The Family Model - A transgenerational approach to mental health in families: personal, clinical, educational, research, systems and policy perspectives

The Family Model – A transgenerational approach to mental health in families This workshop will provide an overview on The Family Model (TFM) and its use in promoting and facilitating a trans­generational family focus in Mental Health services, over the past 10­ - 15 years. Each of the speakers will address a different perspective, including service user/consumer, clinical practice, education & training, research and policy. Adrian Falkov (chair) will provide an overview of TFM to set the scene and a ‘policy to practice’ perspective, based on use of TFM in Australia. Author: Heide Lloyd. The Family Model ­ A personal (consumer/patient) perspective | United Kingdom Heide will provide a description of her experiences as a child, adult, parent & grandparent, using TFM as the structure around which to ‘weave’ her story and demonstrate how TFM has assisted her in understanding the impact of symptoms on her & family and how she has used it in her management of symptoms and recovery (personal perspective). The Family Model ­ Education & training perspective ­ Marie Diggins | United Kingdom PhD Bente Weimand | Norway Authors: ­ Marie Diggins | United Kingdom PhD Bente Weimand | Norway This combined (UK & Norwegian) presentation will cover historical background to TFM and its use in eLearning (the Social Care Institute for Excellence)and a number of other UK initiatives, together with a description of the postgraduate masters course at the University Oslo/Akershus, using TFM. The Family Model ­ A research perspective PhD Anne Grant | Northern Ireland Author: PhD Anne Grant | Ireland Anne Grant will describe how she used TFM as the theoretical framework for her PhD looking at family focused (nursing) practice in Ireland. The Family Model ­ A service systems perspective ­ Mary Donaghy | Northern Ireland Authors: PhD Adrian Falkov | Australia ­ Mary Donaghy | N Ireland Mary Donaghy will discuss how TFM has been used to support & facilitate a cross service ‘whole of system’ change program in Belfast (NI) to achieve improved family focused practice. She will demonstrate its utility in achieving a broader approach to service design, delivery and evaluation.

Providing a ‘whole-of-family’ approach to care: family-focused practices in mental health services

Introduction: Family members including children are all impacted by a family member’s mental illness. Although mental health services are increasingly encouraged to engage in family-focused practice, this is not a well-understood concept or practice in mental health care. Methods: An integrative review using systematic methods was conducted with international literature, with the aim of identifying concepts and practices of family-focused practice in child and youth and adult mental health services. Results: Findings from 40 peer-reviewed literature identified a range of understandings and applications of family-focused practice, including who comprises the ‘family’, whether the focus is family of origin or family of procreation or choice, and whether the context of practice is child and youth or adult. ‘Family’ as defined by its members forms the foundation for practice that aims to provide a whole-of-family approach to care. Six core practices comprise a family focus to care: assessment; psychoeducation; family care planning and goal-setting; liaison between families and services; instrumental, emotional and social support; and a coordinated system of care between families and services. Conclusion: By incorporating key principles and the core family-focused practices into their care delivery, clinicians can facilitate a whole-of-family approach to care and strengthen family members’ wellbeing and resilience, and their individual and collective health outcomes.

Psychiatric Nurses’ Practice with Parents who have Mental Illness, their Children and Families, within Adult Mental Health Services in Ireland

Introduction: While it is recommended that mental health professionals engage in family focused practice (FFP), there is limited understanding regarding psychiatric nurses’ practice with parents who have mental illness, their children and families in adult mental health services.

Methods: This study utilized a mixed methods approach to measure the extent of psychiatric nurses’ family focused practice and factors that predicted it. It also sought to explore the nature and scope of high scoring psychiatric nurses’ FFP and factors that affected their capacity to engage in FFP. Three hundred and forty three psychiatric nurses in 12 mental health services throughout Ireland completed the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Fourteen nurses who achieved high scores on the FFMHPQ also participated in semi-structured interviews.

Results: Whilst the majority of nurses were not family focused a substantial minority were. High scoring nurses’ practice was complex and multifaceted, comprising various family focused activities, principles and processes. Nurses’ capacity to engage in FFP was determined by their knowledge and skills, working in community settings and own parenting experience.

An integrative review of how families are prepared for, and supported during withdrawal of life-sustaining treatment in intensive care

AIM: To conduct an integrative review on how nurses prepare families for and support families during withdrawal of life-sustaining treatments in intensive care.

BACKGROUND: End-of-life care is widely acknowledged as integral to the practice of intensive care. However, little is known about what happens after the decision to withdraw life-sustaining treatments has been made and how families are prepared for death and the dying process.

DESIGN: Integrative literature review.

DATA SOURCES: MEDLINE, CINAHL Plus, PsychINFO, PUBMED, Scopus, EMBASE and Web of Knowledge were searched for papers published between 2000 - May 2015.

REVIEW METHODS: A five stage review process, informed by Whittemore and Knafl's methodology was conducted. All papers were reviewed and quality assessment performed. Data were extracted, organised and analysed. Convergent qualitative thematic synthesis was used.

RESULTS: From an identified 479 papers, 24 papers were included in this review with a range of research approaches: qualitative (n=15); quantitative (n=4); mixed methods (n=2); case study (n=2); and discourse analysis (n=1). Thematic analysis revealed the nurses: equipped families for end of life through information provision and communication; managed the withdrawal of life-sustaining treatments to meet family need; and continued care to build memories.

CONCLUSION: Greater understanding is needed of the language that can be used with families to describe death and dying in intensive care. Clearer conceptualisation of the relationship between the medically focussed withdrawal of life-sustaining treatments and patient/family centred end-of-life care is required making the nursing contribution at this time more visible.

Understanding the bereavement care roles of nurses within acute care: a systematic review

AIM AND OBJECTIVES: To investigate nurses' roles and responsibilities in providing bereavement care during the care of dying patients within acute care hospitals.

BACKGROUND: Bereavement within acute care hospitals is often sudden, unexpected and managed by nurses who may have limited access to experts. Nurses' roles and experience in the provision of bereavement care can have a significant influence on the subsequent bereavement process for families. Identifying the roles and responsibilities nurses have in bereavement care will enhance bereavement supports within acute care environments.

DESIGN: Methods: A mixed-methods systematic review was conducted utilising the databases Cumulative Index Nursing and Allied Health Literature (CINAHL Plus), Embase, Ovid MEDLINE, PsychINFO, CareSearch and Google Scholar. Included studies published between 2006 to 2015, identified nurse participants, and the studies were conducted in acute care hospitals. Seven studies met the inclusion criteria and the research results were extracted and subjected to thematic synthesis.

RESULTS: Nurses' role in bereavement care included patient-centred care, family-centred care, advocacy and professional development. Concerns about bereavement roles included competing clinical workload demands, limitations of physical environments in acute care hospitals and, the need for further education in bereavement care.

CONCLUSIONS: Further research is needed to enable more detailed clarification of the roles nurse undertake in bereavement care in acute care hospitals. There is also a need to evaluate the effectiveness of these nursing roles and how these provisions impact on the bereavement process of patients and families. 

The value of peer support and a strengths-based approach in a groupwork programme for fathers in a family support setting

This paper seeks to share and critically explore the learning gained through the genesis, realisation, and facilitation process of Just for Dads, a groupwork programme for fathers, run in a family support setting. It highlights the importance of and challenges involved in engaging men in practice, and in groupwork aimed at fathers in particular. It recounts the significance of using a strengths perspective as a framework for engaging fathers in groupwork and highlights its value as experienced by participants and facilitators. The dynamic of peer learning which developed as a key part of the groupwork process is discussed, both in relation to how it was experienced by participants and also the degree to which the facilitators were part of that dynamic. Overall the paper aims to document and air key issues arising in this relatively unexplored arena of groupwork and family support practice.

Investigating the cost-effectiveness of video telephone based support for newly diagnosed paediatric oncology patients and their families: design of a randomised controlled trial

Background Providing ongoing family centred support is an integral part of childhood cancer care. For families living in regional and remote areas, opportunities to receive specialist support are limited by the availability of health care professionals and accessibility, which is often reduced due to distance, time, cost and transport. The primary aim of this work is to investigate the cost-effectiveness of videotelephony to support regional and remote families returning home for the first time with a child newly diagnosed with cancer Methods/design We will recruit 162 paediatric oncology patients and their families to a single centre randomised controlled trial. Patients from regional and remote areas, classified by Accessibility/Remoteness Index of Australia (ARIA+) greater than 0.2, will be randomised to a videotelephone support intervention or a usual support control group. Metropolitan families (ARIA+ ≤ 0.2) will be recruited as an additional usual support control group. Families allocated to the videotelephone support intervention will have access to usual support plus education, communication, counselling and monitoring with specialist multidisciplinary team members via a videotelephone service for a 12-week period following first discharge home. Families in the usual support control group will receive standard care i.e., specialist multidisciplinary team members provide support either face-to-face during inpatient stays, outpatient clinic visits or home visits, or via telephone for families who live far away from the hospital. The primary outcome measure is parental health related quality of life as measured using the Medical Outcome Survey (MOS) Short Form SF-12 measured at baseline, 4 weeks, 8 weeks and 12 weeks. The secondary outcome measures are: parental informational and emotional support; parental perceived stress, parent reported patient quality of life and parent reported sibling quality of life, parental satisfaction with care, cost of providing improved support, health care utilisation and financial burden for families. Discussion This investigation will establish the feasibility, acceptability and cost-effectiveness of using videotelephony to improve the clinical and psychosocial support provided to regional and remote paediatric oncology patients and their families.

Why do Indigenous Australians drink and drive? A qualitative exploration of self-reported influences on drink driving behaviours of Indigenous peoples from remote communities

Drink driving contributes towards high injury rates for Indigenous populations in Canada and Australia, particularly in more isolated regions. At present there is limited research on the cultural and psychosocial factors that underpin Indigenous peoples’ drink driving. This study is part of a broader project aiming to inform a culturally sensitive program. Qualitative interviews with 29 convicted Indigenous drink drivers (aged 20-51 years) from a remote region of Queensland, Australia were used to explore their cognitions about, and underlying motivation for, drink driving as well as the factors that might facilitate or impede it. Although a number of themes were identified, this paper will focus on the first theme, respondents’ self-perceived rationale for their behaviour. Two subthemes were identified: ‘being the hero’ referred to situations where respondents were motivated by a bravado mentality to drive after drinking despite having, on some occasions, the opportunity to avoid this (e.g. another person offering to drive); and ‘family obligations’ which referred to situations where respondents described pressure from members of their extended families to drive after drinking. The underlying responsibility for transporting family members appeared to be difficult to avoid and related to cultural values. Findings indicate the social and individual characteristics for younger drink drivers are similar to mainstream populations. However, the reinforcers for Indigenous drink drivers may be different for this population, consistent with findings on other Indigenous populations outside Australia. Specific programs should contain a family-centred approach and explore the kinship value system to build strategies around these strong relationships.

The effectiveness of health education using the teach-back method on adherence and self-management in chronic disease: A systematic review protocol

Review question/objective What is the effect of using the teach-back method for health education to improve adherence to treatment regimen and self-management in chronic disease? Inclusion criteria Types of participants This review will consider all studies that include adult patients (aged 18 years and over) in any healthcare setting, either as inpatients (eg acute care, medical and surgical wards) or those who attend primary health care, family medical practice, general medical practice, clinics, outpatient departments, rehabilitation or community settings. Participants need to have been diagnosed as having one or more chronic diseases including heart failure, diabetes, cardiovascular disease, cancer, respiratory disease, asthma, chronic obstructive pulmonary disease, chronic kidney disease, arthritis, epilepsy or a mental health condition. Studies that include seriously ill patients, and/or those who have impairments in verbal communication and cognitive function will be excluded. Types of intervention This review will consider studies that investigate the use of the teach-back method alone or in combination with other supporting education, either in routine or research intervention education programs; regardless of how long the programs were and whether or not a follow-up was conducted. The intervention could be delivered by any healthcare professional. The comparator will be any health education for chronic disease that does not include the teach-back method. Types of outcomes Primary outcomes of interest are disease-specific knowledge, adherence, and self-management knowledge, behavior and skills measured using patient report, nursing observation or validated measurement scales. Secondary outcomes include knowledge retention, self-efficacy, hospital readmission, hospitalization, and quality of life, also measured using patient report, nursing observation, hospital records or validated measurement scales.

Vammaisen lapsen äidin vanhemmuuden kokemus sekä lähiympäristön ja kasvatuskumppanuuden merkitys

The parenthood experience of a mother with a disabled child and the meaning of the social environment and parent-professional partnerships The importance of parental guidance when a family has a child with a disability or autism has been pointed out by several studies. The present research was based on the premise that by supporting the mother we can help the whole family to cope better and the professionals in day care or at school are able to support parents. The starting point was the subjective experience, which is also the central focus of the phenomenological method. The purpose of this study was firstly to describe the experience of the mother and the dialogue between mother and educational professionals. Secondly it was the task of this research to discover what kind of support and information the mother obtains from her social environment. At the background of this study there was the ecological theory of Bronfenbrenner, the ecocultural approach by Gallimore and the interactive examination of family that take into consideration the whole environment and personal situation. The research data was collected by interviewing the mothers, the day care personnel and the teachers at school. In this research there were a total of 32 interviews and 24 informants: 10 mothers who have a child with a disability and/or autism, 8 professionals in day care and 6 teachers at school. This study was longitudinal because the same mothers were interviewed twice, first in 1998 and then after five years in 2003. It was thus possible to get information on whether their life situation had changed and the nature of those changes. The data of this study was analysed by the method of phenomenological psychology that was applied for this study. The findings indicated that all mothers had experienced many complicated emotional feelings such as: anger, mourning, fear and sadness as well as love and bonding. It can be said that several human feelings existed at the same time. Mothers experienced that the support of the social environment, for example, relatives, families in the same situation and persons taking care of the child had significant meaning for their coping. However the life situation among the mothers varied. Mostly mothers received valuable support for their parenthood and they have adopted a strong emotion for manage ring. Mothers with an autistic child were more stressed than mothers with a mentally retarded child. A few mothers had numerous problems with taking care of their child and they did not get enough help. Same mothers were very exhausted too and the situation was quite the same after five years, when their child was teenager. All mothers said that after starting school the support for the family had significally diminished. Mothers said that dialogue with teacher got on without problems, but there were meetings seldom, so it wasn´t possible to get enough support for their parenthood. Keywords: parenthood, motherhood, disability, early special education, family-centred.

A formação do enfermeiro para atuação na Atenção Básica: uma análise segundo as diretrizes do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde)

O processo de institucionalização do Sistema Único de Saúde (SUS) já dura vinte anos e uma das medidas de organização e implementação é o fortalecimento da Atenção Básica, via Estratégia de Saúde da Família, procurando atender à população de acordo com as realidades locais. Nesse contexto, a partir de 1996, a Lei de Diretrizes e Bases da Educação Nacional e as Diretrizes Curriculares dos cursos de Educação Superior modificam a qualificação do profissional de saúde com vistas ao processo de trabalho no SUS. Esta pesquisa teve como objetivo analisar a formação do enfermeiro na perspectiva do trabalho na Saúde da Família no município do Rio de Janeiro. Foi realizado estudo de caso múltiplo em duas instituições de ensino superior que possuem curso de graduação em enfermagem, utilizando uma abordagem quali-quantitativa de natureza descritivo-exploratória. O instrumento de coleta de dados foi um survey aplicado por meio de questionário aos alunos dos últimos períodos das instituições escolhidas. O eixo norteador da construção do questionário foram as diretrizes do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde), escolhido por ser um programa que visa à indução de medidas de transformação do ensino de saúde no Brasil, com ênfase na Atenção Básica. Os dados obtidos foram processados e tabulados através do software R versão 2.10.0 e receberam tratamento estatístico. Os resultados apontam para um grupo de alunos de graduação em enfermagem com perfil predominantemente feminino e jovem, que reside com os pais e não contribui financeiramente com a manutenção da casa. Em relação à organização das atividades curriculares, há o predomínio da abordagem do processo saúde doença e da saúde como um processo multideterminado, valorizando ações de promoção, prevenção, recuperação e perspectiva de vigilância da saúde. Em relação aos campos de prática, as diferenças observadas nas duas instituições estudadas estão relacionadas à precocidade e predominância da inserção dos alunos nos campos. Em ambas as instituições, prevalece a expectativa profissional dos alunos em buscar aprimoramento profissional após concluírem a graduação. Assim sendo, foi possível verificar que a continuidade e o fortalecimento do incentivo às instituições para a adesão ao programa aproximará cada vez mais a formação do enfermeiro ao modelo de atenção proposto pelo SUS, repercutindo desta forma na qualidade do atendimento prestado aos usuários do sistema de saúde brasileiro.

The health of children with cerebral palsy and stress in their parents

Aim.  This paper is a report of a study conducted to describe the health of children with cerebral palsy and investigate predictors of stress in their parents. Background.  Children with severe cerebral palsy tend to have poorer health than their able-bodied peers, and their parents are more likely to be stressed and have poorer health. Method.  A cross-sectional survey with home visits using standard questionnaires was administered to parents in 2004–05. A total of 102/199 (51%) children and parents participated. The children were compared with a normative sample. Results.  Children with cerebral palsy had poorer physical health, and 79% of parents reported that their child had moderate to severe pain. Their poorer health, in comparison with the normal sample and measured by the Child Health Questionnaire, was related to feeding problems and seizures, general health perceptions to intellectual and feeding impairment, and family activities with severe motor, intellectual and feeding impairment. Poorer psychological well-being on the hyperactivity domain of the Strengths & Difficulties Questionnaire was related to feeding difficulties, on the prosocial domain to more severe forms of all child impairments, and on the social impairment scale to intellectual impairment. Children with psychological problems had statistically significantly increased odds (OR = 7·2, 95% CIs 2·6–20·3) of having parents with high stress. Conclusion.  Children with cerebral palsy and associated impairments are at higher risk of poorer health and family well-being. A family-centred approach to the care of children with cerebral palsy and their families is essential to ensure both receive adequate care and support.

Home-based support for palliative care families:challenges and recommendations

Providing adequate supportive services for the families of palliative care patients is a core principle of palliative care. Caring for a patient with terminal illness at home involves a considerable commitment on the part of family caregivers, and attention must be given to the caregiver's needs as well as those of the patient. Although a home death may be preferred by patients and promoted by healthcare agencies as a cost-effective option, it may be an ideal that is not often realised. Enhanced supportive care strategies can ameliorate the challenges facing families of palliative care patients cared for at home. All health professionals need to improve the standard of family-centred palliative care, and more evidence-based approaches are required.

Service user perspectives on palliative care education for health and social care professionals supporting people with learning disabilities

Background and objectives
Evidence from European and American studies indicates limited referrals of people with learning (intellectual) disabilities to palliative care services. Although professionals’ perceptions of their training needs in this area have been studied, the perceptions of people with learning disabilities and family carers are not known. This study aimed to elicit the views of people with learning disabilities, and their family carers concerning palliative care, to inform healthcare professional education and training.

Methods
A qualitative, exploratory design was used. A total of 17 people with learning disabilities were recruited to two focus groups which took place within an advocacy network. Additionally, three family carers of someone with a learning disability, requiring palliative care, and two family carers who had been bereaved recently were also interviewed.

Results
Combined data identified the perceived learning needs for healthcare professionals. Three subthemes emerged: ‘information and preparation’, ‘provision of care’ and ‘family-centred care’.

Conclusions
This study shows that people with learning disabilities can have conversations about death and dying, and their preferred end-of-life care, but require information that they can understand. They also need to have people around familiar to them and with them. Healthcare professionals require skills and knowledge to effectively provide palliative care for people with learning disabilities and should also work in partnership with their family carers who have expertise from their long-term caring role. These findings have implications for educators and clinicians.

Obesidade infantil: práticas alimentares e percepção materna de competências

A obesidade infantil é um importante problema de saúde pública, não só pelos efeitos adversos durante a infância mas porque tende a persistir na idade adulta, constituindo um factor de risco para diversas doenças crónicas. Os alicerces de uma vida saudável estruturam-se na vida pré-natal e sedimentam-se nos seis primeiros anos de vida, sendo o crescimento da criança fortemente influenciado pelo seu contexto ambiental familiar. Foi neste âmbito que emergiu como objectivo geral deste estudo explorar as relações existentes entre os determinantes infantis (antecedentes obstétricos e peri-natais) e parentais (práticas alimentares, conhecimento dos pais sobre alimentação infantil, percepção parental de competência e percepção do peso da criança) e o desenvolvimento de excesso de peso em crianças pré-escolares. Este estudo, de carácter observacional e transversal, foi realizado com 792 crianças pré-escolares, idade M= 4,39 anos (±0,91Dp) e seus pais, residentes num concelho pertencente às NUTs III Dão-Lafões, sendo efectuada a avaliação antropométrica e classificação nutricional das crianças com base no referencial NCHS (CDC, 2000) e da OMS nos pais. O protocolo de pesquisa incluiu instrumentos de medida que validamos para a população portuguesa e a construção do Questionário de Conhecimentos sobre Alimentação Infantil (QAI) cujas propriedades psicométricas certificam a sua qualidade (Alfa de Cronbach = 0,942; Alfa de Cronbach teste re-teste = 0,977). Nas crianças, 31,3% apresentavam excesso de peso (12,4% obesidade), assim como 41,1% das mães (10,2% obesidade) e 64,4% dos pais (14,8% obesidade), sendo mais evidente nas mães o risco metabólico associado ao Perímetro da Cintura. As mães revelam mais conhecimentos sobre alimentação e sentimentos de eficácia mais elevados com o papel parental, enquanto os pais manifestaram mais sentimentos de motivação e satisfação. Os resultados obtidos corroboram existir efeito significativo dos determinantes infantis e parentais no excesso de peso da criança, designadamente: (i) do peso ao nascer, com impacto dos nascidos grandes; (ii) da higiene do sono especificamente dos que dormem menos de 11horas; (iii) dos que não brincam na rua, (iv) das mães mais jovens, do IMC e risco metabólico dos Pais; (v) da percepção parental da imagem corporal dos filhos, verificando-se que quanto mais elevado o IMC das crianças, mais distorcida é esta percepção dos pais; (vi) das crenças, atitudes e práticas alimentares e que permitem inferir que uma maior preocupação com o peso da criança, maior controlo, restrição e menor pressão para comer se associa a maior excesso de peso. As inferências evidenciam que, na vigilância de saúde periódica se torna imprescindível a valorização dos determinantes de risco biológicos e familiares do excesso de peso infantil, considerando programas de intervenção centrados na família, num processo que encontre sentido a partir daquilo que as famílias experienciam, de forma a ajudá-las a criar recursos fortalecedores de competência para uma parentalidade mais positiva.