Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?Evidence from Ethiopia

Objectives This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance(CBHI)scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms.There is growing concern about the financial sustainability of CBHI schemes in developing countries.However,few empirical studies have identified potential contributors,including ex-ante and ex-post moral hazards.Methods We implement a household fixed-effect panel data regression model,drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.Results The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals.However,CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms.Particularly,on average,we estimate about 4-6 h delay for malaria symptoms,a little above 4 h for tetanus,and 10-11 h for tuberculosis among the insured households.Conclusions While there is evidence that CBHI improve the utilization of outpatient or primary care services,our study suggests that insured members may wait longer before visiting health facilities.This delay could be partly due to moral hazard problems,as insured households,particularly those from rural areas,may consider the opportunity costs associated with visiting health facilities for minor symptoms.Overall,it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

Survey on hospice care attitude of family members of advanced cancer patients at different ages

BACKGROUND Hospice care plays an important role in improving the quality of life of advanced cancer patients,but controversy remains over whether age affects the attitudes of family members toward hospice care.AIM To investigate the attitudes of family members of advanced cancer patients of different ages toward hospice care.METHODS The study participants were 175 family members of patients with advanced cancer from January 2020 and October 2022.The participants were divided into youth(<40 years,n=65),middle-aged(40–60 years,n=59),and elderly(>60 years,n=51)groups.Researchers investigated and compared the degree of awareness regarding hospice care,attitudes,and whether the family members of patients would choose hospice care.RESULTS Among the family members of 175 patients,approximately 28%(49/175)were aware of hospice care.Awareness of hospice care,the proportion of hospice care acceptance and adaptation attitudes,and the proportion of those who chose hospice care in the youth group were higher in the middle-aged and elderly groups(P<0.05).No statistically significant difference was found in these three indicators between the middle-aged and elderly groups(P>0.05).Hospice care was chosen mainly to relieve pain and reduce unnecessary treatment,whereas the reasons for not choosing hospice care were mainly distrust and ethical concerns.CONCLUSION The family members of patients with advanced cancer had relatively low awareness of hospice care,while youth had a higher awareness of hospice care,acceptance,and adaptation attitudes,and were more willing to choose hospice care.

Family counseling of dental and oral care for preventing caries of dental during preschool age: a literature review

Incorrect family behavior in caring for the dental and oral health of preschool-aged children can affect the incidence of dental caries in these children and can cause more serious health problems in the future if not treated immediately,so it is important to find the right solution.This study aims to determine the effect of family counseling on dental and oral care for preschoolers.This study uses a narrative literature review method.Search articles using 5 databases(Pubmed,ScienceDirect,SpringerLink,ProQuest,and Google Scholar)to search for articles with the keywords family counseling AND Oral health AND Early Childhood Caries AND Behavior Change AND Family and the article selection process refers to the Flow diagram of the PRISMA Statement 2020.The results showed that there were 7 articles analyzed in this study.The implementation of family counseling has a significant effect in increasing self-efficacy,knowledge,ability,and motivation of the family,as well as the behavior of the child,to reduce the risk of dental caries in preschool-age children,taking into account several conditions.It was determined that family counseling is effective in reducing the incidence of dental caries in preschool children.

Analysis of the Application Effect of Family Collaborative Care Model on Elderly Patients with Type 2 Diabetes Mellitus and the Situation of Self-Care Ability

Objective: To study the application effect of the family collaborative care model on elderly patients with type 2 diabetes mellitus and its influence on self-care ability. Methods: The elderly type 2 diabetes mellitus patients (400 cases) treated in our hospital between March 2020 and July 2023 were divided into two groups by randomized grouping method;the control group received the conventional nursing program, while the observation group received the family collaborative nursing model. Blood glucose level, self-care ability, and quality of life were compared between the groups. Results: The blood glucose level of the observation group was lower than that of the control group (P < 0.05). The self- care ability and quality of life scores of the observation group were higher than those of the control group (P < 0.05). Conclusion: The family collaborative care model for elderly patients with type 2 diabetes mellitus can promote their self- care ability, improve the effect of glycemic control, and improve their quality of life, and is suitable for further promotion and application.

Construction of Industrialization Development Model for"1+4+X"Community-Based Elderly Care in Gannan Old Revolutionary Base Area in the Context of Population Aging

In the context of controlling population development in a planned way,China entered an aging society in the early 21 st century.In this context,how to meet the needs of the elderly care and form an effective elderly care model has become a key problem to be solved urgently by local government departments.With the continuous advancement of the elderly care policy,the community-based elderly care has gradually become the mainstream and is in the stage of vigorous promotion.Taking the Gannan old revolutionary base area in Jiangxi Province as an example,this study puts forward"1+4+X"community-based elderly care model based on the policy system of community-based elderly care,the physical and mental health of the elderly,the material space and the construction of evaluation system,and explores how to promote the application of this community model efficiently in the form of industrialization,so as to drive the economic growth of the Gannan old revolutionary base area,promote the employment development and improve the community-based elderly care service.

Application of multidisciplinary collaborative nursing with family care for enhanced recovery after surgery in children with inguinal hernia

BACKGROUND Perioperative nursing can reduce the stress reaction and improve the prognosis of children.AIM To elucidate the influence of multidisciplinary collaborative nursing for enhanced recovery after surgery(ERAS)with family care in perioperative nursing children with an inguinal hernia and its impact on the prognosis.METHODS The data of 100 children with inguinal hernia were retrospectively analyzed.The participants were divided into three groups according to different nursing methods:Groups A(n=38),B(n=32),and C(n=30).Group A received multidisciplinary collaborative ERAS nursing combined with family care nursing;Group B received multidisciplinary collaborative nursing for ERAS;and Group C received routine nursing.The postoperative recovery results of the three groups were compared,including intraoperative blood loss and postoperative feeding time,time of getting out of bed,hospitalization time,and defecation time.Furthermore,the incidence of common complications was also compared between the three groups.RESULTS There was less intraoperative blood loss in Groups A and B than in Group C(P<0.05),and the time of getting out of bed and postoperative hospitalization and defecation times were also decreased in Group C(P<0.05).There was no significant difference in postoperative feeding time among the three groups(P>0.05).Each index had no statistical significance between Groups A and B(P>0.05).The incidence of urinary retention,infection,hematoma,and hernia recurrence in Group A was less than that in Group C(P<0.05).No significant difference was observed in the overall complication rate between Groups A and B and between Groups B and C(P>0.05).CONCLUSION The application of multidisciplinary collaborative nursing combined with family care in the perioperative care of children with an inguinal hernia for ERAS may promote postoperative rehabilitation for children and reduce the incidence of complications.

Assessment of Quality of Life, Family Function and Family Empowerment for Families Who Provide Home Care for a Child with Severe Motor and Intellectual Disabilities in Japan

Background: About 70% of Japanese children with severe motor and intellectual disabilities (SMID) live at home, and the number is increasing. Family members have an enormous burden of daily physical care for these children. A top priority is to understand quality of life (QoL), family function, and family empowerment to effectively support these families. We aimed to assess current living situations of families with a SMID child, and to reveal the relationships between QoL, family function, and family empowerment. Methods: Sixty-five family members from 34 families with a SMID child participated in this study. We assessed 5 parameters using the Japanese versions of the following instruments: World Health Organization Quality of Life 26 (WHOQOL26), Kinder Lebensqualitats Fragebogen (KINDL), Family Assessment Device (FAD), Family Adaptability and Cohesion Evaluation Scale KG-4 (FACESKG-4), and Family Empowerment Scale (FES). Correlation and multiple regression analyses were conducted;QoL score was the objective variable. Results: Participants included 54 parents (34 mothers, 20 fathers) and 11 siblings. The mean age of SMID children was 10.4 ± 5.03 years. Twenty-two children needed multiple types of medical care. The mean age of parents and siblings was 41.5 ± 6.16 years and 15.5 ± 2.35 years, respectively. The mean QoL score (3.28 ± 0.5) was similar to the Japanese average. The mean KINDL score (77.2 ± 12.1) was higher than those of previous studies. The mean FAD score was 1.97 ± 0.32. For FACEKG-4, the score of adaptability was correlated with WHOQOL score (r = 0.459, p < 0.05). The mean score of FES was 113.6 ± 14. As the result of multiple regression analysis, lower family FAD scores ([sb] = ?0.61, p < 0.01) indicated higher family function and greater age of participants (sb = 0.495, p < 0.01) was correlated with higher WHOQOL scores (F = 15.208, p < 0.01). Conclusions: Our results indicated that the individual QoL depended on the age of participants (equals the years of experience caring for a SMID child) and the recognition of family function as a whole. Thus, to improve family members’ QoL, we should focus on individuals and also approach the family as a whole.

A Review of Grief Counselling Practices for Family Members of Oncology Patients in Hospice Care

In cancer patients, especially terminal patients, the family members of the patients will develop more serious sadness and find it difficult to face death rationally, which affects the quality of life and activities. Because of this, in the clinical treatment of oncology patients, strengthening hospice care for family members, doing a good job of death education, assisting them to face and participate in the clinical treatment of oncology in a positive way, and avoiding excessive grief can simultaneously improve the quality of life of patients and their families.

Literature Review on Support for Children and Families Experiencing Parental Bereavement

Purpose: This study aimed to understand the actual nursing support in a wide perspective by reviewing overseas literature on support for children who have experienced parental bereavement and their families. The goal was to identify future challenges in nursing support in clinical practice in Japan. Method: Literature searchable as of May 2023 was retrieved using PubMed, resulting in 11 relevant articles. Result: The results revealed the following: 1) For support provided to children, 13 codes were condensed into 5 subcategories and 4 categories. 2) For support provided to families, 36 codes were condensed into 11 subcategories and 4 categories. Conclusion: Open communication was found to be essential for supporting children and their families who have experienced parental bereavement. Moreover, involvement of multiple professions facilitated the provision of specialized support to address diverse needs of children and families, playing a crucial role in overcoming grief. Additionally, the effectiveness of support systems for bereaved families highlighted the need for nursing professionals in Japan to gain knowledge through learning opportunities and to establish a multi-disciplinary approach to support, thus indicating future challenges in nursing support.

Improving pressure ulcer care in intensive care units:Evaluating the impact of bundled care and silver nanoparticle dressings

BACKGROUND Pressure ulcer(PU)are prevalent among critically ill trauma patients,posing substantial risks.Bundled care strategies and silver nanoparticle dressings offer potential solutions,yet their combined effectiveness and impact on patient satisfaction remain insufficiently investigated.AIM To assess the impact of bundled care along with silver nanoparticle dressing on PUs management and family satisfaction in critically ill trauma patients.METHODS A total of 98 critically ill trauma patients with PUs in intensive care unit(ICU)were included in this study.Patients were randomly assigned to either the control group(conventional care with silver nanoparticle dressing,n=49)or the intervention group(bundled care with silver nanoparticle dressing,n=49).The PU Scale for Healing(PUSH)tool was used to monitor changes in status of pressure injuries over time.Assessments were conducted at various time points:Baseline(day 0)and subsequent assessments on day 3,day 6,day 9,and day 12.Family satisfaction was assessed using the Family Satisfaction ICU 24 ques-tionnaire.RESULTS No significant differences in baseline characteristics were observed between the two groups.In the intervention group,there were significant reductions in total PUSH scores over the assessment period.Specifically,surface area,exudate,and tissue type parameters all showed significant improvements compared to the control group.Family satisfaction with care and decision-making was notably higher in the intervention group.Overall family satisfaction was significantly better in the intervention group.CONCLUSION Bundled care in combination with silver nanoparticle dressings effectively alleviated PUs and enhances family satisfaction in critically ill trauma patients.This approach holds promise for improving PUs management in the ICU,benefiting both patients and their families.

Influence of Interrupted Childhood Biographies on Health Development: Evaluation of the Scientific Literature on the Example of Being Taken into Care*

Background: An interrupted family history, as is the case after taking someone into care, can complicate collecting family anamnesis data. In addition, the interrupted family history itself could be considered part of a person’s risk profile. Aim and methods: Literature analysis was conducted to examine whether there are scientific studies on health development after placement in out-of-home-care in order to recognise any existing medical characteristics that may be relevant for internal medical care. Results: There are few scientific publications on the health development of people after being placed in out-of-home-care. Direct reactions to the stress of being taken into custody include nausea and fever. However, effects that go beyond the acute situation and last into adulthood have also been described, such as AD(H)D, asthma, diabetes, cancer, hypertension and cardiovascular diseases (myocardial infarction, stroke), epilepsy and increased overall mortality in adulthood. Studies show that not only previous experience but also the stress of being taken into care is triggers for this. Conclusion: Information about a previous institutionalisation can hence be important for internal medical practice. The available scientific literature shows heterogeneous study methodology and no group of people with experience of out-of-home-placement has yet been scientifically accompanied for a long time period. Further studies on this could help to better weigh up the consequences of omitting and conducting an intervention for child/youth protection as well as to improve the medical care for this group of people.

Comparison of Nurses’ and Families’ Perception of Family Needs in Critical Care Unit at Referral Hospitals in Malawi

This study compared needs of family members as perceived by nurses and the family members themselves. The study design was descriptive and utilized quantitative data collection and analysis method. Nurses (n = 62) working in the Intensive Care Units (ICU) and High Dependency Units (HDU) of three tertiary health facilities in Malawi at the time of the study consented to participate in the study. In addition, family members (n = 62) who were looking after a critically sick relative in the ICU and HDU in the same tertiary facilities consented and participated in the study. Data were collected using a questionnaire developed from the Critical Care Family Needs Inventory for a period of 7 days. STATA version 10 was used to analyze data. The rank correlation between the mean scores of perceived needs across major need categories of support, comfort, information, proximity and assurance between the nurses and family members was significantly different from zero (r = 0.97, p = 0.005). Nurses and family members, respectively ranked assurance (90% and 92%) as the highest priority need, followed by information (78% and 85%) and comfort (78% and 84%) and then support (70% and 73%) and proximity (66% and 69%). The ranking however between the 2 groups on 16 out of 45 individual needs were significantly different (p < 0.05). Among the nurses, the rankings by registered nurses were significantly higher (p < 0.05) from those of nurse midwife technicians. There were also significant differences (p < 0.05) in the mean scores between the gender of family members with men demanding more “comfort” than females. Results show a need for facility authorities to formulate ICU policies and strategies that ensure provision of friendly services to family members of critically ill patients.

Nurses’ Recognition in Nursing for Patients and Families about Organ Donation after Brain Death, Care for Family Members and Supports for Nurses

Background: Globally, there a problem of disequilibrium between donation and organ transplantation, this equilibrium is remarkable in Japan. Especially there are few donations from brain death, and researches from the view point of nurses in clinical situation were needed. Purpose: The purpose of this study was to clarify the recognition of nurses in organ transplantation nursing, required care for families of patients, and required support for nurses to promote quality of nurses in organ donation. Methods: We conducted this research within 2 months in 2019 in Western Japan. A researcher conducted a semi-qualitative interview for nurses in organ transplantation nursing about their recognition of nursing, required care for family members, and required support for nurses once. Results: Nurses recognized that some family members who knew patients’ thoughts made decision easily and some who didn’t know had difficulties. Many nurses felt insufficiency for family cares and some confronted ethical problems. Though some nurses felt conflict about their own thoughts or religion, they took care of patients or family members with responsibility. As for care for families, nurses thought practice of care considering families’ feeling, support of decision making, and care for family to live positively after transplantation as required care. About support for nurses, nurses required education of transplantation, increase of staff members, chance to share dilemma, and mental care. Discussion: Nurses recognized the importance of decision making, and felt an insufficiency for family care or dilemmas. To propose high quality of nursing and organ donation or transplantation, education about transplantation including family care, management about resolution of dilemma or mental health may be required.

Evaluation Items for Community-Based Health Care Focusing on Social Aspects: A Literature Review

The progressive aging of society has become a global concern, and is expected to lead to the development of effective, sustainable, person-centered, integrated community-based care systems. However, there is insufficient evidence regarding effective integrated community-based care. In particular, few studies have focused on social aspects of the community environment related to elderly health. This study aimed to consider social aspects as evaluation items, focusing particularly on social determinants from the perspective of community-dwelling people, to explore truly effective integrated community-based care to improve elderly health. The definition of social determinants means social cohesion in social and community contexts. A literature review of English articles published in peer-reviewed journals up to October 2019 was conducted using PubMed, MEDLINE, and CINAHL with the following search terms: “social cohesion,” “elderly health,” “mental health” and “community.” Identified articles were screened based on title and abstract, and selected articles were subjected to full-text assessment and critical review. All references cited in the selected articles were also reviewed. The following inclusion criteria were used: 1) studies targeting community-dwelling elderly people or community-dwelling people including elderly people as participants;2) studies with clear descriptions of social factors in the Methods section;and 3) studies with clear descriptions of health-related items in the Methods section. From the 21 articles analyzed, of which 9 articles defined social determinants as social cohesion in social and community context, 37 items were extracted as social aspects at the community level that reflect the perspective of residents. These items can be developed as evaluation items for community-based health care outcomes through consensus among community health care providers and further investigation.

Family resilience of cancer patients:a concept analysis

Objective:The concept of family resilience of cancer patients was discussed through literature review,which provided reference for nursing of cancer patients.Methods:China National Knowledge Infrastructure(CNKI),Wanfang Database,SinoMed,PubMed,Web of Science,and Embase were systematically searched,and the concept analysis method proposed by Walker and Avant was adopted.Results:In this study,we defined the concept of family resilience,identified attributes,and analyzed the antecedents and consequences.The proposed operational definition of family resilience was:After a family member is diagnosed with cancer,the whole family can actively explore its own unique internal and external resources and advantages,strengthen self-regulation,jointly cope with the crisis by establishing close family relationships,providing mutual support to family members,and interacting with the outside world.Conclusions:The definition of family resilience of cancer patients is conducive to the development of measurement tools and the improvement of family outcomes of adult cancer patients by intervening family resilience factors.

CICARE 沟通模式结合人文关怀在危重症患者家属探视沟通中的应用

目的研究危重症患者家属探视沟通中实施CICARE沟通模式结合人文关怀的效果。方法选择郑州大学第一附属医院2019年4月至2022年4月430例危重症患者家属作为研究对象,随机分为观察组和对照组,各215例。对照组接受人文关怀,观察组接受人文关怀和CICARE沟通模式。观察两组患者家属干预前后心理状态变化情况[焦虑自评量表(SAS)、抑郁自评量表(SDS)],护理干预后家属需求满足情况(病情动态信息、救治方案及预后、自身舒适、安抚患者、明确治疗费用)、护理满意度及投诉率。结果观察组护理干预后SAS、SDS评分均低于对照组(P<0.05);观察组护理干预后,病情动态信息、救治方案及预后、自身舒适、安抚患者、明确治疗费用评分均高于对照组(P<0.05);观察组护理干预后护理满意率为93.96%,高与对照组(86.98%),投诉率为0.93%低于对照组(6.98%)(P<0.05)。结论危重症患者家属探视沟通中实施CICARE沟通模式结合人文关怀能有效改善患者家属不良情绪,同时改善家属需求满足情况,进而提升护理满意度,降低投诉率,临床应用价值较高。

Concept Development and Implementation of Family Care/Caring Theory in Concentric Sphere Family Environment Theory

Caring is directed toward a variety of things. One of them is thought to be the concept of “family caring” aimed at families. This study attempts to clarify family caring and develop Family Care/ Caring Theory (FCCT), with the aim of implementing it in conjunction with an existing family nursing theory, the Concentric Sphere Family Environment Theory (CSFET). In Japan and in Hong Kong, family ethnography (including formal interviews) was conducted. As a result, the item “family health care nurses and their colleagues” was added to the family external environment of the CSFET. In the family environment, evidence was obtained to the effect that the family system unit is cared for by the nursing professional, and conversely the family system unit cares for the nursing professional, in a circular transaction. Observing the two-dimensional plane formed by the structural distance and functional distance, family caring assumes a structure of concentric circles, and according to transactions, the structural distance and functional distance between the nursing professional and family system unit are gradually approached, and through deepening of mutual trust maintain an appropriate distance. Moreover observing the three-dimensional space-time continuum which is created through addition of the temporal distance, family caring forms a helical structure. As transactions are repeated along the temporal axis, the family system unit’s self-actualization of other individuals and the self-actualization of the nursing professional are realized. Through these processes, a family care/caring relationship is reinforced and established. This is the concept of FCCT. Through future utilization in clinical settings this will be empirically substantiated, and it will be necessary to continue making creative corrections and revisions.

Home visits in brain tumor patient: how nurse and family members cooperate in tumor patient's family self-care

Purposes： We reported the roles and fimctions of nurses in home visits for brain tumor patients using the family health assessment guide in the study. Methods： One patient of brain glioma was chosen as the case illustration. The nurses assessed the patients＇ situation, their families and living environment individually. All these factors were analyzed together. Results： The nurses then implemented their knowledge and skills to adopt different measures in different conditions, investigated the patients＇ health problems and carried out personalized effective actions. Conclusions： Nurses should put effort into community nursing to allow patients to live in a safe environment, to satisfy the health needs of human being and their needs for health knowledge, and enhance their self-care abilities.

Family care and subjective well-being of coronary heart disease patients after percutaneous coronary intervention:Mediating effects of coping strategies

Objectives To analyze the correlations between family care,coping strategies and the subject well-being(SWB)of patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods From November 2019 to October 2020,264 CHD patients who had undergone PCI were enrolled in this questionnaire survey.The research tools applied included General Information Questionnaire,the Adaptation,Partnership,Growth,Affection and Resolve,Medical Coping Modes Questionnaire,and the General Well-being Schedule.SPSS 24.0 and Amos 23.0 software packages were used for statistical analysis.Results The mean scores for family care,confrontation,avoidance,acceptance-resignation and SWB,were 7.59±2.24,20.03±3.78,16.49±2.70,10.42±2.01,and 73.31±11.63,respectively.Subgroup analysis showed that the path coefficient between family care and subjective well-being was higher in males than females.Family care was directly related to coping strategies.The coping strategies were directly related to SWB,while family care showed an indirect association with SWB via coping strategies.Conclusions Family care can improve CHD patients’SWB post-PCI,and coping strategies are important for the link between family care and SWB.Also,men received more family care than women.Based on a patient's characteristics,healthcare providers can promote patients’positive coping strategies,increase their perceived family care,and improve the patient's SWB.

Family empowerment and associated factors in Japanese families raising a child with severe motor and intellectual disabilities

Objectives:Family caregivers raising children with severe motor and intellectual disabilities(SMID)experience the enormous burden of care.The concept of family empowerment is one of the important assessment indexes of family nursing from the perspective of providing comprehensive support for these families.The objective of this study was to identify the factors associated with the empowerment of families raising a child with SMID in Japan.Methods:We conducted a nationwide questionnaire survey involving 1659 primary caregivers raising a child with SMID through 89 special schools.We assessed the main outcomes using the Family Empowerment Scale(FES).We then conducted a multiple linear regression analysis to reveal the factors associated with family empowerment.Results:In total,1362 primary caregivers were included in our study.Our results show that factors contributing to high FES scores are higher age of the primary caregiver,higher education,greater recognition of regional support,lower childcare burden,higher utilization of home visit services,higher usage of a childcare institution,higher household income,and stronger family bonding.Conclusion:Healthcare professionals should carefully assess the state of family empowerment of the primary caregivers who are younger and those who have low education,low household income,high childcare burden,and fragile bonding with the family.Second,they should encourage such families to use regional support resources for childcare.That is,policy makers should consider ways to promote home visits and institutional services for the care of children with SMID,aiming especially for the provision of well-coordinated care and services.