NSG 389 Annotated Bibliography Collection
Boling, P. and Glass, C. (1996). Collaborative Support for Caregivers of Individuals Beginning Mechanical
Ventilation at Home. Critical Care Nurse, 16, 67-73.
This article discussed the issue of friends and family being the caregiver of a ventilator dependent person at home. Rising costs generate pressure to shorten hospital stays, thus more individuals and families are considering homecare as an alternative to institutionalization for persons requiring chronic ventilating support. Homecare, when family and friends provide the majority of patient care, represents a great reduction in cost. However, the families must be taught how to care for a person requiring mechanical ventalation and how to cope with the stress on the caregiver in order for home care to be successful.
A study was performed to assess the needs of caregivers and the adjustments they required to care for ventilator-dependent individuals in the home. Many caregivers reported effective coping but a need for more education on selected knowledge and skills and a need for support from others. As a collaborative effort to meet the needs of family caregivers, the Ad Hoc Committee of Home Ventilator care was formed.
As cost rises and technology improves, more friends and family members, which are probably non-health care providers, will be involved in home care. For this reason, we as nurses should do more teaching and educating than ever. Not only should we teach how to care for the patient but also how to manage stress and take care of themselves.
Reviewer: Bryan Hilbourn, RN
October 1996
Rabb, D. D., Baumer, R. J., & Wieseler, N.A. (1993). Counseling Army Reservists and Their Families During
Operation Desert Shield/Storm. Community Mental Health Journal, 29, 441-447.
This report dealt with primary prevention of stress in the reserve service members and their families of a reserve unit based in Minneapolis. A family support program which was divided into three phases was designed to allay wartime stress. The three phases addressed were pre-deployment, deployment and reunification and sustainment.
The introduction gives an overview of stress with respect to families and service members during mobilization during wartime. The special concerns of the reserve service member and family are explained in contrast to the needs of active duty service member and family. My attention was peaked as I had never thought of the special concerns and lack of professional military support during mobilization of reserve units and the stress which results from mobilization. While often reserve service members have extended family support which their active duty counterparts often lack, reserve service members and their families frequently have a much different experience with less community network support such as support groups, adequate day care, Red Cross, chaplain, mental health services, and family service centers. Family members left behind must deal with misinformation or an overload of information from the media, disruption of family routines, role confusion, decreased income, decrease in health care benefits, uncertainty of when the service member will return home, children's adjustment concerns, confusing military bureaucracy, and worry that the war may change the service member.
During pre-deployment, stress management/mobilization breifings, a children's support group, individual and family counseling, and command consultations were offered. In the deployment phase, stress management seminars, telephone outreach and individual and family counseling were among the services offered. Phase III, reunification and sustainment was the time for reunification seminars, unit debriefings and reunification telephone follow-up calls one to three months after the service members returned home.
While an empirical verification of the benefits of the program was not possible, it was noted that there had not been an outbreak of wartime stress-related physical disorders in Minnesota perhaps due to the primary prevention which was offered.
Reviewer: Angela D. Moody-Parker, RN
October 6, 1996
Fowler, L. (1992). Family Psychoeducation: Chronic psychiatrically ill Caribbean patients. Journal of Psychosocial Nursing and Mental Health Services, 30 (3), 27-32.
This article addresses the development of FPP (Family Psychoeducational Programs) within the last 10 years, specifically for the chronically mentally ill with a diagnosis of bipolar disorder or schizophrenia and in their families. FPP's address the illness from a multidimensional perspective including familial, social, biological, and pharmacological perspectives. The FPP format focuses on blending medication compliance with the culture and belief systems of, in this case, a population of Caribbean patients that had emigrated to New York City from their homeland. A typical program would run a course of 6 months, beginning with the hospitalized patient, preparing him and his family for his discharge, and for incorporating his ongoing medication compliance into a family way of life. Cultures and beliefs were encouraged, and family members were engaged relatively easily when it was clear there was no intention to intrude. Families are prepared by attending a preliminary meeting with the ill relative and a leader. By preparing the family in advance, they know what to expect if the patient displays and psychosis. With the family actively involved in their relative's home regimen and treatment, recidivism rates were improved.
Reviewer: Susan Odom, RN, C, CD
October 3, 1996
Coffman, S., Langley, B., & Martin, V. (1995). Patterns of injury in pediatric patients in one Florida community and implication for prevention programs. Journal of Emergency Nursing, 21(1), 12-16.
Injury is one of the leading causes of death among children. "Evidence suggests that childhood death rates in the United States could be dramatically reduced by preventing and controlling injury." The pediatric trauma center at Broward General Medical Center in Fort Lauderdale, Florida has made a direct contribution to this very premise of injury prevention.
After conducting a retrospective review of the medical records of one-hundred and eighty-four trauma patients that had been treated over the course of one year, prominent injuries were classified according to age group. After the major areas of injury were identified, the trauma center began developing primary prevention programs that they could present to the community. Programs of bicycle safety and seat belt use were devised. The trauma unit actually provided and distributed free bicycle helmets to parents (for them to be able to give their children). I feel that such programs have a focus on the family unit as a whole, because the prevention education classes were devised to meet the needs of the parents and children of the community. Such programs as this one (which was implemented by the Broward General Medical Center in Fort Lauderdale) could prove to be most beneficial to families everywhere!
Reviewer: Shannon Phelps, RN
October 14, 1996
Mittelman, MS, Fierris, SH, Shulman, E, Steinburg, G, Ambinder, A, Mackell, JA, Cohen, J (1995), A Comprehensive Support Program; Effect on Depression in Spouse-Caregivers of AD Patients,
Gerontologist, 35(6), 792-802.
Caregivers of Alzheimer's disease patients often suffer from depression. The NYU Spouse-Caregiver Intervention Study demonstrates that an intervention which enhances social support has the potential for alleviating some of the deleterious effects of caregiving on mental health. Using a longitudinal treatment/control study, they examined the effect of a comprehensive support program treating the primary caregiver and family members over the entire course of the disease through individual and family counseling, the continuous availability of ad hoc counseling, and support group participation.
It has been suggested that depression in caregivers is related both to a sense of loss of control and mastery and the self-blame for events over which they have little or no control. The intervention may have helped to reduce depression because an important focus of the counseling was to make the caregivers more aware of the reason for the patient's behavior and to teach them techniques for managing and interacting with the patients. In the first year after intake, the control group became increasingly more depressed, whereas the treatment group remained stable. By the eighth month, treated caregivers were significantly less depressed than those in the control group. These results suggest that enhancing long term social support can have a significant impact of depression in caregivers.
Reviewer: Hyunchung Choi, RN
October 9, 1996
Bastol, GM, Moon, E, & Linton, M. (1994). Nursing Assistance for Families of Patients. Journal of Psychsocial Nursing, 32(12), 27-29.
With deinstitutionalization, the focus of care of the chronically mentally ill has shifted from state mental institutions to the family; families are now the primary caregivers of the chronically mentally ill. Because more than sixty-five percent of patients discharged from hospitals return to their families annually, families' concerns and needs must be addressed. Families may become overwhelmed because they do not have proper training and skills to care for their ill family member.
Furthermore, many health care professionals feel they lack the skills necessary to help families deal with the daily problems that occur. In this study of mental health clinicians conducted by Minabi and Colleagues (1985), sixty-eight percent of the respondents believed that most mental health professionals do not receive adequate training in the care of the chronically mentally ill. Formal experiences to help provide professionals with an understanding of family needs often are absent. This gap is reflected in studies that have shown a dramatic difference between mental health professionals' perceptions of what families need and the families own perception of what they need. A review of relevant literature suggests that the expressed needs of families of persons with chronic mental illness are not being met.
Nurses, who often provide the most continuous care for seriously mentally ill persons, are in a unique position to reach out to families to provide the help that they need as primary caregivers.
Reviewer: Hyunchung Choi, RN
October 9, 1996
Fisher, T (1995). Family Mediation. British Medical Journal, 310 (6994), 1551
Family mediation has developed in response to 20 years of a rapidly increased divorce rate and a decade of research into the effects of divorce on children. In Britain, a quarter of children under 16 now experience their parents' divorce. Evidence suggests that it is the process by which parents part that is more predictive of harm than the fact of separation, particularly when there is continuing conflict. Children's needs are rarely fully met by parents in the throes of divorce, and the effects of parental conflict can last into adulthood. A key protective factor seems to be the maintenance of the child's self-esteem.
This article shows family mediators try to reduce conflict, help parents cooperate to meet their children's short and long term needs. This can contribute to the formation of a more positive interpretation of events by the children. The study into the effects of divorce on adults has focused more specifically on their health. The risk of admission for psychiatric care was found to be four to six times higher for divorced people than for those who were married. More than 100 studies have shown that married people tend to be happier and healthier than divorced people.
This research has shown that clients particularly value family mediation, which has been shown to improve communication and reduce conflict and distress for adults and children.
Reviewer: Hyunchung Choi, RN
October 9, 1996
Harper, J. S. , Masters, A. (1994). Written Communication with Survivors of Sexual Abuse. Journal of Psychosocial Nursing Mental Health Service, 32(8), 11-16.
In this article the author discussed researchers' use of therapeutic letters with survivors of sexual abuse. Therapeutic letters are letters sent to clients between sessions that provide additional opportunites to highlight strengths and resources, offer information, and encourage reflection. The author described the researchers' theoretical orientation through overviews of both the literature regarding therapeutic letters and use of letters with survivors of sexual abuse.
This article is based on family systems theory and communication theories. This approach highlights interaction and reciprocity in the system.
Reasons for the impact of therapeutic letters on the client first key point is that written therapeutic communication with clients can have a lasting impact by enhancing themes of a therapy session, commenting on strengths , and highlighting changes. Second, therapeutic letters can be used to validate the sexual abuse survivor's experience, offer recommendation, provide information , normalize day to day living , encourage reflection , and seek clarification. Third, the use of therapeutic letters is consistent with a family systems nursing approach to practice, in which the nurse focuses of strengths and resources, interactions, and reciprocity during contact with the patient.
In this study with survivors of sexual abuse, they have found that the written word is a powerful, but overlooked nursing intervention and writing therapeutic letters challenges us as nurses, and continues the client/nurse conversation at a different pace from that of face to face sessions. Therapeutic letter writing invites nurses to extend themselves beyond the safety of their work spaces and in the safe places of their clients.
Reviewer: HyunChung Choi, RN
October 7, 1996
St. John, W., & Rolls, C. (1996). Teaching family nursing: strategies and
experiences. Journal of Advanced Nursing, 23, 91-96.
This research article evaluated students and staff at a nursing school in
Australia regarding the perceptions of the effectiveness of incorporating the
family as a component in the curriculum. This paper describes the
experiences of introducing a family nursing subject in an undergradue nursing
program with the focus of care being the family as a unit. The authors began
by explaining the importance of the family. They also pointed out that even
though there is an awareness of the importance of families in nursing, little
attention has been paid to the family as an object of systematic study, until
recently. They descibed how the curricula at this particular program was the
traditional hospital approach that reflected the needs of the institution,
and was primarily based on a medical-model! The article goes on to explain
why it is essential for nursing curriculums to prepare nurses by giving them
an understanding of the famiy milieu. It takes place at the Burwood campus
of Dean University in Australia. The artilce goes about to describe the aim
of the course, and how family nursing was introduced during the students'
second year. Their curriculum is based on Neuman's Systems theory. The
students were introduced to the Calgary Family Assessment Tool. A variety of
teaching strategies were incorporated such as role playing, small group work,
uses of case studies, and self-directed studies. The course was then
evaluated upon graduation by the students and staff. The evaluation tool,
developed by the authors, consisted of four questions on a four-point Likert
scle and one question on a three-point Likert scale ranging from negative to
positive. The questionnaire was administered to convenience sample of
graduates. A total of 118 evalutations were returned. The results showed
that a high proportion of graduates believed that undertanding families and
family health was meaningful to nursing practice. The findings indicated
achievemnt of the overall aims of the course. The authors concluded that
there is a need for futher development of education and knowledge about
families and family heatlh. They also state that the experience of
deveolpong this progarm focusing on the family as both challenging and
rewarding for staff and students.
Reviewer: Christina George, RN
27 OCT 1996
Gillett, P.A., Johnson,M.,Juretich, M., Richardson,N., Slagle,L., &
Farikoff,K., (1993).
The nurse as exercise leader. Geriatric Nursing, 14, 133-137.
This article is a report of the preliminary findings and observations of
the effectiveness of nurse led exercise & fitness education for overweight
older women. It included 240 overweight women. The women had to have
written medical clearance. These women were interviewed by a geriatric nurse
practitioner. They went through a battery of tests prior to and after the
fitness program. The participants perception of the benefits were positive.
They appreciated having mature leaders. They enjoyed the socialization.
Seventy-five percent reported an increase in range of motion and mobility.
Other improvements were reported in sleep, bowel function and stress
management. They also reported a decrease in low back and joint pain. They
further enjoyed improved posture and increased energy and endurance.
Thirty-five percent reported a decrease in weight, blood pressure and
cholesterol. The nurses reported an adherence rate to exercise intervention
for theis age group that was eighty eight percent higher than non nurse led
programs reported in the literature for overweight wowen. This research
explored the need for nurses to be knowledgeable in exercise science.
Particularly in relation to the aging population.
Reviewer: Sheila Jensen, RN
28 OCT 1996
Wheeler, S. R. (1996). Helping families cope with death and dying.
Nursing 96, 26(7), 25-31.
This article reinforces the fact that individuals deal with the
issue of death in many different ways. It emphasizes that the process
of death effects the entire family. This piece begins with the
processes of anticipatory grief, it goes on to discuss the dimensions of
bereavement and later offers strategies one may use to help family
members move through the grief process. The article goes over four
stages of bereavement and the feelings family members may be
experiencing, along with the length of time each stage normally lasts.
The stages discussed are as follows: 1. Shock and numbness, 2.
Searching and learning, 3. Disorganization, and 4. Reorganization. Some
examples of strategies offered in this article are practicing
therapeutic listening, maintaining confidentiality, and using
appropriate communication skills. The article lists a chart on comments
that are appropriate, as well as the things that are inappropriate to
say during the times of grief.
The discussion of the expected stages of bereavement and the
process of anticipatory grief in this article are interesting. However,
I feel some of the information is common sense. I feel this article is
helpful , but is really only one persons interpretation of the stages of
death and dying. I feel the Kubler-Ross model we all studied in nursing
school was as enlightening. If you were not satisfied with your
exposure to the Kubler- Ross models and are looking for another
interpretation on this topic this may be the article for you to read.
Reviewer: Jennifer Graney, RN
October 27, 1996
Turner, M., Tomlinson,P.& Harbaugh,B. (1990). Parental uncertainty in critical care
hospitalization of children. Maternal-Child Nursing Journal,19 (1), 45-62.
The purpose of this qualitative study was to explore the dimensions of uncertain-
ty, including the source, family effect, and parental response of parents whose child
was hospitalized in a pediatric intensive care unit. Thirteen parents of eight
critically ill children served as subjects using a modified grounded theory method
with 1 - 1.5 hour interviews within 2 - 4 days after admission. Four areas of
uncertainty were examined including environmental uncertainty, illness uncertainty,
caregiver uncertainty and family system uncertainty. It demonstrates an aspect of
illness uncertainty related to the unique dependent relationship within the child
rearing family. It extends theory to guide practice for nurses in the PICU.
This is an easy reading but highly informative study which should be read by all
PICU nurses.
Reviewer: Susan Taphous
October 30, 1996
Ahmann, Elizabeth. (1994). Thinking critically about family centered home care nursing.
Pediatric Nursing, 20(6), 588-590.
This article deals with critical questions that may arise in family centered home care
nursing. The questions identified test the boundaries between home care nurses and the family system.
Three questions are posed which have no clear, single answer that applies in all cases. The author states the only answers there are to the questions will emerge in thoughtful
clinical practice with individual families and may differ from nurse to nurse, family to family and situation to situation.
Question 1 explores where family boundaries lie between collaboration with families in home care nursing and being incorporated into the family system.
Question 2 asks who is to determine the appropriate care of the child. Where are boundaries between respecting parental decisions and choices that differ form those of the nurse and inappropriate or unsafe nursing practice?
Question 3 What is the responsibility of the nurse who may witness child neglect, abuse, family violence and the like?
Although not a research study this article posed interesting questions, which because there was no clear cut answer, stimulated thought on boundaries for nurses in a home and family centered practice. This type of thinking would help the nurse prepare his or herself for some of the potential gray areas in family centered nursing practice of a pediatric client.
Reviewer: Deborah Duchesneau, RN, BA, CCRN, CEN
Oct 30,1996
Pichert,J. W., Synder,G.M., Kinzer,C., Boswell,E.J. (1994) . Problem solving anchored instruction about sick days for adolescents with diabetes. Patient Education and Counseling, 23, 115-124.
This study’s hypotheses were that both shortly after instruction and after 8 month follow-up, diabetic children taught via anchored instruction (AI ), a format for problem solving, would out perform controls. Eighty-four 9-15 year old campers with IDDM were randomly assigned to AI or control groups. AI is defined as an approach in which the study of many concepts and skills is anchored in a single graphically presented context (story or problem). The anchor is presented so that learners and instructors can share a common experience that challenges them to seek new information.
Results of the primary hypotheses that shortly after instruction and after 8 months delay, children taught AI would outperform controls, received mixed support. At the end of the two week camp, AI and control groups’ scores on factual knowledge were equal.
AI ‘s however were more likely than controls to at the end of camp and 8 months later provide a rationale for the use of remembered guidelines. AI appeared at least as good as conventional teaching and may better link rules and reasons perhaps aiding in daily real life problem solving.
Some further questions raised by the researchers were: how much baseline knowledge a patient must possess to profit from AI; how best to tailor it to groups and should this method be used with newly diagnosed diabetics?
This article was valuable because of the practice implications mentioned such as
1) patient educators should consider including problem solving formats as part of small group instruction.
2) practice with problem solving may help families form links between self care
guidelines and their underlying rationale.
3) problem solving application more closely resembles challenges in daily life self care.
Reviewer: Deborah Duchesneau, RN, BA, CCRN, CEN
Oct 30,1996