959877 editorial2020
CNU0010.1177/1474515120959877European Journal of Cardiovascular NursingLuttik
Editorial
Family Nursing: The family as the unit of research and care
European Journal of Cardiovascular Nursing 1–3 © The European Society of Cardiology 2020 Article reuse guidelines: sagepub.com/journals-permissions https://doi.org/10.1177/1474515120959877 DOI: 10.1177/1474515120959877 journals.sagepub.com/home/cnu
MLA Luttik Keywords Family, informal care, family nursing, caregiver role strain, aging, patient-centred, family focused, systemic Date received: 19 August 2020; revised: 29 August 2020; accepted: 31 August 2020
It is generally known that Europe’s population will be ‘turning increasingly grey’ in the coming decades.1 At the same time, the working-age population will decrease significantly resulting in an increasing shortage of staff in healthcare. Most countries in Europe were negatively affected both by the economic crisis at the beginning of the current millennium and by the consequences of the coronavirus disease 2019 (COVID-19) pandemic very recently. In order to keep healthcare systems manageable and affordable, European governments have implemented a number of measures for which increased emphasis is being placed on the responsibility of patients and families for their own health. Future healthcare will rely more heavily on the support of family, including spouses and partners but also (adult) children, grandchildren and others in the social network around patients providing the support and care that is needed. The role of professional care will relatively diminish; hospital admissions or admissions to healthcare institutions, in general, should be prevented or be as brief as possible. In practice, this all means that enormous demands must be made for the help and support from family and relatives. This development has serious consequences for citizens, in general, and more specifically for families and family relationships. The risks and consequences of this development have already become visible; ‘caregiver role strain’ has become an important societal theme. Moreover, there is a significant amount of research indicating that families who provide long-term and intensive care, for example for people with cardiovascular diseases, feel heavily burdened or even overburdened so that they themselves have an increased risk of developing health problems.2–4
Nurses (ICN) as follows: ‘Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings’.5 In this definition, the family is appointed as part of the nurse’s professional responsibility. However, ‘patient-centred care’ is still the most powerful motto in healthcare, and a motto that should be left behind because it no longer does justice to recent social developments. As family becomes increasingly responsible for care, there is a progressive interdependence within families so that we, as nurses, simply cannot afford to only put the patient first. Nurses can no longer ignore the needs of families as these families become important partners in the care for patients. Generally speaking, the importance of family members in care is increasingly acknowledged.6,7 However, research indicates that nurses do not include the role and support of family in their professional activities. Tapp and Moules describe how, although nurses highly acknowledged the importance of family in the care for their (cardiac) patients, there were no formal approaches to family assessment, and interventions towards families were hardly observed.8 Furthermore, nursing diagnoses in the psychosocial domain such as ‘caregiver role strain’ or ‘disrupted family processes’ are hardly present in patient records, although it is known that these diagnoses are relevant in many cases.9 When healthcare professionals do involve families in their care for patients, this is often still unilaterally focused on how family can or must support the patient, which is beneficial and necessary, but the other side of the coin is generally forgotten; how is this family is doing? What is the effect of caring for
Hanze University of Applied Sciences, Groningen, Netherlands
Family and nursing How does the nursing profession relate to the concept of family? Nursing is defined by the International Council of
Corresponding author: M.L.A. Luttik, Hanze University of Applied Sciences, Petrus Driessenstraat 3, Groningen, 9714CE, The Netherlands. Email: [email protected]
2
European Journal of Cardiovascular Nursing 00(0)
a family member’s health and well-being, and what do they need to continue to fulfil their role? These are questions that genuinely need to be delved into for nurses to become competent to optimally support families Meanwhile, nurses in clinical practice are increasingly confronted with complex care situations in which they deal directly with families who are held jointly responsible for the care of their family member. Excellent communication, optimal cooperation and shared decision-making are crucial. This requires different and new competences from nurses; they often talk to families about complex care situations and sometimes complicated family circumstances. In that context, they require knowledge and skills about how it (family structures and family processes in the context of care) works within families in the context of care.
Family Nursing The literature and knowledge area ‘family nursing’ offers valuable insights and tools that can help nurses to meet these challenges. In the international context, family nursing is a scientific discipline that focuses on developing the knowledge of the structure and functioning of families in the context of illness and health.10 Family nursing is based on two scientifically substantiated assumptions.
Families and family relations influence the process and outcome of healthcare Family and family relationships influence the process and outcomes of care.11,12 Scientific literature shows that family and good social relationships are important for the health and well-being of people in general, both in the prevention of illness but certainly also in the case of illness and care. People in general and patients more specifically need their family and their social relationships in order to stay healthy, to recover from illness or to live with chronic conditions.
Health and illness are family events and affect all members of a family The other side of the coin, which is often forgotten or at least not considered as part of professional actions, is that illness and health affects all family members involved with the patient or client.13,14 Family nursing in clinical practice is based on a systemic approach to care situations in which not only the needs of the patient are central but also the health and wellbeing of the family of which the patient is a part.15,16 - The family structure, the mutual relationships and the functioning of a family system as a whole are mapped out by drawing a genogram;
- From there, joint discussion is conducted, for example, by having a family conversation regarding the issues, sorrows and needs of this family; - Ultimately, appropriate interventions can be initiated, and agreements can be made about how to shape the care whereby the balance of give and take in the family is always monitored. Healthcare must shift from a patient-centred approach to a family-focused approach in order to support families in the care of their (chronically ill) family member and in the prevention of caregiver-related stress and hardship. Family nursing,15,16 with its fundamental assumption that a system must be understood as a whole rather than individual parts in isolation from one other, is applicable and highly necessary in light of the healthcare challenges that lie ahead. Research supporting the effectiveness of this familyfocused approach is highly necessary. To build this evidence, it is critical that researchers apply appropriate statistical techniques that account for the interdependency between patients and their family caregivers.17 This relational interdependency, however, is not restricted only to dyads; therefore, research should not only have a dyadic or bilateral focus but also focus on family dynamics and the family as a unit of care. Declaration of conflicting interests The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding The author received no financial support for the research, authorship and/or publication of this article.
References 1. European Commission, Directorate-General for Economic and Financial Affairs. The 2018 ageing report economic & budgetary projections for the EU Member States (2016– 2070). Institutional paper 079. 2018. https://ec.europa. eu/info/publications/economy-finance/2018-ageingreport-economic-and-budgetary-projections-eu-memberstates-2016-2070_en 2. Schulz R, Beach SR, Hebert RS, et al. Spousal suffering and partner’s depression and cardiovascular disease: The Cardiovascular Health Study. Am J Geriatr Psychiatry 2009; 17: 246–254. 3. Agren S, Evangelista L and Stromberg A. Do partners of patients with chronic heart failure experience caregiver burden? Eur J Cardiovasc Nurs 2010; 9: 254–262. 4. Stromberg A and Luttik ML. Burden of caring: Risks and consequences imposed on caregivers of those living and dying with advanced heart failure. Curr Opin Support Palliat Care 2015; 9: 26–30. 5. Bartz CC. International Council of Nurses and PersonCentered Care. Int J Integrated Care 2010; 10: e010.
Luttik 6. Gusdal AK, Josefsson K, Thors-Adolfssen E, et al. Nurses’ attitudes towards family importance in heart failure care. Eur J Cardiovasc Nurs 2017; 16: 256–266. 7. Kim EY, Oh S and Son YJ. Caring experiences of family caregivers of patients with heart failure: A meta-ethnographic review of the past 10 years. Eur J Cardiovasc Nurs 2020; 19: 473–485. 8. Tapp D and Moules N. Enlivening the rhetoric of family nursing: ‘There, in the midst of things, his whole family listening’. J Appl Hermeneutics. Epub before print 16 January 2012. DOI: https://doi.org/10.11575/JAH.V0I0.53189. 9. Paans W and Müller-Staub M. Patients’ care needs: Documentation analysis in general hospitals. Int J Nurs Know 2015; 26: 178–186. 10. Kaakinen JR, Padgett-Coehlo D, Steele R, et al. (eds) Family health care nursing. Theory, practice and research. Philadelphia: FA Davis Company, 2015. 11. Reifman A. Social relationships, recovery from illness, and survival: A literature review. Ann Behav Med 1995; 17: 124–131.
3 12. Luttik ML, Jaarsma T, Moser D, et al. The importance and impact of social support on outcomes in patients with heart failure: An overview of the literature. J Card Nurs 2005; 20: 162–169. 13. Årestedt L, Persson C and Benzein E. Living as a family in the midst of chronic illness. Scand J Caring Sc 2014; 28: 29–37. 14. Luttik ML, Jaarsma T, Veeger NJ, et al. For better and for worse: Quality of life impaired in HF patients as well as in their partners. Eur J Cardiovasc Nurs 2005; 4: 11–14. 15. Wright LM and Leahey M. Nurses and families. A guide to family assessment and intervention. Philadelphia: FA Davis Company, 2013. 16. Wright LM and Leahey M. Trends in nursing of families. J Adv Nurs 1990; 15: 148–154. 17. Moons P, Prikken S and Luyckx K. Chronic illness as a ‘family disease’: The need for appropriate scientific methods for dyadic research. Eur J Cardiovasc Nurs 2020; 19: 98–99.
CNU0010.1177/1474515120959877European Journal of Cardiovascular NursingLuttik
Editorial
Family Nursing: The family as the unit of research and care
European Journal of Cardiovascular Nursing 1–3 © The European Society of Cardiology 2020 Article reuse guidelines: sagepub.com/journals-permissions https://doi.org/10.1177/1474515120959877 DOI: 10.1177/1474515120959877 journals.sagepub.com/home/cnu
MLA Luttik Keywords Family, informal care, family nursing, caregiver role strain, aging, patient-centred, family focused, systemic Date received: 19 August 2020; revised: 29 August 2020; accepted: 31 August 2020
It is generally known that Europe’s population will be ‘turning increasingly grey’ in the coming decades.1 At the same time, the working-age population will decrease significantly resulting in an increasing shortage of staff in healthcare. Most countries in Europe were negatively affected both by the economic crisis at the beginning of the current millennium and by the consequences of the coronavirus disease 2019 (COVID-19) pandemic very recently. In order to keep healthcare systems manageable and affordable, European governments have implemented a number of measures for which increased emphasis is being placed on the responsibility of patients and families for their own health. Future healthcare will rely more heavily on the support of family, including spouses and partners but also (adult) children, grandchildren and others in the social network around patients providing the support and care that is needed. The role of professional care will relatively diminish; hospital admissions or admissions to healthcare institutions, in general, should be prevented or be as brief as possible. In practice, this all means that enormous demands must be made for the help and support from family and relatives. This development has serious consequences for citizens, in general, and more specifically for families and family relationships. The risks and consequences of this development have already become visible; ‘caregiver role strain’ has become an important societal theme. Moreover, there is a significant amount of research indicating that families who provide long-term and intensive care, for example for people with cardiovascular diseases, feel heavily burdened or even overburdened so that they themselves have an increased risk of developing health problems.2–4
Nurses (ICN) as follows: ‘Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings’.5 In this definition, the family is appointed as part of the nurse’s professional responsibility. However, ‘patient-centred care’ is still the most powerful motto in healthcare, and a motto that should be left behind because it no longer does justice to recent social developments. As family becomes increasingly responsible for care, there is a progressive interdependence within families so that we, as nurses, simply cannot afford to only put the patient first. Nurses can no longer ignore the needs of families as these families become important partners in the care for patients. Generally speaking, the importance of family members in care is increasingly acknowledged.6,7 However, research indicates that nurses do not include the role and support of family in their professional activities. Tapp and Moules describe how, although nurses highly acknowledged the importance of family in the care for their (cardiac) patients, there were no formal approaches to family assessment, and interventions towards families were hardly observed.8 Furthermore, nursing diagnoses in the psychosocial domain such as ‘caregiver role strain’ or ‘disrupted family processes’ are hardly present in patient records, although it is known that these diagnoses are relevant in many cases.9 When healthcare professionals do involve families in their care for patients, this is often still unilaterally focused on how family can or must support the patient, which is beneficial and necessary, but the other side of the coin is generally forgotten; how is this family is doing? What is the effect of caring for
Hanze University of Applied Sciences, Groningen, Netherlands
Family and nursing How does the nursing profession relate to the concept of family? Nursing is defined by the International Council of
Corresponding author: M.L.A. Luttik, Hanze University of Applied Sciences, Petrus Driessenstraat 3, Groningen, 9714CE, The Netherlands. Email: [email protected]
2
European Journal of Cardiovascular Nursing 00(0)
a family member’s health and well-being, and what do they need to continue to fulfil their role? These are questions that genuinely need to be delved into for nurses to become competent to optimally support families Meanwhile, nurses in clinical practice are increasingly confronted with complex care situations in which they deal directly with families who are held jointly responsible for the care of their family member. Excellent communication, optimal cooperation and shared decision-making are crucial. This requires different and new competences from nurses; they often talk to families about complex care situations and sometimes complicated family circumstances. In that context, they require knowledge and skills about how it (family structures and family processes in the context of care) works within families in the context of care.
Family Nursing The literature and knowledge area ‘family nursing’ offers valuable insights and tools that can help nurses to meet these challenges. In the international context, family nursing is a scientific discipline that focuses on developing the knowledge of the structure and functioning of families in the context of illness and health.10 Family nursing is based on two scientifically substantiated assumptions.
Families and family relations influence the process and outcome of healthcare Family and family relationships influence the process and outcomes of care.11,12 Scientific literature shows that family and good social relationships are important for the health and well-being of people in general, both in the prevention of illness but certainly also in the case of illness and care. People in general and patients more specifically need their family and their social relationships in order to stay healthy, to recover from illness or to live with chronic conditions.
Health and illness are family events and affect all members of a family The other side of the coin, which is often forgotten or at least not considered as part of professional actions, is that illness and health affects all family members involved with the patient or client.13,14 Family nursing in clinical practice is based on a systemic approach to care situations in which not only the needs of the patient are central but also the health and wellbeing of the family of which the patient is a part.15,16 - The family structure, the mutual relationships and the functioning of a family system as a whole are mapped out by drawing a genogram;
- From there, joint discussion is conducted, for example, by having a family conversation regarding the issues, sorrows and needs of this family; - Ultimately, appropriate interventions can be initiated, and agreements can be made about how to shape the care whereby the balance of give and take in the family is always monitored. Healthcare must shift from a patient-centred approach to a family-focused approach in order to support families in the care of their (chronically ill) family member and in the prevention of caregiver-related stress and hardship. Family nursing,15,16 with its fundamental assumption that a system must be understood as a whole rather than individual parts in isolation from one other, is applicable and highly necessary in light of the healthcare challenges that lie ahead. Research supporting the effectiveness of this familyfocused approach is highly necessary. To build this evidence, it is critical that researchers apply appropriate statistical techniques that account for the interdependency between patients and their family caregivers.17 This relational interdependency, however, is not restricted only to dyads; therefore, research should not only have a dyadic or bilateral focus but also focus on family dynamics and the family as a unit of care. Declaration of conflicting interests The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding The author received no financial support for the research, authorship and/or publication of this article.
References 1. European Commission, Directorate-General for Economic and Financial Affairs. The 2018 ageing report economic & budgetary projections for the EU Member States (2016– 2070). Institutional paper 079. 2018. https://ec.europa. eu/info/publications/economy-finance/2018-ageingreport-economic-and-budgetary-projections-eu-memberstates-2016-2070_en 2. Schulz R, Beach SR, Hebert RS, et al. Spousal suffering and partner’s depression and cardiovascular disease: The Cardiovascular Health Study. Am J Geriatr Psychiatry 2009; 17: 246–254. 3. Agren S, Evangelista L and Stromberg A. Do partners of patients with chronic heart failure experience caregiver burden? Eur J Cardiovasc Nurs 2010; 9: 254–262. 4. Stromberg A and Luttik ML. Burden of caring: Risks and consequences imposed on caregivers of those living and dying with advanced heart failure. Curr Opin Support Palliat Care 2015; 9: 26–30. 5. Bartz CC. International Council of Nurses and PersonCentered Care. Int J Integrated Care 2010; 10: e010.
Luttik 6. Gusdal AK, Josefsson K, Thors-Adolfssen E, et al. Nurses’ attitudes towards family importance in heart failure care. Eur J Cardiovasc Nurs 2017; 16: 256–266. 7. Kim EY, Oh S and Son YJ. Caring experiences of family caregivers of patients with heart failure: A meta-ethnographic review of the past 10 years. Eur J Cardiovasc Nurs 2020; 19: 473–485. 8. Tapp D and Moules N. Enlivening the rhetoric of family nursing: ‘There, in the midst of things, his whole family listening’. J Appl Hermeneutics. Epub before print 16 January 2012. DOI: https://doi.org/10.11575/JAH.V0I0.53189. 9. Paans W and Müller-Staub M. Patients’ care needs: Documentation analysis in general hospitals. Int J Nurs Know 2015; 26: 178–186. 10. Kaakinen JR, Padgett-Coehlo D, Steele R, et al. (eds) Family health care nursing. Theory, practice and research. Philadelphia: FA Davis Company, 2015. 11. Reifman A. Social relationships, recovery from illness, and survival: A literature review. Ann Behav Med 1995; 17: 124–131.
3 12. Luttik ML, Jaarsma T, Moser D, et al. The importance and impact of social support on outcomes in patients with heart failure: An overview of the literature. J Card Nurs 2005; 20: 162–169. 13. Årestedt L, Persson C and Benzein E. Living as a family in the midst of chronic illness. Scand J Caring Sc 2014; 28: 29–37. 14. Luttik ML, Jaarsma T, Veeger NJ, et al. For better and for worse: Quality of life impaired in HF patients as well as in their partners. Eur J Cardiovasc Nurs 2005; 4: 11–14. 15. Wright LM and Leahey M. Nurses and families. A guide to family assessment and intervention. Philadelphia: FA Davis Company, 2013. 16. Wright LM and Leahey M. Trends in nursing of families. J Adv Nurs 1990; 15: 148–154. 17. Moons P, Prikken S and Luyckx K. Chronic illness as a ‘family disease’: The need for appropriate scientific methods for dyadic research. Eur J Cardiovasc Nurs 2020; 19: 98–99.
![[No title available]](/assets/img/hold.png)
