Sims, SL, Boland, DL, & O'Neill, CA. (1992). Decision making in home health care. Western Journal of Nursing Research 14(2), 186-200.

The purpose of this qualitative study was to describe the experiences of families caring for an ill family member in the home. A subpurpose was to elicit descriptions of decision making and problem framing from the perspective of the family caregiver. The study used a grounded theory approach for data collection and analysis. A sample of 17 families in the metropolitan Intermountain West (Utah) area participated in the study. The original study design was to interview families new to home care. Tape-recorded interviews were conducted using a semistructured topic guide. Among the study findings were that decision making was not a static process, but one that evolved simultaneously with participants' increasing control over their situations. Initially passive caregivers became more active and directive in decision making as they became familiar with being a caregiver. Parents of chronically ill children in the sample had the experience of months of the childrens' hospitalization before home care began. Caregivers for adults, on the other hand, were just beginning to learn the caregiver role. Many caregivers did not believe they had any choice except to care for the ill family member at home. The decision for home care was structured to consider a single value rather than to integrate several competing values. Integrating values is a hallmark of analytic or rational decision making. Family decision making often changes radically when a major partner becomes ill or disabled. Family members attempt to maintain past roles in decision making whenever possible by consulting with the ill family member. Sometimes the caregiver was forced to take on all decision making responsibility. Loss of mutual decision making contributed to the sense of isolation and burden felt by caregivers. Other themes identified in the study include "natural" responsibility assigned to caregivers, and group decision making by siblings relative to their parents. Study results are interpreted within the problem framing concept attributed to Tversky and Kahneman (cognitive psychologists). In summary, the study indicated that caregivers become more active and better caregivers as they take control of the, often new, chaos created in their lives by providing care for an ill family member at home. The study also highlighted the preponderance of female caregivers. These findings need to be incorporated into nursing approaches to home care for families with ill family members.

Reviewer: P. Allen Gray, Jr., RN, PhD
3 September 1996

Hall, E.O.C., Wulff, T., White, M.A., Wilson, M.E. (1994). Family dynamics during the third trimester of pregnancy in Denmark. International Journal of Nursing Studies, 31(1), 87-95.

This study emanates from the assumption "What is happening in the family during pregnancy may have long lasting effects." The purpose of the study was to describe family dynamics in Danish families during the final trimester of pregnancy with a first or second child. The study uses six of Barnhill's (1979) healthy family systems dimensions as its conceptual framework. There are clear definitions of the six dimensions: individuation-enmeshment, mutuality-isolation, flexibility-ridigity, stability-disorganization, clear communication-unclear communication, and role reciprocity-role conflict. A sample of 158 mothers and 126 fathers provided data by responding to the Family Dynamics Measure, a 62 item, 6 point Likert-type instrument. The report links data analysis to the following research questions: (1) To what extent are family dynamics related to family structure, social status, parental age, years lived together, and parity in the Danish family during the last trimester of pregnancy? , (2) Are there differences in the partners' perceptions of family dynamics? , and (3) Are there diffferences in family dynamics between families of normative versus delayed childbearing age? Although married and unmarried cohabiting couples were represented almost equally in the sample, married mothers reported more positive family dynamics in mutuality, stability, and clear communication than did unmarried mothers. Married fathers reported more mutality than did unmarried fathers, but the differences were not large. Second-time parents reported less flexibility than firt-time parents. Perhaps there are more demands, both socially and economically, on parents with a growing family. Second-time parents may require a different kind of support than first-time parents. The authors suggest important topics for nurses to address with parents having their second child include sibling rivalry, stress management, and role changes in a growing family. They note that role changes during the transition to parenthood are socially prescribed for women, but men still have to struggle to define the father role. The authors recommend from their findings that nursing support growing families along two paths. First, the nurse should support the mother and father directly. Second, the nurse's support for the parents enables them, indirectly, to support each other.

Reviewer: P. Allen Gray, Jr., RN, PhD
27 September 1996

Lowenberg, J.S. (1995). Health promotion and the ideology of choice. Public Health Nursing, 12(5), 319-323.

This article focuses on the pervasive view that individuals choose their illness by choosing their lifestyles. The article states that genetic, social, and environmental limits to personal choice are often overlooked by some groups. The warnings of the dangers of blaming the victim have come from a variety of social scientists and policy analysts. The concept of lifestyle choice is felt to be more prevelant now because of the burgeoning health emphasis. The article states that current pressures in the United States to control escalating health care costs have increasingly used this ideology to withdraw or limit resource usage to those who are judged guilty of living inappropriate lifestyles. The implications for public health nursing are outlined as 1) nurses need to be aware of this trend and closely monitor its use as justification for cutting and eliminating health programs 2) nurses need to resist what is termed extremist variants by pointing out the complex etiology of disease and emphasizing that lifestyle choices are but one facet of the health/illness continum and 3) that a way nurses can resist the negative consequences is to focus on a population based level. Targeting prevention in terms of social and economic issues such as sanitation, poverty and health care can circumvent blaming an individual.

This article stimulated thought on health promotion and lifestyle modification that can be very important both ethically and as a practice issue to nurses involved in health screenings. Although it gives a plan for nurses to deal with the issue by targeting population based prevention one can easily see that these measures will not stop the use of the ideology of choice as a cost cutting measure by insurance carriers other reimbursement systems. It only gives nurses a place to begin in dealing with this issue.

Reviewed by: D. Duchesneau RN, BA, CCRN, CEN.
Sept 26,1996

Lynam, J.M. (1995). Supporting one another: the nature of family work when a young person has cancer. Journal of Advanced Nursing, 22, 116-125.

This paper was developed from a qualitative study with young adults with cancer that examined social relationships in order to understand the nature of interactions perceived as supportive and the context within which they occurred. A purposive sampling technique was used. Young adults who were in treatment or followup for a diagnosis of lymhoma or sarcoma, at a regional treatment center and who saw themselves as able to respond to questions were invited to participate. The participants were men and women 19-30 years of age. The young adult participants were interviewed 1-3 times. All of the interviews were conducted after the initial treatment phase of their illness. The young adults participated in 1-3 interviews of 1-2 1/2 hours in length. All interviews were audiotaped and later transcribed. These transcribed interviews comprised data for analysis. As young adults described ways in which their illnes influenced thier relationships with their families, a number of themes emerged. The interviews yielded data that could be classified under the following categories of family work : 1) establishing caring partnerships 2) acknowledging the possibilty of death 3) putting the illnes in its place 4) looking toward the future 5) recognizing the roles of others in supporting the young adult. The analysis of the data shows that families play an integral role in offering support to young adult clients. The data also show, however, that many of the challenges associated with the illness are related to the way in which the illness influences the relationships and impacts upon the young adults' ability to continue to fulfil roles and responsibilites within the family and maintain relationships with others outside the family. The paper also identifies that as nurses we cannot disregard the important role which families and the broader system play in enabling young adults to to manage their illness.

This article was of value to nursing practice by reaffirming the fact that vulnerability to stressors differ with each developmental stage. By emphasizing roles and role responsibilty for young adults it makes one realize that patients are not isolated but part of a larger system and nurses must include this larger system in their care of the client. It also emphasized that for many adults they are just establishing themselves in a realtionship and a career therefore a disease such as cancer can be particularly hard at this stage of life because many of the support networks are also in the beginning stage of development. I found this article made me think about how and why disabling disease at this stage of life can be so traumatic and the role nurses can play in dealing with the whole patient including patients and friends.

Reviewed by: D. Duchesneau., RN, BA, CCRN, CEN Sept 20,1996

Lynam, M. J. (1995). Supporting one another: the nature of family work when a young adult has cancer. Journal of Advanced Nursing, 22(1), 116-125.

Reviewer: Patricia C. Williams, RN
30 September 1996

de Cuevas, L. H. O., & Lopez, J. H. (1995). A program for the home care of patients with a symptomatic malignant terminal disease. Cancer Nursing, 18(5), 368-373.

This journal article is about the program that was developed for twenty cancer patients and their families in their homes. Patient needs were assessed, problems were identified, and family members were given guidelines, instructions, and training. This program was implemented in Columbia, South America. A holistic view was taken in the care of these patients The article also addresses the increase in stress levels when members were notified that their loved ones had reached the final stage of ilness and that they must be cared for in the home. Training family members in the care helped to ease their fear and self-doubt. The program included assessment and diagnosing the patient, care planning, and teaching caretakers by the family nurse during home visits. Quality of care improved for these terminally ill patients. Satisfaction of care was rated by family caregivers and the patients with positive outcomes (rated good to optimal). An added bonus was the increased closeness among the family members. I am encouraged by this article with regard to family nursing because of the stress reduction in the families and the increase in closeness of the members.

Reviewer: Patricia C. Williams, RN
30 September 1996

Hinrichsen, G. A., & Niederehe, G. (1994). Dementia Management Strategies and Adjustment of Family Members of Older Patients. The Gerontologist, 34(1), 95-102.

Many behavior problems are often present in elderly patients with dementia. Family members (the caretakers) used three stategies to manage these problems. These were criticism, encouragement, and active management. They experienced burden, psychiatric symptoms, and a desire to institutionalize their patient. The research involved 152 patients with dementia along with their family members who provideed their care. The outcome was that the strategy that related to less burden and less desire to institutionalize by caregivers was encouragement. The tool used for assessing the strategies was the Dementia Management Strategies Scale which is included in the article. Families assessing these strategies are assisted in a difficult job of caring for their demented older relative becuase these assessments help identify the interventions that help. I enjoyed this journal article because I work in a facility where several of my patients have been medically diagnosed with dementia. The article is helpful.

Reviewer: Patricia C. Williams, RN
30 September 1996

Vehvilaien-Julkunen, K. (1995). Family training: supporting mothers and fathers in the transistion to parenthood. Journal of Advanced Nursing, 22(4), 731-737.

This journal article takes a look at the perceptions of 189 Finnish mothers and 127 Finnish fathers with regard to family training for transition to parenthood as judged nine weeks after the birth of their child. The outcome of the study showed the importance of family training to the parents. Birth process, parenthood themes, ways to alleviate pain during labor, and problems during childbirth were all addressed along with many other related subjects. Families were given opportunities to verbalize feelings and questions with their leaders but desired more opportunities for group discussions. I think this journal article was very interesting and I appreciate the importance of training before childbirth because of my personal experiences. It greatly prepares the mothers and fathers for the birth process and birth of their baby.

Reviewer: Patricia C. Williams, RN
30 September 1996

Newacheck, P.W., Hughes, D.C., & Stoddard, J.J. (1996). Children's access to primary care: Difference by race, income, and insurance status. Pediatrics, 97(2), 26-32.

The purpose of this study was to assess the access to and use of primary care services for poor, minority, and uninsured children of the United States. Data was analyzed on 7578 children ranging in age from 1 to 17 years old who responded to the 1987 National Medical Expenditure Survey. Each adult who responded were asked to report on several measures of access and use of care for children in their household. These measures included the presence of a routine source of care and its' characteristics which included type of site, travel time to site, waiting time at site, after-hours care, and the availability of a regular physician. Also examined was the number of physician contacts relevant to the child's health status, receipt of measles vaccination, and whether the child received care in response to certain symptoms of ill health. Results of this study showed that poor, minority, and uninsured children fared worse than the children who were white, non-poor, and insured on all indicators. Children in each of the three at-risk groups were twice as likely to lack usual sources of care, nearly twice as likely to wait 60 minutes or longer at the site of care, and used only half as many physician services after adjusting for health status. Analyses revealed that poverty, minority status, and absence of insurance have independent effects on access to and use of primary care. In conclusion of this study, it is seen that substantial barriers to access to and use of primary care for low-income, minority, and uninsured children is a significant concern during a time of government cutbacks.

Reviewer: Sherri Hayes, RN
10/6/96.

Anglin, T.M., Naylor, K.E., & Kaplan, D.W. (1996). Comprehensive school-based health care: High school students' use of medical, mental health, and substance abuse services. Pediatrics,97(3), 318-330.

Reviewer: Bill Mercer, RN
10/6/96.

Clawson, J. A. (1996). A child with chronic illness and the process of family adaptation. Journal of Pediatric Nursing, 11(1), 52-61.

Reviewer: Russell S. Reagan, RN, CCRN
9 October 1996

Chablewski, F., & Gaedeke-Norris, M.K. (1994). The gift of life: Talking to families about organ and tissue donation. American Journal of Nursing, 94(6), 28-33.

This article was very useful in terms of definition and approach. As health care providers we know it is always difficult to deal with death, especially when it is an unexpected occurrence. These families need support. They also need to know that they have a right to make the decision about organ donation. They need to feel like they have some control during these difficult times. I feel we can provide that sense of control by presenting options such as the donation of organs.

Reviewer: Jennifer Graney, RN
October 12, 1996

Mitchell, Susan. (1995, October). The Next Baby. American Demographics, 22-31.

Reviewer: Deanna Noble, RN
October 17, 1996

Mitchell, S. (1995, October). The next baby. American Demograghics, 22-31.

Reviewer: Kimberly Register, RN
27 OCT 1996

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Ormel, Catherine. (1995, January). The Decline and Rise of the Family. Focus, 34-37.

With fewer marriages more divorces, and increased single parenting the traditional family is on decline. According to this article, the 21st. century's family will look very different from today's family. On current trends, the numbers of unmarried mothers and cohabities will continue to grow in Europe and America. The mid 20th. century western, heterosexual two parent familys living together under one roof is already becoming the exception rather than the rule. The family of the mid 21st. century will more likely be inter-racial and could be bi-sexual. Because the old taboos surrounding divorce and cohabitation have been broken we are less likely to stay with our partner. Women are able to raise children by themselves and it is socially accepted. Women are more serious about their careers and some are having children at a later age. They are also using a variety of means to have children. Another thing facing families of the next century will be complex custody disputes. Elderly people will also play an important role since life expectancy will slowly increase due to good nutrition, good health, and medical advances. I thought this was an interesting article. Some of the things that were talked about are already happening and I foresee more to come.

Reviewer: Kim Register, RN
October 17, 1996

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Ormell, C. (1995, January). The Decline and Rise of the Family. Focus, 34-37.

Fewer marriages, more divorces and increased single parenting mean that the traditional family is in decline. The family of the 21st Century will look very different from today's model. The numbers of unmarried mothers and cohabitees are increasing in Europe and America. By the end of this century, it is predicted that only half of all British children will live in a conventional family with heterosexual married parents living together in the household. It is likely that the family of the mid 21 st Century will be a pick and mix affair: probably interracial, possibly bi-sexual and certainly multi-generational. Many of its members will be bred using new birth technologies. In the loosely knit clans of "the blended family", the children will have to divide their love and loyalties among different step-mothers, birth mothers, biological fathers and ex-stepparents as well as grandparents.

Reviewer: DeAnna Noble, RN
November 1996

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Tickle, E., E Hull, K. (1995). Family members roles in long-term care. MEDSURG Nursing, 4(4), 300-304.

The author's used participation - observation methodology to develop a qualitative study of the effects of family interactions on residents of a long-term care facility. The principal method was observation over a 3 month period. This study involved 38 family members or friends of 30 residents. Although most interactions were actually considered nursing interventions, e.g. feeding, bathing, ambulation, the staff didn't meet this help with eagerness and collaboration but more of tolerances. There was no real team effort. Staff didn't involve the family in planning or goals attainment, nor did they try to help educate the family in proper performance or priority of needs. Recomendations were made toward better attainment in quality of care, quality of life and maximum utilization of efforts and resources. Residents did show a positive correlation to the amount of time spent with family members but how much better could their lives be if it became a true team effort.

Reviewer: Robert Savage, RN
October 17, 1996

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last updated: 20 OCT 1996