To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU.
We used the Council of Medical Specialty Societies principles for the ...development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis, and family-centered care to revise the 2007 Clinical Practice Guidelines for support of the family in the patient-centered ICU. We conducted a scoping review of qualitative research that explored family-centered care in the ICU. Thematic analyses were conducted to support Population, Intervention, Comparison, Outcome question development. Patients and families validated the importance of interventions and outcomes. We then conducted a systematic review using the Grading of Recommendations, Assessment, Development and Evaluations methodology to make recommendations for practice. Recommendations were subjected to electronic voting with pre-established voting thresholds. No industry funding was associated with the guideline development.
The scoping review yielded 683 qualitative studies; 228 were used for thematic analysis and Population, Intervention, Comparison, Outcome question development. The systematic review search yielded 4,158 reports after deduplication and 76 additional studies were added from alerts and hand searches; 238 studies met inclusion criteria. We made 23 recommendations from moderate, low, and very low level of evidence on the topics of: communication with family members, family presence, family support, consultations and ICU team members, and operational and environmental issues. We provide recommendations for future research and work-tools to support translation of the recommendations into practice.
These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care.
Aim
To describe the lived experiences of nurses caring for patients and families in the context of COVID‐19 in Brazil and United States.
Design
A phenomenological philosophical approach following the ...van Manen analysis method.
Methods
Participants were recruited in Brazil and the United States, including nurses working in health care settings caring for COVID‐19 patients. Recruitment used purposive and snowball sampling. Participants completed a demographic survey and semi‐structured interviews that were audio‐recorded and transcribed for analysis. A cross‐cultural examination occurred among researchers from each country.
Results
The result was described (n = 35) by the themes, representing the essences of each lifeworld (relationship, time, space and body). The nurses' lived experience was one of reframing care while enduring repeated trauma of witnessing disrupted patient‐family‐nurse relationships. Themes were as follows: (a) Living a silent and lonely experience; (b) Providing connectedness for disrupted patient and family relationships; (c) Feeling the burden of the demands; (d) Being a helping connector; (e) Reshaping spaces amidst evolving interventions and policies; (f) Creating safe spaces, surrounded by turmoil, threat, and distress within an unsafe environment; (g) Reorganizing care and reframing time; (h) Reconciling losses, regrets, victories and lessons.
Conclusion
The nurses' lived experience of caring for patients and families during the COVID‐19 pandemic prompted the need to respond to repeated traumas and distress posed by interrupted patient‐family and nurse‐own family relationships, vulnerable bodies, threatened space and dynamic and volatile time.
Impact
Cultural nuances were discovered depending on the practice setting, political discourse and the autonomy of the nurse. Innovative models of care that create structures and processes to support nurses in caring for patients in threatening environments and the commitment to connecting family members have potential to contribute to the ongoing health of the nursing profession.
Latino parents can experience acculturation stressors, and according to the Family Stress Model (FSM), parent stress can influence youth mental health and substance use by negatively affecting family ...functioning. To understand how acculturation stressors come together and unfold over time to influence youth mental health and substance use outcomes, the current study investigated the trajectory of a latent parent acculturation stress factor and its influence on youth mental health and substance use via parent-and youth-reported family functioning. Data came from a 6-wave, school-based survey with 302 recent (<5 years) immigrant Latino parents (74% mothers, Mage = 41.09 years) and their adolescents (47% female, Mage = 14.51 years). Parents' reports of discrimination, negative context of reception, and acculturative stress loaded onto a latent factor of acculturation stress at each of the first 4 time points. Earlier levels of and increases in parent acculturation stress predicted worse youth-reported family functioning. Additionally, earlier levels of parent acculturation stress predicted worse parent-reported family functioning and increases in parent acculturation stress predicted better parent-reported family functioning. While youth-reported positive family functioning predicted higher self-esteem, lower symptoms of depression, and lower aggressive and rule-breaking behavior in youth, parent-reported family positive functioning predicted lower youth alcohol and cigarette use. Findings highlight the need for Latino youth preventive interventions to target parent acculturation stress and family functioning.
COURTYARD HOUSING TYPOLOGY PALESTINE REHABILITATION PROCESS TRADITIONAL ARCHITECTURE The courtyard, an architectural composition in traditional architecture, has been continuously applied throughout ...history. It has been able to provide important, practical and logical organization of space for protection and intimacy of life. From a foreign and domestic perspective, the traditional Palestinian courtyard house is a significant housing typology that should undergo further research in order to allow for change during rehabilitation process. DVORISTE STAMBENA TIPOLOGIJA PALESTINA PROCES OBNOVE TRADICIJSKA ARHITEKTURA Dvoriste kao arhitektonska kompozicija u tradicijskoj arhitekturi trajno je prisutno u povijesti graditeljstva. Svojom prakticnom i logicnom organizacijom prostora, dvoriste je oduvijek omogucavalo zastitu i privatnost. Kako iz lokalne tako i iz strane perspektive, tradicijska palestinska kuca s dvoristem predstavlja vazan tip stambene arhitekture pa bi ga stoga trebalo pomnije istraziti kako bi se omogucile promjene tijekom procesa obnove.
The psychological effects of trauma are well-documented among refugee adults and children alone, yet less research has attended to the intergenerational transmission of trauma within refugee ...families. Additionally, there is considerable diversity between refugee populations as well as within-group variation in the experiences and effects of refugee trauma.
The current study examines the longitudinal effects of maternal traumatic distress on family functioning and child mental health outcomes among Southeast Asian refugee women and their adolescent children. Given the potential for variation in these effects, we also explore group differences in these relationships by ethnicity and child nativity.
Longitudinal data were collected from a random sample of 327 Southeast Asian refugee mothers and their children in the United States. We employed structural equation modeling to examine associations between latent variables representing maternal traumatic distress, family functioning, and child mental health outcomes (i.e., depressive symptoms, antisocial and delinquent behavior, and school problems). We then tested for group differences in these associations by ethnicity (Cambodian and Vietnamese subgroups) and child nativity (U.S.-born and foreign-born children).
We found maternal traumatic distress was indirectly linked to child mental health outcomes, and that child nativity was associated with these paths while ethnicity was not. For foreign-born children, maternal traumatic distress was associated with diminished family functioning a year later, which was associated with increased school problems at the two-year mark. Maternal traumatic distress was indirectly associated with depressive symptoms and antisocial and delinquent behavior, respectively, after accounting for family functioning. For all children, weaker family functioning was significantly associated with poorer mental health.
Findings suggest that refugee parents’ trauma can adversely affect family relationships and the mental health of children. Interventions that address parental trauma and support intergenerational relationships may enhance mental health within refugee communities for future generations.
•Research on the intergenerational transmission of trauma in refugee families remains scant.•We examined maternal traumatic distress within Southeast Asian refugee families in the U.S.•Maternal traumatic distress had negative effects on family and child mental health.•Intergenerational effects were clearest for foreign-born children.
The authors review the literature on sibling relationships in childhood and adolescence, starting by tracing themes from foundational research and theory and then focusing on empirical research ...during the past 2 decades. This literature documents siblings' centrality in family life, sources of variation in sibling relationship qualities, and the significance of siblings for child and adolescent development and adjustment. Sibling influences emerge not only in the context of siblings 'frequent and often emotionally intense interactions but also by virtue of siblings' role in larger family system dynamics. Although siblings are building blocks of family structure and key players in family dynamics, their role has been relatively neglected by family scholars and by those who study close relationships. Incorporating study of siblings into family research provides novel insights into the operation of families as social and socializing systems.
Previous research has shown inconsistent findings of the effect of familism on academic outcomes among adolescents from Latino immigrant families. Guided by social capital theory and the concept of ...gendered familism, the current study examined differential effects of family obligation and family cohesion as subcomponents separately. This study also investigated the moderating effect of familial SES on the association of each component of familism and academic outcomes by gender.
Participants were 1801 adolescents from Latino immigrant families (Mage = 14.1 years, SD = 0.83, range = 14–17) drawn from the Children of Immigrant Longitudinal Studies. The current study employed a series of multiple regression analyses to examine the effects of familism, assessed by family obligation and family cohesion, on adolescents' grade point average (GPA), educational expectations and aspirations. Multigroup analyses were also conducted to examine gender differences in the effect of familism on adolescents’ academic outcomes.
Analyses revealed the positive main effect of family cohesion and the negative effect of family obligations on Latino and Latina adolescents' GPA and educational expectations. For Latino adolescents, negative effect of family obligation on GPA was stronger for adolescents from high-SES families than those from low-SES families.
It is imperative for researchers to conceptualize familism and operationalize the construct clearly. The effect of differences in family context and gender role expectation also needs to be considered in examining the association between familism and the academic outcomes of adolescents from immigrant families.
During the recent COVID‐19 outbreak in Spain, we explored the individual and relational well‐being of people confined together with their partners and/or children during the first 3 weeks of ...state‐regulated lockdown. Adults 18 years or older (N = 407) completed an online survey that included demographic, household, and employment information along with standardized measures of psychological distress (State‐Trait Anxiety and Beck Depression) and relationship functioning—either the Dyadic Adjustment Scale if there were no children in the household or a Basic Family Relations Evaluation Questionnaire (CERFB) measuring conjugal, parental, and coparental functions. Qualitative analyses of responses to an open‐ended question about perceived changes in couple or family dynamics during lockdown revealed nine specific themes comprising two overarching categories: relational improvement and deterioration. The overall prevalence of improvement themes (61.7%) exceeded deterioration themes (41.0%), with increased (re)connection and conflict atmosphere cited most often. Quantitative analyses found elevated levels of state anxiety but not trait anxiety or depression during lockdown. Consistent with the qualitative results, couples having no children at home reported high levels of dyadic adjustment, but with children present CERFB parental functioning exceeded conjugal functioning, a pattern sometimes associated with child triangulation into adult conflicts. Although correlates of psychological distress (e.g., unemployment, perceived economic risk) were relatively stable across subgroups, predictors of relationship functioning varied substantially with household/parental status (e.g., telecommuting and employment facilitated conjugal functioning only for couples with children).
ResumenDurante el reciente brote de la COVID‐19 en España, analizamos el bienestar individual y relacional de las personas confinadas con sus parejas o hijos durante las primeras tres semanas de confinamiento regulado por el estado. Un grupo de adultos mayores de 18 años (N=407) completó una encuesta con datos demográficos, información sobre la vivienda y el empleo, evaluaciones estandarizadas de distrés psicológico (ansiedad‐rasgo y ansiedad‐estado, depresión de Beck) y funcionamiento familiar (la Escala de ajuste diádico si no había niños en la vivienda o un Cuestionario básico de evaluación de las relaciones familiares (CERFB) que miden las funciones conyugales, parentales y coparentales. Los análisis cualitativos de las respuestas a una pregunta abierta acerca de los cambios percibidos en la dinámica de pareja o familiar durante el confinamiento revelaron nueve temas específicos que comprenden dos categorías dominantes: la mejora y el deterioro relacional. La prevalencia general de los temas de mejora (61.7 %) excedió los temas de deterioro (41.0 %), y se mencionó con más frecuencia una mayor (re)conexión y un ambiente de conflicto. Los análisis cuantitativos indicaron niveles elevados de ansiedad‐estado pero no de ansiedad‐rasgo ni de depresión durante el confinamiento. De acuerdo con los resultados cualitativos, las parejas que no tienen hijos en la casa informaron niveles altos de ajuste diádico, pero con los niños presentes, el funcionamiento parental del CERFB excedió el funcionamiento conyugal, un patrón asociado a veces con la triangulación de los niños en los conflictos de los adultos. Aunque las relaciones de distrés psicológico (p. ej.: desempleo, riesgo económico percibido) fueron relativamente estables entre los subgrupos, los predictores del funcionamiento relacional variaron considerablemente con la situación habitacional/parental (p. ej: el teletrabajo y el empleo facilitaron el funcionamiento conyugal solo en el caso de las parejas con niños).
摘要最近在COVID‐19新冠肺炎爆发期间的西班牙，我们探索了在国家管控封城禁足的头三个星期里，在人们与其伴侣和/或儿童一起被关闭起来的情况下，个体的健康状况和关系的健康情况。407位18岁或以上的成年人(N=407) 完成了一项在线调查，内容包括人口、家庭和就业信息，还有标准化的心理困扰量表(状态‐特质焦虑、贝克抑郁)以及关系功能‐‐‐‐如果家庭中没有儿童，则采用二分调整量表，或者基本家庭关系评估问卷(CERFB)测量夫妻、父母和共同父母的功能。本研究对一个开放式问题的回答作了定性分析，结果揭示了9个特定的主题，两个大的类别即关系得到改善和关系走向恶化两种。使用的问题是关于伴侣关系方面或家庭互动方面发生的可觉察变化。关系有改善的主题占了主导，达测量对象的61.7%，超过了关系有所恶化的主题(占41.0%)，其中最常提到的是相互之间的（重新）连接增强了 ，还有更多的冲突情况。定量分析研究发现，在管制禁闭期间，情绪状态型的焦虑水平升高，但生理特质性焦虑或生理性抑郁的水平没有升高。与定性研究结果相一致的是，没有孩子的家庭报告了高水平的二元适应，但有孩子的情况下，问卷中归纳出的为人父母的功能超过了配偶的功能，这种模式有时和儿童构成的三角关系演变成成人冲突。虽然心理压力的相关因素(如失业、感知到的经济风险)在各个亚群体中相对稳定，但关系功能的预测因素因家庭/父母现状而显著不同(例如，远程办公和就业促进的婚姻功能仅适用于有孩子的夫妇)。
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