Journal of Family Nursing

Researchers studying vulnerable families can face formidable impediments. The purpose of this article is to provide an overview of methodological challenges commonly encountered in research with vulnerable family units or members and to suggest problem-solving strategies. The following issues are examined: (a) obstacles to identifying, accessing, recruiting, and retaining vulnerable families as research participants; (b) responsibilities of researchers concerning unanticipated health care crises, informed consent, and participant and researcher safety; and (c) issues in training clinicians as research team members. Examples are drawn from the literature as well as from family and family-related research studies conducted by the authors that involve both quantitative and qualitative designs, along with various family situations.

The challenges that cause and result from vulnerability in families are complex. Systematic methods for studying the issues underlying vulnerability are needed. In this article, the utility of mixed methods for nursing science with vulnerable families is addressed. The use of mixed methodology resulted in more precise descriptions of the complex reality of living as a vulnerable family, such as living in a family with a member with HIV/AIDS, a child with a chronic condition, or a family member with other life-threatening conditions. Coupling qualitative methods with quantitative methods can illuminate phenomena related to vulnerable families that cannot be captured using a singular approach. To advance our understanding of family vulnerability, it is essential that we define research strategies that contribute to both the depth and the breadth of our knowledge. Mixed methods are logically congruent with this goal.

Caregiving, creating a situation of vulnerability, can result in increased mortality and morbidity for illness and emotional stress. This study using secondary analysis focused on spousal involvement in the lung transplant process and vulnerability for caregiver strain. In the original studies, taped telephone interviews were conducted with 24 spouses of transplant candidates or recipients using a cross-sectional design. Transcripts were recoded for significant statements related to caregiver role strain. Spouses during organ-waiting periods had higher numbers of statements reflecting caregiver role strain. For posttransplant spouses, caregiver strain was greatest at the time of transplant and early recovery period. Caregiver strain was evident with new crises of infection or rejection. Individual spouses with the most evidence of caregiver strain were those balancing multiple roles and tasks. Health care providers should assess entire transplant families throughout the transplant process for vulnerability related to caregiver strain and assist members to activate coping strategies.

Research with families described as vulnerable is a rapidly evolving area. This study provides a brief commentary on articles from the Eastern Nursing Research Society (ENRS) symposium on research of vulnerable families using standards for research of families. These standards constitute science policy that is intended to advance nursing or family science through setting broad-based standards and providing guidelines for research. This commentary also discusses the usefulness of these standards for research with vulnerable families and provides recommendations for positioning this research to inform social and health policy to improve the outcomes for these families.

Hypotheses derived from the Developmental Model of Health and Nursing were tested by examining relationships among mothers’ resilience (health potential), family health-promoting activity (health work), and mothers’ health-promoting lifestyle practices (competence in health behavior) in 67 families with preschool children. Mothers completed a mailed survey containing self-report measures of the study variables and a demographic form. As hypothesized, both mother’s resilience and family health work were positively related to mother’s health-promoting lifestyle practices. Mother’s resilience was also associated with health work. Mother’s resilience and health work were found to predict 41% of the variance in mother’s health-promoting lifestyle practices, after controlling for the effects of family income. Mother’s resilience and health work were most strongly related to different, but complementary, aspects of mother’s health-promoting lifestyle practices. Implication for nursing practice and future research are identified.

Family-centered care (FCC) has been promoted as the optimal philosophy for children and families in their interactions with health professionals. Furthermore, FCC is a health care delivery model that seeks to fully involve families in the care of children through an approach that is respectful and supportive. This multisite survey was undertaken to determine the differences in health professionals’ perceptions and practices of FCC and to examine factors that influence those perceptions and practices. Findings revealed that although advances have been made in recognizing the key elements of FCC, difficulties remain in implementing these elements. The “dilemma of helping,” the potential lack of interprofessional collaboration, the design of the health care delivery system, as well as the potential lack of continuing education and mentoring programs are proposed as explanations for these findings.