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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

Background: Due to the complexity of the provision of care for people with dementia, pain assessment and management is still considered to be lacking. An optimal way to support frontline staff in providing pain assessment and management for people with dementia living in nursing homes has not yet been identified. The success of supporting interventions seems dependent on contextual factors in the nursing homes. This study, therefore, analyzes the feasibility of a nurse-led training intervention, using repeated on-site case studies, in modifying pain intensity and frequency in people with dementia. Methods: Using a quasi-experimental design, we undertook a multi-center study of nurse-led training in pain management, with subsequent on-site case studies. Healthcare workers from 3 nursing homes assessed pain in 164 residents with dementia over 147 days. We used mixed-effect growth curve models with spline regression to analyze the data. Results: We found that on-site case studies support frontline staff with pain management and assessment. Repeated reflection in case studies led to significantly longer pain free intervals (from 4.7 at baseline to 37.1 days at second follow-up) and decreased frequency of pain events (OR 0.54 at first follow-up and 0.43 at second follow-up). However no trends regarding pain intensity could be found. Therefore, on-site case studies may be valuable for improving pain frequency and pain-free intervals over time. Conclusion: This feasibility study shows the potential of on-site support for frontline nursing home staff. On-site case studies may also affect health outcomes in people with dementia. However, the complexity of dementia care necessitates the management of a broader range of needs.

Background: Critical illness is distressing for families, and often results in negative effects on family health that influence a family's ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood. Objectives: To describe nurses' perceptions and practices of family engagement in adult intensive care units from a global perspective. Design: A qualitative-descriptive multi-site design using content analysis. Settings: The study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents. Participants: A total of 65 registered nurses (77% women, age of M = 39.5, SD = 11.4 years) participated. Most held intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. Methods: Semi-structured, individual interviews (M = 38.4 min, SD = 12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis. Results: We found that nurse-family engagement was an ebb and flow of relational power that needed to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses' practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses' attitudes and perceptions of family, the patient's condition, and workload. Lastly, family engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses' ability to engage with families. Conclusions: This global study provides an in-depth understanding of the way nurses engage with families in ICU an

Kinder und Jugendliche, die regelmäßig ein chronisch krankes Familienmitglied pflegen, sind ein globales Phänomen. In Österreich ist der Situation pflegender Kinder und Jugendlicher, mit Ausnahme einer größeren Anzahl von Diplomarbeiten am Institut für Pflegewissenschaft der Universität Wien, bisher noch wenig Aufmerksamkeit geschenkt worden. Es fehlt sowohl am Einblick in das Thema der sogenannten „Young Carers“ generell als auch an qualifizierten Hilfsangeboten. Ausgehend von einem parlamentarischen Entschließungsantrag hat das Bundesministerium für Arbeit, Soziales und Konsumentenschutz das Institut für Pflegewissenschaft der Universität Wien mit einer Studie beauftragt, die die Situation pflegender Kinder in Österreich untersuchen soll. Das Ziel der vorliegenden Studie besteht darin, Einsicht in die Situation pflegender Kinder zu nehmen. Diese Einsicht erfolgt in Form einer fundierten Zahlenbasis über die genaue Anzahl und die Situation gegenwärtig pflegender Kinder ebenso wie auf Grundlage der Beleuchtung der Situation ehemaliger pflegender Kinder und der Auswirkungen kindlicher Pflegeerfahrungen im Erwachsenenalter. Abgeleitet von den Ergebnissen und dem internationalen Diskurs werden Empfehlungen formuliert, auf deren Grundlage pflegende Kinder und Jugendliche unterstützt werden können.

Ende des Jahres 2012 wurde eine Studie – beauftragt vom Bundesministerium für Arbeit, Soziales und Konsumentenschutz (Sozialministerium) – veröffentlicht, die erstmalig in Österreich auf die Situation pflegender Kinder und Jugendlicher aufmerksam machte. Damit rückte eine Gruppe ins öffentliche Interesse, die bisher als solche noch nicht wahrgenommen wurde. Laut dieser Studie leben in Österreich über 40.000 Kinder und Jugendliche, die regelmäßig im Sinne der Langzeitpflege Verantwortung für ein chronisch krankes Familienmitglied übernehmen. Die damit verbundenen Tätigkeiten sind vielfältig und gehen hinsichtlich ihrer Art und Intensität häufig über das hinaus, was für das Alter und die Entwicklung der Betroffenen angemessen ist (Nagl-Cupal et al. 2012). Dies hat zur Folge, dass Pflege durch Kinder und Jugendliche in direktem Zusammenhang mit negativen gesundheitlichen und sozialen Auswirkungen steht. Das Ziel der vorliegenden Arbeit besteht somit in der Entwicklung eines Rahmenkonzepts als Grundlage zur Unterstützung von Young Carers und deren Familien. Damit wird aufgezeigt, durch welche konkreten Maßnahmen Hilfe für diese Gruppe geleistet werden kann. Gleichzeitig gibt das Rahmenkonzept eine Orientierung für jene Institutionen, die zielgruppen- und bedürfnisorientierte Unterstützungsmaßnahmen für Young Carers implementieren wollen. Das Ziel der vorliegenden Arbeit besteht somit in der Entwicklung eines Rahmenkonzepts als Grundlage zur Unterstützung von Young Carers und deren Familien. Damit wird aufgezeigt, durch welche konkreten Maßnahmen Hilfe für diese Gruppe geleistet werden kann. Gleichzeitig gibt das Rahmenkonzept eine Orientierung für jene Institutionen, die zielgruppen- und bedürfnisorientierte Unterstützungsmaßnahmen für Young Carers implementieren wollen.