Over the past two decades, dyadic health science has grown rapidly to focus on dyads across the lifespan in health and illness contexts. There have been increasing numbers of dyadic theories developed and a wide spectrum of dyadic methods (both quantitative and qualitative) employed to address questions centered on the interpersonal context of health, health behaviors, and wellbeing. Family nurse scholars have unique expertise to contribute to the field of dyadic health science and optimize dyadic health. The purpose of this paper is to provide an overview of theories and methods of dyadic health science and to highlight examples of dyadic health research conducted by family nurse researchers. The paper concludes with a call for family nurse researchers to continue to advance dyadic health science that guides nursing practice in diverse health care settings.
PURPOSE:We aimed to explore the ethical challenges encountered by nurses when providing family-centered care. METHODS:Thematic analysis was conducted using data from 82 semi-structured interviews with practicing nurses across four states in the United States. FINDINGS:Theme 1: Navigating professional and ethical boundaries in nursing care that complement or complicate family advocacy; Theme 2: Experiencing family conflicts and disagreements; Theme 3: Feeling helpless at times from ethical, legal, and familial expectations and moral constraints. CONCLUSION:Participants showed commitment to involving families in patient care. Yet, we also observed tension in balancing respect for families' wishes with patient autonomy, which led to moral distress and ethical uncertainty in their professional boundaries. While family-centered care recognizes families' contributions to patient care and health care decisions, ongoing efforts are needed to address the ethical challenges that arise in its implementation in practice.
This paper explores ethical complexities in qualitative research involving families/interrelated persons. Such research requires consideration of relational dynamics, informed consent, and methodological choices to avoid unintended harm to relationships. Drawing on research experiences across diverse clinical contexts, the authors reflect on ethical challenges encountered in family interviews, integrating established ethical frameworks with practical insights from joint and family interviews. Key considerations include: clarifying research objectives, distinguishing research interviews from therapeutic encounters; informed consent as an ongoing process, particularly with vulnerable populations; managing confidentiality and withdrawal in relational settings; attending to verbal and nonverbal cues to balance participant voices; maintaining professional boundaries while recognizing unintended therapeutic effects; sensitivity to interview location and group composition; and relational hierarchies. Ethical dilemmas in family-centered qualitative research are context-dependent and require reflexivity, empathy, and deliberate planning. By anticipating challenges and adopting flexible, participant-centered strategies, researchers can generate meaningful data while safeguarding respect for persons.
An urgent need exists to elevate the agenda of family ethics, rooted in family nursing's moral commitment to the well-being of families and society. This paper highlights the practice, research, and educational implications for this agenda. Grounded in relational ethics, this vision calls for a curriculum and practice landscape that reflects the lived realities of diverse families and communities. Clinically, it recommends the creation of interdisciplinary care protocols that embed structured family ethics conversations, drawing on an understanding of family systems. In research, it advocates for expanding studies that examine how familial and cultural values shape moral distress and care outcomes, and for broadening traditional bioethical inquiries to include family-centered perspectives. Educationally, it urges the integration of real-world scenarios, cultural analysis, and emotional intelligence training into classrooms and skills labs. Together, these strategies aim to cultivate ethically grounded, socially responsive nurses equipped to lead transformative changes in family health care.
In this study, a nurse-led supportive family health conversation intervention delivered through one to three video-conferencing sessions was evaluated for patients undergoing open-heart surgery and their self-selected family members. Based on the Family Systems Nursing framework, the intervention aimed to improve family well-being, functioning, and involvement by fostering shared understanding and challenging limiting beliefs. Patients and family members were randomized into two groups. Both received usual surgical care, while the intervention group also participated in digital family health conversations before and after surgery. Participants completed questionnaires at baseline and at 30 and 90 days after discharge. The analysis included 101 patients (control = 54, intervention = 47) and 99 family members (control = 52, intervention = 47). The intervention was not superior to usual care for the primary outcome, family well-being. Most secondary outcomes showed no effect, although some aspects of quality of life improved. Further research should examine long-term effects, feasibility, and appropriate outcome measures.Clinical trials register number and URL: NCT05045196, https://clinicaltrials.gov/study/NCT05045196?cond=NCT05045196 & rank=1;
Qualitative study using semi-structured individual interviews. Adolescents between 13 and 19 years old were interviewed. They had either a mother or a father with heart disease diagnosed between 6 months and up to 5 years prior to the interview. Analyses were inspired by Reflexive Methodology. Four main themes were found across 33 interviews: (a) the family as fundamental support; (b) peers as a free space; (c) health care professionals as reliable sources and (d) school teachers as validators. Family members provided a trustful atmosphere when open and transparent communication was used. Peers fostered greater openness, honesty, and relatability. Health care professionals and schoolteachers validated and objectified information, which seemed important to handle the situation. A collaborative effort involving family, friends, health care professionals, and schoolteachers is essential for effectively supporting adolescents with parental heart disease.
Background: Managing heart failure (HF) can be challenging for rural dyads, potentially contributing to depressive symptoms. Coping resources may be important components for dyadic interventions targeting depressive symptoms.Purpose: To explore actor and partner effects of coping resources on depressive symptoms in rural HF dyads.Methods: Using a cross-sectional design, data were collected from 42 rural HF dyads using the Interpersonal Support Evaluation List-12, Social Problem-Solving Inventory Revised-Short, Global Family Function, Family APGAR, and the Center for Epidemiological Studies-Depression scales. Data were analyzed using the Actor-Partner Interdependence Model.Results: Patients were 66.42 and caregivers were 60.83 years old. No partner effects noted. Significant actor effects for patients and caregivers between their own social support and depressive symptoms and their own problem-solving and depressive symptoms were found. There was also a significant actor effect between the caregivers' family satisfaction and depressive symptoms.Conclusions: Dyadic interventions that enhance coping resources are needed.
Congenital heart disease (CHD), the most common birth defect globally, often requires hospitalization for cardiac surgery. While the stress of infant surgery is well-documented, less is known about the experiences of families with older children. We explored the experiences of families of children aged 3-17 hospitalized for cardiac surgery. Semi-structured interviews were conducted. Data were analyzed using qualitative content and thematic analysis. Thirty-two parents (30 mothers and 2 fathers) and 14 patients (10 males and 4 females) participated. Seven themes emerged across three domains: (a) Challenges: disruptions in family and social support, unexpected events and inadequate communication, and uncertainty and strong emotions; (b) Preparations: emotionally preparing yourself, your children and your family, and planning for hospitalization and surgical recovery; and (c) Recommendations: enhance communication and connection for support, and provide resources and education for empowerment. Findings highlight opportunities for targeted interventions to support families across child development.
Substance use disorders (SUDs) are a pervasive public health problem facing families in the United States. Although families are frequently urged to support loved ones who have SUDs and cautioned against enabling them, there is a dearth of literature that distinguishes between supporting and enabling. This phenomenological study examined the experiences of parents (n = 8) with adult children with SUD who were currently in recovery. The primary research question in this study centers on how parents navigate their loved one's SUD, attempting to support recovery without enabling addiction. Three themes emerged from the data, including (a) addiction and recovery knowledge, (b) support group philosophy, and (c) differentiation. The results of this study add to the literature by demonstrating the importance of respective family support group affiliation on family's perception of enabling versus supporting. More research is needed to compare and contrast family support groups and their respective philosophies.
Family-centered care is essential for addressing the complex health needs of families globally, yet its implementation remains inconsistent across different cultures and health systems. PURPOSE:Guided by JBI methodology, this scoping review mapped the dissemination and influence of the four core International Family Nursing Association (IFNA) Position Statements (PSs) on education and practice. Five electronic databases and gray literature sources were searched for documents citing the statements from 2013 onward. Following the removal of duplicates, screening was facilitated using Rayyan software. Data on citation metrics and documented influence across the domains of education, practice, research, and policy were charted and synthesized. FINDINGS:The review identified 124 citing sources. A significant disparity exists: the practice-focused statements are widely disseminated and influential, particularly within the practice and education domains, while the education-focused statements show limited uptake. Dissemination is geographically concentrated in high-income countries, and policy influence is minimal. Notably, the practice-focused statements demonstrated greater influence within the education domain than the education-focused statements themselves. CONCLUSIONS:The IFNA-PSs serve as foundational documents for family nursing, but their potential to globally standardize education and shape policy is not yet fully realized. Key barriers include structural inconsistencies across documents and a publication strategy relying on web-based resources rather than indexed journal articles, limiting citation tracking. Future strategies should prioritize revising the statements, pursuing publication in peer-reviewed journals, and applying Implementation Science frameworks to develop targeted initiatives that bridge gaps in education, policy, and geographic reach.
Families of intensive care unit (ICU) patients often experience distress and dissatisfaction with communication. Structured communication frameworks may strengthen family-centered care and improve outcomes. This quasi-experimental, nonrandomized study was conducted in five ICUs across three referral hospitals. Families of patients with reduced consciousness were recruited, with one representative per patient completing questionnaires. In the control group (n = 48), families received routine communication. In the intervention group (n = 48), 10 ICU nurses trained in COMFORT conducted daily 20-min structured sessions for 5 days. Family satisfaction was assessed on Day 5 using the FS-ICU-24, and nurse-family communication quality was measured in the intervention group on Days 1, 3, and 5 with the QUALPAC communication subscale. Families in the intervention group reported significantly higher satisfaction scores, and communication quality improved over time. Implementation of the COMFORT model enhanced family satisfaction and strengthened nurse-family communication in ICUs.
Research in family and peer systems has demonstrated the value of supportive conversations in helping children understand and express emotions around challenging experiences. The aim of this study was to explore the patterns, perceptions, and outcomes of a brief narrative sharing intervention designed to facilitate supportive conversations with youth. We utilized a mixed-methods approach with concurrent data collection among 88 parent-child, peer-peer, and researcher-child dyads. Data were collected through audio-recorded interviews and surveys. We used inductive and deductive coding to characterize interviewer behaviors. Qualitative and quantitative data were integrated to identify patterns in interviews and outcomes. Participants reported high levels of listener supportiveness, comforting responses, and insights through the activity. Integration of data revealed patterns of emotion coaching and participant perceptions in five types of interviews. The brief narrative sharing activity can be tailored by family nurses to support parents and youth in engaging in supportive, strengths-based conversations.
Family members of individuals with polysubstance substance use disorder (PSUD) face many stressors that negatively affect their quality of life (QoL). This study examined the mediating roles of internalized stigma and perceived caregiving burden in the relationship between psychological resilience and QoL among parents of individuals with PSUD. A cross-sectional study was conducted with a sample of 277 individuals consisting of mothers or fathers of individuals diagnosed with PSUD. Participants completed several instruments, including the Connor-Davidson Resilience Scale, Parents' Internalized Stigma of Mental Illness Scale (adapted), Perceived Family Burden Scale, and WHOQOL-BREF. Data analyses included descriptive statistics, correlation analyses, and serial mediation analysis performed using SPSS 27.0 and PROCESS macro (Model 6). Psychological resilience was positively associated with higher QoL and showed an indirect association with QoL through a sequential mediation involving internalized stigma and perceived care burden. The model explained 67% of the variance in QoL (R² = 0.672). Internalized stigma was associated with perceived care burden, which in turn was negatively associated with QoL. Our study emphasizes the importance of addressing psychological resilience, stigma, and caregiving burden together to improve the QoL of families affected by PSUD. Multifaceted interventions targeting these interrelated factors are recommended to improve the QoL of caregivers.
The Family Systems Care Unit (FSCU) is a real-life laboratory including a counseling service for family-systems-centered therapeutic conversations with families with burdening health issues. Health care students and professionals observe these conversations for vicarious learning. Video-recorded conversations are used for research and educational purposes. Since 2020, the FSCU has been developed using project management and action learning strategies. As of June 2025, 34 families had used therapeutic conversations. Fifty health care students and professionals observed conversations and participated in the clinical team's pre- and post-sessions. Thirteen students completed their master's theses. A case vignette illustrates a family confronted with one family member's decision to obtain medical aid in dying, demonstrating the interconnectedness of the FSCU's clinical work, education, and research. The FSCU is a care model that addresses today's health care and higher education needs. The objectives of this article are to present how this FSCU was realized over a 5-year project period.
