Evaluation of health promoting conversations with families with a family member, under the age of 65 years, suffering from stroke
Family centered nursing is a growing research area in Sweden. This intervention study will evaluate effects from health promoting conversations, conducted by nurses, with families experiencing a life after a family member has survived a stroke.
Evidence for effects of family centred nursing with families in which a family member has survived a stroke is still very limited. When family members take on a caregiving role it may be seen as a short term health economic advantage for the society, but possibly a long term disadvantage because of costly consequences leading to illness and disease for the individual caregiver. If families are not given the support needed, the caregiving might result in increased physical and mental strain. Nurses’ health promoting conversations has shown to alleviate suffering and improve family health and well-being in families living with illness.
Stroke is an illness that might lead to significant consequences for both the patient and his or hers family. The impact of both the illness and its treatment require individuals and their families to make changes to their lifestyles. From a systemic view it is obvious that an illness held by one family member affects all other family members and vice versa. The home is more and more seen as the ideal place to stay also when becoming ill, and a trend is emerging that the responsibility to care for the ill person is shifting from the public sector to the family. Scenarios with family members as caregivers have become more common and might lead to increased emotional strain and illness also for the caring relative.
In Sweden, an intervention, “health-promoting conversations” with the purpose to help families experiencing illnesses create or begin to create new beliefs, new ideas, meanings and/or possibilities in relation to a problem, has been developed. In this manner the family can, hopefully, find new alternative ways to view their situation and find suitable solutions. The conversations are led by two nurses/researchers. The three conversation sessions focus on topics that the families consider as important and the dialogue has an intention to identify and release resources within and outside the family. During the conversations all family members are invited to tell their story and to listen to each other’s stories. In order to create alternative ways for families to think about their situation, reflecting questions are offered. It has been shown that a serie of three conversations is enough for most families. After the last conversation, “a closing letter” is sent to the family. In the letter the nurses offer their reflections on what has happened during the conversations and the resources of the family are highlighted. The intervention has a sound theoretical and clinical based foundation.
The overall aim of this project is to evaluate family members’ intervention experiences, effects of intervention, and cost effectiveness from the intervention, “health promoting conversations conducted" by nurses, with families in which one family member younger than 65 years has been diagnosed with stroke. The inclusion of families has started by using a consecutive sample strategy, at Neurorehab, Sävar (intervention families) and at Rehabiliteringskliniken Sundsvall/Härnösands hospital (intervention and comparison families). Six to ten families with a family member under 65 years are included in each group. The patient in both groups will receive traditional care. The intervention families will in addition be offered three health promoting conversations as described above. Finally a closing letter is sent.
The study uses an embedded mixed-method design with quantitative and qualitative components allowing in-depth exploration of the intervention and quantitative assessments of outcomes. To evaluate effects, measures are performed at baseline and post intervention (after 1 and 6 month) in both the intervention and the comparison groups. Selected instruments measures family members’ experiences of the general atmosphere for social interaction within the family, hope as a multi-dimensional dynamic power, quality of life and cost effectiveness. Furthermore, evaluative interviews are conducted with family members in the intervention group one and six months post intervention. The conversations and the evaluation interviews are recorded after the family members have given their informed consent. Quantitative data is analyzed by statistical methods to provide pre- and post intervention comparisons within and between groups on both individual and family level. All conversations and evaluative interviews are analyzed by qualitative methods. Qualitative and quantitative data is furthermore integrated using mixed methods research.
Well conducted family centered nursing interventions have the potential to support individuals and families living with illness to better cope with their situation. Such an approach might prevent ill-health, alleviate suffering and promote quality of life. The evidence base supporting effects and cost effectiveness of family centered nursing interventions with families suffering from stroke is still limited. Family members acting as caregivers may lead to short term health economic advantage for the society, but possibly long term health disadvantages such as significant suffering experiences by both the stroke patients and their families. It is consequently of great importance that the professional care focus on the whole family. Nurses’ health promoting conversations has shown to be useful to alleviate suffering and improve the wellbeing of families. Strengthening families’ ability of self-support has the potential to achieve health promoting values for families but also to be cost effective care.
Keywords: Family centered nursing, health promoting conversations, stroke