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Objectives To evaluate the effects of an advanced practice nurse (APN) in-home health consultation program (HCP) on quality of life, health indicators (falls, acute events), and healthcare utilization. Design Randomized clinical trial. Setting One urban ar

Aim. This paper reports a study to describe meanings that couples mutually assign to, and practices they develop, after the onset of cardiac disease and to understand the impact of the illness on the couples' relationships in everyday life. Background. Patients as well as partners are affected by the onset of cardiovascular disease. Social support within intimate relationships has been shown to be important for patient survival and well-being, and couples' coping strategies are pivotal for well-being and adjustment to the chronic condition in both patients with cardiovascular disease and their partners. Method. Twenty-four couples participated in this phenomenological study. Data were collected during 2003. Participants were interviewed after having been hospitalized due to an acute event and having participated in a rehabilitation programme. Three in-depth interviews were obtained for each dyad: one couple interview and two individual interviews with each partner of the dyad. Paradigm cases were sought and thematic analyses conducted. Findings. All couples experienced a 'brush with death' at the onset of heart disease, which called for changes in lifestyle. Three distinct patterns of dealing with the illness emerged. The first revealed that some couples assess the illness as a positive, transformative experience in their lives, bringing them closer together. The second showed that a proportion of couples experience the illness as a threat which imposes fear on both partners. The challenges are faced as mutual tasks and new routines are developed. The third pattern revealed couples who experience a missed opportunity to change. These couples are disenchanted about each other but return to life as usual. Conclusions. Nurses can use the information gained from this study to support couples in their attempts to come to terms with the illness, and can enhance their supportive role in rehabilitation efforts. [ABSTRACT FROM AUTHOR]

The complexity of caring for the ageing heart failure (HF) population is further complicated by concomitant chronic conditions (i.e., polypharmacy, depression), age related impairments (i.e., hearing, visual and cognitive impairments, impairments in activities of daily living (ADL/IADL), and other issues (e.g., health illiteracy, lack of social support). This paper provides an overview of these risk factors, outlines how they individually and in interplay endanger favourable outcome by putting patients at risk for poor self-management. Moreover, suggestions are made on how these issues could be addressed and integrated in heart failure management by applying gerontological care principles in caring for the ageing heart failure population. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the extent, range and variety of research in Europe describing healthcare interventions for older people with dementia (PwD) and family caregivers., Methods: This was a scoping review and followed the PRISMA Scoping Review guideline. MEDLINE, CINAHL and Cochrane library databases were searched for studies published between 2010 and 2020. Studies reporting healthcare interventions in Europe for PwD over 65 years and their family caregivers were included., Results: Twenty-one studies from six European countries were included. The types of healthcare intervention identified were categorized as follows: (1) family unit intervention (interventions for both PwD and their family caregiver), (2) individual intervention (separate interventions for PwD or family caregivers) and (3) family caregiver only intervention (interventions for family caregivers only but with outcomes for both PwD and family caregivers)., Conclusions: This review provides insight into healthcare interventions for older PwD and family caregivers in Europe. More studies are needed that focus on the family as a unit of care in dementia., (© 2023 The Authors. International Journal of Nursing Practice published by John Wiley & Sons Australia, Ltd.)

Aim: To provide an overview of the characteristics, variety and outcomes of knowledge translation (KT) strategies used in nursing care involving adult patients and their family members., Background: The gap in providing family nursing practice could be due to a lack of explicit KT frameworks and understanding of ways to translate evidence-based knowledge into clinical practice., Design: A scoping review conducted according to the Joanna Briggs Institute., Methods: The review is reported according to PRISMA-ScR. Relevant studies were searched in MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL Complete, ProQuest Nursing & Allied Health Premium, PsycINFO, Social Work Abstracts, Social Services Abstracts and Scopus. Grey literature was searched in ProQuest Dissertations & Theses Global. Search results were imported into the web-based programme Covidence. Studies describing concepts of KT, strategies of implementation, involvement of families and nurses/family caregivers in adult health care and conducted within the last 15 years were included., Results: Eight studies met the inclusion criteria. Three studies used the KTA Framework to guide the implementation process. The remaining five studies used different frameworks/guidelines to translate a variety of family focused interventions into their clinical practice. Translation strategies were often targeted towards nurse education. Reported outcomes included nurses' attitudes towards and acceptance of involving families in health care. The outcomes were conceptualized and measured differently, showing inconclusive results on effectiveness on family focused care and family health., Conclusion and Implications for Clinical Practice: The application of KT frameworks to implement evidence-based family nursing into clinical practice is limited. The process of KT mainly targets at nurses' adoption of family focused interventions with limited information about short-, intermediate- and long-term efficacy on family health. Clinical leaders should consider time and resources needed to implement family focused care KT strategies before putting it into practice., Patient or Public Contribution: No Patient or Public Contribution. Data were obtained from other's literature., (© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Aims and Objective: To explore differences in nurses' attitudes regarding the importance of family in nursing care and factors associated with nurses' attitudes across 11 European countries., Background: Family involvement in healthcare has received attention in many European healthcare systems. Nurses have a unique opportunity to promote family involvement in healthcare; however, their attitudes and beliefs may facilitate or impede this practice., Design: A cross-sectional survey across European countries., Method: A broad convenience sample of 8112 nurses across 11 European countries was recruited from October 2017 to December 2019. Data were collected using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire. We used the STROBE checklist to report the results., Results: There were significant differences in nurses' attitudes about families' importance in nursing care across Europe. Country was the factor with the strongest association with the total scores of the FINC-NA. Older age, higher level of education, increased years since graduation, having a strategy for the care of families in the workplace, and having experience of illness within one's own family were associated with a higher total FINC-NA score. Being male and working in a hospital or other clinical settings were associated with a lower total FINC-NA score., Conclusion: Nurses' attitudes regarding the importance of family in nursing care vary across 11 European countries. This study highlights multiple factors associated with nurses' attitudes. Further research is necessary to gain a deeper understanding of the reasons for nurses' different attitudes and to develop a strong theoretical framework across Europe to support family involvement in patient care. The inclusion of family healthcare programs in the baccalaureate curriculum may improve nurses' attitudes., Relevance for Clinical Practice: In clinical practice, the focus should be on identifying influencing factors on nurses' attitudes to enhance families' importance in nursing care across Europe., (© 2022 John Wiley & Sons Ltd.)

Background: In Europe, cardiovascular disease is one of the predominant causes of mortality and morbidity among older people over 65 years. The occurrence of cardiovascular disease can have a negative impact on the quality of life of older patients and their families and family health overall. Assuming that illness is a family affair shaped by culture and health care systems, we explored European health care practices and interventions toward families of older patients with cardiovascular disease and heart failure., Aims: This paper aimed to determine the extent, range, and variety of practices and interventions in Europe directed to families of older patients and to identify knowledge gaps., Materials & Methods: A scoping review was conducted including studies published in Medline, CINHAL, or Cochrane library between 2009 and mid-2020., Results: A total of 22 articles from 17 studies were included, showing diverse practices and interventions. The interventions targeted the family as a unit (six studies), dyads (five studies), patients alone, but assessed family members' reactions (five studies) or the family member primarily, but assessed the reaction of the patient (one study). Target outcomes were family caregiver burden; health-related QoL; and perceived control in patients; and family functioning and changes in health behavior or knowledge in both, family members and patients. Most studies did not include an integral view of the family as the unit of care but rather had a disease-centered approach., Discussion: This scoping review provides insight into a variety of healthcare practices towards families of older patients with cardiovascular disease in Europe. Clarifying underlying assumptions to involve families is needed. More studies with family-focused approaches as integral models could lead to practices that improve families' well-being. Exploring integral models for their acceptance in health care and family systems appears pertinent to develop European policy to support and add to family health., (© 2021 Nordic College of Caring Science.)

Introduction: Home-dwelling older people with chronic diseases often need the support of informal and formal caregivers in order to continue living at home. Family members, however, need to be willing and prepared for caregiving together with home care nurses., Objectives: The purpose of this study was to explore factors associated with family caregivers' preparedness to care for older home-dwelling adults who also receive home care nursing services., Methods: For this cross-sectional correlational study, a structured questionnaire was sent to family caregivers of adults aged 65 years or older receiving services from a community care agency. A total of 243 participants returned the questionnaire, of which 199 could be analyzed., Results: The stepwise backward regression model explained 29.1% of the variance of family caregivers' preparedness. Mutuality was the most strongly associated factor with family caregivers' preparedness whereas professional involvement of family caregiver in care process was important as well. Care intensity showed no significant impact., Conclusion: Nurses should support the whole family emotionally, and appreciate, admire, reinforce, and respect the caregivers' situation. Home care nurses need to invest in helping families to find solutions, to strengthen their relationships between family members and the older person dwelling at home.

Introduction: In Europe, cancer is one of the predominant causes of mortality and morbidity among older people aged over 65. A diagnosis of cancer can imply a negative impact on the quality of life of the older patients and their families. Despite research examining the impact of cancer on the family, it is unclear what kind of information is available about the types of clinical practice towards older patients with cancer and their families. The aim is to determine the extent, range and variety of research in Europe describing health practices towards families of older patients with cancer and to identify any existing gaps in knowledge., Methods: Scoping review., Results: A total of 12 articles were included, showing that family interventions are generally based on end-of-life care. Most studies used a qualitative approach and involved different types of family member as participants. Most studies were conducted in the UK., Conclusions: Review findings revealed limited knowledge about health practices in Europe towards families with an older patient with cancer. This review indicates a need to increase family-focused research that examines health practices that meet the needs of families of older patients with cancer. Seeing cancer as a chronic disease, there is an urgent need for the implementation of family-focused interventions., (© 2020 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Aims: Neuromuscular diseases are rare conditions that present with progressive muscular weakness. As affected children transition into adulthood, they become more physically dependent on their families for support. There is little evidence on the family transition experience, which this study explored to identify experiences, challenges, and strategies of coping., Design: Informed by family systems theory, a constructivist grounded theory study was conducted (2014-2017)., Methods: Data were collected by one-on-one interviews with a purposive sample of affected Swiss individuals and their families from 2015 to 2016. Data analysis used coding, memo writing, theoretical sampling, and constant comparison techniques., Results: The analysis of 31 interviews with 10 affected individuals and 21 family members resulted in an interpretive theory constituted of four categories: (a) living with physical dependence, while striving for independence; (b) balancing proximity; (c) conforming and challenging social standards and expectations; and (d) grieving for loss, while joining forces for life., Conclusion: Family functioning and well-being were threatened by recurring tension from stress, physical and emotional difficulties, strained relationships, and conflict. The families' strategies of coping and adaptation and their relationships and communication shaped their transition experience., Impact: Families that experience threats to their well-being and functioning would benefit from: needs assessment and monitoring; planning of appropriate family interventions; support of family relationships and communication, effective coping, and mastery; and positive adaptation to change., (© 2021 John Wiley & Sons Ltd.)

Aims and Objectives: This study evaluates the short-term (3 months), medium-term (6 months) and long-term (12 months) effect of family nursing therapeutic conversations added to conventional care versus conventional care on social support, family health and family functioning in outpatients with heart failure and their family members., Background: It has been emphasised that increased social support from nurses is an important resource to strengthen family health and family functioning and thus improve the psychological well-being of patients with heart failure and their close family members., Design: A randomised multicentre trial., Methods: A randomised multicentre trial adhering to the CONSORT checklist was performed in three Danish heart failure clinics. Consecutive patients (n = 468) with family members (n = 322) were randomly assigned to either the intervention or control group. Participants were asked to fill out family functioning, family health and social support questionnaires. Data were measured ahead of first consultation and again after 3, 6 and 12 months., Results: Social support scores increased statistically significant both at short-term (p = 0.002) medium-term (p = 0.008) and long-term (p = 0.018) among patients and their family members (p = <0.001; 0.007 and 0.014 respectively) in the intervention group in comparison with the control group. Both patients and their family members reported increased reinforcement, feedback, decision-making capability and collaboration with the nurse. No significant differences between the intervention and control groups were seen in the family health and family functioning scales among patients and family members., Conclusions: Family nursing therapeutic conversations were superior to conventional care in providing social support from nurses., Relevance to Clinical Practice: Family nursing therapeutic conversations are suitable to improve the support from nurses among families living with heart failure., (© 2020 John Wiley & Sons Ltd.)

Background: Family members often need to be supported in informal care of the elderly and desire to be involved into care planning and decision-making. Valid and reliable instruments are needed to measure how family members perceive the care and support they receive from nurses for older family members living at home., Aim: The purpose of this study was to translate the 20-item social support scale of the Family Functioning, Family Health and Social Support (FAFHES) questionnaire from English to German and test the validity and reliability of the scale among Swiss-German-speaking family caregivers of home-dwelling elderly people who receive home healthcare services., Methods: A cross-sectional study was conducted to test the empirical and psychometric properties of the translated and culturally adapted version of the social support questionnaire. A factor analysis with the principal component analysis PCA was used to test construct validity. The internal consistency of items was measured with the Cronbach`s alpha coefficient., Results: After a rigorous translation process the original 20-item questionnaire was adapted into a 19-item version and tested with family caregivers (n = 207) of home-dwelling elderly. Psychometric testing of the German version of the social support questionnaire revealed that the three factors - affirmation, affect and concrete aid - were congruent with the original questionnaire. The accounted variance was 79.5% and the internal consistency determined by the Cronbach's alpha was 0.973., Conclusion: The German version of the social support scale of the FAFHES questionnaire is a valid and reliable instrument to assess family perceived support on three dimensions - affirmation, affect and concrete aid - received from nursing professionals. The questionnaire should be tested further in other German-speaking populations., (© 2019 Nordic College of Caring Science.)

Purpose: The study aims to assess differences in family preferences for involvement in the ongoing care of a hospitalized family member with spinal cord injury based on whether the patient was hospitalized for initial rehabilitation (Group R) or hospitalized to treat secondary complications (Group C)., Design: Explorative cross-sectional design., Method: Family members rated the importance and experience of involvement on five subscales of the Patient Participation in Rehabilitation Questionnaire. Differences among the importance and experience scores between the groups were tested using the Mann-Whitney U test., Findings: Group C scored the importance to be involved significantly higher than Group R (M = 3.17 vs. M = 4.04, p =.01). No other significant differences between groups were detected., Conclusion: Family members of patients hospitalized for secondary complications want greater involvement in care compared to those hospitalized for rehabilitation., Clinical Relevance: Results indicate the need for tailored interventions using a family-centered approach and ongoing needs assessment.

Often family members provide care-giving, which allows older adults to remain in their homes. With declining health and increasing frailty, care-giving of elderly people becomes a task of family caregivers (FC) in conjunction with home care nurses. It has been shown in both acute care settings and long-term care facilities that family members prefer to be involved in decision-making and care planning for their next of kin. Therefore, an integrative review was conducted to explore the body of knowledge of FCs' involvement in home-care settings from the FCs' perspective. CINAHL, PubMed, and Cochrane databases was searched with the terms family caregiver, involvement, home care, and community dwelling. Studies written in German or English between 1996 and 2017 focusing on FCs' caring for home-dwelling older adults together with home care nurses were included and critically appraised. The extracted findings were analysed with concept analysis method. Twenty-six studies were included and five themes were identified. Four themes formed the basis of assistance towards family caregivers by nurses and included "relationship building with professionals," "negotiating with professional care," "being professionally supported," and "managing role expectations and knowledge sharing". The fifth theme, "working together" described the mutual care for the care recipient. Although the first four themes were consistent with a pre-existing conceptual model by Sims-Gould and Marin-Matthews (2010), the fifth required an expansion of the model with an additional contribution "collaborative practice". The findings illustrate that involvement in care is an interactional process, which provides the basis for collaborative practices with the home care nurses for family caregivers. Family members often want to be part of the healthcare team, and nurses need contextual factors that allow providing their full range of skills and knowledge to involve family caregivers accordingly., (© 2018 John Wiley & Sons Ltd.)

Preparedness to provide care in relation to the satisfaction with hospital discharge planning and level of knowledge of relatives to elderly patients Abstract., Background: Relatives are a great resource for older people who are discharged after hospitalization. Studies have so far shown very little about the readiness of relatives to aid in caregiving., Aim: The study examined if relatives showed a relationship between readiness to provide care and satisfaction with hospital discharge management as well as group differences between well-informed and less informed relatives., Method: In addition to demographic data, the preparedness to provide care, satisfaction and extent of knowledge of relatives were surveyed using a retrospective cross-sectional study. Analyses were made of the relationship between preparedness to provide care and satisfaction with hospital discharge management, as well as group differences between informed and less informed relatives in terms of their preparedness to provide care., Results: Of the 111 relatives, the majority were adult offspring (55.9 %) and partners (32.4 %) that participated in the study. A weak correlation was detected between the satisfaction with the hospital discharge planning of relatives and their willingness to provide care (rs = -0.113, p = 0.267). The group differences between well-informed and less informed relatives were significant (t(102) = 2.301, p = 0.023)., Conclusion: Relatives that evaluated themselves as well informed are more likely to be in the position to provide informal care. Therefore, it is necessary to involve relatives more in the planning of hospital discharges and to inform them better. Experimental studies are necessary to find out if the preparedness to provide care can be increased through good discharge planning and specific information provision.

Purpose: Patient-centeredness, evidence-based interventions, and interdisciplinary teamwork have been described as key in neurological rehabilitation nursing. In order to develop future action plans, a group of Swiss rehabilitation nurses sought agreement on concrete principles that led the efforts to develop a common understanding of rehabilitation nursing care in Switzerland., Design: A three-round Delphi study was conducted., Methods: Literature-based statements were formulated and sent out twice to 54 rehabilitation nursing stakeholders. In the third round, the participants ranked the three most important statements out of 13., Findings: Highest priority reached the statements: Rehabilitation nursing care (1) considers the uniqueness of the patients and their family, (2) offers support that promises the greatest potential for patients and their family, and (3) uses evidence-based knowledge., Conclusion: Statements on patient- and family-centeredness were ranked highest. Patients and families' preferences have to be considered as much as evidence-based knowledge and interventions to support patients and family., Clinical Relevance: The study supported the discussion on action plans and enlivened new services and nursing interventions in a Swiss nursing community.

Objective: To evaluate the short-term (3 months) effects of family nursing therapeutic conversations (FNTC) on health-related quality of life, self-care and depression in outpatients with Heart failure (HF)., Methods: A randomised multi-centre trial was conducted in three Danish HF clinics. The control group (n = 167) received usual care, and the intervention group (n = 180) received FNTCs as supplement to usual care. Primary outcome was clinically significant changes (6 points) in Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score between groups. Secondary outcomes were changes in self-care behaviour and depression scores. Data were assessed before first consultation and repeated after three months., Results: No statistically significant difference was found in the change of KCCQ, self-care and depression scores between the groups. KCCQ scores of patients in the FNTC group changed clinically significant in seven domains, compared to one domain in the control group, with the highest improvement in self-efficacy, social limitation and symptom burden., Conclusion: FNTC was not superior to standard care of patients with HF regarding health-related quality of life, self-care and depression., Implication for Practice: Addressing the impact of the disease on the family, might improve self-efficacy, social limitation and symptom burden in patients with heart failure., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To assess the self-care of patients with heart failure (HF), reliable and validated instruments are needed. The aim of this study was to test the validity and reliability of the Danish version of the European Heart Failure Self-care Behavior Scale (EHFScBS-9) based on previous studies reporting 1, 2 and 3 factors, respectively., Methods: A convenience sample of 147 patients with HF completed the EHFScBS-9. Psychometric properties of the Danish version of the EHFScBS-9 were tested with factor loadings, factor correlations and goodness-of-fit indices for four different measurement models based on confirmatory factor analysis., Results: All of the items, except item 9 about regular exercise, demonstrated satisfactory item-total correlation ≥0.30. Regarding the fit of the models on the sample data, the most superior fit was observed for the two-factor solution in terms of root-mean-square error of approximation (RMSEA), goodness-of-fit index (GFI), adjusted GFI (AGFI) and comparative fit index (CFI), which all reached the predefined threshold value, except for the normed fit index (NFI) at 0.90. Factor score determinacy (FSD) for the four models tested was 0.88 for the one-factor solution, 0.54 and 0.87 for the two-factor model, 0.83-0.55 for the first three-factor model and 0.87-0.38 for the second three-factor model., Conclusions: The EHFScBS-9 questionnaire is a valid and reliable instrument to assess heart failure-specific self-care behaviours in a Danish population., (© 2016 Nordic College of Caring Science.)

Aims and Objectives: To determine subgroups of family carers based on family relational and caregiving variables and to explore group differences in relation to selected carer outcomes., Background: Family caregiving in later life holds a myriad of positive and negative outcomes for family members' well-being. However, factors that constitute family carers' experience and explain variances are less well understood., Design: A secondary data analysis using cross-sectional data from a controlled randomised trial with community-dwelling people 80 years or older and their families., Methods: A total of 277 paired data sets of older persons and their family carers were included into the analysis. Data were collected via mailed questionnaires and a geriatric nursing assessment. A two-step cluster analysis was performed to determine subgroups. To discern group differences, appropriate tests for differences with Bonferroni correction were used., Results: Two family carer groups were identified. The low-intensity caregiver group (57% of carers) reported high relationship quality and self-perceived ease of caregiving. In contrast, the high-intensity caregiver group (43% of carers) experienced significantly lower relationship quality, felt less prepared and appraised caregiving as more difficult, time intensive and burdensome. The latter cared for older, frailer and more dependent octogenarians and had significantly lower levels of quality of life and self-perceived health compared to the low-intensity caregiver group., Conclusions: A combination of family relational and caregiving variables differentiates those at risk for adverse outcomes. Family carers of frailer older people tend to experience higher strain, lower relationship quality and ability to work together as a family., Implications for Practice: Nurses should explicitly assess family carer needs, in particular when older persons are frail. Family carer support interventions should address caregiving preparedness, demand and burden, as well as concerns situated in the relationship., (© 2016 John Wiley & Sons Ltd.)

Background: To improve the effectiveness of community-based care programs, especially those targeting the oldest-old population (80+), data are needed that elucidate those factors associated with a successful response to the intervention. Two comparable nurse-led care programs have been evaluated in two large randomized controlled trials (RCTs), one in Switzerland and one in the Netherlands., Aims: To identify common patient characteristics that are related to a successful response to proactive nurse-led care, we explored if and to what extent, identical factors were present in both study populations., Methods: A secondary data analysis using trial data from the intervention group of both RCTs was conducted. The study sample consisted 461 older adults, 230 from the U-PROFIT trial (the Netherlands) and 231 from the HPC trial (Switzerland). The mean age of the total sample was 85.1 years (SD 3.7). The UPROFIT intervention, delivered by registered nurses, included a frailty assessment and a comprehensive geriatric assessment (CGA) at home followed by an individualized evidence-based care plan, care coordination, and follow-up. The HCP intervention was delivered by advanced practice nurses consisting of four home visits and three phone calls, and was guided by the principles of health promotion, empowerment, partnership, and family-centeredness. A successful response was defined as "stable" or "no decline" in daily functioning at follow-up. Daily functioning was measured with 13 items of activities of daily living and instrumental activities of daily living. Multivariate logistic regression models were applied to calculate the association between individual characteristics and a successful response., Results: Almost half of the participants in the U-PROFIT trial (50.9%), and two-thirds (65.7%) of the participants in the HCP trial had a successful response at follow-up. Fewer comorbidities and a better self-rated health had the strongest predictive value for benefiting from the intervention (OR = 0.83 [95% CI 0.66-1.03], and OR = 1.5 [95% CI 0.92-2.45]), respectively., Linking Evidence to Action: Two large RCTs demonstrated that a preventive nurse-led care program can preserve daily functioning in the oldest-old population. Older people with few comorbidities and higher self-rated health had a higher likelihood of a positive outcome. Unraveling the characteristics associated with a successful response provides important information for further refining and targeting an intervention to obtain maximum effectiveness. More effort is needed to modify interventions for the oldest-old with multiple morbidities and low levels of education., (© 2017 Sigma Theta Tau International.)

Aims: The aim of this study was to investigate the impact of the death of an older member on families., Background: The death of a significant other in later life is a dramatic moment. Research has demonstrated that some older persons face negative consequences for their well-being. A majority, however, exhibit resilience in the wake of loss. Nonetheless, the relational process through which older persons come to terms with the loss in interaction with their families is little understood, but vital to support bereaved families., Design: Heideggerian hermeneutic phenomenology., Methods: A purposive sample of ten older persons with their families, represented by children, grandchildren and in-laws (n = 30) were interviewed several times in 2013, alone (n = 16) and in family groups (n = 21), 6-23 months after their significant other's death (mean age 81 years). Data collection and thematic analysis was informed by van Manen's and Benner's analytical strategies., Findings: Three family themes were discerned. First, through meaning-making, bereaved families weaved the death into their family narrative. Second, through sharing-not sharing their feelings and daily moments, family members lived with the loss both together and alone. Third, some families faced upheaval in their family life, which required them to re-create their everyday life, whereas other families continued with little change., Conclusions: Findings demonstrate that families hold an inherent capacity to make meaning of the death and enact family thereafter. Family relations arose as interplay of different, contradicting forces. Nurses should facilitate families' meaning-making of the death, attend to their converging and diverging sense of loss and strengthen family caring., (© 2016 John Wiley & Sons Ltd.)

Background: Live-in arrangements with migrant care workers have considerably increased over the last years since they allow older frail persons to age-in-place despite functional limitations. However, little is known about the ramifications live-in care arrangements for families. Aim: The aim of the study was to investigate families’ experience with live-in migrant care workers and indicators of quality from their perspective. Method: Constructivist grounded theory study with 22 families who were recruited via care agencies in the German-speaking part of Switzerland and participated in 29 individual or dyadic interviews. Results: Live-in care by migrant care workers has potentially positive ramifications for older persons and their families, but only so if families, first, reach a consensus about the need for the employment of migrant care workers; second, experience them as competent; and third, mutually forge relationships and negotiate daily life. A successful care arrangement occurs when there is a relational fit among those involved, which leaves families feeling cared for, safe and relieved. They experience a renewed stability in their family system, enriching relationships, and assuredness about the quality present in the care situation. Conclusions: A successful care arrangement is the result of relationships that have been actively created and a negotiated shared existence in a family-like network. It has a positive effect on the well-being of those receiving care and their family members. The family-like network needs competent support.

Introduction: The transition into adulthood is a developmental stage within the life cycle. A chronic childhood condition can disrupt this transition and create major challenges for both the young person and his or her family. Little is known about families' experiences when living with a rare genetic disease. Therefore, the purpose of this literature review was to understand experiences of families living with a chronic childhood disease during transition into adulthood by integrating evidence., Method: A systematic review using an integrative approach to data inclusion and analysis comprising qualitative, quantitative and other methodological studies about a range of genetic and chronic childhood diseases was undertaken to identify relevant information. Databases searched were PubMed, Cochrane Library, PsychINFO, CINAHL, and AMED, using the search terms (1) family, caregivers, young adult, adolescent; (2) adolescent development, transitional programs, transition to adult care; (3) muscular dystrophy, spinal muscular atrophy, cystic fibrosis, haemophilia and sickle cell disease. Study findings were critically appraised and analyzed using critical interpretive synthesis., Results: A total of 8116 citations were retrieved. 33 studies remained following the removal of duplicates, papers unrelated to genetic childhood conditions and families' experiences of the transition into adulthood. Findings provided three perspectives: (1) the young person's perspective on how to "live a normal life in an extraordinary way" and "manage a chronic and life threatening disease"; (2) the parent perspective on the "complexity of being a parent of a chronically ill child" and "concerns about the child's future" and (3) the sibling perspective on "concerns about the siblings future". As a consequence of the genetic childhood condition, during the ill family members' transition into adulthood all family members were at risk for psychosocial difficulties as they mutually influenced each other. Previous research focused predominately on the individual illness experience, and less emphasis was put on the family perspective., Conclusions: Young people and their family members experienced multiple challenges and not only for the ill individual but also there were consequences and health risks for the whole family system. Therefore, a family systems perspective to research and care is indicated to assist affected families to cope with their complex life and health situation., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Aims and Objectives: To explore the experiences of being an informal caregiver for a relative with liver cirrhosis and overt hepatic encephalopathy., Background: Overt hepatic encephalopathy is a common complication in patients with liver cirrhosis. It is associated with decreased quality of life for patients, and presents a major burden for caregivers. The involvement of informal caregivers in medical care is recommended, but it has not been clearly described. An understanding of the experience of caregivers is needed to improve the support provided to them by healthcare professionals., Design: A qualitative, interpretative, phenomenological approach was used., Methods: Twelve informal caregivers participated in qualitative interviews. The analysis followed the six steps of the interpretative phenomenological approach., Results: Caregivers' experiences were described using five themes: (1) feeling overwhelmed by their loved one having unexplainable symptoms and behaviours; (2) learning that this and previous experiences were complications of liver disease; (3) becoming aware of the symptoms of hepatic encephalopathy; (4) having feelings of being tied down and (5) experiencing and overcoming obstacles in working with healthcare professionals., Conclusions: This study provides insight into caregivers' experiences and the consequences for their lives. The first occurrence of symptoms was a shock, but receiving the diagnosis was seen as an important step in understanding and learning. Caregivers provide daily assessments of their relatives' conditions, and they feel responsible for medication management. Over time, the caregivers impressively showed how they were able to incorporate their personal experiences into caregiving and to accept more accountability in managing the disease., Relevance to Clinical Practice: Nurses should acknowledge caregivers as experts in caring for their loved ones. Nurses can assist caregivers in managing an episode of hepatic encephalopathy and can provide individualised interventions to ease the future burden., (© 2016 John Wiley & Sons Ltd.)

Background: At time of discharge, patients with acute coronary syndrome often have a knowledge deficit regarding their disease, further treatment and necessary behavioural changes. It is well known that self-efficacy as a prerequisite for behavioural changes can be influenced by patient education. This study investigated whether an individualized education programme starting early in the cardiac care unit enhanced self-efficacy and rehabilitation programme attendance, and was feasible and satisfying for patients., Methods and Design: In a pilot randomized controlled trial, 40 patients with acute coronary syndrome were enrolled. The intervention group received in addition to standard care an early individual needs-oriented educational session in the cardiac care unit and subsequently one on the ward addressing risk factors, medication and self-management as well as referral to a rehabilitation programme by a nurse. Self-efficacy was assessed twice, at attendance in a rehabilitation programme six weeks after discharge. The participants' satisfaction with the intervention was assessed qualitatively., Results: When controlling for anxiety and depression, the intervention group showed significant better self-efficacy scores on the ability to control the symptoms (p=0.034). When controlling additionally for age, no significant differences could be detected. The attendance of a rehabilitation programme was higher in the intervention group. The participants in the intervention group reported high satisfaction with the early education., Conclusion: Early education seems to benefit patients with acute coronary syndrome. In light of increased confidence to control one's symptoms and the higher attendance in rehabilitation programmes, as well as a high satisfaction with the intervention, a full powered study will be pursued., (© The European Society of Cardiology 2014.)

Background: Families influence the wellbeing of patients and are influenced by illness themselves. Involving caregivers in patient care was examined in multiple studies., Aim: The aim of this literature review was to investigate the different approaches to family-centered interventions (FI) and to evaluate the tested outcomes as well as the detected effect sizes., Methods: This search for a systematic literature review of randomized controlled trials and metaanalyses revealed three Meta Analyses with studies until 2007 and six randomized controlled studies from 2007 to 2012., Results: FI showed small to middle positive effects on the outcomes depression, mental health, anxiety of patients and family members and on caregiver burden. A conclusive effect on physical health could not be shown. The results strongly depend on the enrolled patient population, the targeted participants of FI, as well as the focus, type and dose of FI. The studies showed vast differences in the length and type of intervention, the target population and the selection of outcomes. Comparing outcomes was difficult due to the use of different outcome measures., Conclusion: Further research with various populations, different FI intensity but with same, valid outcome measures is needed.

Background: With the support of family members many elderly people can live an independent life at home. Accepting support respectively providing support might be a challenge for both elder and family member. Families often have little professional support to manage those challenges., Aim: Therefore, a nurse-led counseling program for families of the elders has been established., Method: The counseling program was developed with community-based participatory research (CBPR) methodology using individual and focus group interviews, as well as a written survey and tested in a pilot study., Results: Managing disease in everyday life, helpful means of support at home, changes in family relations, information about services as well as information how to navigate the healthcare system have been themes to discuss in the counseling sessions. Participants in the pilot study showed a statistically not significant increase in well-being, and preparedness for care and were highly satisfied with the counseling program., Conclusions: Families of the elderly could actively participate in developing and researching a nurse-led family counseling program. Several family members still engage as co-researcher in the program and participate to improve the new service.