In nursing care, it is important to support both patients and their family members. To provide continued and high-quality service, nurses need to evaluate whether their own care is effective in enhancing the patient’s family’s self-care function. There are several available instruments to measure nursing practice abilities, nurses’ beliefs, and nurses’ attitudes in the field of family nursing, many of which have been developed with a specific area focus, for example, the Family Nurse Caring Belief Scale for nurses working in the Pediatric Intensive Care Unit/Neonatal Intensive Care Unit (NICU) [1], the Family Nursing Practice Scale in Psychiatry [2], and a measure of emergency nurses’ attitudes towards family members who have experienced consultation with a patient because of injury or illness, or sudden death [3].

Through the evaluation of family nursing practice and family nursing training, it has been reported that the system and environment of nursing facilities [4] [5], the acquisition of family nursing knowledge and skills [6] [7] [8], the caring experience of nurses’ own family [9] [10] [11], and the capacity to establish human relationships [12] affected nursing care for patients’ families. Among these related factors, the effect of the acquisition of knowledge and skills has been investigated in numerous studies. However, there have been few studies on nurses’ work environment or their individual background characteristics, and some of these previous findings have been inconsistent [13] [14]. On the other hand, there are many studies on relationship between life events or stress and nursing practice [15] [16] [17].

In previous studies on nurses’ attitude toward, which is one of the criteria for evaluating family nursing, the relationship between the working environment and individual characteristics of nurses has been reported. Fisher [18] developed a scale of 18 items that evaluate the attitudes and behaviors of nurses in their daily care, and showed that nurses who regarded the presence of family as important were more involved in daily care; however, no other studies have used this scale, so the results have yet to be confirmed. Benzein et al. [19] developed the FINC-NA to measure nurses’ attitudes towards the importance of involving family in nursing care. The FINC-NA scale has been used in several countries in addition to Sweden where it was developed, and nurses’ attitudes toward families in various countries are gradually becoming more clear [20] [21] [22] [23] [24]. Exploring the factors affecting FINC-NA, which is a reliable measure, is expected to help clarify the factors related to family nursing attitudes. Furthermore, to provide more effective family support, we believe that it is important to approach nurses from various perspectives.

The conceptual framework of this study is shown in Figure 1. Nurses play a role as professionals, employees, and members of their families. We believe that the knowledge, experiences, and feelings gained from each of these roles are correlated with each other and represent facility, professional, and individual factors that affect family nursing attitudes.

Questionnaires were distributed to 638 nurses from seven medical facilities and 480 nurses responded (75.2% response rate). The divisions in which they were working were as follows: internal medicine, surgery, intensive care unit/high care unit, neonatal intensive care unit/growing care unit, obstetrics and gynecology, pediatrics, psychiatry, emergency, gastrointestinal, orthopedic surgery, cardiovascular, neurosurgery, respiratory, operating room, laboratory, outpatient, nursing department, visiting nursing department, dialysis room, rehabilitation, regional collaboration room. Nurses with less than 5 years of clinical experience who did not fully complete all items for FINC-NA, nursing practice abilities, job satisfaction, and FSOC, and those with more than 20% of the answers to all questions missing were excluded. Finally, the responses of 416 nurses (valid response rate 65.2%) were analyzed.

The participants’ characteristics are shown in Table 1. The mean age of participants was 36.6 (standard deviation [SD] = 7.7) years, the number of years of clinical experience was 13.5 (SD = 7.1) years, and the rate of managerial experience was 15.5%. Approximately half of the participants had built a reproductive family (presence of a partner was 53.6%, presence of parenting experience was 46.3%). In addition, the rate of experience of caring for own family was 27.2%.

The total FINC-NA score was 91.1 (SD = 10.0), and the scores for each subscale were as follows: Fam-RNC was 36.0 (SD = 4.0), Fam-CP was 27.7 (SD = 3.7), Fam-B was 14.1 (SD = 2.8) and Fam-OR was 13.3 (SD = 2.4). The total score of Version 3 of the Clinical Practice Proficiency Measurement Scale for Mid-career Nurses was 72.8 (SD = 11.2), the job satisfaction total score was 16.6 (SD = 3.5) and the FSOC total score was 58.3 (SD = 11.6).

In the case of univariate analyses of total FINC-NA scores, there was a significant correlation (p < 0.05) between nursing practice ability, FSOC, job satisfaction, family nursing learning experience, presence of partner, and experience of family nursing (Table 2).

The results of the multiple regression analysis with FINC-NA as the dependent variable are shown in Table 3. From the 351 nurses who responded to all variables that were significant by the stepwise method, single regression analysis and in preceding studies [9] [10] [14]. we were excluded the two participants

SD: standard deviation.

^a)Spearman’s rank correlation coefficient, ^b)t-test, ^c)Pearson’s correlation coefficient. SD: standard deviation; FSOC: Family Sense of Coherence.

r: Pearson’s correlation coefficient, β: standardized partial regression coefficient, FINC-NA: Families’ Importance in Nursing Care-Nurses’ Attitudes. *p < 0.05, **p < 0.01.

who had the highest and lowest total FINC-NA scores in the residual analysis, leaving 349 nurses for analysis.

The coefficient of determination was R² = 0.309 (p < 0.01) and the variables that affected FINC-NA were nursing practice ability (β = 0.442, p < 0.01), FSOC (β = 0.187, p < 0.01), and job satisfaction (β = 0.104, p < 0.05).

As a result of the path analysis with nursing practice ability as the dependent variable, job satisfaction (β = 0.284, p < 0.01), FSOC (β = 0.215, p < 0.01), managerial experience (β = 0.134, p < 0.05), and family nursing learning experience (β = 0.118, p < 0.05) were significant. In addition, as a result of calculating the indirect effects of job satisfaction and FSOC on FINC-NA, the indirect effect mediated by nursing practice ability (β = 0.126) was higher than the direct effect (β = 0.104) for job satisfaction (Table 3, Figure 2).

Based on the number of years of clinical experience or managerial experience, the participants of this study were considered proficient or expert [30]. In comparison with a previous study [25], the total FINC-NA and Fam-CP scores were almost the same, but the Fam-RNC score was slightly lower and the Fam-B score was higher. This showed that the participants did not regard the family as an important resource in nursing care, but instead felt the presence of the family to be a burden.

Sveinbjarnardottir et al. [10] showed that nurses with more than a university education do not consider patients’ families to be a burden. In addition, Luttik et al. [14] reported that completing graduate school or holding the position of a researcher, educator or administrator had an effect on attitudes towards families. Comparing the present participants’ characteristics with those in previous studies revealed differences in educational background or their position in the workplace. These reasons were assumed to explain the differences in the Fam-RNC and Fam-B scores.

In this study, nursing practice ability most strongly affected FINC-NA, followed by FSOC and then job satisfaction. For nurses working in medical facilities, patient care is the most important role and new nurses learn and practice patient-centered nursing from the beginning of their employment. The Scale of Nursing Practice Ability of Mid-career Nurses that was used in this study was

developed through repeated examinations and revisions of the scale. This scale contains items that whether setting goals by talking with patients and their families, and whether to evaluate patients and their families’ satisfaction for practiced care. This means that mid-career nurses with high nursing practical ability can pay attention not only to patients, but also to their families, and are capable of building good relationships with them. The results of the present study supported that.

FSOC had a direct effect on nursing practice ability and on nurses’ attitudes towards families. In a double ABCX model [31] used to analyze family stress in the long term, it was said that family coping became a bridging concept which had both cognitive and behavioral components wherein resources, perception, and behavioral responses interact as families try to achieve a balance in family functioning. Nurses with high FSOC scores can be regarded as having a high coping ability to balance family functions, and it was assumed that they made use of this ability to help families cope with various stresses caused by the patient’s illness. Furthermore, the FSOC consists of questions about family values, such as their thoughts and the importance of family life. Since the FSOC influences nurses’ attitudes towards families, it was suggested that nurses’ values towards their own families affected their family nursing practice. It is important for nurses to recognize the diversity of patients’ families as well as to sympathize with them, and to acknowledge their values towards their own families.

Although job satisfaction showed a direct effect on nurses’ attitude towards families, the effect of nursing practice ability was stronger. Previous studies [32] [33] have shown that job satisfaction enhances the quality of care, and the same results were obtained in this study.

Managerial experience and family nursing learning experience were mentioned as factors that influence nursing practice ability. We believe that nurses with managerial experience already had high nursing practice ability, and they were further enhancing their comprehension by performing tasks such as staff coordination and family support.

In this study, nurses with family nursing learning experience had high nursing practice ability. The participants included a certain number of nurses who had learned family nursing systematically in graduate school or training. It was believed that the ability to respond to families required as nursing practical skills has been enhanced by acquiring knowledge and skills in family nursing. Furthermore, they had continued their education to improve their skills as nurses, and they were highly motivated to learn. It was considered that their willingness to learn was influenced by the acquisition of nursing practice ability.

It is possible that attitudes and willingness to perform family nursing were higher in the participants of the present study than nurses at other facilities because the participants were recruited from medical facilities that conduct family nursing training. Therefore, it is necessary to exercise caution when generalizing the findings of the present study.

It is necessary to consider that the answers to questions about managerial experience, family nursing experience, and family nursing learning experience showed large individual differences.

The factors associated with the attitudes of nurses working at medical facilities were nursing practice ability, FSOC and job satisfaction. In addition, the factors indirectly affecting attitudes through nursing practice ability were job satisfaction, FSOC, managerial experience and family nursing learning experience. It was suggested that it is possible for nurses to have a good relationship with the patient’s family by looking back on and recognizing their own values in addition to acquiring skills and knowledge.

We would like to thank the participants for their cooperation. This study was supported by JSPS KAKENHI Grant Number 16H05565 (PI: A Yamazaki).

The authors have no conflicts of interest to disclose.

Hori, M., Yamazaki, A., Soeda, A., Odatsu, K., Buyo, M., Matumoto, M., Tokutani, R., Mine, H., Tsumura, A., Kimura, C. and Nakayama, Y. (2020) The Factors Associated with the Attitudes of Nurses Working in Medical Facilities towards Family Nursing. Open Journal of Nursing, 10, 171-183. https://doi.org/10.4236/ojn.2020.102011