Short-term patient and family counselling for acute health change - an integrative literature review

www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3 REVIEWS Sho - e m pa ien and amily counselling o acu e heal h change - an in eg a i e li e a u e e iew K is iina Rai anen ∗1,2, Ja i Kylmä1, Eija Paa ilainen1,2 1School o Heal h Sciences, Uni e si y o Tampe e, Finland 2E elä-Pohjanmaa Hospi al Dis ic , Finland Recei ed: Janua y 8, 2015 Accep ed: Ap il 12, 2015 Online Published: May 3, 2015 DOI: 10.5430/cns. 3n3p96 URL: h p://dx.doi.o g/10.5430/cns. 3n3p96 ABSTRACT The pu pose o his in eg a i e li e a u e e iew is o desc ibe exis ing esea ch knowledge on sho - e m counselling o pa ien s and amily membe s unde going acu e heal h change. The da a consis ed o 25 esea ch a icles and i e li e a u e e iews om he yea s 2003-2015, analysed using induc i e con en analysis. The esea ch knowledge was ound o desc ibe elemen s o good pa ien counselling, sa is ac ion wi h he elemen s o good pa ien counselling, de eloping he elemen s o good pa ien counselling and impac o he pa ien counselling elemen s. Focussing on he pa ien ’s indi idual li e si ua ion, use o mul iple counselling me hods and p o ision o in o ma ion in good in e ac ion con ibu e o high quali y pa ien counselling. Some pa ien s and amily membe s we e sa is ied wi h he pa ien counselling elemen s while o he s exp essed needs o he de elopmen o he elemen s. The con lic ing esul s indica e a need o de elop a uni o m, sys ema ic pa ien counselling me hod, wi h special a en ion paid on he quali y o counselling. Key Wo ds: Pa ien counselling, Family counselling, Sho - e m, Acu e heal h change, In eg a i e li e a u e e iew 1. INTRODUCTION An acu e change in heal h is an expe ience ha a ouses emo- ions, wi h each indi idual eac ing di e en ly o illness and he ensuing loss o independence. The expe ience is a ec ed by he acu eness, se e i y and a ali y o he si ua ion. Acu e illness o en occu s d ama ically, wi hou wa ning signs o p eceding e en s. Pa ien s and hei amily membe s may ace a c isis imbued wi h mixed emo ions and expec a ions. [1] Du ing acu e illness, cha ac e ized by unp edic abili y and uncon ollabili y, he e is a isk ha he pa ien ’s basic needs will no be me .[1] Pa ien educa ion and counselling a e concep s commonly used in nu sing science and p ac ice o desc ibe a p o es- sional ac i i y o p ocess, bu he e a e no single commonly ag eed de ini ions. The concep s a e used pa allelly and syn- onymously o desc ibe ad ising, counselling, eaching and in o ming pa ien s. Typical ea u es o pa ien counselling in ol e he con ex , in e ac ion and he ela ionship be ween he p o ide and ecipien o counselling, who a e engaged in an ac i e, goal-o ien ed unde aking. [2] This s udy uses he mo e comp ehensi e e m pa ien counselling h oughou he ex , e en when e e ing o s udies, which ha e employed he e m pa ien educa ion. As a planned p ocess, pa ien counselling in ol es de in- ing counselling needs, se ing goals as well as planning, e alua ing and documen ing he ac i i y. A success ul pa- ien counselling p ocess will secu e pa ien commi men ∗Co espondence: K is iina Rai anen; Email: [email p o ec ed]; Add ess: E elä-Pohjanmaa Hospi al Dis ic , Hanneksen inne 7, 60220 Seinäjoki, Finland. 96 ISSN 2324-7940 E-ISSN 2324-7959 www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3 and con inui y o ca e. [3] I has been p oposed ha essen ial componen s in high quali y pa ien counselling include he nu se’s p o essional esponsibili y, he pa ien ’s and nu se’s backg ound ac o s, hei in e ac i e ela ionship, ac i e and goal-o ien ed ac i i y, as well as he esou ces, adequacy and impac o counselling. [4] High quali y counselling has been ound o p omo e pa ien s’ heal h, o example by im- p o ing hei unc ional capaci y, li e quali y, commi men o ca e, coping a home and independen decision-making. I can also dec ease anxie y, [5,6] dep ession and loneliness and help clien s o be e unde s and and emembe in o ma ion ela ed o hei ca e.[7] A pe son’s heal h a ec s he whole amily’s well-being and, ecip ocally, he amily’s unc ionali y a ec s he pe son’s li e. The ole o he amily becomes e en mo e p onounced when one amily membe ge s ill. [8] Acu e illness imposes s ess on he amily. [9] In ol ing amily membe s in pa ien counselling can p omo e he coping o pa ien s, [10] especially since amily membe s may no be amilia wi h he heal h se ice and i s p ac ices and ha e an inc eased need o in- o ma ion. The e m amily membe e e s membe s o he amily, companions o o he pe sons ha a e close o he pa ien . In his li e a u e e iew, pa ien s hemsel es ha e de ined who hei amily membe s a e.[8,11] Mul iple me hods should be used o maximize he impac o pa ien counselling. The choice o me hods is a ec ed by a numbe o ac o s, o example by he clien ’s abili y o as- simila e in o ma ion and by he goal de ined o counselling. Mos commonly, pa ien counselling is p o ided o ally and suppo ed by ma e ial in a w i en o m. [7] To be e ec i e, he w i en ma e ial mus be easy o ead and comp ehend. [12] Indi idualised counselling is o en he mos e ec i e lea n- ing me hod and i is commonly app ecia ed by pa ien s. I is based on he indi idual’s needs and makes i easie o nu ses o mo i a e and encou age pa ien s o become ac i e. Indi idualised counselling also allows con inuous eedback and acili a es he c ea ion o an open a mosphe e. Good e- cip ocal in e ac ion p o ides pa ien s wi h an oppo uni y o ask ques ions, co ec misunde s andings and ecei e suppo om nu sing s a .[7] In his in eg a i e li e a u e e iew, he e m sho - e m pa- ien and amily counselling e e s o a con ac o limi ed du a ion be ween nu sing s a , pa ien s and hei amily membe s. The o e all ime a ailable o in o ming and coun- selling pa ien s and amily membe s is limi ed. Sho - e m counselling no only occu s in acu e ca e se ings, bu also a ou pa ien clinics and in in ensi e ca e uni s, as pa ien s unde go sudden changes. Consequen ly, he da a selec ed o his s udy co e s eme gency clinics, ou pa ien clinics and in ensi e ca e uni s. Counselling has been s udied ex ensi ely, bu no ye ex- haus i ely om he iewpoin p esen ed in his e iew. This in eg a i e li e a u e e iew, sys ema ically sea ching and in eg a ing all a ailable esea ch e idence on wha is known on his opic will be use ul in de eloping sho - e m pa ien and amily counselling o acu e changes in heal h. Mo e han e e , nu ses a e expec ed o demons a e compe ence in pa ien and amily counselling. Acco ding o Kää iäinen, [4] o example, pa ien s and hei amily membe s equi e sup- po and adequa e in o ma ion and counselling o be able o cope wi h he changing si ua ions. Pa ien s ha e he igh o ecei e counselling and nu ses ha e he du y o p o ide i , based on good p o essional p ac ice and on he p inciple o heal h p omo ion. Nowadays, p omo ing pa ien au on- omy by counselling is impe a i e, as hospi alisa ion pe iods a e sho e and pa ien s mo e he e ogeneous, o en su e ing om mul iple p oblems.[4] Pu pose o he s udy This in eg a i e li e a u e e iew aims a desc ibing exis ing esea ch knowledge o sho - ime counselling o pa ien s and amily membe s, who ace an acu e change in heal h. The e- sea ch ques ion is: Wha is known o sho - ime counselling o pa ien s and hei amily membe s o acu e changes in heal h? 2. METHODS This s udy uses he i e-s age in eg a i e e iew me hod p o- posed by Whi emo e and Kna l [13] in ol ing p oblem iden i- ica ion, li e a u e sea ch, da a e alua ion, da a analysis and epo ing he esul s. Acco ding o Poli and Beck, [14] in e- g a i e e iews can be used o comp ehensi ely b inging oge he da a on a gi en subjec a ea om di e en pe - spec i es a ound he opic, o e alua ing he unde pinning e idence base and o d awing conclusions ega ding he p e ailing s a e o esea ch. In eg a i e me hods a e use ul o gaining an ex ensi e o e all pic u e o a subjec a ea [15] and hey can be used as a basis o u he esea ch o de el- opmen al ac i i ies. 2.1 Da abase sea ch and choice o a icles Da a sea ch was pe o med wi h assis ance om an in o ma- ion specialis using he da abases Melinda, Medic, Cinahl, Pubmed and Psycin o. The ini ial sea ch yielded a limi ed numbe o a icles, so a wide pe spec i e wi h new sea ch e ms was adop ed and se e al sea ches ca ied ou o all da abases, excep ing Pubmed. A manual sea ch was also pe o med in ol ing na ional nu sing scien i ic jou nals and e e ence lis s o a icles al eady selec ed o he e iew. Published by Sciedu P ess 97 www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3 Figu e 1 lis s he da abases, sea ch e ms and numbe o a i- cles accep ed h oughou he p ocess. Only esea ch a icles published in he yea s 2003-2015 in Finnish o English we e deemed eligible. Fu he inclusion c i e ia o a icles we e ha hey p o ided an answe o he esea ch ques ion and a - ge ed adul pa ien s wi h adul amily membe s. O e lapping s udies we e excluded, as well as esea ch conduc ed in a wa d o in o he long- e m ca e. The o he exclusion ac o s we e end-o -li e pa ien counselling, child o psychia ic pa- ien s and pa ien counselling p o ided by medical s a only. Some s udies ound o be o poo quali y we e also excluded. Figu e 1. Da abase sea ch o a icles 2.2 Sea ch esul s The esea ch da a (n= 30) consis s o quali a i e (n= 7) and quan i a i e (n= 18) s udies and li e a u e e iews (n= 5) conduc ed in Finland (n= 15), Uni ed S a es (n= 8), Belgium (n= 2), Sweden (n= 2), Taiwan (n= 1), Aus alia (n= 1) and Canada (n= 1). The sample size a ied be ween 6 and 62 in quali a i e s udies and be ween 50 and 3,301 in quan i a i e s udies. The numbe o a icles included in he i e li e a u e e iews anged be ween 12 and 22, excep ha one e iew did no s a e he numbe o a icles discussed. The s udies had used g ounded heo y, phenomenology, con en analysis and a ious s a is ical me hods o analyse da a. 2.3 Da a e alua ion All esea ch a icles we e c i ically app aised using he c i e- ia ou lined by Joanna B iggs Ins i u e. [16] The a icles inally selec ed a e o high quali y; hey all eached a minimum o 60% o o al poin s in he e alua ion. In he app aisals conduc ed using he Quali a i e Assessmen and Re iew In- s umen (QARI), he quan i a i e MAS ARI Ins umen o 98 ISSN 2324-7940 E-ISSN 2324-7959 www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3 andomized con ol/pseudo- andomized ials and he Ins u- men o Sys ema ic Re iews, he sco e a ied be ween 6 and 10 ou o 10 poin s, wi h a majo pa o he a icles gaining 8 poin s. In he app aisal conduc ed using he quan i a i e MAS ARI Ins umen o desc ip i e and case s udy designs, he sco e a ied be ween 6 and 8 ou o 9, wi h nea ly hal o he a icles gaining 8 poin s and he es 6 o 7 poin s. 2.4 Da a analysis Induc i e con en analysis was used o analyse he da a. [17,18] Tex segmen s ha answe ed he esea ch ques ion we e iden- i ied, educed and assigned o ca ego ies acco ding o hei con en . The ca ego ies we e app op ia ely labelled and hen combined in o b oade ca ego ies acco ding o con en . Fi- nally, he uppe le el ca ego ies we e gi en labels.[19] 3. RESULTS As a esul o he li e a u e e iew, sho - e m pa ien and amily counselling o acu e heal h changes was ound o in ol e he ollowing: Elemen s o good pa ien counselling, sa is ac ion wi h he elemen s o good pa ien counselling, de- eloping he elemen s o good pa ien counselling and impac o he pa ien counselling elemen s. The elemen s depic ed in he uppe mos pa o he igu e cons i u e a ounda ion o counselling. These elemen s a e associa ed wi h he o he main ca ego ies: sa is ac ion wi h he elemen s o good pa- ien counselling as well as he de elopmen and impac o pa ien counselling (see Figu e 2). Figu e 2. Elemen s o good pa ien counselling 3.1 Elemen s o good pa ien counselling In s udies analysed o his li e a u e e iew, pa ien -cen ed, indi idualised counselling was p esen ed as a good pa ien counselling me hod. S udies e ealed, among o he hings, ha hospi al s a we e ound compe en in p o iding indi id- ual counselling o ally [20] and ha mos counselling si ua ions we e indi idualised. [21] Acco ding o a s udy, e en amily membe s ecei ed ace- o- ace in o ma ion in he wai ing oom. [22] Kää iäinen, e al. [20] epo ha a majo pa o he pa ien s we e gi en pa ien -cen ed counselling. Acco d- ing o ano he s udy, pa ien s we e app oached as indi id- uals, wi h di e en capaci ies o assimila e in o ma ion. [23] Koonce, Giuse and S o ow [24] epo ha hose pa ien s who had ecei ed counselling ailo ed o hei lea ning s yle, Published by Sciedu P ess 99 www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3 ound he in o ma ion use ul and gained in unde s anding o hei condi ion. I was also ound ha pa ien s’ willingness o in o m amily membe s a ied; in a s udy by Paa ilainen, e al. [25] app oxima ely hal o he pa ien s ag eed ha hei amily membe s should be in o med o hei illness, cu en s a us and ca e by elephone. Va ious counselling me hods we e ound o be e ec i e in mee ing he clien s’ lea ning goals. Among hem we e lec- u es and ins uc ional ools,[26] w i en ins uc ions and dis- cussion, [21,26] demons a ion and p ac ice echniques. [26] Us- ing a wide a ie y o counselling me hods demands ha s a membe s p epa e hemsel es well o he counselling si u- a ions. The compa ibili y o in o ma ion gi en by medical and nu sing s a was ound impo an , wi h a ious p o es- sional g oups complemen ing each o he . [23] Ins uc ions in a w i en o m we e essen ial o coping a home, [27,28] espe- cially o olde pa ien s. [21,25,28] I was ound ha a gene al pa ien counselling b ochu e had helped pa ien s o unde - s and he s ages o hei ca e and he easons o ha ing o wai . [29] Se e al s udies asse ha pa ien s ound he w i en ins uc ions easy o unde s and [28,30,31] and e ec i e due o uncomplica ed language.[26] Counselling p o ided by a ious p o essionals means ha acco ding o a numbe o s udies, pa ien s and amilies e- cei ed counselling om bo h nu ses and doc o s, [20,30,32,33] mainly in he con ex o ca e. [21] Family membe s ound he in o ma ion p o ided a he bedside comp ehensible and conc e e, because hey we e able o obse e he pa ien ’s si ua ion and see he ca e equipmen and ins umen s.[23] Good in e ac ion, as an elemen o good pa ien counselling, had a posi i e impac acco ding o Nikki and Paa ilainen; [34] clien s desc ibed he a mosphe e in he counselling si ua ion using wo ds like compe en , eliable, [20,30] compassiona e, encou aging and success ul. [20] Open, clea communica ion and p o ision o explana ions helped o mee he needs o amily membe s. [35] One s udy epo s ha a ious modes o communica ion we e used in counselling, in ol ing o mal, di e ing and humo is ic communica ion.[33] High quali y p o ision o in o ma ion was impo an o am- ily membe s. Acco ding o he li e a u e e iewed, in o - ma ion has o be p o ided openly, [23,34] u h ully [23,32] and accu a ely. [36] P o ision o in o ma ion is an essen ial pa o pa ien counselling, as he need o in o ma ion is one o he mos impo an needs, [34,37,38] especially in amily mem- be s o c i ically ill pa ien s. [34,38] In a s udy, nea ly hal o nu ses’ wo kload du ing ou pa ien isi s consis ed o coun- selling [39] and i was ound impe a i e ha pa ien s should ecei e adequa e in o ma ion. [23] Repe i ion and clea , in o - mal language made in o ma ion easie o comp ehend. [23] Timeliness o in o ma ion and keeping clien s up o da e we e also ound o be o impo ance. Especially a he beginning o he ca e, he in o ma ion needed o be clea and uncompli- ca ed. [23,34] A s udy epo s ha pa ien counselling s a ed a he e y beginning o he illness p ocess. [40] Acco ding o Ve haeghe, e al. [38] in o ma ion p o ided as co ec ly and comple ely as possible c ea ed a ounda ion o ealis ic hope. 3.2 Sa is ac ion wi h he elemen s o good pa ien coun- selling Sa is ac ion wi h in e ac ion in ol es amily membe s’ sa - is ac ion wi h he encoun e and pa ien s’ sa is ac ion due o he p esence o amily membe s du ing counselling. Ac- co ding o Au a, e al. [41] amily membe s we e con en wi h he manne hey we e ea ed and wi h he s a ’s help ul- ness, iendliness and p o essional suppo . In ano he s udy, nea ly all pa ien s wished o hei companions o be p esen when ca e ins uc ions we e p o ided.[28] Pa ien s’ and amily membe s’ sa is ac ion wi h counselling me hods means ha hey we e con en wi h he counselling si ua ion. Repo ed sou ces o sa is ac ion among pa ien s in- cluded pe sonal counselling, [30] cla i y o ins uc ions, [28,30] unhu ied a mosphe e, [28] nu ses’ heo e ical and p ac ical counselling compe ence, [28,30] nu ses’ a i ude, [30] adequacy o counselling, [20,21,30,42] ime alloca ed o discussion wi h nu ses [28] and pa ien counselling se ing. [20,25,30] Se e al s udies asse ha he majo i y o pa ien s app ecia ed pa ien counselling. [20,25,30,39] Almos all amily membe s ega ded hei p esence in he counselling si ua ion as impo an .[43] Some s udies epo ha pa ien s [25] and amily mem- be s [43] we e sa is ied wi h he counselling du ing wai - ing ime. Bo h pa ien s and amily membe s we e con- en ha he e was adequa e counselling o he ca e o he illness. Pa ien s we e also ound o be sa - is ied wi h su icien counselling conce ning examina- ions, [25,28,30,39] p ocedu es, [25,28,44] ca e [20,28,30,31] and pha - maceu ical ca e.[25,28,31] Sa is ac ion wi h counselling o ollow-up ca e means ha acco ding o some s udies, pa ien s we e con en wi h he counselling conce ning home and ollow-up ca e. Pa ien s e- cei ed adequa e counselling a discha ge om hospi al. [25,28] Has ings, e al., [31] o example, epo ha pa ien s we e pleased wi h discha ge planning. Also amily membe s we e sa is ied wi h counselling conce ning ollow-up ca e and, acco ding o Salminen-Tuomaala, e al. [43] hey ound he counselling su icien . One s udy asse s ha amily membe s exp essed sa is ac ion wi h counselling conce ning a ious se ices; hey app ecia ed he a ious o ms o suppo o - 100 ISSN 2324-7940 E-ISSN 2324-7959 www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3 e ed o pa ien s and amilies by hospi al. [32] Clien s had been bes in o med o he heal h se ices a ailable.[45] 3.3 De eloping he elemen s o good counselling The li e a u e e iew also e ealed dissa is ac ion wi h he counselling p o ided o pa ien s and amily membe s. Se - e al a ge s o de elopmen we e iden i ied. To s a wi h, pa ien s wished o mo e esou ces o pa ien counselling, including addi ional acili ies, ime, s a esou ces and coun- selling compe ence. [20] Lack o esou ces esul ed in dis- con en ; pa ien s obse ed, among o he hings, ha he e was a lack o ins umen s and ha he pe sons who p o ided counselling kep changing [20] and he ime alloca ed o coun- selling was limi ed.[20,30] Some s udies s a e ha pa ien s wished o mo e in o ma ion du ing he wai ing ime. They wan ed o ha e an es ima e o how long hey would be equi ed o wai [25,46,47] and in o - ma ion o how o ac du ing he wai ing ime. [25,28,30] No knowing he expec ed leng h o he wai ing pe iod o easons o ha ing o wai caused some discon en .[44] A ew s udies disclosed a need o mo e counselling o he ca e o heal h p oblems. In one s udy, pa ien s wished o mo e in o ma ion conce ning hei illness, p ognosis, p oce- du es, insu ance eimbu semen , [30] medica ion and e ec o medicines. [25] Fu he s udies e ealed ha pa ien s we e dissa is ied wi h counselling conce ning he cause o hei illness, hei p ognosis, isk ac o s, ea men op ions, com- plica ions ollowing he ea men , examina ion esul s, [20] he illness, i s symp oms and ollow-up ca e. [46] Family mem- be s wished o mo e in o ma ion conce ning changes in he pa ien ’s condi ion [34,36] and eco e y. [37] Family membe s we e also ound o expec mo e counselling ega ding he ca e o illness, including ca e o he pa ien , [35–38] medica- ion[34] and he expec ed ou comes.[37] Bo h pa ien s and amily membe s wished o mo e high quali y p o ision o in o ma ion. This means ha amily membe s’ wished o he in o ma ion o be u h ul, [35,38] comple e [38] and open. [34] The need o de elop o al coun- selling was also men ioned. [41] Dissa is ac ion and insecu i y we e oiced by hose who el ha he in o ma ion p o ided was lacking, [34,38,44,47] nu ses’ non- e bal communica ion in con lic wi h e bal in o ma ion [48] and he o al and w i en ins uc ions [41] o ins uc ions gi en by a ious s a mem- be s[30] incompa ible. Pa ien s and amily membe s wished o mo e counselling o ollow-up ca e. Acco ding o Chin-Yen, e al. [27] o be able o cope a home, bo h pa ien s and amily membe s e- qui e in o ma ion o he pa ien ’s condi ion and ca e. Mo e speci ically, some amily membe s wan ed mo e in o ma ion abou ans e plans, [36,41] o ally p o ided counselling con- ce ning he ollow-up ca e, [45] e en mo e w i en ins uc ion on he ollow-up ca e.[21,34,43,45] Family membe s’ wish o mo e good in e ac ion in ol es hei wish o in e ac wi h hospi al s a and o be lis ened o du ing he wai ing ime; acco ding o pa ien s, nu ses should pay a en ion o he quali y o he in e ac i e si ua ions. [34] Family membe s’ wish o a human encoun e in ol ed an idea o posi i e in e ac ion. I also became e iden ha amily membe s’ capaci y o ecei e in o ma ion should be assessed be o ehand. [48] Family membe s wan ed o know how hey could assis he pa ien [34] and wha could be done a he bedside. [36,37] On he o he hand, amilies’ nega i e a i ude owa ds counselling de e io a ed in e ac ion and counselling ac i i y. Finally, amily membe s wished o mo e counselling o sup- po hei own coping. Acco ding o se e al s udies, amily membe s we e dissa is ied wi h he suppo p o ided o pe - sonal coping, unde s anding emo ions [41] and dealing wi h ea s[30] and el ha hey did no ecei e su icien in o ma- ion ega ding hei coping.[41,45] 3.4 Impac o he pa ien counselling elemen s The in o ma ion deli e ed had a good impac , as he amoun o esponsible in o ma ion inc eased. Chin-Yen, e al. [27] epo ha pa ien counselling was he co ne s one o sel - ca e. Acco ding o o he s udies, oo, pa ien counselling inc eased clien s’ in o ma ion and esponsibili y o ca e [20] and acili a ed hei decision-making.[37,49] Pa ien counselling had a posi i e psychological impac . Fam- ilies epo ed ha being suppo ed [48] and becoming awa e o one’s esou ces and s eng hs [25] we e empowe ing ex- pe iences. Pa ien counselling was also ound o imp o e pa ien s’ a i udes [20,30] and commi men o ca e. [25] As o amily membe s, in o ma ion conce ning pa ien s a ec ed hem in mul iple posi i e ways, o example by educing hei anxie y, [37,49] dep ession and pos - auma ic s ess. [49] In o he wo ds, pa ien counselling was ound o dec ease nega i e mood. Finally, acco ding o some s udies, pa ien counselling also had some impac on pa ien ’s in luence o e ca e and on in o ma ion ecei ed by amily membe s. Counselling was o some ex en ound o be o bene i o decision-making conce ning ca e. [20,30] A s udy sugges s ha he leas use ul counselling in ol ed being in o med o he exis ence o w i - en ma e ial a he clinic and lea ning whe e one could seek u he in o ma ion i equi ed.[32] Published by Sciedu P ess 101 www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3 4. DISCUSSION 4.1 Conside a ion o he esul s The e is cu en ly li le esea ch on sho - e m counselling o pa ien s and amily membe s and on counselling du ing acu e heal h changes. The a icles discussed in his e iew deal wi h pa ien counselling gi en in eme gency and ou - pa ien clinics and in ensi e ca e uni s; ha is, in se ings whe e counselling can be assumed o be o sho du a ion and pa ien s ha e unde gone an acu e change in heal h s a us. The elemen s desc ibed in his a icle seem o ep esen he ollowing co ne s ones o good pa ien counselling: indi id- ualized, pa ien -cen ed ac i i y, mul iple me hods, con i- bu ion o a ious p o essional g oups, in e ac ion and p o i- sion o in o ma ion. E en in indi idualized, pa ien -cen ed counselling, howe e , he pa ien s’ willingness o in ol e amily membe s may a y. In one s udy, [25] app oxima ely hal o he pa ien s wan ed hei amily membe s o be in- o med o hei illness, s a us o ca e. In o he s udies, he majo i y o he pa ien s we e pleased o ha e hei amily membe s p esen du ing pa ien counselling. [25,28] Ano he inding is he essen ial ole o w i en ins uc ions as a pa- ien counselling me hod. The s udy con i ms ha ecei ing in o ma ion is a undamen al ea u e o counselling, [35–38] which makes i all he mo e impo an o p o ide high quali y, su icien , comp ehensible and imely in o ma ion. The s udy e eals bo h con en and discon en wi h he el- emen s o pa ien counselling. Fo example, pa ien s and amily membe s o en exp ess sa is ac ion wi h pa ien coun- selling si ua ions, bu also dissa is ac ion due o insu icien in o ma ion and con lic ing aspec s o counselling. Family membe s wish o mo e high quali y p o ision o in o ma ion and o he de elopmen o o al pa ien counselling. Pa ien s commonly seem pleased wi h nu sing s a ’s counselling compe ence, bu a s udy by Kää iäinen, e al. [20] epo s pa ien s’ wish o he imp o emen o nu ses’ counselling skills. Some s udies documen pa ien s’ sa is ac ion wi h he ime esou ces, scope and se ing o pa ien counselling, whe eas o he s epo pa ien s’ expe iences o lacking e- sou ces and limi ed counselling ime. Acco ding o some indings, pa ien s a e pleased wi h he counselling p o ided du ing wai ing ime, while o he s e eal dissa is ac ion and an expec a ion o mo e in o ma ion. Bo h pa ien s and am- ily membe s gene ally appea o be sa is ied wi h counselling o he ca e o illness, bu an analysis o hei de elopmen ideas also e eals some discon en and a need o ecei e mo e in o ma ion conce ning illness. In a simila ein, many pa- ien s seem pleased wi h home ca e counselling, bu some wish o mo e in o ma ion on home ca e ins uc ions. Family membe s also exp ess con en wi h ollow-up ca e coun- selling, bu many o hem s ill wish o mo e counselling and w i en ins uc ions on he pa ien ’s ollow-up ca e. The con- lic ing iews ega ding he elemen s o counselling could be associa ed wi h di e ences in he quali y o counselling bu also wi h clien s’ di e en manne s o p o iding eedback. The in o ma ion ha pa ien s and amily membe s ecei ed du ing counselling had a posi i e impac , no only in he o m o inc eased unde s anding bu also psychologically. These esul s con i m he impo ance o pa ien counselling. 4.2 Resea ch eliabili y and e hics This li e a u e e iew in ol es knowledge om 30 scien i ic publica ions on sho - e m amily and pa ien counselling du ing acu e heal h change. The sea ch e ms, selec ed on he basis o he esea ch ques ion, we e as b oad as possible. The elec onic sea ch p ocess was conduc ed wi h assis ance om an in o ma ion specialis using he da abases Melinda, Medic, Cinahl, Pubmed and Psycin o. Se e al sea ches wi h a wide pe spec i e and addi ional sea ch e ms we e neces- sa y o collec su icien da a. The s udy is an in eg a i e li e - a u e e iew, which acco ding o To aco [50] enables gaining in o ma ion om mul iples sou ces and pe spec i es. This inc eases he eliabili y o he s udy. The sea ch and ana- ly ical p ocess we e desc ibed ca e ully o u he inc ease eliabili y. Only s udies w i en in Finnish o English we e included, which may be seen as a limi ing ac o . [20] How- e e , he eliabili y o his s udy is s eng hened by good esul s in he quali y e alua ion o he publica ions, ca ied ou sys ema ically ollowing he quali y c i e ia p oposed by he Joanna B iggs Ins i u e.[16] The eliabili y o he esul s may be a ec ed by he inclusion o some s udies, [20,21,30,41,45] in which pa o he pa ien s and amily membe s had ecei ed counselling in a wa d. Secondly, al hough counselling p o ided by medical s a only was one o he exclusion c i e ia, one o he a icles[23] in ol ed doc o s (n= 2) besides nu ses (n= 18) and amily membe s (n= 26). On he o he hand, eliabili y is enhanced by he inclusion o i e li e a u e e iews [26,34,36,37,40] as pa o he da a. Ca e ul induc i e con en analysis was conduc ed o analyse he da a. The p ima y au ho pe o med a p elimi- na y analysis, whose esul s we e discussed in he esea ch eam a se e al poin s du ing he analysis. The esea ch p ocess has been conduc ed hones ly, using e hically sound esea ch me hods.[51] 5. CONCLUSION The esea ch esul s: elemen s o good pa ien counselling, sa is ac ion wi h he elemen s o good pa ien counselling, de- eloping he elemen s o good pa ien counselling and impac o he pa ien counselling elemen s, can be gene alised and 102 ISSN 2324-7940 E-ISSN 2324-7959 www.sciedu.ca/cns Clinical Nu sing S udies 2015, Vol. 3, No. 3 applied o a ious pa ien and amily counselling si ua ions in heal h se ices. The con lic ing esul s ega ding counselling elemen s and hei de elopmen indica e a need o de elop a uni o m, sys ema ic pa ien counselling me hod. The quali y o counselling appea s o a y a g ea deal; e o s should be made o imp o e counselling by using mul iple me hods, by ocussing on indi idual pa ien s’ li e si ua ion and by p o iding in o ma ion in good in e ac ion wi h pa ien s and amilies. Success in hese e o s will inc ease he impac o counselling. Fu he mo e, a shi is equi ed om pa ien counselling owa ds amily counselling. In u u e, he e will be g ea e in ol emen o amilies in he ca e o pa ien s, as he popula ion is ageing, hospi al pe iods a e ge ing sho e and he need o home ca e is inc easing. Nu ses will be expec ed o de elop hei compe ence in amily counselling me hods. The de elopmen o an e alua ion ins umen is also p oposed o examine he quali y o pa ien counselling, o s udy and de elop counselling in e en ions and possi- bly o e alua e how a u u e, sys ema ic counselling me hod migh con ibu e o he quali y o counselling and ca e. REFERENCES [1] Kuisma M, Holms öm P, Nu mi J, e al. Eme gency ca e. 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