement of identification of acute IPV requires that training be arranged and jointly agreed written procedures for handling IPV be introduced., (© 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.)

The authors describe a Web-based continuing education course focusing on patient counseling in an emergency department. Course materials were developed based on data collected from the department's patients and their family members and on earlier findings on counseling. Web-based education is an appropriate method for continuing education in a specific hospital department. This puts special demands for nurse managers in arranging, designing, and implementing the education together with educators.

Aim: This paper is a report of a study of experiences of domestic violence and coping among ninth-grade (14-17 years old) adolescents., Background: Domestic violence is commonplace and adolescents are involved in it either as witnesses or victims. Research has shown that different degrees of domestic violence play a major role in adolescent well-being and coping., Method: A survey of ninth graders in one municipality in Finland was conducted in 2007. A total of 1393 adolescents participated, giving a 78% response rate. The survey included two validated scales, the Violence Scale and the Adolescent Coping Scale. Logistic regression analysis was performed to determine coping among adolescents with and without experience of domestic violence., Results: Sixty-seven per cent of adolescents had experienced parental symbolic aggression, 55% mild violence and 9% serious violence. The multivariate logistic regression model showed that experiences of violence were associated with deterioration in self-rated health, life satisfaction, adolescent giving in when in a conflict situation, approval of corporal punishment and coping by seeking to belong and self-blame. Those with experience of domestic violence did not seek professional help., Conclusion: Adolescents experiencing domestic violence do not seek help and care providers should therefore take active measures to help them. These adolescents reported that they were satisfied with life, which makes it difficult to identify their need for help. Resources should be developed to identify and help these adolescents.

Despite the fact that father-child involvement has extensive effects on the health and well-being of the family, there is a paucity of research on fathers' presence in health care research. The design and development of an instrument for assessing the characteristics of fathers' availability and engagement with their preschool-aged children in Finland is presented. Data collection was undertaken in two separate periods involving 263 and 821 fathers. Results indicate that the father-child instrument (FCI) is ready for use in research seeking to assess fathers' availability and engagement with their preschoolers. Further research is nonetheless required to assess the potential for a more sensitive interaction and for the generalization of the FCI.

The purpose of this study was to describe women's perceptions of their violent behavior in a heterosexual partnership. The study followed the traditions of Husserlian descriptive phenomenology and the philosophy of existential phenomenology. Twenty-four volunteer Finnish women, aged 19 to 58 years, with a history of different manifestations of intimate partner violence (IPV) participated in open-ended interviews. The data were analyzed by the method developed by Colaizzi. The findings revealed that some of the women who opposed all violence on ethical grounds did not label their behavior as violent; some others minimized or justified their violent behavior. The findings offer professional insight into women's violent behavior and call for a readjustment in approaches to work in the area. Prevention and early identification of IPV require knowledge of the various manifestations and individual meanings of violence. Helping methods should provide women with the opportunity to talk about their abusive behavior and to confront and address their feelings of guilt, disappointment, and shame.

Understanding the dynamics of contemporary, postmodern families and how these relate to health is critically important to nurses and other health care providers throughout the world. Much can be learned by studying not only one's own culture but also other countries. Thus, the purpose of this study was to compare family dynamics of families in the United States, Finland and Iceland. To date relatively little has been published related to families in these Nordic countries. Six family dimensions in Barnhill's Family Health Cycle served as the theoretical framework. Adult respondents (n = 567) purposively selected from varied community groups, completed the Family Dynamics Measure II (FDM II) and a sociodemographic questionnaire. Main findings from the three countries were positive family dynamics, with mutuality contributing the strongest factor to partially confirm the theoretical propositions in Barnhill's Family Health Cycle. Respondents from all countries reported (1) clear communication and flexibility that contribute to mutuality; (2) younger age of respondents and increased education that were associated with more positive family dynamics; and (3) larger families associated with more negative dynamics. Mixed reports occurred according to gender, with Nordic men tending to perceive some negative dimensions. Marriage was important for more positive family dynamics only in the United States. Families in the United States and in Iceland had in common more negative family dynamics during illnesses. Problems and changes affected mostly families in the United States. In general, families in Finland and Iceland had greater strengths than in the United States. This benchmark study offers information for health practitioners to assist families, as well as contribute to the improvement of family social policies, especially in the United States.

The aim of this study was to investigate the negative impact of illness on health-related quality of life (HRQoL) of people with chronic obstructive pulmonary disease (COPD) or chronic bronchitis. The study population consisted of the participants (N = 8028) of a health examination survey conducted in Finland. The sample in the present substudy was composed of 4718 participants who had complete information about spirometry. Variables age, gender, body mass index (BMI), illnesses, smoking in lifetime, education, FEV1% and incomes were entered in blockwise bivariate regression analysis to examine the relationships between capability for day-to-day activities (physical, psychological and social functioning) of those with COPD. Also, COPD (n = 277) and chronic bronchitis (n = 630) were compared with the general population (n = 3817). Study results showed that women with COPD had worse HRQoL than men, regarding the activities in daily living (ADL; odds ratio [OR] 2.63, 95% confidence interval [Cl] 1.15-5.99), instrumental activities of daily living (IADL; OR 4.23, 95% Cl 1.92-9.29) and exercise (OR 2.66, 95% Cl 1.21-5.84). Compared with the general population, people with chronic bronchitis were associated with poor ADL, IADL and exercise, (OR 1.58, 95% Cl 1.32- 1.92). Those with COPD, had difficulties managing in ADL (OR 4.02, 95% Cl 2.98-5.44), IADL (OR 3.27, 95% Cl 2.43-4.39), exercise (OR 3.35, 95% Cl 2.47 to 4.53). In this representative population-based sample, COPD and chronic bronchitis mean a significantly poor capability in physical functioning. People with chronic bronchitis experienced their daily life to be worse compared with the general population. Reductions in physical functioning for women and especially with COPD were also noteworthy.

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., (© 2009 The Authors. Journal compilation © 2009 Nordic College of Caring Science.)

Aim: To describe patients' experiences of counselling, defined as information giving and advice by nursing staff, in the emergency department. A particular focus was on the waiting period and on the importance of family participation in counselling., Background: Counselling is a widely studied topic in nursing. Too little is known about counselling in emergency departments and especially about participation of family members and suitability of counselling for the patient's life situation., Design: Descriptive quantitative study., Methods: Data were collected by questionnaires from patients (n = 107) visiting a hospital emergency department. The data were subjected to statistical analysis., Results: Forty-two per cent of patients arrived at the emergency department with a family member: spouse or cohabiting partner, mother, father or daughter. Patients were fairly satisfied with the counselling. The presence of a family member was important to the majority of patients (75%). About half of the patients wanted information concerning their illness, condition and treatment to be given to their family members. Those visiting the department with a family member were more satisfied with counselling and felt that it promoted their participation in care., Conclusion: It is to encourage patients' family members to participate in counselling situations in emergency departments. However, the type of information passed on to family members should be carefully discussed and prepared., Relevance to Clinical Practice: Patients' family members seem to be important partners in counselling situations. The presence of family members supports patients in the emergency department during the waiting period and helps them orientate in their situation. When family members are present, issues which patients wish to discuss should be carefully planned. Family presence should be encouraged in emergency departments.

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.

Violence against women has been extensively studied in various disciplines, whereas less attention has been paid to the experiences of men. Even the violent behavior of men in their intimate relationships has been mostly studied as experienced by women. This study follows Husserlian descriptive phenomenology. Twenty open-ended interviews were conducted with 10 Finnish men with a history of intimate partner violence (IPV). The data were analyzed by the method developed by Colaizzi. Findings suggested that men considered communication and dynamics of the relationship important. Fundamentally, these abusive men had a need to be respected as men, and they sought to experience human dignity. It is necessary to readjust the framework on interpersonal violence, listen to the voice of men, and develop prevention, early identification, and supportive intervention strategies for men, couples, and families. Research on IPV should be expanded to include the experiences of both genders.

This paper deals with research on cooperation with the school nurse described by sixth graders. The data were collected via six focus group interviews in 2003-2004. Twenty-two sixth graders (aged 11-12 years) participated in the research. The data were analysed by the constant comparison method based on grounded theory. The analysis yielded a number of concepts that describe the basis of the cooperation: the trusted expertise of the school nurse, informative interaction with the family and knowing the family situation. The cooperation consisted of supporting the pupil's growth and development, need for individual counselling and supporting coping at school. The cooperation was characterized by an open atmosphere and friendliness, a low level of reciprocity, the school nurse's stereotyped activities and respect for the pupil's privacy. Pupils' experiences and perspectives can be used to develop more holistic strategies for the school health service.

Aim and Objectives: The purpose of this study was to describe family dynamics in families with severe chronic obstructive pulmonary disease (COPD) on the basis of Barnhill's framework for healthy family systems. The sample consisted of 35 severe COPD patients and 30 family members at Tampere University Hospital, Finland or in the neighbouring regions., Background: Chronic obstructive pulmonary disease is a public health problem worldwide. It is a slowly progressive airway disease, producing a decline in lung function which is not fully reversible., Design: The sample included the families of patients without oxygen therapy and the families of patients who had long-term oxygen therapy (LTOT). The data were collected using the Family Dynamics Measure 2 (FDM2) and the Family Dynamics Questionnaire (FDQ)., Method: A quantitative research method was employed in the study. Frequency and percentage distributions, as well as cross-tabulations, were used to describe the data. Mean values and standard deviations were calculated for the sum variables of six dimensions of the FDM2., Results: In the dimensions of individuation, mutuality and flexibility, dynamics in the families of patients with LTOT was significantly better than of the patients without oxygen therapy. Especially in the dimension of mutuality, the families of LTOT patients functioned very well, while in the dimensions of communication and roles, family dynamics in these families was notably worse, although still good., Conclusion: Poor self-identity--enmeshment, isolation from others and lack of flexibility to varying conditions--in families with severe COPD can weaken the ability of the families to manage in everyday life., Relevance to Clinical Practice: Families need family nursing to adapt to alterations occurring when a family member has severe COPD. Nurses can give support and help for these families for their roles of patient and caregiver, as well as opportunities to speak with someone about their situation.

The aim of this study is to describe the experiences of people with severe chronic obstructive pulmonary disease (COPD) in their everyday lives by using the World Health Organization's International Classification of Functioning, Disability, and Health. Five people with COPD and four spouses participated in the study. The data were collected by thematic personal interviews and were analyzed by deductive content analysis. The findings describe the impairment of body function of people with COPD, they provide knowledge of those factors that promote the well-being of people with COPD, how they cope on a daily basis, and the importance of their spouse. Knowledge about COPD for all health-care professionals is a precondition to ensure that people receive the help they need. People with COPD found it important to have a care relationship with their own treatment unit. The findings of the present study showed that peer support was an important matter.

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 family's contribution to family health, the better the family's 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 member's 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 member's age and knowledge of health issues also need to be further considered and studied as the basis of care.

The purpose of this study was to explore changes in family health associated with child's chronic illness and hospitalization. The aim was to answer the following questions: (i) What kind of changes do families experience when a child in the family is afflicted by a chronic illness; and (ii) What kind of changes do families experience when their child is admitted to hospital? The data were collected in 2002 in interviews with 29 such families whose children were receiving treatment or who had previously received treatment on the paediatric wards of two hospitals in Finland. Data were collected until reaching theoretical saturation, in which no additional data are found. Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Family health was formed out of two different dimensions: the constituent systems and the resources of family health. The constituent systems describe the impact of the child's chronic illness and period of hospitalization at the level of both individual family members and the family as a whole. These systems were described by five categories: (i) ill child at the centre of family attention, (ii) siblings in a minor role, (iii) the child's illness governs parental well-being, (iv) the roller coaster of the couple relationship and (v) the whole family is ill. The resources promoting and maintaining family health were divided into six different categories: (i) creative and maintaining mental images, (ii) active involvement, (iii) internal coping means, (iv) reinforcement of coping means, (v) awareness and change of values and (vi) social network shares emotional burden and responsibility for care. The results of the study show that family health is highly vulnerable when a child has to be admitted to hospital because of a chronic condition. They should help nursing staff gain a clearer picture of the depth and diversity of family health and support the resources that promote family health. Future research should study the methods of family nursing used in the care of families with children with chronic conditions.

The purpose of this quality improvement project was to determine patients' perceptions of the emotional support and information provided to their family members by nurses in a day surgery setting. The project was conducted in a day surgery unit of a hospital in western Finland. Data were collected from 60 participants using a questionnaire designed specifically for the project. The results showed that half of the patients appreciated the presence of their family members during hospital care. The emotional support provided to family members was rated as moderate, and more than 50% of the patients believed their family members were adequately informed. The results were used to help develop tools for patient and family member education.

Aims and Objectives: The study set out to describe women's experiences of intimate partner violence, the consequences of such violence, the help they received and women's experiences of their survival., Background: Social and health professionals do not have sufficient ability to identify and help families who suffer from intimate partner violence. Methods for identifying and treating partner violence not have been developed adequately., Method: The study was conducted in Finland by loosely formulated open-ended interviews with seven battered women. The data were analysed by inductive qualitative content analysis., Findings: Women had past experience of maltreatment and a distressing climate at their parental home. Women experienced both themselves and their spouse as having weak identities; their ideals, patterns of marriage and sexuality were different. Violence occurred in situations of disagreement. Women tried to strike a balance between independence and dependence in the relationship. The different forms of couple violence were interlinked. The women sought help when their health and social relationships got worse. An awareness of the problem, taking action, counselling and social relationships helped them survive. Religiousness was a factor that involved commitment to the couple relationship, made religious demands on women and promoted the recovery of integrity., Conclusions: Intimate partner violence was associated with the family model, childhood experience of maltreatment, the partners' weak identity and conflicts between individualism and familism. Social and healthcare professionals need competence in early intervention and skills to discuss moral principles, sexuality, and violence in a way that is free of prejudice and condemning attitudes. Spiritual approaches in the context of interventions should be taken into consideration., Relevance to Clinical Practice: In a clinical context, nurses should be aware of the symptoms of violence, and they should have skills in dealing with intimate moral and spiritual issues.

Aims and Objectives: This study set out to explore, from the family's point of view, ways in which nursing staff can promote family health during the child's hospital stay., Background: Having a child in hospital is a major source of stress and anxiety for the whole family. Earlier studies have described parental coping strategies, ways to strengthen those strategies and to support parental participation in child care, but no one has studied the promotion of family health during the child's hospitalization from the family's point of view., Design: Interviews were conducted in 2002 with 29 families who had a child with a chronic illness which were receiving or had received treatment on the paediatric wards of two Finnish hospitals., Methods: Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Data collection and analysis phases proceeded simultaneously., Results: Five domains were distinguished in the promotion of family health: (1) reinforcing parenthood, (2) looking after the child's welfare, (3) sharing the emotional burden, (4) supporting everyday coping and (5) creating a confidential care relationship., Conclusions: The results strengthen the knowledge base of family nursing by showing how nursing staff can promote family health during the child's hospital stay., Relevance to Clinical Practice: The results have a number of practical applications for nursing, both for clinical practice and research. The results can be used in paediatric hospital wards caring for chronically ill children and their families. The five domains of family health promotion described here should be tested in other paediatric wards and in other geographical locations.

Aim: This paper reports a study whose aim was to describe how nurses in a paediatric unit promote the health of families of children with chronic conditions during the children's hospitalization., Background: It is stressful for a family when a child has a chronic condition and hospitalized. Nurses have the opportunity to promote family health while a child is hospitalized, and previous studies contain a wealth of recommendations on how this should be done. However, there is little research evidence about family care and how nurses promote the health of a family with a chronically ill child., Methods: Forty nurses who worked in two paediatric units providing care for children with chronic conditions and their families participated in the study. Data were collected in two Finnish hospitals in 2002 using group interviews, and nursing actions were observed in both units for a period of 84 hours. Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Data were collected until theoretical saturation was reached., Findings: Family care was based on three distinctive strategies. Nurses used a systematic, selective or situation-specific strategy while promoting family health during a child's hospitalization., Conclusions: The findings indicate that nurses used different strategies while promoting family health during a child's hospitalization. The systematic way of working with families identified in the study seems a useful strategy. All three strategies of family nursing described here should be tested in other paediatric wards and in other geographical locations.

Background: Heart disease is a severe long-term illness, which often requires lifestyle changes and self-care and affects the life of the whole family. Perceived family health is highly complex. It combines people's values and everyday experiences, such as knowledge about their own health, what they do to promote their health, how their life progresses, and how they feel physically and emotionally., Aim: The aim of this paper is to report a study to describe the perceived health of families of patients with heart disease and to ascertain factors related to family health., Methods: Data were collected by questionnaire with a convenience sample of 161 family members of patients receiving treatment on two medical wards of a university hospital in southern Finland. Data were analysed using means and medians and tested by parametric and non-parametric tests. A stepwise regression analysis was also used., Results: The most important predictors of family health were family structural factors, effect of illness symptoms on daily life, and family relationships. The strongest predictor was family structural factors. It was found that the better the family structure and relationships, the better the family health. Similarly, the greater the effect of the illness on the patient's daily life, the worse the family health., Conclusion: The findings suggest that supporting family functioning in the families of people with heart disease is an important challenge for family nursing.

Background: On the basis of earlier research, caregivers' actions when interacting with clients should be developed. However, nursing research has focused little attention on the interaction between caregivers and families expecting a fetally impaired child., Aim: The study aimed at generating a practical family nursing theory of caregivers' interaction with families expecting a malformed child., Methods: A grounded theory study was undertaken at Tampere University Hospital in Finland in 1999-2000. Data consisted of semi-structured interviews with 22 (n=22) nurses and doctors. The data were analysed using the constant comparative method., Results: The interaction process starts when a caregiver informs the parents of the fetal impairment. The process is influenced by caregivers' attitude towards issues related to the family's life situation. Caregivers' views of their job, and of human coping and cultural attitudes towards these issues are also of importance. These factors account for their goals in the interaction, which, in turn, underlie their actions. When the caregiver's interpretation is that the family accepted the help provided, the outcome of the interaction is satisfaction with having been able to help. Correspondingly, in the case of an opposite interpretation, the caregiver experiences strain caused by inadequacy of the help he/she is providing. The core of interaction consists of two dimensions: gaining strength and losing strength in relation to impairment issues., Conclusions: Caregivers' views of helpful interaction were consistent with earlier research on the subject, but the findings of this study showed that more attention should be focused on the family as a whole. Furthermore, caregivers rarely criticized their own actions, thus their interaction skills should be upgraded by focusing on systematic self-assessment through training. Nursing research deepening our understanding of why interaction fails is warranted., Relevance to Clinical Practice: The study results can be used in the family nursing practice as tools in reinforcing the caregivers' ability to helpful interaction with families expecting a fetally impaired child. The results may enhance caregivers' systematic self-evaluation and conscious use of the self.

Background: The birth of a new family member always brings changes to family dynamics. The family has to adjust to a new situation and, although the time after childbirth is happy for most families, postnatal depression affects 10-15% of mothers annually., Aims and Objectives: The purpose of this study was to ascertain families' experiences of family dynamics when the mother suffers from postnatal depression., Design: Nine families (nine mothers, five fathers) where the mother had displayed symptoms of postnatal depression took part for the study., Methods: Data were collected through interviews with nine families where the mother had scored 13 or more on the Edinburgh Postnatal Depression Scale, completed 6-8 weeks after childbirth. Families were offered the opportunity to volunteer for the interview while taking part in a follow-up study of postnatal depression in Finland. Interviews were analysed using the principles of grounded theory., Results: The findings showed that there was great discrepancy between expectations and reality in the depressed mothers' families. Parents, especially mothers, strove for perfection, perceived the infant to tie them down and had high expectations of family life., Conclusions: Everyday family life and human relationships change, the depression and the parents' attitudes towards the infant manifest themselves in different ways, and support is of great importance., Relevance to Clinical Practice: Women, especially those expecting their first child need a great deal of information about mood changes after childbirth and the opportunity to discuss the changes brought about by the birth of a child.

Purpose: The purpose of this study was to ascertain family dynamics of Finnish patients with severe chronic obstructive pulmonary disease (COPD) on the basis of Barnhill's framework for healthy family functioning., Design and Method: This study used description and comparison and an interview-administered questionnaire and survey., Sample: Participants were patients with COPD and their family members (n = 65) living in the Tampere University Hospital catchment area. The sample consisted of families of home oxygen therapy patients (n = 36) and families of inpatients (n = 29). Families consisted of patients and their family members., Instruments: Data were collected from patients by interview-administered questionnaires and from family members by survey. The instrument used was the Family Dynamics Measure 2, operationalized and tested by the American Family Research Group., Results: Families of home oxygen therapy patients experienced significantly more mutuality (P =.03) and made decisions about their illness and life significantly more independently (P =.05) than families of inpatients. Families of home oxygen therapy patients handled change significantly more flexibly (P =.03) than families of inpatients., Discussion: For the most part, families of both patient groups functioned well, but overall family functioning was clearly better in families of home oxygen therapy patients. The sample included some dysfunctional and even severely dysfunctional families. The results of this study cannot be generalized beyond the study sample because of the small sample size, but they provide suggestions for developing the care of patients with COPD and their families.

The purpose of this study was to describe family dynamics of Finnish families in which there is abuse or neglect of a child in that family. One adult from 41 families with recognized child abuse/neglect completed the Family Dynamics Measure II (FDM II) consisting of six dimensions of family life, and answered questions about problems, changes and illnesses. Nurses and social workers in community health care and social agencies identified potential subjects in their agencies and collected data. Four of the six dimensions of the FDM II reached statistical significance (p =.05) with child age and number of children, education, marital status, and age of respondent. They are: Flexibility vs. rigidity, Stability vs. disorganization, Clear vs. distorted communication, and Role reciprocity vs. role conflict. FDM II is useful in identifying several of the less positive family dynamics dimensions in abuse:neglect families. Conclusions for clinical management cannot be drawn at this time.

Chronic illness in one family member influences all aspects of family life. Research has documented the positive contributions of social support in an unexpected and stressful event such as a family member's heart disease. The aim of the study was to describe in-hospital social support provided by nurses to families of heart patients and to identify factors related to social support. Data were collected using a mailed questionnaire to family members of heart patients (n = 161) receiving treatment on two medical wards of a university hospital in southern Finland. The results show that the family members were not very satisfied with the social support from nurses, because about 40% were dissatisfied with the concrete aid and affirmation they received and about 30% with emotional support. According to regression analysis the most important predictors of social support were family structure, patient's age, gender of family member and whether the patient had been hospitalized for cardiac symptoms. This report shows that supporting families of cardiac patients need development according to the family nursing practice.

The purpose of this study was to examine the relationships between adolescent subjective well-being (SWB) and family dynamics perceived by adolescents and their parents. A sample of 239 pupils (51% female) from seventh and ninth grades completed the Berne questionnaire of SWB (youth form), two subscales from an original Finnish SWB scale and the Family Dynamics Measure II, and one of their parents (n = 239) filled in the Family Dynamics Measure II. Results indicated that parents assessed family dynamics better than did their adolescent child. Furthermore, there was no association between family dynamics perceived by adolescents and family dynamics assessed by one of their parents or between the adolescent SWB and parental perception of family dynamics. Multiple stepwise regression analysis indicated that certain aspects of family dynamics perceived by adolescents were related to adolescent global satisfaction and ill-being. Specifically, adolescents' perception of high level of mutuality and stability in the family as well as male gender and lack of serious problems in family were predictors of adolescent global satisfaction. Furthermore, disorganization in the family and poor parental relationship perceived by adolescents, being female, serious problems and illness in family predicted a high level of adolescent global ill-being.

The purpose of this study was to develop a preliminary theoretical model of functioning of child maltreating families. Child maltreatment was defined as physical, psychological or sexual abuse or neglect caused by the child's primary caregivers. The aim was to generate knowledge needed in developing understanding and the care of these families. Data were collected using interviews with open-ended questions from child maltreating families (n = 20). Transcribed interviews were analysed by using grounded theory and its constant comparative method. The categories of family functioning included structural factors of the family, relationships between family members, relationships outside the family, family strengths, and risk factors and manifestations of maltreatment. The relationships that emerged between these categories included conflicts and negative circles of family life and the effects of child maltreatment on the family. Lack of resources for caring within the family emerged as the core category which described the phenomenon in general and was connected to all other categories of family functioning. The findings can be useful in developing the care of child maltreating families, in nursing education and in preventing child maltreatment.

Purpose: The article describes challenges related to the transfer of a family assessment instrument, the Assessment of Strategies in Families-Effectiveness (ASF-E), and its theoretical basis to another culture., Design: Instrument development encompassed translation and discussion of theoretical and cultural relevance of the items. Patients from two clinics in Tampere, Finland (N = 196) completed the ASF. Psychometric tests involved factor and reliability analysis., Results: The theoretical constructs of stability, growth, control and connectedness/spirituality were represented in the factor structure, and reliability ranged from .65 to .83., Discussion: There were cultural differences in the interpretation of certain items. Characteristics of Finnish culture with impact on instrument validity were homogeneity and family emphasis on conflict resolution. Insights contributed to further instrument development and broader understanding of culture.

Background: Earlier research has shown that the care of families expecting a malformed child should be intensified and that the topic is understudied., Aim: This study aimed at generating a practical nursing theory of interaction between caregivers and families expecting a malformed child, as experienced by families., Methods: A grounded theory study was undertaken at a university hospital, Finland. Data consisted of semi-structured interviews with 29 mothers and fathers, analysed using the constant comparative method., Findings: The interaction process starts with the confirmation of the diagnosis. It usually comes as a shock to the parents, and gives rise to questions about the nature of the malformation, family members' relationship with themselves, family relationships and relationships with people outside the family. These questions are crucial to the family's coping and form the core of interaction. Families' own coping strategies are either reinforced or undermined by caregivers' actions and are reflected in parents' expectations about caregivers, which in part account for their actions and experiences of interaction. The care system as an interactive environment is part of a process which results in the experiences of being helped or being left without help. The core of the interaction process comprises two dimensions: gaining strength and losing strength in relation to malformation issues., Conclusions: The findings of the study are consistent with earlier research and complement it by providing a detailed delineation of the interaction from the perspective of the family. They can be used to formulate recommendations for improving caregivers' interactive skills and awareness of the topic through training. The care system should be developed to ensure that families receive psychological support and that the family as a whole receives proper care. Consideration of the viewpoint of siblings is a challenge for further research.

Although nurse educators enthusiastically endorse visiting professors, cross-school collaboration, cross-cultural teaching, and international faculty exchange programs, no previous studies have documented students' perceptions of visiting faculty. An open-ended questionnaire was used to identify Finnish students' perceptions of a visiting Fulbright professor and how faculty and students can better prepare for educational exchanges. Four themes emerged from the content analysis of responses to the questionnaire: course content, teaching methods, the role of the teacher, and expectations and developmental challenges. Generally, students were satisfied with the course content and teaching methods. They indicated that it was important that the teacher was encouraging and positive and challenged them to speak up in class. Students commented that the visiting professor should perhaps have been more knowledgeable about and therefore able to make applications to Finnish culture, education, and the health care system. Others noted that it was helpful to learn about the American health care system and then to make applications to Finnish culture themselves. Overall, the findings of this project support continuation of visiting professors and continued research on methods of increasing visiting faculty program effectiveness., (Copyright 2003 Elsevier Inc. All rights reserved.)

In this paper Hanna Maijala, Eija Paavilainen and Päivi Astedt-Kurki examine the use of grounded theory from the perspective of data analysis. The paper reports on the findings of a Finnish study of interaction between caregivers and families expecting an impaired child. The objective of the study was to describe and explain the social processes between caregivers and families expecting an impaired child by identifying the central descriptive concepts, their interconnections, and the overall structure of the interaction process. The authors conclude that grounded theory is a diverse approach to studying interaction, and that the constant comparative method is a challenge to a researcher's perseverance and flexibility.

The purpose of this study was to determine how public health nurses in Finland defined child abuse and how they assessed their capability to identify child abuse in the family. Public health nurses described child abuse as consisting of physical and emotional abuse. They described physical abuse as consisting of two categories, direct physical abuse towards children and other acts causing children physical harm. Emotional abuse included neglect, teasing the child, frightening the child, rejecting the child in the family, and forcing the child to assume an adult role. The nurses divided the identification of child abuse into two categories: tools for identifying child abuse and markers indicating child abuse. The tools for identifying abuse included knowledge acquisition and interactive skills, intuition, and the capacity of the nurse to handle problematic situations. Public health nurses identified child abuse in the child's behavior and appearance and in family behaviors. Public health nurses seem to be aware of child abuse, but further research is needed if they need more-specific skills regarding how to apply their theoretical knowledge to nursing practice to provide nursing care for abused children and their families.

In this paper, Hanna Maijala, Päivi Åstedt-Kurki and Eija Paavilainen discuss ethically sensitive family nursing research. A study of the interaction between caregivers and families expecting a child with an abnormality is used as an example: 29 parents and 22 caregivers were interviewed. Complementary data were obtained from essays written by five parents. This sensitive subject required discretion, especially when the parents were first asked to participate in the study, and during subsequent interviews. From the perspective of the data analysis, it was essential to obtain the informants' personal experiences unaltered. The constant comparative method of grounded theory was used to analyse the data. In the study findings, special attention was paid to presenting the results truthfully, while safeguarding the informants' anonymity. In conclusion, the ethical questions related to the subject of the study are discussed from the point of view of both the participant and the researcher.

Postnatal depression in mothers is commonplace as it affects 10-15% of recent mothers. Postnatal depression is still an under-diagnosed illness and if unidentified, is often left untreated. If left untreated, the depression can have an adverse effect not only on the mother, but also on the child's development and on the well-being of the whole family. The aim of this survey was to investigate the prevalence of postnatal depressive symptoms among Finnish mothers and to ascertain the relationship with sociodemographic factors in mothers. A sample of 1000 families at 2 months postnatal was studied by mailing the Edinburgh Postnatal Depression Scale to mothers and a questionnaire on demographic characteristics to mothers and fathers. The response rate was 39%. The data were examined by means of frequency and percentage distributions. Connections were examined using Spearman correlation coefficient and analysis of variance. In all, 373 mothers and 314 fathers took part in the study. Fifty-five (13%) mothers had depressive symptoms. Results show that the number of pregnancies, deliveries or children, the mode of delivery or the mother's age were not associated with depressive symptoms. However, mothers who had depressive symptoms had fewer years of education, shorter duration of breast-feeding and were more dissatisfied with family life compared with mothers who exhibited no depressive symptomatology. The families of mothers with depressive symptoms had also experienced more problems and changes having a profound impact on the family compared with other mothers.

This article focuses on the introduction of team learning and shared knowledge creation using computer-based learning environments and teams as networks in the development of healthcare organizations. Using computer technology, care units can be considered learning teams and the hospital a network of those learning teams. Team learning requires that the healthcare workers' intellectual capital and personal competence be viewed as an important resource in developing the quality of action of the entire healthcare organization.

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.

Aim of the Study: The aim of this study was to establish whether paediatric nurses and doctors in a university hospital need supplementary training in the identification of child physical abuse and whether there is a need to develop health care education on child abuse issues., Background: Child physical abuse was defined as actions of a parent or a primary caregiver of a child under 18 years of age, which have caused physical injuries to the child., Methods: The sample consisted of paediatric staff (n=513) in a university hospital. Data were collected with a questionnaire, and the response rate was 62%. The data were analysed using statistical methods and quantitative content analysis., Findings: Sixty per cent of respondents needed supplementary training in the identification of child abuse. Those having experience in caring for abused children considered the identification most difficult (P < 0.001) and needed training more often (P < 0.005) than the others. The need for training was explained by stating that their basic education had not addressed child abuse issues, and by the complexity of the issue., Conclusions: The findings indicate that research-based knowledge of the identification and treatment of child abuse should be incorporated into health care education. Supplementary education should address the management of complex and sensitive issues with customers, legislation, division of labour and multiprofessional collaboration in which nurses and doctors have an important, family wellbeing promoting role.

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 child's or parent's 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 staff's 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.

In this paper, Hanna Maijala, Päivi Astedt-Kurki and Eija Paavilainen discuss ethically sensitive family nursing research. A study of the interaction between caregivers and families expecting a child with an abnormality is used as an example: 29 parents and 22 caregivers were interviewed. Complementary data were obtained from essays written by five parents. This sensitive subject required discretion, especially when the parents were first asked to participate in the study, and during subsequent interviews. From the perspective of the data analysis, it was essential to obtain the informants' personal experiences unaltered. The constant comparative method of grounded theory was used to analyse the data. In the study findings, special attention was paid to presenting the results truthfully, while safeguarding the informants' anonymity. In conclusion, the ethical questions related to the subject of the study are discussed from the point of view of both the participant and the researcher.