Hsiao Chiu-Yueh, Lu Huei-Lan, Wu Kuan-Yi, Li Chia-Chun, Li Chi-Rong, Tsai Yun-Fang
School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan.
Department of Psychiatry, Chang Gung Memorial Hospital, Linko Branch, Tao-Yuan City, Taiwan.
J Nurs Scholarsh. 2025 Mar;57(2):190-203. doi: 10.1111/jnu.13013. Epub 2024 Aug 9.
Family engagement in care has been advocated to promote recovery for patients with mental health conditions. Attitudes of mental health nurses toward the importance of families influence the way they partner with families in mental healthcare. However, little is known about how mental health nurses engage with families and quality of family-centered care (FCC) perceived by patients and caregivers. The study aimed to examine the mediating effect of family nursing practice on the association between mental health nurses' attitudes toward integrating families into care and quality of FCC perceived by patients with schizophrenia and caregivers.
A cross-sectional study was conducted.
A convenience sample of 143 dyads of patients with schizophrenia and their caregivers and 109 mental health nurses were recruited from inpatient wards at two psychiatric hospitals in Taiwan. Demographic and clinical questionnaires, Families' Importance in Nursing Care-Nurses' Attitudes scale, Family Nursing Practice Scale, and Measure of Process of Care for Adults were used to collect data. Data were analyzed using descriptive statistics, independent-sample t-tests, one-way analysis of variance, Pearson correlation coefficients, paired-sample t-tests, and intraclass correlation coefficient (ICC). Mediation analyses were performed using Hayes' PROCESS macro in SPSS (Model 4) with bootstrapping.
Mental health nurses exhibited supportive attitudes toward integrating families into care (Mean = 98.96) and greater perceptions of family nursing practice (Mean = 2.44). The concordances between patients and caregivers on perceived quality of family-centered care were significant (ICC = 0.63-0.77). Attitudes of mental health nurses toward integrating families into care had both the total and direct effects on all domains of quality of FCC perceived by patients and caregivers, respectively. The indirect effects of mental health nurses' attitudes toward integrating families into care on aspects of quality of FCC through family nursing practice were significant for patients (95% bias-corrected bootstrap CI of 0.015-0.053) and caregivers (95% bias-corrected bootstrap CI of 0.004-0.041). The magnitude of the indirect effects was medium to large for patients (ES = 0.209-0.257) and caregivers (ES = 0.148-0.221).
Family nursing practice partially mediated the association between mental health nurses' attitudes toward integrating families into care and aspects of quality of FCC from perspectives of patients and caregivers.
Interventions tailoring mental health nurses' practice skills and reciprocity with families have the potential to enhance supportive attitudes of mental health nurses toward working with families and further improve perceived quality of FCC in patient-caregiver dyads in mental healthcare practice.
倡导家庭参与护理以促进精神疾病患者的康复。精神科护士对家庭重要性的态度会影响他们在精神卫生保健中与家庭合作的方式。然而，对于精神科护士如何与家庭互动以及患者和护理人员所感知的以家庭为中心的护理（FCC）质量，我们知之甚少。本研究旨在探讨家庭护理实践在精神科护士将家庭纳入护理的态度与精神分裂症患者及其护理人员所感知的FCC质量之间的关联中所起的中介作用。
进行了一项横断面研究。
从台湾两家精神病医院的住院病房招募了143对精神分裂症患者及其护理人员以及109名精神科护士作为便利样本。使用人口统计学和临床问卷、《护理中家庭的重要性 - 护士态度量表》、《家庭护理实践量表》以及《成人护理过程测量量表》收集数据。数据采用描述性统计、独立样本t检验、单因素方差分析、Pearson相关系数、配对样本t检验和组内相关系数（ICC）进行分析。使用SPSS中的Hayes' PROCESS宏（模型4）进行带有自抽样的中介分析。
精神科护士对将家庭纳入护理表现出支持态度（均值 = 98.96），并且对家庭护理实践的认知度更高（均值 = 2.44）。患者和护理人员在感知的以家庭为中心的护理质量上的一致性显著（ICC = 0.63 - 0.77）。精神科护士将家庭纳入护理的态度分别对患者和护理人员所感知的FCC质量的所有领域具有总体效应和直接效应。精神科护士将家庭纳入护理的态度通过家庭护理实践对FCC质量方面的间接效应对于患者（95%偏差校正自抽样CI为0.015 - 0.053）和护理人员（95%偏差校正自抽样CI为0.004 - 0.041）均显著。对于患者（效应量 = 0.209 - 0.257）和护理人员（效应量 = 0.148 - 0.221），间接效应的大小为中等至较大。
从患者和护理人员的角度来看，家庭护理实践部分中介了精神科护士将家庭纳入护理的态度与FCC质量方面之间的关联。
针对精神科护士的实践技能以及与家庭的互动进行干预，有可能增强精神科护士与家庭合作的支持态度，并进一步提高精神卫生保健实践中患者 - 护理人员二元组所感知的FCC质量。
