The invisibility of patients' family in nursing documentation: An integrative review

cns.sciedup ess.com Clinical Nu sing S udies 2017, Vol. 5, No. 3 REVIEWS The in isibili y o he pa ien ’s amily in nu sing documen a ion: An in eg a i e e iew Heleena Lai inen∗1, Eija Paa ilainen2,3 1Tampe e Uni e si y o Applied Sciences, Tampe e, Finland 2Facul y o Social Sciences/Hea h Sciences, Uni e si y o Tampe e, Tampe e, Finland 3Sou h Os obo hnia Hospi al Dis ic , Seinäjoki, Finland Recei ed: Ap il 2, 2017 Accep ed: July 4, 2017 Online Published: July 17, 2017 DOI: 10.5430/cns. 5n3p54 URL: h ps://doi.o g/10.5430/cns. 5n3p54 ABSTRACT Objec i e: The objec i e o his in eg a i e e iew is o p esen he cu en s a e o esea ch knowledge ega ding e e ences o he pa ien ’s amily in documen a ion in heal h ca e se ings. Me hods: Ten (N = 10) esea ch a icles om 1998 o 2014 we e ound and analyzed using induc i e, hema ic analysis. All a icles we e e alua ed using he c i ical app aisal ools de eloped by he Joanna B iggs Ins i u e (JBI). Resul s: Two main hemes we e e ealed: he con en and he s uc u al aspec s o amily documen a ion. Quan i a i e, quali a i e and mixed me hods we e used in gene a ing he da a o he e iewed a icles. Re e ence o amilies in documen a ion was conside ed impo an in all he a icles. S uc u al aspec s consis ed o semi-s uc u ed o ms, summa y no es and a ick-box sys em o ma king he issues which we e discussed wi h amilies. The classi ica ion sys em and ou comes assessmen ega ding amily documen a ion we e in es iga ed, and hei impo ance was highligh ed. The con en o amily documen a ion was ypi ied, o example, by pa en ing issues in men al heal h s a us and how he pa en s cope when a child is ill. Di icul li e si ua ions and ad anced ca e planning b ough amilies in o he documen a ion, albei a he in equen ly. Simila ly, e e ences o counseling amilies o conside ing hei psychosocial, spi i ual and cul u al dimensions we e a ely ound in he li e a u e. Addi ionally, he amily’s impo ance in suppo ing he pa ien ’s ca e was o en missed in documen a ion. Conclusions: The esul s show he necessi y o de eloping bo h amily nu sing and i s documen a ion. Consequen ly, in o de o imp o e he quali y o bo h o hese, mo e in es iga ion om mul iple pe spec i es is needed. Key Wo ds: Pa ien ’s amily, Family nu sing, Nu sing documen a ion, Family documen a ion, Pa ien eco ds, In eg a i e li e a u e e iew 1. INTRODUCTION The aim o amily nu sing is o help bo h pa ien s and ami- lies main ain a suppo i e ela ionship in heal h ca e. [1,2] The ocus o amily nu sing is on bo h he pa ien ’s and he amily membe s’ conce ns in a ious heal h/illness si ua ions. [2,3] I is also impo an o unde s and ha amily nu sing includes he en i e y o a pe son’s li espan, hus applying o pa ien s om child ca e o elde ly ca e in all heal h ca e se ings. [3] The impo an goal in all i s phases is o p omo e he well- being o he whole amily. [3] In his in eg a i e li e a u e e iew, he ocus is on e ealing how he p esence o he pa ien ’s amily is documen ed in pa ien eco ds. The impo ance o collabo a ion be ween hospi al s a and pa ien s’ amily membe s has been s udied widely. [4–7] The bond be ween amily membe s is undamen al. When pa- ien s a e in hospi al, hey a e s ill membe s o hei am- ∗Co espondence: Heleena Lai inen; Email: [email p o ec ed]; Add ess: Vellamonka u 22 A 21, 33500 Tampe e, Finland. 54 ISSN 2324-7940 E-ISSN 2324-7959 cns.sciedup ess.com Clinical Nu sing S udies 2017, Vol. 5, No. 3 ily. Pa ien s wo y abou hei amily membe s, and ice e sa. [8] Being sepa a ed om amily membe s can lead o dis ess as well as physical and psychological diso de s. [9] The impo ance o amily p esence and isi a ion is also much app ecia ed in acu e c i ical si ua ions. [10,11] Smi h e al. [12] indica ed ha open and lexible isi ing imes in in en- si e ca e uni s inc eased bo h pa ien s’ and amily membe s’ sa is ac ion, leading o posi i e changes o all he amily. Mo eo e , i is impo an ha adul pa ien s hemsel es de- ine hei close amily membe s [10] and make he decisions ega ding amily membe s’ pa icipa ion in hei ca e. [13] Family membe s a e o en he pa ien s’ legal ep esen a i es and hus ac as ad oca es o he pa ien s in di icul heal h si ua ions. [14] Fu he mo e, bo h pa ien s and amily mem- be s need in o ma ional and emo ional suppo in o de o cope a home. [15] In a s udy by Ma ila e al., [15] he nu ses suppo ed pa ien s and amilies, e.g., by ca ing, gi ing in o - ma ion, and dealing wi h emo ional si ua ions. By ha ing a suppo i e ela ionship wi h he nu ses, he amily membe s el accep ed and a ailable o be in ol ed wi h hei close one’s ea men . Howe e , when he suppo was inadequa e, he amily membe s el hemsel es “ou side s” ega ding he ea men gi en hei close ones. [15] Sha ing in o ma ion wi h he amily membe s gi es hem an unde s anding o how hey can cope in he a -home collabo a ion. [16] Ne e heless, acco ding o Majasaa i e al., [17] he pa ien ’s amily mem- be s seem o be qui e in isible, e.g., in discha ge counseling si ua ions. Genuine pa ien - ocused documen a ion e eals he oice o he pa ien s [18] and, as an in eg al pa o nu sing, docu- men a ion has a c ucial place om he amily pe spec i e as well. [8,18,19] B owning [20] s esses he impo ance o am- ily documen a ion, which may be ad anced by elec onic eco ds; documen a ion is a bene icial way o collec da a om amily membe s o in e disciplina y collabo a ion. Documen a ion o ele an in o ma ion in pa ien eco ds is a legal esponsibili y wo ldwide. W i ing pa ien eco ds con- ce ns all heal h ca e p o essionals. [21] The e a e occasions in heal h ca e when au ho ized amily membe s ha e o ake esponsibili y o making decisions on behal o he pa ien s, e.g., because o he pa ien ’s heal h condi ion. In si ua ions when pa ien s canno communica e, he e a e signi ican am- ily issues which need o be documen ed. [10] When amily membe s ake esponsibili y o he pa ien ’s ca e, he doc- umen ed in o ma ion is essen ial. [22] Fo example, in he coun y o he p esen au ho s, Finland, he s a us o close ela i es o legal ep esen a i es as pa ien s’ ad oca es is spelled ou in he law.[23] Cu en heal h sys ems a e complex. [8,24] In he o ali y o one ca e p ocess, pa ien s can be ea ed in nume ous uni s wi h mul iple heal h p o essionals pa icipa ing. [24] In such agmen ed and complex si ua ions, an e o needs o be made o in ol e amily membe s in he pa ien ca e. [24] To suppo he con inui y, e ec i e documen a ion is e- qui ed [8,25,26] and i is a way o bo h communica e wi h he in e disciplina y p o essionals [20] and p omo e he pa ien s’ sa e y.[27] Pa ien s hemsel es app ecia e when nu ses in ol e hei amily membe s in hei ca e. [19,28] I has been shown ha i was o en he pa ien s’ own ini ia i e in es ablishing ha hei spouse could come o an admission mee ing wi h a nu se o o a doc o ’s appoin men . This was a way o ha e emo ional and in o ma ional suppo . [8] Family membe s’ pa icipa ion in he pa ien ’s li e can be c ucial in he ime ahead, [2,7,29] as hey a e he ones who p ima ily ake ca e o he pa ien s a home a e discha ge; hence, hey need guidance and suppo om compe en p o essionals. [11,28,29] When pa ien s and hei amily membe s li e hei li es ou side o hospi als, bu using heal h ca e se ices, he con inui y o high-quali y ea men can be asce ained by means o accu a e documen- a ion. [8] Such documen a ion is also needed when amily membe s a e he pe manen ca egi e s o hei lo ed ones, in o de o suppo all he pa ies in coping.[29–32] In se e al p e ious s udies conce ning documen a ion, he impo ance o amily membe s has been men ioned. [33–35] Also, amilies’ pa icipa ion was documen ed in ega d o coo dina ing he con inui y o ca e. [18] Howe e , he ac ual pa icipa ion o amily membe s in he pa ien ca e is, in gen- e al, qui e b ie ly no ed in such documen a ion, e en hough i has a c ucial ele ance o he pa ien ’s discha ge om hospi al and su i al a home. [36] As pa o hei ac ion esea ch, Okaisu e al. [37] included he amily nu sing pe - spec i e in he hospi al admission p ocess in o de o imp o e he documen a ion. So, he impo ance o pa ien s’ amily membe s has been no iced as pa icipan s in he ea men , bu hei isibili y in documen a ion has emained on he le el o men ioning. Nu sing documen a ion has been ex ensi ely s udied and many li e a u e e iews ha e p omo ed a as body o knowl- edge om mul iple iewpoin s. [34,38–43] Howe e , he in- e es o he au ho s o his pape has been piqued by he appa en absence o any p e ious li e a u e e iew speci i- cally ocusing on amily documen a ion. The e o e, he aim o he au ho s he e is o conduc an in eg a i e li e a u e e iew o he exis ing knowledge on his opic. Pu pose o he s udy This in eg a i e li e a u e e iew aims o desc ibe exis ing e- sea ch knowledge ega ding documen a ion which has been Published by Sciedu P ess 55 cns.sciedup ess.com Clinical Nu sing S udies 2017, Vol. 5, No. 3 done conce ning he amily while one o hem is a clien o pa ien in some heal h ca e se ing. The esea ch ques ion is: Wha is known abou amily docu- men a ion in heal h ca e se ings? 2. METHODS This s udy is based on an in eg a i e e iew me hod which includes p oblem iden i ica ion, a li e a u e sea ch, da a e al- ua ion, da a analysis and epo ing he esul s. [44] The in e- g a i e e iew me hod is e y sui able o syn hesizing da a a ailable in opics which ha e sca cely been s udied, such as amily documen a ion. S udies included in an in eg a i e e iew can be done by di e en esea ch me hods and he esul s a e p esen ed in na a i e o m, o en by hema ic anal- ysis. This app oach acili a es he acquisi ion o a de ailed gene al unde s anding o a esea ch ocus. This unde s and- ing can gene a e addi ional s udies o de elopmen in he a ea.[45] 2.1 Da abase sea ch and selec ion o a icles Da a sea ches we e pe o med wi h assis ance om an in o - ma ion specialis a he Uni e si y o Tampe e lib a y. The sea ch e ms we e ca e ully selec ed by he esea che s and he in o ma ion specialis and he sea ches we e planned and conduc ed oge he in he da abases Cinahl and Medline. The sea ch e ms a e desc ibed in Figu e 1. The e ms we e used in all possible combina ions, o enhancing inding o all s udies which answe ou esea ch ques ion. A manual sea ch was also conduc ed in e e ence lis s o a icles al- eady selec ed o he e iew. Figu e 1 desc ibes he sea ch, sea ch e ms and selec ion p ocesses o he da a o his s udy. Da a sea ch and selec ion we e qui e complex, due o he lack o s udies conce ning he opic, i.e., amily documen a ion. Many s udies i s showed p omising bu a e eading hem, hey we e no abou he opic o in e es . Excluded a icles did no mee he inclusion c i e ia and a e no p esen ed. Da a o he included a icles we e analyzed and desc ibed in Table 1. The able consis s o he au ho s o he a icle, coun y, c i ical app aisal; aims; me hods and pa icipan s o he s udy; and he esul s ela ed o amily documen a ion, educed om he o iginal s udies selec ed in his in eg a- i e e iew. Da a included only o iginal a icles o hose which we e pa o a la ge s udy bu epo ed as an indi- idual s udy. The a icles we e published in Japan (n = 1), Canada (n = 2), Aus alia (n = 2), Sweden (n = 1), he USA (n = 2), No way (n = 1) and he Ne he lands (n = 1). Mixed- me hod s udies (n = 2) used bo h a quan i a i e and quali a i e app oach. The esea ch da a (N = 10 s udies) also include s udies using only quali a i e (n = 5) o quan i a i e (n = 3) app oaches. Resea ch conce ning amily documen a ion was done in he con ex s o pa ien educa ion, heal h p omo ion, ch onic illness, pallia i e ca e and men al heal h, conce ning bo h child en and adul s. 2.2 Da a e alua ion All selec ed a icles we e c i ically app aised using he c i e- ia p esen ed by he Joanna B iggs Ins i u e (JBI). Sepa a e assessmen c i e ia a e ou lined o quali a i e, quan i a i e and mixed-me hod s udies. [46] Each assessmen ool has up o 11 c i e ia s a emen s which we e hen e alua ed. The quali y o a icles was accep able, a ying om 4 o 10 poin s; he poin s o each s udy a e desc ibed in mo e de ail in Table 1. Howe e , hey we e he bes which we e a ailable o his li le-s udied opic. 2.3 Da a analysis Thema ic analysis [47] allows ecogni ion o signi ican opics o p ominen hemes, as well as o ganized and s uc u ed ways o dealing wi h he con en unde hese hemes. I also allows in eg a ing he da a om quali a i e and quan i a i e s udies, while summa izing he esul s o di e en s udies unde hema ic headings, based on he da a. Thema ic, induc- i e da a analysis was conduc ed o e eal he hemes among he e iew a icles, based on he esea ch ques ion. In o de o iden i y he hemes, he chosen a icles we e ead mul i- ple imes. [44,45,47,48] Tex segmen s answe ing he esea ch ques ion we e i s educed in Table 1 and a e ha named and combined, acco ding o hei con en . Two main hemes we e e ealed, desc ibing he con en and s uc u al aspec s o he amily documen a ion. 3. RESULTS In gene al, documen ing di e en aspec s o amilies, besides he pa ien , was conside ed impo an in all pape s included in his s udy. Two main hemes a e p esen ed in he ollow- ing. 3.1 S uc u al aspec s o amily documen a ion Family ca e was conside ed as one cen al domain o doc- umen a ion. [49] Family ela ionships, desc ibing key pe - sons in pa ien ca e, a e c ucial. [50] I is impo an ha he documen ing sys em equi es who in he amily should be included in he ca e o he pa ien .[51] Nu ses’ no es, bo h in a semi-s uc u ed o ma and as sum- ma y no es, a e essen ial o desc ibing high-le el amily- cen e ed wo k. [51] Also, he use o ick boxes, while dis- cussing impo an poin s o ca e wi h amilies, is essen ial. [52] A classi ica ion sys em in documen a ion is needed o s uc- u ing he documen ed issues in a o ma which ad ances hei use as he basis o ca e. Quali y indica o s [49] and de- sc ibing ca e ou comes conce ning amilies [53] a e means o 56 ISSN 2324-7940 E-ISSN 2324-7959 cns.sciedup ess.com Clinical Nu sing S udies 2017, Vol. 5, No. 3 he assessmen o ca e. Heimendigge ’s s udy [53] con ained a ious measu es, hus he indings om he documen a ion we e no di ec ly wi hin each. Howe e , he s udy gi es a wo hy pa e n o he use o documen a ion, including a s anda dized me hodology o how issues a e discussed wi h a pa ien ’s amily membe s and how hey a e documen ed. Figu e 1. Da abase sea ches and da a selec ion, by inclusion and exclusion 3.2 Con en o amily documen a ion Pa en ing issues comp ise an impo an aspec o he wo k o communi y men al heal h nu ses, and he e is a need o highligh he sys ema ic iden i ica ion o pa en al s a us in men al heal h pa ien s. [54] Documen ing pa en ing issues is conside ed impo an , e.g., pa en s exp essing di icul ies in coping wi h hei ole in he con ex whe e hei child is ill. [54] Miyashi a e al. [49] ound ha expec a ions o he am- ily in discussing c ucial issues, e.g., abou do-no - esusci a e, a e e y impo an o documen . Simila ly, Heyland e al. [55] emphasized he impo ance o documen ing ad anced ca e planning o end-o -li e ca e. Howe e , e en hough pa ien s and amily membe s exp essed p e e ences when asked abou end-o -li e ca e, in almos 30% o he included da a hei iews we e no documen ed.[55] Family p esence du ing counseling, [50] amily- ocused nu s- ing diagnoses [56] and psychosocial, spi i ual and cul u al aspec s o pa ien and amily ca e [57] we e ound o be impo - an o documen , howe e in equen ly his is ac ually done. I was ound ha amily membe s a e a suppo i e esou ce in ca e; howe e , his is no as well documen ed as i should be. [56] Heimendigge [53] ound i impo an o documen amily isi s and coaching con e sa ions wi h hem. Family ad iso s documen ed he ime, da e, and loca ion o he isi , as well as amily membe pa icipa ion, pe sonal in ol emen and amily dynamics du ing hose con e sa ions.[53] Acco ding o Ro egå d, [58] he amily was men ioned in doc- umen a ion om mo i a ional and p o ec i e pe spec i es o how he pa ien el abou he amily, and especially con- ce ning (1) he pa ien ’s child en, e.g., he wish o see hem Published by Sciedu P ess 57 cns.sciedup ess.com Clinical Nu sing S udies 2017, Vol. 5, No. 3 g ow, and (2) he spouse, in ega d o issues such as wo y and exhaus ion. Thus, i was an impo an aspec o desc ibe he pa ien s’ eelings abou hei amily membe s. The in ol emen o amilies in documen a ion o he ed- uca ion p o ided a pa ien discha ge was in es iga ed by Cook e al. [50] In he elec onic medical eco ds o pa ien educa ion documen ed mos o en (n = 173), he equency o pa ien and amily oge he was 23, while he equency in ol ing he amily alone was qui e low (n = 3). This li e a u e e iew showed disc epancies be ween nu sing ca e and i s documen a ion. Hega y e al. [57] no ed ha he amilies’ conce ns we e pa o he nu sing ca e, bu hese conce ns only a ely showed up in he documen a ion. Ac- co ding o Heyland e al., [55] he p e e ences which pa ien s and amilies exp essed we e no consis en wi h wha was w i en in he documen a ion. In he s udy by Ziege , [56] he e ealed hemes emphasized he amily membe s’ suppo i e esou ces, enabling hei eadiness o con ibu e o he pa ien s’ home ca e and o co-ope a e wi h hem in ha ca e. 4. DISCUSSION 4.1 Discussion o he esul s I is impo an o emphasize ha he p esen au ho s’ ocus was especially on amily nu sing documen a ion. While, in gene al, pa ien documen a ion has been ho oughly in es i- ga ed, cu iously, amily documen a ion [18] has no . Howe e , he e a e many s udies [18,59] which s ess he need o amily documen a ion and ha e con ibu ed o he de elopmen o amily documen a ion. Wi h he excep ion o he s udy by Ziege e al., [56] he e we e no o he s udies concen a ing pu ely on amily doc- umen a ion. Documen a ion was used as a da a collec ion me hod, among o he s, in se e al s udies. Myashi a e al. [49] used medical cha s o ind quali y indica o s o cance pa- ien s’ end-o -li e. Heimendinge e al. [53] assessed he ou - comes o a coaching p og am, wi h he pu pose o p omo ing a heal hy li es yle among schoolchild en. Ro egå d e al.[58] in es iga ed he heal h asse s o cance pa ien s. When a pa ien alls ill, he signi icance o he amily is c ucial. On he basis o he esul s e ealed in he p esen s udy, he impo ance o amily in ol emen in documen a- ion should be s ongly emphasized. Howe e , he esul s o his in eg a i e e iew, as well as o o he p e ious s udies, ound ha he amilies in ac seem o be in isible in he documen a ion. This was con i med in he li e a u e e iew pe o med by Sa an o and Kinnunen. [34] The amily mem- be s’ p esence was o en no ed in documen a ion, a some le el, bu hey we e objec i ied. This is consis en wi h he esul s o a s udy by Lai inen e al.[26] Fu he mo e, Ree es e al. [60] obse ed ha e en hough amily membe s a e o dina ily p esen in he ICU, hei day- o-day in e ac ions wi h he in e p o essional ca e eam ha e no been explo ed o documen ed. Documen ing cen al is- sues conce ning he amily, besides he pa ien , is c ucial o eamwo k enhancing high-quali y ca e. I is impo an o un- de s and ha p o essional compe ence is no only knowledge and skills in a specialized clinical a ea. The compe ence needs o be shown in he skills o in e ac ion o communica- ion wi h he pa ien s and in e disciplina y pa ne s.[8] S udies included in his e iew desc ibe amily documen a- ion as pa o he di e se in o ma ion e ie al. Pe sonal expe ience as well as belie s, a i udes and mindse a e e- lec ed in he w i ing. [61,62] The e is an old saying “i i is no documen ed, i is no done”. This may e lec he ac ha some heal h ca e p o essionals a e mo e ask-o ien ed han pa ien - o amily-o ien ed. I heal h ca e p o essionals and, e en mo e, he o ganiza ional hie a chies a e no ac- coun able o hei pa ien s’ and amily membe s’ well-being and ela ed documen a ion in he i s ins ance, hen a huge amoun o aluable in o ma ion o he con inui y o ca e is lacking. [8] The complexi y and agmen a ion o heal h ca e a e acknowledged in p e ious li e a u e. [8,11] Consequen ly, wi hou se ious concen a ion on amily membe s’ in ol e- men in nu sing documen a ion, he sa e y and quali y o he ca e p ocesses a e diminished. By aking ac ion owa ds bo h amily nu sing p ac ice and ela ed documen a ion, he con inui y o ca e would be imp o ed. 4.2 E hics and he eliabili y o he s udy The au ho s o his pape ha e ollowed he guidelines o esea ch e hics. [63] Since his is an in eg a i e e iew, he ocus has been on anspa ency in he s udy p ocess. [44] The wo au ho s bo h conduc ed he li e a u e e iew. The da a sea ch was ca ied ou i s in collabo a ion wi h an in o - ma ion specialis a he uni e si y lib a y. A wide ange o key wo ds and sea ch e ms was used in a ious sea ch en- gines. The au ho s decided o use only English language e ms, a e no icing ha hei na i e language, Finnish, did no gi e any esul s in ega d o he esea ch ques ion. Also, a hand-sea ch was pe o med, which yielded one mo e a i- cle. This can be conside ed as enhancing he eliabili y o he da a sea ch, since he o al numbe o esea ch pape s abou he opic emained small. All he s ages o he e iew we e conduc ed in ag eed collabo a ion by bo h au ho s. This e iew is he e o e limi ed o he su p isingly small numbe o s udies pe aining o he e iew ques ion. Signi ican ly, o he included a icles only one was pu ely ocusing on amily nu sing documen a ion. [56] Howe e , his can be conside ed as a esul , gi ing a wide-open ield o u he in es iga ions. 58 ISSN 2324-7940 E-ISSN 2324-7959 cns.sciedup ess.com Clinical Nu sing S udies 2017, Vol. 5, No. 3 Table 1. The s udies included in he in eg a i e e iew Au ho (s), yea , coun y, c i ical app aisal esul Aims Me hods and pa icipan s Resul s desc ibing amily documen a ion Ziege K, e al.[56] 2007, Sweden 8/10 To examine he p o essional suppo o he nex o kin (NoK) o ch onic haemodialysis pa ien s, as documen ed in he pa ien eco ds.  To al o i y (N = 50) pa ien eco ds, each app oxima ely 100 pages. VIPS-model was he o ganiza ion o he eco ds.  Con en analysis  amily’s ole should be documen ed in amily- ocused nu sing diagnoses  amily membe s a e a suppo i e esou ce in he nu sing ca e Cook L, e al.[50] 2008, USA 4/9 To assess he equency and na u e o documen a ion o pa ien educa ion by in e disciplina y s a in elec onic medical eco ds.  Re iew o elec onic medical eco ds o discha ged inpa ien s (N = 244).  Teaching in e en ion  Quan i a i e analysis  mos elec onic pa ien eco ds lack any pa ien educa ion  i documen ed, was done by nu ses  also some amily p esence du ing educa ion was documen ed  he sys em equi es who in he amily should be included in he educa ional p ocess Feeley N, e al.[51] 1998, Canada 6/10 To desc ibe he de elopmen o h ee classi ica ion sys ems heal h conce ns o he amilies, s a egies o a ain he goals and he obse ed ou comes.  In e en ion  Rec ui ed and consen ed amilies (N = 332) andomly selec ed amilies wi h ch onically ill child, assigned o in e en ion g oup (n = 171) o con ol g oup (n = 161)  Con en analysis  documen a ion should be done abou he ac ions he nu ses ake o help amilies achie e hei goals  nu ses’ no es (semi-s uc u ed o ma ): desc ip ion o he amily’s cu en si ua ion, he nu se’s assessmen , s a egies o in e en ion, any ou comes o changes no ed  summa y no e: b ie summa y o he majo ea u es o he wo k wi h each amily Hega y M, e al.[57] 2005, Aus alia 9/10 To explo e di e gences be ween nu ses' knowledge and hei documen a ion in pallia i e ca e.  Re ospec i e case-no es o deceased pa ien s (n = 20)  in e iews o he nu ses who we e in ol ed wi h pa ien s’ ca e  Quali a i e in e iews  Quan i a i e audi  psychosocial, spi i ual and cul u al aspec s o ca e a e in equen ly documen ed Heimendinge J, e al. [53] 2007, USA 7/10 To assess he ou comes o a coaching p og amme, aiming o p omo e heal hy die s and physical ac i i ies among school child en.  Eigh y-eigh (N = 88) ec ui ed amilies we e andomly chosen o an in e en ion g oup and a ‘delayed-con ol condi ions’.  S a is ical analysis  Quali a i e in e iews  Cha e iew.  documen ing he isi s, coaching con e sa ions  amily ad iso s documen ed ime, da e, loca ion o he isi , amily membe a endance, indi idual deg ee o in ol emen , and amily dynamics Van Loo M, e al.[52] 2008, UK 7/10 To assess he equency o ini ia ion and non-ini ia ion o discussion abou issue dona ion wi h suddenly be ea ed ela i es, by eme gency nu ses.  Pa ien s’ compu e ized case no es (n = 242)  S a is ical analysis  nu ses eco ded no es on he compu e , using a ick box when hey discussed issue dona ion wi h he ela i es  he ini ia ion episodes by indi idual nu ses occu ed occasionally om one episode o eigh ; he non-ini ia ion episodes occu ed om one o eigh een Ro egå d A, e al.[58] 2012, No way 7/10 To desc ibe heal h asse s based on analysis o nu sing documen a ion in cance pa ien s’ eco ds.  Con en analysis  amily was men ioned in documen a ion ega ding ela ional, mo i a ional, and p o ec i e pe spec i es conce ning how he pa ien el abou he amily  we e connec ed wi h child en (wish o see hem g ow, says ha hey handle he illness well), and spouse (is wo ied abou he /him, sees ha he spouse is exhaus ed) Heyland DK, e al.[55] 2013, Canada 6/9 To de e mine he p e alence o an ad anced ca e plan and i s componen s, om he pe spec i es o acu ely ill pa ien s and hei amily membe s, To de e mine he conco dance be ween he pa ien s’ wishes and he ca e plan documen ed in he medical eco d. To assess he pa ien s’ and amily membe s’ o e all sa is ac ion wi h end o li e communica ion and decision making du ing he las ou weeks.  278/513 pa ien s (54.2%)  225/366 amily membe s (61.5%) in 12 acu e ca e hospi als  In e iews wi h pa ien s and amily membe s using a ques ionnai e;  The medical eco d e iew immedia ely a e he in e iew  less han a hi d o he pa ien s and amilies we e asked abou he ad anced ca e plans (ACP)  pa ien s’ p e e ences abou end o li e ca e we e poo ly documen ed and he e we e disc epancies be ween he p e e ences and hei documen a ion; amily membe s ha e exp essed p e e ences o medical ea men s a he EOL  communica ion wi h heal h ca e p o essionals and documen a ion o EOL ca e p e e ences is inadequa e Liangas G, e al.[54] 2014, Aus alia 6/10 To audi pa en al eco ds abou he issues o pa en al conce ns ega ding hei child en’s men al heal h issues.  Audi ed iles (N = 280),  175 (n = 175) wi h pa en al conce ns aining in e en ion  Quan i a i e analysis  pa en ing issues a e a signi ican pa o he wo k load o men al heal h eams  need o highligh sys ema ic ecogni ion o pa en al s a us in ol ing men al heal h pa ien s  pa en ing issues documen ed: pa en s exp essing di icul ies in coping wi h pa en al ole, pa en s ely on child en o suppo , pa en ing suppo , child en’s wel a e and sa e y, pa en ing issue men ioned as a p oblem Miyashi a M, e al.[49] 2008, Japan 9/10 To iden i y quali y indica o s (QI) o end-o -li e o cance ca e by e iewing medical cha s.  Modi ied Delphi me hod, based on sys ema ic li e a u e e iew abou QI using communica ion in he in e ne ; pa icipan s mul i-p o essional specialis s (n = 17); pallia i e ca e physicians (n = 5); medical oncologis (n = 1); gene al medicine physician (n = 1); psycho-oncologis s (n = 3); sociologis s (n = 2); medical e hicis (n = 1); expe on Delphi me hodology (n = 1)  amily ca e as one cen al domain o documen a ion: amily ela ionships, key pe son in pa ien ca e, amily’s p e e ence o place o ca e/explana ion o medical condi ion, explana ion o medical condi ion o pa ien o amily, expec a ions o amily, discussion abou a do-no - esusci a e o de , explana ion o amily abou : cou se o disease un il dea h, pa ien ’s impending dea h, one week p io o dea h, ca e s a egy o amily Published by Sciedu P ess 59 cns.sciedup ess.com Clinical Nu sing S udies 2017, Vol. 5, No. 3 5. CONCLUSIONS Documen a ion ela ed o amily nu sing is qui e sca ce. This may pa ly demons a e how heal h ca e s a eel abou he amily as a collabo a i e companion in pa ien ca e. On he o he hand, i may also demons a e de iciencies in docu- men a ion in gene al. This could be imp o ed by means o basic and con inuing educa ion and by de eloping p ac ices and wo king condi ions which enable a amily p esence and in ol emen in pa ien ca e and, consequen ly, ela ed docu- men a ion. Wi h comp ehensi e documen a ion, in ol ing he pa ien s and hei amilies, he quali y and con inui y o ca e can be imp o ed. In addi ion, mo e esea ch is needed in o de o imp o e amily documen a ion. ACKNOWLEDGEMENTS We a e g a e ul o Ma k Ma son o e ising he language o his pape . CONFLICTS OF INTEREST DISCLOSURE The au ho s decla e hey ha e no con lic o in e es . REFERENCES [1] F iedemann ML. The concep o amily nu sing. J Ad Nu s. 1989 Ma ; 14 (3): 211-216. 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