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Tröst genom hälsostödjande familjesamtal: upplevelser och effekter av en familjecentrerad intervention
Umeå University, Faculty of Medicine, Department of Nursing.
2016 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Consolation through Family Health Conversations : experiences and the effects of a family system nursing intervention (English)
Abstract [en]

Aim: The overall aim of this thesis was to evaluate the experiences of nurses and families participated in Family Health Conversations (FamHC) and the effects of this intervention on those families with a family member living in a residential home for older people. Methods: This thesis comprises four studies. The FamHC were structured as three conversations held at two-week intervals and a closing letter. In two of the studies (I and II), group interviews with family members were interpreted using qualitative content analysis. A mixed-method research design was used in study three (III). Data were collected through group interviews with families and by using the instruments FHI and SWED-QUAL completed by the family members. The qualitative and quantitative data were analyzed and then integrated. In the fourth study (IV), registered nurses who had performed the FamHC participated in individual interviews after they had completed four conversation series each. The RNs also wrote diary notes about what they experienced directly after conducting each conversation. The interviews and diary notes were interpreted with qualitative content analyses. Result: The findings from study I one month after participating in the conversations showed that the families felt alleviated from guilty consciences. The FamHC gave the family members confirmation that they were, indeed, good enough. Study II showed that, six months after participating in the conversations, the families had experienced the FamHC as healing because the sharing and reflections through dialogue within the conversations mediated confirmation, which made the families feel consoled. Study III revealed that the families’ emotional wellbeing had increased six months after participating in the FamHC. The families also showed an improved ability to work together. In study IV, the nurses reported that the FamHC was a useful care action in their work with families. Conclusion: The overall conclusion from the findings is that the families were consoled by participating in the FamHC. The conversations offered an arena for families to listen to each other’s narration which provided a better relationship and cooperation within the family and a greater sense of well-being for the family members. 

Abstract [sv]

Bakgrund: Att ha en sjuk närstående som bor på ett särskilt boende för äldre påverkar hela familjen. Familjemedlemmarna kan uppleva känslor av saknad, skuld, maktlöshet och sorg. Det finns därför ett behov av att utvidga omvårdnaden till att innefatta hela familjen som ett system för att minska ohälsa hos familjer. Detta kan ske genom familjecentrerade interventioner. Ett exempel på en familjecentrerad intervention är hälsostödjande familjesamtal (FamHC). Det är en vårdhandling med focus på familjens styrkor, resurser och relationer inom familjen. Det finns begränsad kunskap om dessa familjeinterventioner i kontexten vård och omsorg av äldre. Syftet: Syftet med avhandlingen är att ur ett familje- och sjuksköterskeperspektiv studera upplevelser, responser och effekter av sjuksköterskeledda hälsostödjande familjesamtal med närstående som har en familjemedlem boende på ett särskilt boende för äldre. Metoder: Denna avhandling är baserad på en intervention med FamHC genomförd vid tre särskilda boenden för äldre i norra Sverige. Samtalens struktur är tre på varandra följande samtal varannan vecka med skilda fokus och avslutas med ett avslutande brev. Avhandlingen består av fyra delstudier. I studie I-II användes semistrukturerade gruppintervjuer med närstående som analyserades med kvalitativ innehållsanalys. I studie III användes mixad metod. Kvalitativa resultat från intervjuer och kvantitativa resultat från instrumenten SWED-QUAL och FHI, analyserades parallellt samt integrerades därefter. I Studie IV intervjuades tre sjuksköterskor med semistrukturerade individuella intervjuer. Sjuksköterskorna skrev även dagboksanteckningar. Intervjuerna och dagböckerna analyserades med kvalitativ innehållsanalys. iv Resultat: Resultaten från studie I visar att de närstående en månad efter deltagandet i FamHC upplevde en lindring av sitt dåliga samvete då de krav som familjerna ställer på sig själva minskat. Vid samtalen fick de närstående bekräftelse på att de gjorde så gott de kunde. Genom att dela sina föreställningar med varandra genom berättelser skapades en ökad förståelse för hela familjens upplevelse av situationen. Studie II visar att sex månader efter samtalsseriens avslutande upplevde familjen deltagandet i FamHC som ett delande i en dialog med en läkande kraft. Delandet upplevdes bekräftande vilket gjorde att de närstående upplevde samtalen som trösterika. Studie III visar att de närståendes emotionella välbefinnande hade förbättrats sex månader efter att ha deltagit i FamHC. Studien visar på förbättrad kommunikation och relationer samt förbättrat samarbete inom familjen. Studie IV visar att sjuksköterskorna upplevde att FamHC var en tillämpbar omvårdnadsåtgärd i arbetet med familjer. Det gav en förbättrad förståelse av familjens situation och förbättrade relationen med närstående. Konklusion: Den övergripande slutsatsen från resultaten i delstudierna är att genom att delta i FamHC blev familjerna tröstade. Samtalen skapade en arena för de närstående att berätta samt att lyssna till varandras berättelser. Det gavs utrymme att gråta och sörja över sin situation över att ha en sjuk familjemedlem på ett särskilt boende. Samtalen medförde reviderade föreställningar bland närstående och sjuksköterskorna samt en ökad förståelse och ett bättre samarbete inom familjen och en ökad känsla av välbefinnande hos de närstående. Hälsostödjande familjesamtal kan därmed föreslås vara ett användbart verktyg för sjuksköterskor i deras arbete med närstående inom kontexten särskilda boenden för äldre personer.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2016. , 71 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1808
Keyword [en]
Family Health Conversations, Family Systems Nursing, FamHC, Family Health, Nursing care, Residential home for older people
Keyword [sv]
Hälsostödjande familjesamtal, Familjecentrerad omvårdnad, FamHC, Familjeomvårdnad, Omvårdnad, Särskilt boende för äldre
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-119759ISBN: 978-91-7601-435-6 (print)OAI: oai:DiVA.org:umu-119759DiVA: diva2:923433
Public defence
2016-05-26, Aulan, vårdvetarhuset, 90187 Umeå, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-05-02 Created: 2016-04-26 Last updated: 2016-05-26Bibliographically approved
List of papers
1. Experiences With Family Health Conversations at Residential Homes for Older People
Open this publication in new window or tab >>Experiences With Family Health Conversations at Residential Homes for Older People
Show others...
2016 (English)In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 25, no 5, 560-582 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to highlight family members' experiences of participating in Family Health Conversation (FamHC), based on families in which a family member was living in a residential home for older people. A total of 10 families and 22 family members participated in evaluating family interviews 1 month after participating in FamHC. The interviews were analyzed by qualitative content analysis. The main finding was being a part of FamHC increased family members' insights, understanding, and communication within the family. Getting confirmation from nurses was essential to cope with the new life situation, which also meant that they felt comfortable to partly hand over the responsibility for the older person who moved to the residential home. By being open and expressing their feelings, a bad conscience could be relieved. These findings showed that FamHC could be helpful for family members in adapting to this novel situation.

Keyword
family health conversations, family nursing intervention, family support, family systems nursing, residential home for older people
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-100022 (URN)10.1177/1054773814565174 (DOI)000383385500007 ()25550306 (PubMedID)
Available from: 2015-02-18 Created: 2015-02-18 Last updated: 2017-12-04Bibliographically approved
2. Becoming visible: Experiences from families participating in Family Health Conversations at residential homes for older people
Open this publication in new window or tab >>Becoming visible: Experiences from families participating in Family Health Conversations at residential homes for older people
2016 (English)In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 37, no 4, 260-265 p.Article in journal (Refereed) Published
Abstract [en]

Having a sick family member living at a residential home for older people can be difficult for families, who as a result often suffer from feelings of forsakenness and powerlessness. In response, the purpose of this study was to illuminate family members' experiences with participating in Family Health Conversations at residential homes for older persons 6 months after concluding the conversation series. Twenty-two family members who participated in the conversations later took part in group interviews, the texts of which were analyzed according to qualitative content analysis. Findings showed that participating in Family Health Conversations mediated consolation, since within such a liberating communicative interaction, family members for the first time felt visible as persons with individual significance. Family members reported a positive experience involving both being open to each other and speaking and listening to each other in a new, structured way. As a result, families were able to discover their family members' problems and suffering, as well as to identify their family's resources and strengths.

Keyword
Family Health Conversations, Family nursing intervention, Family support, Family systems nursing, Residential home for older people
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-118747 (URN)10.1016/j.gerinurse.2016.02.015 (DOI)000382102500002 ()26995489 (PubMedID)
Available from: 2016-04-01 Created: 2016-04-01 Last updated: 2017-11-30Bibliographically approved
3. Family Health Conversations have positive outcomes on families: A mixed method study
Open this publication in new window or tab >>Family Health Conversations have positive outcomes on families: A mixed method study
(English)Article in journal (Refereed) Submitted
Abstract [en]

Background: A Family Systems Nursing intervention, “Family Health Conversations” (FamHC) was conducted in order to strengthen the health of families having relatives at residential home for older people. Having a family member living in a residential home affects the entire family and can be hard to handle. Family members require encouraging and open communication support from nurse during and after relocation to a residential home.

Objectives: The aims of this study were to evaluate the responses to and effects of the Family Health Conversations in families with a member living at a residential home for older people and to integrate the empirical results with a theoretical assumption upon which the intervention was based.

Methods: A mixed method research design was used. The Swedish Health-Related Quality of Life Survey and the Family Hardiness Index were administered before and 6 months after the intervention. Qualitative data was collected by semi-structured interviews with each family 6 months post-intervention. The sample included families of residents, a total of 10 families comprising 22 family members.

Result: Main finding was that FamHCs helped family members process their feelings about having a member living at a residential home and made it easier for them to deal with their own situations. FamHCs helped to ease their consciences, improve their emotional well-being, and change their beliefs about their own insufficiency and guilt. Seeing problems from a different perspective facilitated the families’ thinking in a new way.

Conclusion: These findings showed that FamHC can be an important type of intervention to improve family functioning and enhance the emotional well-being.

Keyword
Family Hardiness Index, Family Health Conversation, Family Systems Nursing, Intervention, Mixed method design, Older people, Transition, Quality of Life
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-119756 (URN)10.2174/1874434601711010014 (DOI)
Available from: 2016-04-26 Created: 2016-04-26 Last updated: 2017-03-28
4. Nurses' perspective of conducting family conversation
Open this publication in new window or tab >>Nurses' perspective of conducting family conversation
2016 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, 30867Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Nurses are in a prime position to manage to support families that have a family member living in a residential home for older people. Nurses' attitudes about meeting patients' family members vary. Studies describe that some nurses consider family members as a burden. But some nurses consider family members a resource and think it is important to establish good relationships with them.

AIM: The aim of this study was to describe how registered nurses (RNs) experienced to participate in and conduct the intervention Family Health Conversations (FamHCs) with families in residential homes for older people.

METHODS: The intervention FamHC was accomplished at three residential homes for older people. FamHC is a family systems nursing (FSN) intervention developed to support families facing the ill health of someone in the family. One RN from each residential home conducted the conversations. The RNs wrote diary notes directly after each conversation. The RNs were also interviewed 1 month after they had each conducted four FamHCs. The diary notes and the interviews were analysed separately by qualitative content analysis, and the findings were then summarized in one theme and further discussed together.

FINDINGS: The main findings were that the RNs experience the conversations as a valuable professional tool involving the whole family. The RNs grasped that silence can be a valuable tool and had learned to attentively listen to what the families were saying without interrupting, allowing them and the families to reflect upon what the family members said.

CONCLUSION: The findings show that the FamHC can be helpful for RNs in their work, helping them to perceive and understand the needs and desires of the families.

Place, publisher, year, edition, pages
CoAction Publishing, 2016
Keyword
Family nursing, family systems nursing, family health conversation, intervention, older people, relatives, residential home, support, qualitative content analysis
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-119746 (URN)10.3402/qhw.v11.30867 (DOI)000375926300001 ()27104342 (PubMedID)
Available from: 2016-04-26 Created: 2016-04-26 Last updated: 2017-11-30Bibliographically approved

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