PURPOSE: To identify factors that influence American and Icelandic parents' health perceptions among families of infants or young children with asthma. DESIGN: A cross-sectional research design of 76 American families and 103 Icelandic families. Data were collected mainly in the Midwest of the United States (US) and in Iceland from August 1996 through January 2000. METHOD: Parents in these two countries who had children aged 6 or younger with chronic asthma completed questionnaires regarding family demands, caregiving demands, family hardiness, sense of coherence, and health perceptions. Descriptive statistics, chi-square tests and t tests were compiled. Multiple regression analysis was used to test path models and for mediation. FINDINGS: American parents differed from their Icelandic counterparts in family hardiness. In both countries, significant differences were found in caregiving demands and health perceptions between mothers and fathers. Illness severity and caregiving demands affected health perceptions of both mothers and fathers. Sense of coherence mediated the relationship between family demands and parents' perceptions for both parents. For mothers only, family hardiness mediated the relationship between family demands and health perceptions. CONCLUSIONS: The Resiliency Model of Family Stress, Adjustment, and Adaptation was useful for building knowledge on parents' health perceptions in two Western cultures for families of young children with asthma. Interventions emphasizing family and individual resiliency and strengths have the potential to affect parents' views of their children's health.
To test the effectiveness of a two-to-three session family therapeutic conversation intervention (FAM-TCI) for primary and partner caregivers of children and adolescents in active cancer treatment on perceived family support and on expressive family functioning.
Quasiexperimental; one group pre- and post-test.
Inpatient cancer unit and a day treatment cancer unit at the Children's Hospital in Reykjavik, Iceland.
19 parent caregivers (10 primary, 9 partner) of children in active cancer medical treatment.
The caregivers completed baseline measure questionnaires and were offered the first sessions of the FAM-TCI. About four to eight weeks later, the second session was administered and then the caregivers were offered a third session, if needed, one week later. When the caregivers had finished all sessions, they answered the same set of questionnaires about one week later.
The FAM-TCI for primary and partner caregivers, family support, and expressive family functioning.
Primary caregivers perceived significantly higher family support after the intervention compared to before. Those caregivers also reported significantly higher expressive family functioning and significantly higher emotional communication after the intervention. Partner caregivers, however, reported significantly lower verbal communication after the FAM-TCI compared to before.
Shortening hospital stays in pediatric oncology populations has focused attention on effective short-term psychosocial interventions. The FAM-TCI is promising as an effective short-term intervention but requires additional testing.
The FAM-TCI strengthened pediatric oncology caregivers in their caregiving activities and was found to benefit primary caregivers regarding their perception of family support and expressive family functioning; therefore, the intervention might benefit future families of children and adolescents in active cancer treatment.
The FAM-TCI was brief, easy to provide, and well fitted. Pediatric oncology nurses can offer brief, beneficial interventions to families of children and adolescents with cancer who are in active treatment. Knowing that primary caregivers experienced support and information may result in more effective evidence-based family care.
AIMS: This paper reports a study to evaluate caregiving demands among mothers and fathers of children with cancer, parents' well-being, and how the parents perceive the health status of their child over a period of 18 months. BACKGROUND: Cancer among children has psychological impact on all family members. Most previous research has focused on distress, coping patterns and social support, and less is known about how parents are dealing with the illness experience over time. No study was found that evaluated caregiving on a daily basis, or the impact of the cancer on wellbeing and perceptions of health within families. METHODS: Data were collected between 1999 and 2001. Parents of 26 Icelandic children under 18 years with cancer completed questionnaires about caregiving activities, general wellbeing and health perceptions. Descriptive statistics and Repeated Analyses of Variance were conducted at baseline, 12 and 18 months. RESULTS: The most time-consuming and difficult caregiving activities for both mothers and fathers were giving emotional support to the child with cancer, and to other children in the family. Mothers also found it difficult and time-consuming to manage behavioural problems and to structure and plan activities for the family. Fathers found it difficult to manage work and organize care for the child at the same time, and to give their partner emotional support. When evaluated over time, mothers' caregiving demands differed statistically significantly from fathers', and fathers' caregiving demands and health perceptions changed statistically significantly over the 18 months of the study. CONCLUSION: These findings underline the long-term impact of children's cancer on their families. Interventions focusing on emotional support, parents' wellbeing, and how families perceive the health of their child with cancer might benefit the family as a whole.
The primary purpose of this exploratory, cross-sectional study was to determine the degree of agreement between parents' and adolescents' rating of adolescents' asthma-related quality of life (QOL). A secondary aim was to compare the degree of agreement between parent-adolescent dyads in two countries; 15 dyads each were recruited from Kentucky and Iceland. Both adolescent and adult participants completed separate paper surveys at the time of the adolescent's clinic appointment. The QOL instrument used (PedsQL 3.0 Asthma Module) contains the subscales of asthma symptoms, asthma treatment, worry, and communication. Parent-adolescent differences were determined using paired t-tests; associations were assessed with intraclass correlation coefficients (ICCs). Two-sample t-tests investigated between-country differences in parent-child consistency in the assessment of the adolescent's asthma-related QOL. Adolescents rated their QOL higher than their parents did, but not significantly. The ICC of the QOL score for the 30 dyads was 0.39. The degree of agreement was high for asthma symptoms, but low for asthma treatment, worry, and communication. U.S. parents tended to underrate their child's QOL, while parents from Iceland overrated it (p = 0.007). Family-centered interventions may improve parents' understanding of how asthma affects QOL in adolescents, and such interventions may have to be tailored for cultural differences.
Illness beliefs affect how individuals and families deal with illness. A valid and reliable instrument has not yet been developed to measure "illness beliefs" in family nursing research and clinical practice. This article describes the purpose, reliability, validity, and the potential clinical and research applications of a new instrument, the Iceland-Family Illness Beliefs Questionnaire (ICE-FIBQ). The ICE-FIBQ is a short, self-report measure of an individual's beliefs about illness. Drawing from an advanced nursing practice model called the Illness Beliefs Model, the instrument was developed to measure illness beliefs about (a) cause of illness, that is, etiology; (b) control of illness on family and control of family on illness; (c) effect of illness on the individual and family; (d) illness suffering; and (e) support received from health care professionals during illness. The instrument was tested on 139 family caregivers of adolescents/youth with an illness or a disorder. Exploratory factor analysis reduced the original questionnaire from eight to seven items with a one-factor solution (Cronbach's a = .780). Confirmatory factor analysis supported the one-factor solution (Cronbach's a = .789). Further research is needed to determine concurrent validity with other illness belief/illness perception scales and if the instrument is sensitive to capture change in illness beliefs following family nursing intervention.
To identify and compare how school nurses in Reykjavik, Iceland and St. Paul, Minnesota coordinated care for youth with asthma (ages 10-18) and to develop an asthma school nurse care coordination model.
Little is known about how school nurses coordinate care for youth with asthma in different countries.
A qualitative descriptive study design using focus group data.
Six focus groups with 32 school nurses were conducted in Reykjavik (n = 17) and St. Paul (n = 15) using the same protocol between September 2008 and January 2009. Descriptive content analytic and constant comparison strategies were used to categorize and compare how school nurses coordinated care, which resulted in the development of an International School Nurse Asthma Care Coordination Model.
Participants in both countries spontaneously described a similar asthma care coordination process that involved information gathering, assessing risk for asthma episodes, prioritizing healthcare needs and anticipating and planning for student needs at the individual and school levels. This process informed how they individualized symptom management, case management and/or asthma education. School nurses played a pivotal part in collaborating with families, school and healthcare professionals to ensure quality care for youth with asthma.
Results indicate a high level of complexity in school nurses' approaches to asthma care coordination that were responsive to the diverse and changing needs of students in school settings. The conceptual model derived provides a framework for investigators to use in examining the asthma care coordination process of school nurses in other geographic locations.
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Detecting intimate partner violence (IPV) might empower women to start working on the impact that the abuse experience has had on their lives. Little, however, is known about disclosure of abuse in community and in clinical settings. The purpose of this study was to explore whether there was a difference in the disclosure of abuse experience among women who were attending the emergency department (ED) at Landspitali University Hospital or were located at a university site, that is, at the University Square at the University of Iceland. A cross-sectional research design was used. Data were collected at the same time in 2009 over a period of 9 months from N = 306 women ranging in age from 18 to 67 years (n = 166 at the University Square and n = 140 at the ED). A significantly higher proportion of the women at the ED reported that they were victims of IPV in their current marital/partner relationship and scored higher on the Women Abuse Screening Tool total scale than the women at the university site. This gave a clear indication that the women at the ED experienced significantly more frequent and more severe IPV in their current marital/partner relationship compared with the women at the university site. Identifying IPV in primary and clinical settings might, therefore, function as a protective factor if these women are offered appropriate first response and interventions.
The aim of this study was to evaluate the effectiveness of therapeutic conversation intervention in group and caregiver sessions on the supporting role of caregivers.
Caregivers of people with eating disorders are known to suffer major difficulties and are in great need of support. Unhelpful parental support strategies can delay the recovery of an individual with an eating disorder. Skill training interventions can equip parents with skills, guidance and techniques by helping them to be a support person and making them one of the most important links in the treatment process.
The therapeutic conversation intervention consisted of five group and caregiver sessions and three booster sessions. The Calgary Family Assessment and Calgary Family Intervention Models, the Illness Beliefs Model and the New Maudsley Method were used as theoretical frameworks. The content of the intervention consisted of work on difficult behaviours, feelings and helpful strategies. The participants (n = 58) included primary and secondary caregivers of 12- to 24-year-old patients with eating disorders. Eight caregivers dropped out of treatment.
This study had a quasi-experimental design with one pre- and two post-test measures.
Between 90-96% of caregivers rated the therapeutic conversation intervention as supportive. Furthermore, the study revealed significant differences in caregiver emotional and cognitive support, illness beliefs, disruptive behaviour and quality of life, negative aspects of care giving demands and caregiver and patient behavioural difficulties after the intervention and/or at follow-up.
Therapeutic conversation intervention with caregivers in group and private sessions proved to be beneficial.
This outcome provides information for healthcare professionals on how they can help primary caregivers in their supporting role, which can, in turn, improve services in healthcare centres and psychiatric hospitals.
An innovative opportunity is being created by nursing leaders from practice and education in Iceland to implement Family Systems Nursing at an institutional level on all units and divisions with the Landspitali University Hospital. This article describes the phases of the implementation model for knowledge translation that will be operationalized over four years. The goals of implementing Family Systems Nursing at the Landspitali University Hospital are to (a) educate all practicing nurses in Family Systems Nursing and, in particular, the Calgary family assessment and intervention models; (b) strengthen practicing nurses' clinical skills for intervening with families by offering specific clinical training courses to all nurses using family skills labs; and (c) explore and assess the difference that the theoretical and clinical programs make for the nurses, the patients and their families, and the nurses' practice (the family-nurse relationship).
The purpose of this study was to evaluate the impact of a family systems nursing hospital training educational program (ETI program) on nurses' and midwives' perception of job demands, control, and/or support. Of the nurses and midwives who were working in the Women's and Children's Services Division at The National University Hospital in Iceland, 479 participated in the study on three time periods from 2009 to 2011. Scores for the characteristics of job demands and job control were created to categorize participants into four job types (Karasek and Theorell, 1990). These four job types are high strain (high demand, low control), passive (low demand, low control), low strain (low demand, high control), and active (high demand, high control). However, when the data were evaluated based on the proportion of job characteristics as reported by the nurses and the midwives, no significant difference was found over time (2009 to 2011) (?(2)=5.203, p=.518). However, based on the results from the independent t-tests at time 1, a significant difference was found amongst the high strain job group regarding perceived support from administrators and colleagues among the nurses and midwives who had taken the ETI program compared to those who had not taken the program (?(2)=2.218, p=.034). This indicates that the health care professionals who characterized their job to be of high demand but with low control evaluated the support from their administrators and colleagues to be significantly higher if they had taken the ETI program than did the nurses and midwives who did not take the ETI program. These findings are promising because they might, in the long run, increase the nurses' and midwives' autonomy and control over their own work.