Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Vägen mot implementering av familjecentrerad omvårdnad
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0002-4773-8796
2019 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Towards implementation of family systems nursing (English)
Abstract [sv]

Bakgrund: När människor är inkluderade i varandras liv påverkar en förändring av livssituationen hos en person även de övriga personerna som står den nära. Det innebär att när en person drabbas av ohälsa eller sjukdom påverkas även personens familj. Familjens upplevelse av den situation som uppstår i samband med ohälsa kan dessutom negativt påverka familjemedlemmarnas medvetenhet om familjens tillgängliga styrkor och resurser, vilket i sin tur kan påverka familjers kamp för att återfå och bibehålla hälsa. Traditionellt sett har vården fokuserat på att erbjuda stöd på personnivå, och främst då till patienter. De senaste decennierna har dock en tendens uppmärksammats till ökad förståelse för att hela familjen behöver inkluderas i omvårdnaden. Att anamma ett familjecentrerat förhållningssätt – det vill säga, att se och möta familjen som en enhet och som ett system – har visat sig ha flera fördelar utifrån såväl patient- och familje- som sjuksköterskeperspektiv. Detta har medfört en efterfrågan på forskning om hur familjecentrerad omvårdnad kan läras ut och implementeras i den kliniska hälso- och sjukvården.

Syfte: Det övergripande syftet med avhandlingen är att belysa erfarenheter av stöd från distriktssköterskor/sjuksköterskor till familjer i ordinärt boende, samt att utvärdera implementering av familjecentrerade samtal.

Metod: Avhandlingen inkluderar tre studier med kvalitativ design och en studie med mixad-metod design. I delstudie I samlades data in genom tio fokusgruppintervjuer med 36 distriktssköterskor och analyserades sedan med en fenomenologisk hermeneutisk metod. Datainsamlingen för delstudie II bestod av ljudinspelade familjecentrerade samtal med sju familjer, samt sju avslutande brev riktade till familjerna som distriktssköterskorna/sjuksköterskorna skrev efter samtalen med familjerna. Familjesamtalen och breven analyserades med hjälp av kvalitativ innehållsanalys. I delstudie III analyserades individuella intervjuer med 21 distriktssköterskor/sjuksköterskor med kvalitativ innehållsanalys. Mixad metod användes i delstudie IV, där kvantitativa data från instrumentet Families’ Importance in Nursing Care – Nurses’ Attitudes (FINC-NA) integrerades med kvalitativa data från individuella intervjuer med 14 distriktssköterskor/sjuksköterskor.

Resultat: Resultatet visar att distriktssköterskor/sjuksköterskor strävar efter att stödja familjer (I, IV) och att familjecentrerad omvårdnad i form av familjecentrerade samtal kan vara ett sätt att stöda familjer att dela med sig av sina upplevelser och känslor både inom familjen och med distriktssköterskan/ sjuksköterskan (II, IV). Det upplevda stödet från såväl familjen som distriktssköterskan/sjuksköterskan ansågs värdefullt för att bättre hantera situationen och framtiden (II). Distriktssköterskorna/sjuksköterskorna uppfattade den webbaserade utbildningen i familjecentrerad omvårdnad inklusive familjecentrerade samtal som överlag funktionell och välanpassad (III). Utbildningen med den påföljande implementeringen beskrevs bidra till ett förändrat förhållningssätt hos dem, där de tänkte och arbetade mer inkluderande och stödjande gentemot familjer, även när de inte utförde familjecentrerade samtal enligt den tänkta strukturen (III, IV). Utvärderingen av implementeringen av de familjecentrerade samtalen visade att införandet av familjecentrerade samtal fortgick även om de inte hade implementerats fullt ut som avsett. Acceptans och lämplighet utvärderades överlag positivt, dock framkom personliga, sociala och organisatoriska hinder, vilka påverkade genomförandet, användningen och metodtroheten (IV).

Konklusion: Stöd från distriktssköterskor/sjuksköterskor till familjer är en omvårdnadshandling som förutsätter medveten omsorg i ett aktivt möte med familjen, där varje enskild person, men även familjen som enhet, behöver beaktas. Detta stöd för familjers hälsa kan ske genom familjecentrerad omvårdnad. En webbaserad utbildning för distriktssköterskor/sjuksköterskor i familjecentrerad omvårdnad och familjecentrerade samtal utgör ett adekvat steg i processen att implementera detta arbetssätt i den kliniska verksamheten. Sammanfattningsvis bidrar avhandlingen till kunskap om hur stödjande familjecentrerade samtal kan implementeras i klinisk verksamhet och vilka aspekter som kan påverka detta.

Abstract [en]

Background: When a person experiences illness, it can affect the whole family; thus, all family members may need support. Moreover, a family’s experience with illness can negatively affect the members’ ability to accurately realize their strengths and resources, which can influence the family’s struggle to regain and sustain health. Traditionally, the practice of nursing focuses on supporting individual patients; however, over the last few decades, the importance of involving the whole family in the care has been increasingly emphasized. Having a family systems nursing approach – that is, viewing the family as a unit and as a system – has shown benefits for patients, families, and nurses. Furthermore, research has been requested on how family systems nursing (including family systems nursing conversations) can be learned and implemented in health care.

Aim: The overall aim of this thesis is to evaluate perceptions and experiences of support from nurses to families in their homes, and to evaluate an implementation regarding nurse-led family systems nursing conversations.

Methods: The thesis consists of three studies with a qualitative design and one study with a mixed-methods design. In the first study (I), data were collected through ten focus group interviews with 36 primary health care nurses and then analyzed with a phenomenological hermeneutic approach. The data of the second study (II) consisted of seven recorded family systems nursing conversations with seven families and seven closing letters addressed to the families, written by the participating nurses after the conversations. The conversations and the closing letters were analyzed by qualitative content analysis. In the third study (III), individual interviews with 21 nurses were analyzed by means of qualitative content analysis. Mixed-methods were used in the fourth study (IV), where quantitative data from the instrument Families’ Importance in Nursing Care – Nurses’ Attitudes (FINC-NA) were analyzed and integrated with the qualitative data from individual interviews with 14 nurses.

Results: The findings in the thesis show that nurses strive to support families in their homes (I, IV) and that family systems nursing, in the form of family systems nursing conversations, can be a way for nurses to help families share their experiences within the family and with the nurse (II, IV). Support from nurses and from the family was seen as essential to coping with the current situation and the future (II). A web-based learning intervention in family systems nursing that taught supportive family systems nursing conversations was perceived by the participating nurses as generally functional and suitable (III). Furthermore, the educational program altered the nurses’ way of thinking, meeting with, and working with families, becoming more inclusive and supportive even when not performing the family systems nursing conversations (III, IV). The evaluation of the implementation of nurse-led family systems nursing conversations reveals that the implementation was in progress, even if it was not as fully implemented as intended. The acceptability and appropriateness were assessed as positive; however, some obstacles were seen related to feasibility, adoption, and fidelity (IV).

Conclusion: Nurses strive to support families’ health, which can be done through family systems nursing conversations. A web-based learning intervention can be an appropriate step in the process of implementing these conversations in home health care. The findings of this thesis contribute to enhancing knowledge concerning how to support families in health care, how family systems nursing and family systems nursing conversations can be implemented in home health care, and what aspects influence successful implementation. This is useful when planning further implementation of family systems nursing in health care.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2019. , p. 83
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2030
Keywords [en]
Family Support, Family Systems Nursing Conversations, Family Systems Nursing, Home Health Care, Implementation
Keywords [sv]
Familjecentrerad omvårdnad, Familjecentrerade samtal, Familjestöd, Hemsjukvård, Implementering
National Category
Nursing
Research subject
health services research
Identifiers
URN: urn:nbn:se:umu:diva-158673ISBN: 978-91-7855-058-6 (print)OAI: oai:DiVA.org:umu-158673DiVA, id: diva2:1314203
Public defence
2019-05-31, Aulan, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-05-10 Created: 2019-05-07 Last updated: 2019-05-09Bibliographically approved
List of papers
1. District nurses' lived experiences of meeting significant others in advanced home care
Open this publication in new window or tab >>District nurses' lived experiences of meeting significant others in advanced home care
2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 1, p. 93-100Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this study was to illuminate the meanings of district nurses' lived experiences of meeting significant others in the home when giving advanced home care to patients.

METHODS: The data was collected through 10 audio-taped narrative focus-group interviews with 36 district nurses and interpreted using a phenomenological hermeneutic approach.

FINDINGS: Three themes emerged. The first theme, Feeling close, consists of three subthemes: Being available, Sharing understanding and Being aware. The second theme, Mediating strength, contains the subthemes Being a resource and Sharing trust. Being emotionally influenced is the third theme and involves the subthemes Experiencing emotional distress and Experiencing emotional gratitude.

CONCLUSION: Meeting significant others as a district nurse in advanced home care means creating and maintaining a trustful relationship with significant others, both on a personal and family level, aiming to illuminate and respond to their needs and desires. The district nurses strive to reach a mutual understanding and co-operate to mediate support. Being a district nurse in advanced home care is both emotionally demanding and emotionally rewarding.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
advanced home care, caring, district nurse, family, family nursing, informal care providers, palliative care, phenomenological hermeneutic, relationships, significant other
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-88628 (URN)10.1111/scs.12134 (DOI)000350285500009 ()24684479 (PubMedID)
Available from: 2014-05-12 Created: 2014-05-12 Last updated: 2019-05-07Bibliographically approved
2. Envisioning the future as expressed within family health conversations by families of persons suffering from stroke
Open this publication in new window or tab >>Envisioning the future as expressed within family health conversations by families of persons suffering from stroke
Show others...
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 2, p. 707-714Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The whole family is affected when a person suffers from stroke, but few studies have focused on families' expectations following the stroke.

OBJECTIVE: The aim of this study was to illuminate what persons with stroke and their family members talk about in Family Health Conversations (FamHCs) with focus on the future and how nurses leading these conversations apprehended the families' future shown in closing letters based on these conversations.

METHOD: In this study, seven families with a member ≤65 years who had suffered a stroke participated in FamHC in their homes after the person with stroke had been discharged from the rehabilitation clinic. The FamHC comprised a series of three conversations conducted every other week and a closing letter sent by the nurses to the family to conclude the series. In this study, the third conversations were recorded and they and the closing letters were transcribed and analysed using qualitative content analysis.

RESULT: The family members including the persons with stroke were found to be able to tell their stories and express their feelings, worries, losses, hopes and wishes for the future within the context of the Family Health Conversations. Support within the family was highlighted as essential to the satisfactory management of future situations.

CONCLUSION: The persons with stroke and their belonging family members' vision of the future was reflected over in the light of theories about beliefs, possible selves, hope and suffering, and the findings highlight the need for broader use of family conversations to support persons with stroke and their families to manage the future.

Place, publisher, year, edition, pages
Oxford: Wiley-Blackwell, 2018
Keywords
cerebrovascular disorder, closing letters, family health conversations, family nursing, future, relatives, stroke, suffering
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-139878 (URN)10.1111/scs.12501 (DOI)000436254800027 ()28851069 (PubMedID)
Available from: 2017-09-25 Created: 2017-09-25 Last updated: 2019-05-07Bibliographically approved
3. Nurses' perceptions about a web-based learning intervention concerning supportive family conversations in home health care
Open this publication in new window or tab >>Nurses' perceptions about a web-based learning intervention concerning supportive family conversations in home health care
Show others...
2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 7–8, p. 1314-1326Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To describe the perceptions that municipal primary healthcare nurses and municipal registered nurses had about a web-based learning intervention concerning supportive family health conversations in municipal home health care.

BACKGROUND: Even though family health conversations are well grounded in theory with several reported benefits for patients and families, most working nurses have little or no training in practising family systems nursing including family health conversations. Continued learning is necessary for nurses, where web-based learning may be one answer of updating the professional skills and knowledge of nurses regarding supporting families.

DESIGN: The study used a descriptive design and followed the "Consolidated criteria for reporting qualitative research" (COREQ) checklist.

METHODS: Twenty-one nurses participated in an educational intervention that consisted of web-based learning and two face-to-face seminars about family systems nursing including family health conversations. The nurses were interviewed after completion, and the audio-recorded interviews were transcribed verbatim and analysed using qualitative content analysis.

RESULTS: The findings consist of nurses' perceptions regarding the disposition of instruction, the prerequisites for learning and a changed approach when working with families. The findings are further reflected on through Illeris' theory concerning learning triangle.

CONCLUSIONS: The findings are encouraging for educating nurses in family health conversations at their workplace, with the purpose of supporting patients and families. However, it is important to be aware of the different dimensions of learning, in addition to the appraisal of social aspects and organisational circumstances when educating nurses as they influence the utilisation of the knowledge.

RELEVANCE TO CLINICAL PRACTICE: This web-based learning intervention seems to be suitable for educating nurses in family health conversations and could be an appropriate step towards implementing these conversations in home health care with the purpose of supporting families.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
continuing professional education, education, family conversations, family health conversations, family nursing, home health care, learning, municipal care, online learning, support
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-155314 (URN)10.1111/jocn.14745 (DOI)000460767400026 ()30554435 (PubMedID)2-s2.0-85062720431 (Scopus ID)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-05-07Bibliographically approved
4. Implementation outcomes of a family systems nursing approach in home health care: A mixed-methods study
Open this publication in new window or tab >>Implementation outcomes of a family systems nursing approach in home health care: A mixed-methods study
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158672 (URN)
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-05-08Bibliographically approved

Open Access in DiVA

fulltext(1075 kB)136 downloads
File information
File name FULLTEXT01.pdfFile size 1075 kBChecksum SHA-512
63be8c955eb77bc12d31f51eb8accb4514685900c22195f54a7db00eec832fe5fe330fc97e7151fbcdfed1736ea5e013bea6c02a27c59bfe06a9d9cc0ec59abb
Type fulltextMimetype application/pdf
spikblad(204 kB)7 downloads
File information
File name SPIKBLAD01.pdfFile size 204 kBChecksum SHA-512
9e3954b7f5d3f1560f92c8a9eb9adc979d1592b8633690a8e6ed87d9f351f2d257221392523908310e580156f310d19ce043f9f3a71e6d7f974e3f8c1dda131f
Type spikbladMimetype application/pdf

Search in DiVA

By author/editor
Pusa, Susanna
By organisation
Department of Nursing
Nursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 136 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 942 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf