The RPI stimulated double loop learning that changed paediatric critical care nurses' attitudes about family, enhanced their communication and ability to build trusting relationships with families and brought about a new appreciation of the uniqueness of family stress. There was a new integration of family care into the nurses' practice as a result of the intervention.

( 2 0 1 1 ) ( 2 0 1 1 ) Journal of Nursing and Healthcare of Chronic Illness 3, 283-292 Reintegration within families in the context of chronic illness: a family health promoting process Aim. To describe the processes families use to manage family life in the context of a chronic illness and build theory that clarifies elements of the family processes. Background. Illness has been described as a family affair triggering families to shift their individual and family patterns as they attempt to manage ongoing life with a chronic illness. Family processes are central to the tasks and goals of a family living with a chronic illness. One in two families will experience a chronic illness in the next decade, hence it is important that research focus on understanding family processes that can influence health of the member with an illness and family health. Design. Grounded theory methodology was used for this study. Nine families participated with 46 participant family members interviewed aged between 6-75 years. Families included members with varied chronic illnesses. Semi-structured, audiotaped interviews with group analysis methods focused on family level data. Data were collected in 2005. Results. The central phenomenon was identified as an ongoing process of reintegration within families in the context of chronic illness. Recognising the vulnerability and reality of chronic illness prompts families to initiate reintegration within a context of uncertainty presented by the specific illness and its ongoing management. As a result of the caring strategies chosen by families, a pattern of engagement with Ó 2011 Blackwell Publishing Ltd 283 the chronic illness was developed that focused on ongoing connecting, pondering, relating and struggling. Conclusions. A model of reintegration provides new understandings of ongoing family processes of a chronic illness. Supporting the evolving family as they engage with the chronic illness through processes of connecting, pondering relating, and struggling promotes family health.Relevance to clinical practice. Findings provide direction for health professionals planning family interventions to support family caring strategies and family processes as families engage with the chronic illness.

The purpose of the study was to understand and interpret caring in the family health experience by exploring the interactional phenomenon of family-nurse co-construction of meaning in the paediatric intensive care unit (PICU). A hermeneutic phenomenological method within a framework of existentialism and symbolic interactionism was used in the investigation. The convenience sample for this study was four family-nurse dyads, that is four families of critically ill children (all with positive outcomes) and the four nurses assigned to their care who were participating in a larger study. Data were derived from semi-structured interviews regarding significant interactions throughout the child's illness and subsequent significant interactions of families with other nurses and nurses with other families. Trustworthiness of the study was addressed through the criteria of credibility, dependability, transferability and confirmability. Co-construction of meaning in the family health experience was found to have two dimensions: interdependent and independent. Both families and nurses described being like family as an essential component of the interdependent experience. Independent dimensions for families were journeying through troubled waters of learning the meaning of the illness event and sensing family comfort through the nurse's care. Independent dimensions described by nurses were journeying through troubled waters of learning to care for families and living with another's fear. The family-nurse interaction, the relational connection and the evolution of meanings that families and nurses construct, was affirmed as the major vehicle in the co-construction experience. Family caring is influenced by the existential meaning constructing, process-oriented, interactional nature of the family health experience. Caring in the family health experience is enhanced through actions the nurse performs on behalf of, and with, the family while understanding the family's unique situation. Caring enacted by nurses in participation with families holds abundant potential for enhancing the family health experience and honor the ethic of caring as central to nursing.

Clinical nurse specialists are expected to contribute to the development of new nursing knowledge through research activities. Competing demands require constant juggling of time and priorities, and activities, such as research, often do not receive the attention they deserve. Research requires specific skills and knowledge and significant time expenditure. Collaborative research is an appropriate way for the clinical nurse specialist to both contribute to research and improve his or her research skills. This article discusses two pediatric critical care clinical nurse specialists' participation in a collaborative research team led by university faculty. The study was designed to reduce family uncertainty and stress and to increase staff nurse competency in providing family care. The ability of the clinical nurse specialists to contribute to the research team was enhanced by knowledge of the research process, good communication skills, and clinical expertise in the specific population of interest. Challenges for the clinical nurse specialists included limited experience in conducting clinical research and balancing clinical and research priorities. Both clinical nurse specialists and the university faculty benefited from this collaboration. The clinical nurse specialist, with expertise in a clinical specialty, is able to bridge the gap between the academic and clinical sites, making clinical research more likely. At the same time, working with expert researchers allows the clinical nurse specialist to increase his or her research skills.