TUGAS ANALISA FILM “The Diving Bell and The Butterfly”

Keperawatan Keluarga

Disusun untuk memenuhi tugas mata kuliah Keperawatan Keluarga

Disusun oleh:

Kelompok 4
Putri Rahmania Agustin
Indri Andriani
Galuh Safitri Febri Astari
Febria Savitry Arum M
Dewi Negeri Atika Y
Elsa Yolanda Talapessy
NIM 162310101003
NIM 162310101016
NIM 162310101017
NIM 162310101019
NIM 162310101030
NIM 162310101045

KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI

PROGAM STUDI SARJANA KEPERAWATAN
FAKULTAS KEPERAWATAN
UNIVERSITAS JEMBER
2018
 ASUHAN KEPERAWATAN KELUARGA
A. KEHADIRAN KELUARGA
1. Gambaran Film The Diving Bell and the Butterfly
Jean Dominique Bauby : Kepala Keluarga
Ny. Celine : Istri
Ines : Kekasih
Theopile : Anak pertama
Caleste : Anak kedua
Hortense : Anak ketiga
dr. Alain Lepage : Dokter 1
dr. Choceton : Dokter 2
Marie : Fisioterapi 1
Hanriette Dunant : Fisioterapi 2
Laurent Pierrousen : Teman pertama
Betty Mialet : Teman kedua
Claude : Juru tulis

Film The Diving Bell and the Butterfly menceritakan tentang

seorang pria yang bernama Jean-Dominique Bauby atau akrab
dipanggil dengan sebutan Jean-Do yang menderita total body
paralysis akibat dari penyakit stroke yang dideritanya. Seluruh
tubuhnya lumpuh, serta pernafasan nya pun menggunakan
trakeostomi. Awal mula ia mengalami penyakit tersebut yaitu
ketika Jean- Do berkunjung kerumah anaknya dan anak sulungnya
meminta untuk menonton film di bioskop dengan Jean-Do. Mereka
berangkat bersama-sama menuju bioskop dengan menggunakan
mobil baru miliknya. Pada saat itu ditengah perjalanan Jean Do
tengah asyik untuk bercerita, Jean-Do mendapatkan serangan
stroke di tengah perjalanan.

Jean-Do merupakan seorang jurnalis salah satu bukunya yaitu

tentang autobiografi perjalanan hidupnya, dan kepala editor disalah
 satu majalah yang ada di Paris. Dia sudah koma selama 3 minggu
kemudian sadar dan akhirnya dipindahkan ke rumah sakit yang ada
di Berck untuk perawatan yang lebih intensif. , Jean- Do hanya bisa
berkomunikasi melalui visual dan pendengarannya. Jean-Do hanya
bisa mengedipkan salah satu matanya yang normal yaitu mata sebelah
kiri dan mata sebelah kanan Jean-Do mengalami iritasi sehingga harus
ditutup dengan cara dijahit, Jean-Do juga hanya bisa sedikit
menggerakkan kepalanya. Jean Do sempat mengalami rasa putus
asa. Namun, mulai saat itu Jean Do mendapatkan perawatan di
Rumah sakit, dari pemenuhan kebutuhan dasar manusia, hingga
berkomunikasi dengan mengedipkan matanya seperti satu kedipan
untuk ―ya‖ dan dua kedipan untuk ―tidak‖, serta terapis atau
keluarga akan mengejakan alphabet dan ketika pada huruf yang
dikehendaki dia dapat mengedipkan matanya dan Jean Do mulai
mendapatkan semangat dalam dirinya.

Jean-Do mempunyai tiga orang anak yaitu dua anak perempuan dan
satu anak laki-laki yang bernama Theopile, Caleste dan Hortense,
beliau telah pisah dengan istrinya yang bernama Celine, hubungan
dengan orangtuanya yaitu ayah sangat baik mereka saling
menyayangi. Sebagai terapi untuk pemulihan kondisinya dan juga
sebagai inspirasinya untuk menyusun bukunya Jean-Do diajak untuk
menikmati pantai, bukit, gunung, dan berlibur dengan mantan istri dan
anak-anaknya serta kekasih, mantan istri, dan anak-anaknya sering
untuk mengunjunginya. Namun, di hari setelah publikasi bukunya
yaitu pada tahun 1997 Joen-Do meninggal dunia.

2. Mengidentifikasi Data
a. Nama Keluarga
Nama Kepala Keluarga (KK) : Jean-Dominique Bauby
Usia : 42 tahun
Pendidikan :-
 Pekerjaan : Jurnalis dan Kepala Editor
Majalah
Alamat : Perancis
Komposisi Anggota Keluarga :

Hub Umur
No Nama Jenis Pekerjaan
dgn (tahun) Pendidikan
Kelamin
KK
1. Bp. Jean- L KK 42 - Jurnalis dan
Do
Editor
Majalah
2. Celine P Istri - -
3. Thiophile L Anak1 -
4. Cileste P Anak -
2
5. Hortense P Anak -
3
Tabel 1. Komposisi Anggota Keluarga Bp. Beverly
3. Komposisi Keluarga (Genogram)

Gambat 1. Genogram keluarga Tn.Jean-Do

Keterangan:
Berdasarkan gambar genogram Tn. Jean-Do memiliki seorang
kekasih dan tiga orang anak, dia hidup sendiri tidak dengan ketiga
anaknya maupun istrinya, dia juga tidak tinggal dengan ayahnya.
a. Tipe keluarga
 Keluarga terdiri dari ayah, ibu dan ketiga anaknya. Namun
ibu dan ketiga anaknya tidak tinggal satu rumah. Berdasarkan
data diatas keluarga Tn. Jean termasuk dalam tipe keluarga The
Non Marital Heterosexual Conhibitang Family (Keluarga yang
hidup bersama-sama berganti-ganti pasangan tanpa melakukan
pernikahan).

b. Suku bangsa
Keluarga dalam kehidupan sehari-hari menggunakan bahasa
Inggris. Keluarga tinggal di Perancis, Tn. Jean-Do dan
keluarganya tetap melakukan kerohaniannya di gereja yang
dimana saat itu digereja ada kegiatan perjamuan dan misa pada
hari minggu. Cara berpakaiannya sama seperti masyarakat
Eropa lainnya. Dan dalam pandangan kesehatan sangat baik,
ditunjukkan ketika Jean-Do mengalami stroke dan koma segera
dibawa ke rumah sakit untuk mendapatkan perawatan.

c. Agama
Agama yang dianut adalah Kristen, ditunjukkan ketika Jean-
Do dibawa ke misa pagi (doa pagi) untuk perjamuan dan akan
melakukan ziarah ke Patung Bunda Maria untuk berdoa demi
kesembuhan Jean-Do. Dan diaat keluarga ada masalah, selalu
diselesaikan dan dibicarakan dengan baik-baik.

d. Status sosial ekonomi keluarga

Tn. Jean-Do bekerja sebagai jurnalis dan kepala editor
majalah sehingga bisa dikatakan baik, tetapi disaat Tn. Jean-Do
sakit ia tidak dapat bekerja lagi. Namun ketika Tn. Jean-Do
mendapatkan terapi untuk berkomunikasi ia bertekat untuk
menyeleseaikan kontraknya dengan penerbit untuk sebuah buku
yang sempat terbengkalai. Dan akhirnya ia dapat menyelesaikan
 dengan baik dan juga mendapatkan apresiasi positif dari
pembacanya maupun dari keluarga dan kerabatnya.

e. Aktivitas rekreasi keluarga

Aktivitas rekreasi keluarga Tn. Jean-Do sering dilakukan.
Ditunjukkan ketika anak-anaknya datang, mereka melakukan
tamasya ke pantai dekat rumah sakit. Untuk menulis dan
menyelesaikan buku Tn. Jean-Do menghabiskan waktunya di
bukit pinggir pantai dekat dengan rumah sakit, dan Tn. Jean-Do
bersama anak pertamanya juga sempat pergi ke bioskop bersama
sebelum ia terserangan penyakit stroke.
f. Riwayat dan Tahap Perkembangan Keluarga
 Tahap perkembangan keluarga saat ini
Tn. Jean mengalami stroke ketika mengendarai mobil
bersama anak pertamanya saat pergi ke bioskop untuk
menonton film. Kemudia Tn. Jean mengalami koma di rumah
sakit hampir 3 minggu lamanya. Saat tenaga kesehatan
mengetes Tn. Jean berbicara melalui beberapa pertanyaan ia
mengira, ia dapat menjawab pertanyaan yang diajukan
kepadanya dan ternyata tidak. Tim tenaga kesehatan tidak
dapat memahami dan mendengar apa yang dikatakan Tn. Jean
dan pada akhirnya dokter mendiagnosa Tn. Jean mengalami
sindrom terkunci. Meskipun dalam keadaan seperti ini Tn.
Jean tetap mendapatkan dukungan dari petugas kesehatan
yang merawatnya, terapis bicara, teman-temannya dan yang
paling penting yaitu dukungan dari Celine dan ketiga
anaknya. Celine selalu setia mengunjungi Tn. Jean dan
membantunya meskipun ia sudah berpisah, begitu juga
dengan anak-anaknya selalu mendoakan Tn.Jean agar
 mendapatkan kesembuhan.

 Tahap Perkembangan Keluarga yang Belum Terpenuhi

Yang belum terpenuhi saat ini yaitu tahap keluarga
dengan anak sekolah. Anak-anak Tn. Jean dan Celine sudah
memasuki tahap masa sekolah, di tahapan ini seharusnya
keluarga dapat bekerjasama dengan baik untuk memenuhi
tugas perkembangan anak dimasa sekolah seperti membantu
sosialisasi anak di lingkungan sekitar maupun sekolah,
memenuhi kebutuhan dan biaya yang semakin meningkat,
dan mempertahankan keintiman pasangan. Keluarga ini
belum bisa memenuhi semua perkembangan tersebut, karena
Tn. Jean dan Celine sudah berpisah dan juga jarang bertemu
sehingga kerjasama dalam menjalankan tugas perkembangan
anaknya dalam masa sekolah belum tercapai.

 Riwayat Keluarga Inti

Tn. Jean dan Celine memiliki tiga orang anak hasil dari
pernikahannya yaitu Theophile, Celeste, dan Hortense. Tn.
Jean saat ini mengalami penyakit langka yaitu Locked-in
Syndrome (Sindrom Terkunci) yang mana penderita akan
mengalami stroke mulai dari kepala hingga kaki tetapi tidak
menyerang mentalnya. Kelumpuhan yang Tn. Jean alami
mulai dari kepala hingga kaki hanya saja mata bagian kanan,
imajinasi, dan ingatannya masih berfungsi dengan baik.
Untuk Celine dan ketiga anaknya tidak memiliki riwayat
penyakit yang pernah dialami sebelumnya atau riwayat
penyakit sekarang.
  Riwayat Keluarga Sebelumnya
Dalam film ini tidak dijelaskan adanya riwayat keluarga
yang pernah memiliki penyakit seperti yang sedang di derita
oleh Tn. Jean.
g. Lingkungan
1. Karakteristik Rumah
 Denah Rumah
Dalam film denah rumah tidak terkaji dan tidak
digambarkan dengan jelas.
 Keadaan Dalam Rumah
Dalam film keaadan dalam rumah Tn. Jean atau Celine
tidak digambarkan dengan jelas
2. Keadaan Lingkungan di Luar Rumah
 Pemanfaatan Halaman
Keadaan lingkungan apartemen yang ditempati oleh Tn.
Jean digambarkan secara jelas berada di kota kondisinya agak
ramai, disekitar apartemen terdapat banyak parkiran mobil
dan terdapat banyak pepohonan yang tumbuh di sekitar
apartemen. Sedangkan keadaan rumah Celine memiliki
halaman yang luas dan di halamannya ditanami berbagai jenis
tumbuhan.
 Sumber Air Minum
Tidak terkaji
 Pembuangan Air Kotor
Tidak terkaji
 Jamban
Ketika Tn. Jean mengalami kelumpuhan untuk kegiatan
eliminasi (BAB) ia dibantu oleh petugas kesehatan diatas
tempat tidur. Sedangkan jamban di rumah Celine tidak
terkaji.
  Sumber Pencemaran
Tidak terkaji

 Sanitasi Rumah
Terlihat bahwa di film ini memiliki sanitasi udara yang
baik karena lingkungannya juga masih banyak ditubuhi
pepohonan dan sedikit adanya pencemaran udara selain dari
asap kendaraan.
3. Karakteristik Tetangga dan Komunitas
Tidak terkaji aktivitas tetangga. Komunitas yang terdapat
dalam film ini yaitu komunitas orang yang dirawat di rumah sakit
dan petugas pelayanan kesehatan. Setiap hari mereka diberikan
pelayanan yang baik oleh petugas kesehatannya
4. Mobilitas Geografis dan Keluarga
Ketika Tn. Jean dan Celine masih sah menjadi pasangan
suami-istri sering berpergian bersama menggunakan mobil.
Setelah mereka bererai, Tn. Jean tetap menggunakan mobil,
sedangkan Celine dan anaknya tidak digambarkan dengan jelas.
Di dekat rumah sakit tempat Tn. Jean dirawat terdapat stasiun
kereta apa, sepertinya kemungkinan besar Celine dan ketiga
anaknya menggunakan jasa kereta api untuk mengunjungi Tn.
Jean si rumah sakit.
5. Perkumpulan Keluarga dan Interaksi dengan Masyarakat
Tidak ada perkupulan keluarga khusus yang pernah dilakukan
dan juga interaksi dengan masyarakatpun tidak digabarkan dalam
film.
6. Sistem Pendukung Keluarga
Keluarga Tn. Jean dan Celine meiliki sumber dukungan
berupa dukungan fisik seperti tempat tinggal yang mereka tempati
sebagai tempat berlindung dan rumah sakit sebagai tempat
pengobatan Tn. Jean. Tn. Jean juga mendapatkan dukungan dari
orang-orang yang berada disekitarnya seperti petugas pelayanan
di rumah sakit, terapis bicara, Celine dan ketiga anaknya, teman-
teman Tn. Jean, dan juga Claude Mendibil yang dengan sabar
membantu Tn. Jean dalam menulis buku.
4. Gambaran Ecomap

FISIOTERAPIS DOKTER CLAUDE

ORANG TUA

PERAWAT

TEMAN Jean-Do Celine

KETERANGAN :

: Perempuan

: Laki-laki
PEKERJAAN
: Hubungan Normal

Theophile Hortense : Hubungan sangat kuat

Celeste

KEKASIH : Bercerai
5. Analisis Gambaran Ecomap

 Hubungan Jean-Do dengan istrinya yang bernama Celine kurang

baik karena mereka sudah bercerai dan Jean-Do memiliki kekasih
baru yang bernama Ines.Tetapi saat Jean-Do terbaring sakit, Celine
selalu berkunjung setiap minggunya dan berusaha untuk
merawatnya memberikan semangat serta dukungan. Celine sangat
mencintai Jean-Do. Celine juga memiliki hubungan yang sangat
kuat dengan ketiga anaknya yaitu Theophile, Celeste, dan Hortense.

 Hubungan Jean-Do dengan kekasihnya yang bernama Ines sangat

kuat. Hal tersebut dibuktikan pada adegan film bahwa Jean-Do
mengatakan begitu mencintai Ines dan menunggu kedatangannya.

 Hubungan Jean-Do dengan ketiga anaknya sangat kuat. Terlihat

dalam film tersebut anaknya begitu menyayanginya dan sebaliknya.

 Hubungan Jean-Do dengan Dokter spesialis sangat kuat karena

sering bertemu terkait dengan masalah penyakit Stroke yang
diderita Jean-Do.

 Hubungan Jean-Do dengan Claude Mendibil sangat kuat. Karena

Claude sering menjumpai Jean-Do dan sering menghabiskan waktu
bersama terkait sebuah pekerjaannya sebagai penulis.

 Hubungan Jean-Do dengan orang tua sangat kuat. Meskipun dalam

film diceritakan bahwa ibu dari Jean-Do telah meninggal tetapi
dalam film sedikit menggambarkan bagaimana hubungan ayah
Jean-Do dengannya yang sangat dekat.\

 Hubungan Jean-Do dengan fisioterapi atau ahli bahasa yang

bernama Hanriette dan Marie sangat kuat karena mereka berdua
yang membantu dalam proses terapi penyembuhan penyakit Jean-
Do

 Hubungan Jean-Do dengan Perawat adalah normal atau sedang.

 Karena perawat bertemu dengan Jean-Do sebatas keprofesionalan
dalam bekerja yang setiap pagi harus membangunkan Jean-Do dan
menyiapkan kebutuhan Jean-Do yang lainnya.

 Hubungan Jean-Do dengan teman-temannya seperti Laurent dan

Betty yaitu normal. Karena dalam film tidak dijelaskan secara
spesifik hanya saja disebutkan bahwa terdapat teman-temannya
yang berkunjung atau dinantikan kehadirannya oleh Jean-Do.

 Hubungan Jean-Do dengan Pekerjaannya sebagai penulis

digambarkan sangat kuat. Hal tersebut ditunjukkan melalui adegan
dalam film dimana Jean-Do yang keadaanya sedang sakit tetapi
sangat bersemangat untuk tetap menulis buku meskipun dengan
bantuan orang lain yaitu Claude Medibil.

B. PENILAIAN KEUARGA DAN PRIORITAS KEBUTUHAN

1. Kondisi Fisik Dan Psikososial
Kondisi fisik dari Tn. Jean-Dominique tidak baik yaitu
lumpuh pada seluruh bagian tubuhnya kecuali mata sebelah kiri
dan pendengarannya yang normal. Tn. Jean-Dominique mengalami
penyakit stroke dan menggunakan alat bantu pernapasan aitu
trakeostomi. Awalnya Tn. Jean-Dominique merasa putus asa dan
ingin mati tetapi setelah mendapat terapi oleh perawat yang
merawatnya sehingga beliau kembali bersemangat dalam
memulihkan kondisinya.

2. Faktor Lingkungan Dan Sosiokultural

Tn. Jean-Dominique dan Ny. Celine telah bercerai sehingga
menjalani kehidupannya masing-masing. Walaupun demikian Ny.
Celine dan anak-anaknya berhubungan baik, dan Tn. Jean juga
terkadang mengunjungi anaknya. Begitu pula Tn. Jean-Dominique
dan Ny. Celine juga masih berhubungan baik, dapat dilihat pada
 saat Tn. Jean sakit, mantan istri dan anaknya juga sering
mengunjunginya.

3. Status Gizi Dan Obat-Obatan

Status gizi dari Tn. Jean dan keluarganya didalam film tidak
digambarkan dengan begitu jelas. Namun dalam beberapa cuplikan
menggambarkan bahwa Tn. Jean tidak mampu menggambarkan
saraf vagusnya, sehingga tidak memungkinkan untuk Tn. Jean
memenuhi nutrisinya secara per oral. Tn. Jean terpasang alat bantu
pernapasan trakeostomi untuk membantu proses pernapasannya dan
mengkonsumsi obat untuk mengendalikan penyakit strokenya.

4. Penggunaan Sumber Perawatan Kesehatan Atau Pengobatan

Alternatif
Tn. Jean mendapatkan perawatan di rumah sakit, sehingga
seluruh aktivitasnya bergantung pada tenaga kesehatan mulai dari
perawat, dokter, dan terapis. Latar tempat pada film ini bertempat
pada rumah sakit khusus yang menangani gangguan
cerebrovaskular, disini Tn. Jean tidak mendapatkan pengobatan
alternatif apapun, kecuali perawatan rutin dan dukungan psikis dari
keluarga dan orang yang ada disekitarnya.

5. Diagnosa Medis
Locked in Syndrome by Cerebrovaskular Accident

6. Bagaimana Kondisi Klien Mempengaruhi Keluarga Dan Reaksi

Mereka
Tn. Jean mengalami lumpuh total karena pengaruh dari
penyakit stroke. Pada film dijelaskan bahwa Tn. Jean mengalami
penurunan kesadaran dan dibawa ke rumah sakit, pada saat itu
menimbulkan rasa empati bahwa anak-anaknya merindukan sosok
ayahnya yang bersama meraka, namun keluarga Tn. Jean selalu
mendoakannya dalam berbagai kondisi. Tn. Jean merasa sedih
 karena ia tidak bisa membelai anak-anaknya layaknya seorang ayah
pada umumnya.

7. Persepsi Keluarga Tentang Kesehatan

Keluarga Tn. Jean sangat memperhatikan kesehatannya,
diuktikan dengan pada saat Tn. Jean terdiagnosa stroke ia dirawat
di rumah sakit untuk mendapatkan perawatan yang baik dari
petugas kesehatan.

8. Kekuatan Keluarga
Anggota keluarga Tn. Jean saling mendukung untuk
kesembuhannya. Tn. Jean yang hampir putus asa mendapatkan
banyak cinta dari keluarganya terutama anak-anaknya yang selalu
mendoakan dan menjenguk walaupun dalam kondisi apapun.
Dukungan yang kuat dari keluarga memberikan haraan pada Tn.
Jean untuk terus bersemangat.
 C. IDENTIFIKASI PERMASALAHAN KELUARGA
DATA DIAGNOSA RENCANA TINDDAKAN KEPERAWATAN/TERAPI
JURNAL RUJUKAN
MALADAPTIF KEPERAWATAN KEPERAWATAN KELUARGA
1. Tn. Jean tidak Hambatan komunikasi Peningkatan Komunikasi: Menggunakan pendekatan teori grounded Caring Interaction with
mampu berbicara verbal Tn. Jean b.d Kurang Bicara (4976) Glaserian, penelitian dilakukan stroke survivors’ family
atau gangguan fisiologi 1. Monitor proses kognitif, menggunakan wawancara terbuka dengan members — Family
mengeluarkan (penyakit Locked anatomis dan fisologi anggota keluarga dan wawancara kelompok members’ and nurses’
suara saat ingin Sysndrome) dan terkait dengan dengan perawat.Teori Grounded kualitatif perspectives
berbicara kepada hambatan fisik kemampuan berbicara digunakan untuk memeriksa dukungan
perawat, dokter (trakeostomi) d.d (misalnya :memori, emosional yang diberikan oleh perawat
dan orang lain sulit berbicara atau pendengaran dan bahasa) kepada anggota keluarga dalam fase akut
serta mengeluarkan suara. 2. Kolaborasi bersama setelah stroke pasien usia kerja berdasarkan
keluarganya, keluarga dan ahli/terapis pengalaman perawat dan anggota keluarga.
karena penyakit bahasa patologis untuk GT adalah metode fleksibel yang
stroke yang mengembangkan rencana memungkinkan peneliti untuk
dideritanya. agar bisa berkomunikasi mengidentifikasi masalah yang menjadi
secara efektif. perhatian orang dan menganalisis perilaku
3. Sediakan metode mereka karena kekhawatiran ini. GT
alternative untuk didasarkan pada interaksionisme sosial,
berkomunikasi dengan yang memiliki fokus pada interaksi antara
berbicara ( orang-orang. Ini adalah pendekatan
misalnya:kedipan mata) penelitian induktif, yang membantu orang
4. Modifikasi lingkungan memahami keragaman manusia. Dalam
untuk bisa memininalkan penelitian ini, fokusnya adalah pada
kebisingan yang interaksi antara anggota keluarga dan
berlebihan dan perawat.
menurunkan distress
emosi.
 5. Ulangi apa yang
disampaikan pasien untuk
menjamin akurasi.

1. Mantan istri Tn. Kesiapan meningkatkan Pemeliharaan Menggunakan pendekatan teori Grounded Caring Interaction with
Jean (Celine) proses keluarga b.d ProsesKeluarga (7130) Glaserian, penelitian dilakukan stroke survivors’ family
mengajari mendukung 1. Berikan kesempatan menggunakan wawancara terbuka dengan members — Family
mantan kesejahteraan berkunjung dalam anggota keluarga dan wawancara kelompok members’ and nurses’
suaminya keluarganya d.d memenuhi kebutuhan dengan perawat.Teori grounded kualitatif perspectives
bagaimana cara mengungkapkan keluarga dan pasien. digunakan untuk memeriksa dukungan
berkomunikasi keinginan untuk 2. Diskusikan mekanisme emosional yang diberikan oleh perawat
dan meningkatkan pola dukungan social yang ada kepada anggota keluarga dalam fase akut
mengajarkan komunikasi untuk keluarga. setelah stroke pasien usia kerja berdasarkan
ketiga anaknya 3. Bantu anggota keluarga pengalaman perawat dan anggota keluarga.
bagaimana untuk menggunakan GT adalah metode fleksibel yang
berkomunikasi mekanisme dukungan memungkinkan peneliti untuk
dengan ayahnya yang ada. mengidentifikasi masalah yang menjadi
dengan perhatian orang dan menganalisis perilaku
melakukan Dukungan Keluarga (7140) mereka karena kekhawatiran ini. GT
terapi berbicara 1. Fasilitasi komunikasi akan didasarkan pada interaksionisme sosial,
(menyebutkan kekhawatiran atau yang memiliki fokus pada interaksi antara
huruf-huruf perasaan antara pasien dan orang-orang. Ini adalah pendekatan
yang sering keluarga atau antar penelitian induktif, yang membantu orang
muncul) yang keluarga. memahami keragaman manusia. Dalam
telah diajarkan 2. Tingkatkan hubungan penelitian ini, fokusnya adalah pada
oleh fisioterapi. saling percaya dalam interaksi antara anggota keluarga dan
keluarga. perawat.
 3. Bantu keluarga untuk
mendapatkan
pengetahuan,
keterampilan, dan alat
yang diperlukan untuk
mendukung keputusan
mereka terhadap
perawatan pasien.
1. Tn. Jean pernah Diskontinuitas proses Peningkatan Integritas Menggunakan pendekatan teori Grounded Caring Interaction with
mengatakan keluarga b.d Pergeseran Keluarga (7100) Glaserian, penelitian dilakukan stroke survivors’ family
dalam hatinya pada status kesehatan 1. Fasilitasi suasana menggunakan wawancara terbuka dengan members — Family
―tidak ada yang anggota keluarga (stroke) kebersamaan diantara anggota keluarga dan wawancara kelompok members’ and nurses’
bisa mengetahui d.d Perubahan anggota keluarga. dengan perawat.Teori grounded kualitatif perspectives
kesedihanku,aku ketersediaan untuk 2. Fasilitasi komunikasi digunakan untuk memeriksa dukungan
ayah mereka, menunjukkan kasih yang etrbuka antar emosional yang diberikan oleh perawat
bahkan tidak bisa sayang, perubahan dalam anggota keluarga. kepada anggota keluarga dalam fase akut
membelai rambut keintiman,perubahan 3. Sediakan perawatan bagi setelah stroke pasien usia kerja berdasarkan
mereka, memeluk dalam pola komunikasi. pasien yang bisa pengalaman perawat dan anggota keluarga.
mereka. dilakukan oleh keluarga GT adalah metode fleksibel yang
Bagaimana aku sesuaikebutuhan. memungkinkan peneliti untuk
senang melihat mengidentifikasi masalah yang menjadi
mereka datang, perhatian orang dan menganalisis perilaku
bercanda dan Peningkatan Keterlibatan mereka karena kekhawatiran ini. GT
tertawa. Aku Keluarga (7110) didasarkan pada interaksionisme sosial,
menyebutnya hari 1. Monitor keterlibatan yang memiliki fokus pada interaksi antara
yang indah‖ dan anggota keluarga dalam orang-orang. Ini adalah pendekatan
―Kenapa saya perawatan pasien. penelitian induktif, yang membantu orang
selama ini tidak 2. Dorong perawatan oleh memahami keragaman manusia. Dalam
bisa mencintai anggota keluarga selama penelitian ini, fokusnya adalah pada
istriku‖ perawatan di rumah sakit interaksi antara anggota keluarga dan
atau perawatan difasilitas perawat.
perawatan jangka panjang.
3. Berikan informasi penting
kepada anggota keluarga
mengenai pasien sesuai
dengan keinginan pasien.
4. Dorong anggota keluarga
untuk menjaga atau
mempertahankan
hubungan keluarga yang
sesuai.
D. CRITICAL APPRISAL
1. Judul Jurnal
Caring Interaction with stroke survivors’ family members— Family members’
and nurses’ perspectives
2. Abstrak
Tujuan dan sasaran: Untuk menguji dukungan emosional yang diberikan
oleh perawat kepada anggota keluarga dalam fase akut setelah stroke pasien
usia kerja berdasarkan pengalaman perawat dan anggota keluarga.
Latar Belakang: Jumlah pasien dengan stroke meningkat secara global. Ada
kurangnya pengetahuan tentang dukungan emosional anggota keluarga selama
fase akut para korban stroke usia kerja. Untuk dapat memberikan perawatan
yang berkualitas tinggi selama fase ini, kami memerlukan informasi tentang
dukungan emosional dari perspektif anggota keluarga dan perawat.
Metode: Menggunakan pendekatan teori grounded Glaserian, penelitian
dilakukan menggunakan wawancara terbuka dengan anggota keluarga dan
wawancara kelompok dengan perawat. Data dikumpulkan antara 2012–2013.
Hasil: Dalam penelitian ini, dukungan emosional diidentifikasi sebagai
Interaksi Caring. Situasi kehidupan yang berubah dan beragam perasaan yang
dibangkitkan oleh stroke adalah titik awal untuk memberikan dukungan
emosional kepada anggota keluarga. Penting bahwa perawat memperhatikan
kebutuhan anggota keluarga untuk mendapat dukungan pada saat yang tepat,
menggunakan intuisi mereka dan merespons dengan tepat.
Kesimpulan: Anggota keluarga pasien adalah penting ketika memberikan
perawatan menyeluruh untuk seluruh keluarga. Serta memberikan dukungan
emosional, intervensi keperawatan berkualitas tinggi meningkatkan perawatan
anggota keluarga. Penelitian ini memberikan penjelasan tentang proses
interaksi antara anggota keluarga dan perawat. Ini membantu anggota keluarga
dan perawat untuk lebih memahami satu sama lain. Meskipun data
dikumpulkan 5 tahun yang lalu, diasumsikan bahwa interaksi antara anggota
keluarga dan perawat tidak berubah selama tahun-tahun ini luar biasa.
Relevansi dengan praktik klinis: Menurut pengalaman anggota keluarga dan
perawat yang berpartisipasi dalam penelitian ini, dukungan emosional
 bermanifestasi dalam Interaksi Peduli. Menyadari bahasa tubuh dan perilaku
anggota keluarga, perawat dapat berinteraksi lebih baik dengan mereka.
3. Pendahuluan
Tujuan dilakukannya penelitian pada jurnal ini yakni untuk menguji dukungan
emosional yang diberikan oleh perawat untuk anggota keluarga dalam fase akut
setelah stroke pasien usia kerja berdasarkan pengalaman anggota keluarga
perawat.
4. Metode Penelitian
Teori Grounded kualitatif digunakan untuk memeriksa dukungan emosional
yang diberikan oleh perawat kepada anggota keluarga dalam fase akut setelah
stroke pasien usia kerja berdasarkan pengalaman perawat dan anggota
keluarga. GT adalah metode fleksibel yang memungkinkan peneliti untuk
mengidentifikasi masalah yang menjadi perhatian orang dan menganalisis
perilaku mereka karena kekhawatiran ini. GT didasarkan pada interaksionisme
sosial, yang memiliki fokus pada interaksi antara orang-orang. Ini adalah
pendekatan penelitian induktif, yang membantu orang memahami keragaman
manusia. Dalam penelitian ini, fokusnya adalah pada interaksi antara anggota
keluarga dan perawat.
Dalam melakukan penelitian, peserta yang dipilih yakni semua anggota
keluarga termasuk dalam penelitian ini adalah anggota keluarga dewasa korban
stroke usia kerja. Usia mereka dari mulai umur 18 sampai umur 63 tahun yang
sudah berada di Rumah Sakit tersebut.
5. Prosedur
Rumah Sakit tempat penelitian tidak dideklarasikan.
6. Result and Discussion
Dalam wawancara yang dilakukan, keluarga secara terbuka menceritakan
pengalaman mereka ketika salah satu anggota keluarganya terkena stroke. Di
dalam jurnal terdapat intervensi-intervensi apa yang diberikan oleh perawat
terhadap keluarga yang dilakukan penelitian, seperti mendemonstrasikan
keterampilan untuk diberikan kepada keluarga. Perawat juga menceritakan
bagaimana memberi dukungan emosional kepada anggota keluarga terkadang
membutuhkan keputusan independen untuk dibuat. Dalam hal ini perawat
mendorong anggota keluarga untuk mengekspresikan perasaan mereka dalam
merawat anggota keluarganya yang terkena stroke dimana situasi ini
 memungkinkan anggota keluarga menangis dan terlibat dalam percakapan
intim dengan perawat.
Dalam penelitian tersebut mendapatkan hasil bahwa penyediaan dukungan
secara emosional bagi keluarga yang salah satu anggota keluarganya terkena
penyakit stroke. Dalam memberikan intervensinya dalam dukungan emosional,
penting bagi perawat untuk memperhatikan suasana yang sedang terjadi di
dalam keluarga tersebut. Status emosional yang dimiliki oleh keluarga
mempengaruhi kehadiran mereka dalam merawat anggota keluarga yang
terkena stroke. Dengan adanya dukungan emosional yang di berikan oleh
perawat dapat memperkuat kemampuan mereka untuk lebih merawat anggota
keluarganya tersebut.
7. Global Issue
Para penulis mengkonfirmasi bahwa setiap penulis telah berkontribusi pada
kategori berikut dalam proses penulisan naskah ini: (1) desain penelitian; (2)
pengumpulan data dan analisis; dan (3) persiapan naskah. Para penulis ingin
mengucapkan terima kasih kepada Yayasan Otsakorpi, dan anggota keluarga
dan perawat yang berpartisipasi dalam penelitian ini.
Received: 15 December 2017 | Revised: 26 June 2018
DOI: 10.1111/jocn.14620
ORIGINAL ARTICLE
Caring Interaction with stroke survivors’ family members—
Family members’ and nurses’ perspectives
Birgitta Lehto1 | Jari Kylmä2,3 | Päivi Åstedt-Kurki2,3,4
1
Department of Health Care and Social
Services, Saimaa University of Applied
Sciences, Lappeenranta, Finland
2
Faculty of Social Sciences—Nursing
Science, University of Tampere, Tampere,
Finland
3
School of Health Sciences, University of
Tampere, Tampere, Finland
4
Science Center, Nursing Science Pirkanmaa
Hospital District, Pirkanmaa, Finland
Correspondence
Birgitta Lehto, Saimaa University of Applied
Sciences, Health and Social Care,
Skinnarilankatu 36, Lappeenranta
FIN-53850, Finland.
Email: birgitta.lehto@quicknet.inet.fi
Funding information
This research has received financial support
from the Otsakorpi Foundation.
J Clin Nurs. 2018;1–10.
| Accepted: 3 July 2018
Abstract
Aims and objectives: To examine emotional support given by nurses to family
members in the acute phase after a working‐aged patient's stroke based on nurses’
and family members’ experiences.
Background: The number of patients with stroke is increasing globally. There is a
lack of knowledge about the emotional support of family members during the acute
phase of working‐aged stroke victims. To be able to provide high‐quality nursing
care during this phase, we need information about emotional support from family
members’ and nurses’ perspective.
Method: Using a Glaserian grounded theory approach, the study was conducted
using open interviews with family members and group interviews with nurses. Data
were collected between 2012–2013.
Results: In this study, emotional support is identified as Caring Interaction. The
changed life situation and diverse feelings aroused by the stroke are the starting
point of providing emotional support to family members. It is important that the
nurses notice family members’ need for support at the right time, use their intuition
and respond appropriately.
Conclusions: The patient's family members are important when providing holistic
nursing care for the whole family. As well as providing emotional support, high‐qual-
ity nursing interventions enhance the care of family members. This study provides an
explanation of the interaction process between family members and nurses. It helps
family members and nurses to better understand each other. Although the data were
collected 5 years ago, it is assumed that the interaction between family members
and nurses has not changed during these years remarkably.
Relevance to clinical practice: According to the experiences of family members and
nurses who participated in this research, emotional support manifests in Caring
Interaction. Being aware of body language and behaviour of family members, nurses
can better interact with them.
KEYWORDS
emotional support, family member, nurse, stroke patient
wileyonlinelibrary.com/journal/jocn © 2018 John Wiley & Sons Ltd | 1
2 |
1 | INTRODUCTION
There are national and international guidelines which give instruc-
tions on how to care for patients who have had a stroke, and follow-
ing these guidelines has a positive influence on the treatment
outcomes of stroke patients (Meretoja, 2011) According to Mathers
et al. (2017), 15 million people suffer from stroke worldwide each
year, and of these, over 6 million die. The prognosis of a patient
who has had a stroke has improved due to effective acute care,
rehabilitation and secondary prevention, which results in patients liv-
ing longer with poststroke sequelae.
This study offers a new insight into family nursing research by
looking at emotional support with a focus on the acute care of the
family member. There are few studies about emotional support in
this context, and it is usually seen as part of the social support pro-
cess. Social support involves tangible, emotional and informational
support (Schaefer, Coyne, & Lazarus,1981). Even a mild stroke has
an impact on the everyday life of family members and their quality
of life (Tellier, Rochette, & Lefebvre, 2011).
1.1 | Background and significance
For example, in USA each year average 795,000 people experience a
stroke (Mozaffarian et al., 2016).
According to earlier studies (Coco, Tossavainen, Jääskeläinen, &
Turunen, 2013; Mattila, Kaunonen, Aalto, & Åstedt‐Kurki, 2014; Mitch-
ell, 2009), emotional support is important to family members. House
(1981) states that emotional support involves the provision of care,
empathy, love and trust. Emotional support is a nursing intervention,
which aims to respond to the support needs of the family member. It is
a part of high‐quality nursing care, and it may reduce feelings of shock
and distress that often family members following a loved one's stroke
(Cameron & Gignac, 2008; Vandall‐Walker, Jensen, & Oberle, 2007).
It is important to family members that they have an opportunity to
speak with the nurse and that nurses have enough time to listen (Ara-
ngo‐Lasprilla et al., 2010). However, there is also research that reports
that family members do not always get emotional support, even if they
needed it (Rossetto, Lannutti, & Smith, 2014). In acute care, nurses are
by the patient all the time taking care of their condition and vital func-
tions. It has been noted that nurses’ ability to discuss and empathise
with family members will strengthen their ability to take better care of
both family members and patients (Sauls & Warise, 2010).
The interaction between family members and nurses is very
important, and it will help the family members to go forward in their
lives (Åstedt‐Kurki et al., 2008). When thinking about the life situa-
tion of the patient's family members after the stroke, it is important
to remember that they are often living in a state of chaos. The world
outside the stroke experience loses meaning for the family members,
and they may experience loneliness. This time also includes high anx-
iety, shock and family members began to recognise what has hap-
pened (Greenwood & Mackenzie, 2010; Lutz, Young, Cox, Martz, &
Creasy, 2011). During the first weeks, it is important to them that
the sick person receives the best care possible (Lehto, Kylmä, &
LEHTO ET AL.
What does this paper contribute to the wider
global clinical community?
• Getting emotional support when needed from the nurse
is not always obvious.
• Using intuition is important for nurses when providing
emotional support to family members.
• Emotional support consists of multifarious emotional
states.
• Family members are an important part of the patient's
care and usually need emotional support.
Åstedt‐Kurki, 2013; Wallengren, Friberg, & Segersten, 2008). Family
members may behave different ways; they can keep themselves very
calm or react being angry or very sad. They can also have feelings of
guilt or anger (Coco et al., 2013).
Despite these circumstances, they must stay strong. It is there-
fore apparent that it is not always easy to go forward in your own
life when a nearest one has fallen ill (Lehto et al., 2013).
Given the impact of stroke on family members, the purpose of
this study is to examine emotional support given by nurses to family
members in the acute phase after a working‐aged patient's stroke
based on the experience of nurses and family members. This
research article is based on the dissertation research named Caring
interaction (Lehto, 2015).
1.2 | The aims and objectives of the research
The purpose of this study was to examine emotional support given
by nurses to family members in the acute phase after a working‐
aged patient's stroke based on nurses’ family members’ experiences.
This study explores the core category termed as caring approach of
nurses interacting with family members. In this study, acute phase
means patient's treatment period in the ward immediately after
stroke. The treatment in the ward lasted average 2 weeks.
2 | METHODOLOGY
Qualitative grounded theory was used to examine emotional support
given by nurses to family members in the acute phase after a working‐
aged patient's stroke based on the experience of nurses and family
members. Glaserian grounded theory (GT) was selected as the research
method because it is a general research method using different types
of data (Glaser, 1978). In addition, Charmaz (2011, xii) states that when
using GT in qualitative analyses of interviews, it can help you to make
your work more insightful and incisive. She continues that GT fosters
creating an analytic edge to your work too. GT is usually used to sub-
ject where research is nonexistent or scant or a new point of view is
wanted. When using this method it is possible to generate concepts
and find connections between them. To obtain this information, it was
LEHTO ET AL.
natural to ask about it from people who had personal experience of
this important and sensitive subject (Glaser, 1978). In addition to this,
GT is a flexible method allowing researcher to identify issues of con-
cern to people and analyse their behaviour due to this concern (Arti-
nian, Giske, & Cone, 2009). GT is based on social interactionism, which
has a focus on the interactions between people. It is an inductive
research approach, which helps people understand human diversity
(Benoliel, 1996; Oliver, 2012). In this research, the focus was on the
interaction between family members and nurses.
2.1 | Ethical consideration
After ethical statement was obtained from the university hospital of
research area, the permission to conduct this study was obtained
from a local central hospital. In the covering letter, there were state-
ments about the anonymity of the participants, voluntary nature of
the participation and informed consent. Places for conducting inter-
views were not declared. In addition to this, participants were
informed about the study details and interview data were used only
for research purposes.
2.2 | Recruitment
All family members included this study were adult family members
of working‐aged stroke victims. Their age was 18 years and over but
not older than 63 years. They all have experience about interacting
and communicating with nurses. They all have been at hospital with
their loved one during acute stage of caring process.
After ethical approval, there were some difficulties in finding
family members who wanted to participate. It emerged that family
members were only ready to participate about 6 months after the
patient had suffered their stroke. The subject of the research was so
sensitive to family members that it was easier for them to talk about
it after their daily life was settled down. In order to get participants
to interview, researcher published an announcement in a local news-
paper. In this way, most of the family members participating in this
study were found. The rest of the family members were reached via
the coordinator of stroke patient care at the local central hospital.
She gave the contact information of the researcher to family mem-
bers. They contacted the researcher if they wanted to participate.
Nurses were recruited from a local central hospital. One group of
nurses participating in this study was from a rehabilitation ward. This
was since these nurses have a work rotation between acute and reha-
bilitation ward, so they all cared for stroke patients. The researcher
participated clinical meetings with nurses and told them about this
research.
2.3 | Data collection
2.3.1 | Interview processes
When meeting the family members and the nurses, the aims and the
objectives of the study were communicated and they were informed
| 3
of their right to interrupt their participation in the study at any point.
Participation in the study was voluntary. Their acceptance to record
the interviews was confirmed. Also, their anonymity was guaranteed
and their informed consent was signed before their interviews.
Open individual interviews of the family members (n = 17) of
stroke patients were conducted at the participants’ home or some
other place like in the meeting room of a local healthcare centre.
There were also situations where it was easier to talk about the sub-
ject without patient's presence. In the ethical approval, no restric-
tions were mentioned to where interviews were to be conducted.
The pair and group interviews of nurses (n = 12) were conducted
in the meeting rooms of their respective hospitals. Number of partic-
ipants varied between two and four in these interviews.
2.4 | Data analysis
2.4.1 | Theoretical sampling
Theoretical sampling is a process in data collection to construct a
substantive theory (Glaser, 1978). This means while collecting and
analysing the data it “showed the way where to go next.” After
every interview, the data were coded and memos were written. Cod-
ing means generating of categories and their properties by constant
comparison of incidents and categories (Glaser, 1998). According to
Charmaz (2011, 45), coding generates the bones of your analysis
shapes an analytic frame from which you build the analysis.
The researcher can decide what kind information is still needed
and also where to find it. This was the way how the content of data
was saturated after every interview conducted with family members
and nurses. Saturation means that the concepts were completed and
also the gap in the emerging theory was almost filled perhaps not
entirely. Theoretical sampling keeps up the motivation to continue
on with data collection (Glaser & Strauss, 1967). Theoretical sam-
pling was achieved by choosing participants and finding during analy-
sis those point of views where more information was needed
(Glaser, 1978). This was also how the substantive theory begun to
emerge from the data. According to Glaser & Strauss (1967, 79),
substantive theory means that it is grounded in research on one par-
ticular substantive area, it might be taken to apply only to that speci-
fic area. In this research that specific area is Caring Interaction with
working‐aged stroke survivors’ family members—family members’
and nurses’ perspectives in acute care.
Contents of interviews were continuously compared during the
research process. Steps in GT analysis are presented in Table 1.
2.5 | Data coding
Open coding is part of the analysis where all significant events and
processes are denoted. In this study, Atlas.ti was used. In open cod-
ing, those significant expressions are named according to their con-
tent, and later, they will be moved to more abstract level. The
researcher familiarises oneself with the data by listening to the tape‐
recorded interviews, transcribes them and reads the transcribed data.
4 |
T A B L E 1 Steps in GT analysis according to Glaser (1978, 1998)
Analysis Phase of analysis
Theoretical • Data collection based on the analysis of previously
sampling collected data: what data are needed and where to find it;
collecting relevant data in relation to the development
of the theory.
Open • Part of the analysis where the data are cleared and
coding remarkable incidents/phenomenon/processes are named.
Open coding will be stopped when the core category has
been found.
• In open coding, expression will be named according to
its’ content, which will later export to more abstract
level. At the same time, their properties are search and
named.
• According their properties, substantive codes are
grouped under categories, which are named by their
properties (Glaser, 1978). A category is a higher level
concept than property.
Selective • This step begins after core category has been found.
coding It is the second part of coding process, and it is limited
only to the categories that are connected to the core
category. The core category controls emerging theory
and data collection.
Theoretical • Sorting theoretical memos according to their
coding substantive and theoretical codes rising from their
categories.
• Ties together the elements of the theory emerging
from the data.
The data are divided into smaller entities which are significant for
the phenomenon studied. Analysis includes asking questions from
the data; what is happening here and at same time collecting new
data and analysing it. Open coding ends when the core category is
found (Glaser, 1978). In open coding, expressions are named so that
the name describes their content and they are called substantive
codes. Based on their properties, substantive codes are grouped
under subcategories, which are named according to their properties.
Comparison of substantive codes continues as long as new proper-
ties are found. Substantive codes conceptualised the empirical con-
tents of the data and bound the fragmented data together (Glaser,
1978).
In all, 17 interviews, lasting from 30–60 min each, were recorded
and transcribed verbatim, first those of family members and then
those of nurses. First the researcher read the transcribed data many
times to familiarise with it. Also listening to tape‐recorded interviews
helped in understanding the content. In open coding, Atlas.ti soft-
ware was used. This made it easier to read through the data, and at
the same time to mark expressions that related to emotional sup-
port. In open coding, remarkable expressions were denoted with
coloured lines. Family members’ and nurses’ expressions were
coloured with different colours and named according to short
LEHTO ET AL.
In this study
• Interviews/data collection relevant Continuous comparison,
to earlier data. memo writing, drawing
mind maps
• Reading the data, listening interviews.
• Denoting remarkable expressions
relevant to the phenomenon under
investigation using Atlas.ti.
• Connecting same kind of expressions
to substantive codes.
• Asking questions from the data: “What
is happening here?” “What is this
incident connected with?”
• Comparing their properties.
• Moving expressions/substantive codes
to Word file.
• Naming categories and their
subcategories.
• Finding the core category
• Moving back to the original data and
verifying the contents of subcategories.
• Comparing the contents of subcategories.
• Sorting analysed memos under categories.
• Naming the core category.
• Comparing categories and their contents.
• Finding causal relationships and naming
theoretical codes using “work hypothesis.”
• The theory emerges around the core
category.
expressions that reflected their contents—these formed the substan-
tive codes. The data were very rich and yielded 1,173 substantive
codes. Open coding was finished after the core category was found.
Substantive codes were formed via open coding. The phase when
during open coding those significant expressions are named accord-
ing to their content and when they are later moved to more abstract
level is called construction of substantive codes. These identified
substantive codes were then moved to a Word file. The substantive
codes were grouped in categories according to their contents, all the
time being subjected to a continuous comparison (Table 2). This con-
tinued until no new properties were found. Subcategories were then
named.
Selective coding is the other phase of coding, and it started after
finding the core category. The coding is limited to those categories
which relate to the core category (Glaser, 1978). Selective coding
started after the core category the caring approach of nurses when
interacting with family members was identified in open coding. Com-
parison of subcategories and their properties and collecting them
under categories which were formed around core category were
done. The researcher had to return many times in original data of
family members and nurses to check the content of the subcate-
gories. During the selective coding, analysed notes were shared
LEHTO ET AL.
T A B L E 2 An example of the original expressions in the interviews, their substantive codes and subcategories
Original expressions
… they said hello and were quite… (FM1)
She didn't promise us anything, but she softened
those words with… (FM4)
I was surprised … and I didn't remember anything
about this the first time…, or the nurse said to us,
remember to live in this moment with your husband. (FM4)
So, one of these nurses came and said: Have you got
something to drink and have you got anything to eat ….(FM4)
Note. FM: family member.
under the main categories according to their meanings and suitability
(Glaser, 1978). The researcher divided notes, writing them in small
post it papers and grouped them under all main categories at same
time intensively checking how the concepts were and might be in
mutual connection to each other.
Theoretical coding means that theoretical memos, written during
analysing process, and are sorted according to their substantive and
theoretical codes arising from their categories. Categories and their
properties are compared to each other. Theoretical codes were formed
by searching causes and consequences. When connecting causes and
consequences “working,” hypotheses were used. Their content was
born from substantive codes and relationships between them. The the-
ory was compiled around the core category (Glaser, 1978).
During theoretical coding, categories and their contents were
compared to each other. At the same time, causes and consequences
between them were searched for. Theoretical codes were formed.
The substantive theory was formed around the core category. The
final theory was formed using these concepts and their connections
(Glaser, 1978; Hernandez, 2010). The notes written during the open
coding helped to link “the pieces” of the resulting theory together.
Theoretical coding “waves” the pieces of the theory together
(Glaser, 1978). At the end of the analysis, there were 11 categories,
30 subcategories and 90 properties. The experiences of the family
members and the nurses were analysed separately because of their
explicit contexts, and the data were connected in the selective cod-
ing process when the core category was identified. The core cate-
gory was named as caring approach of nurses interacting with family
members.
| 5
Substantive codes Subcategories
Greeting family member Caring behaviour
Consoling family member
Nurse's demonstration of
compassion
Nurse shows real empathy towards
family member
Taking care of family member
3 | RESULTS
3.1 | Participants’ background information
The family members were mostly women (n = 15). Participants’ ages
ranged between 32–61 years of age. Nurses too were mostly
women (n = 12). Their ages ranged between 32–55 years of age.
3.2 | Setting
In all of the interviews, the atmosphere was warm and sensitive,
especially with the family members. They were pleased with their
opportunity to participate in the interviews because there was some-
one who had time to listen to them. Most of them have very clear
memories of the acute phase at hospital. The family members openly
recounted what had happened when the patient had suffered the
stroke. They also discussed their experiences at the hospital and
what kind of interactions they had with the nurses.
The nurses freely related their experiences of providing emo-
tional support to family members of stroke victims. In the interviews,
the researcher used open questions which were guiding the inter-
view process. The researcher took care that the participants stayed
in the topic (Fontana & Frey, 2000).
3.3 | Caring interaction
In the dissertation study, the substantive theory was named Caring
Interaction. The core category explored here was termed as caring
6 | LEHTO ET AL.

approach of nurses interacting with family members including the main
categories Holistic care by nurses (Table 3) and Family members’ expe-
riences of care given by nurses (Table 4).
Holistic care by nurses reflected properties such as demonstrating
skills, using intuition in holistic care, giving time, permitting interaction
between the family members and the patient, and nurses building trust
for the future of the family members.
Demonstrating skills described professional encounters, knowing
your own limits, separating work and leisure time, and prioritizing your
own work. Professional encounters reflected the nurses’ experience
that it was important to meet the family members and respect their
personal needs. This was important when implementing nursing care.
There was a tendency for nurses to actively make contact with the
family members during their visits to the acute ward. Nurses also
T A B L E 3 Main category, subcategories and properties
Main category: holistic care by nurses
Subcategories Properties
Demonstrating Professional encounter
skills Knowing your own limits
Separating work and leisure time
Prioritizing your own work
Using intuition in Meeting at the right time
holistic care Getting a grip of oneself in difficult situations
told how giving emotional support to the family members sometimes
required independent decisions to be made. Knowing your own limits
reflected those situations when nurses met family members and
nurses always tended to know their own limits. For example, if the
situation with the family members was extremely difficult, it was
possible to consult psychiatric nurses. The nurses on the acute
wards told that it was extremely important to be able to recognise
whether the nurse was capable of meeting and handling the diverse
range of feelings that arose in family members. Most of the nurses
felt that therapeutic conversation with family members was not an
area of expertise in an acute ward setting. Separating work and leisure
time reflected that it was an important way for nurses to save men-
tal resources for their daily work. During their leisure time, nurses
felt that the situations they met in the line of their work were out
of mind. This gave them an opportunity to relax, and because of this,
they had more resources for giving emotional support. They also got
new energy for daily nursing care. Prioritizing your own work reflected
situations when the patient's condition deteriorated. Taking care of
the patient was the most important thing; however, they usually
explained the situation to the family members. As a consequence of
this, family members felt they were cared and noticed by the nurses
and they felt this was extremely important.
Using intuition in holistic care described meeting family members
at the right time, getting a grip of oneself in a difficult situation,
encouraging the family members to express their feelings and warm

Encouraging family members to express their interactions. Intuition is literally defined as “presence,” “visible,”
feelings “clear” and “insight.” In other word, it is a human ability for knowing
Warm interaction or doing without adequate reasons (Thompson, 2014).
Giving time Listening Meeting family members at the right time reflected how it was

“Walking beside” the family members important that nurses used their intuition when meeting the family
members. One nurse described this: “If I see that some of the family
Pacification
members feel very bad and they are alone, I will hug them.” (Inter-
Permit interaction Giving time to the patient and the family
between family members to be together view 1/Nurse3).
members and the Permission to give information about the There might be many situations where the body language of the
patient patient's situation family members revealed their feelings and indicated that this was
Provision of guidance an appropriate time to meet when they needed emotional support.
Nurses build trust Looking at the future for a moment at a time It was seen as question about how “you read” the body language of
for the future of Showing different possibilities the family member. There were also emotional feelings that arose
the family between nurses and family members.
members Supporting
Getting a grip of oneself in difficult situations reflected situations
where nurses have to be able to give support to the family members,
even though the patient's condition might be very serious and unsta-
T A B L E 4 Family members’ experiences about the care given by
ble, and there was little hope to be seen in the patient's situation. In
nurses: subcategories and their properties in Caring Interaction
spite of this, nurses have to be strong, calm and sensitive at the
Main category: family members’ experiences about the care given by
same time. They have to be present and ready to answer any ques-
nurses
tions the family members may ask them. Encouraging the family mem-
Subcategories Properties
bers to express their feelings reflected situations where it was
Participate in Propose meeting the doctor important to allow family members to cry and engage in intimate
the care of Ask the family members to take part in a care meeting conversation with the nurse. It is not always easy to express deep
the patient
Taking care of the personal welfare of family members feelings, and many family members were pleased when there was
Feeling trust Telling the truth someone who listened and had time to be with them. Warm interac-
towards the Feeling safe tion reflected situations where mutual trust was achieved between
nurse
the nurse and the family member. Nurses expressed that it was
LEHTO ET AL.
easier to give emotional support when interactions were warm and
mutual. “Many family members keep hold of themselves remarkably
well. I have often said that you are allowed to cry if you want and it
is not forbidden. When they are trying to say ‘I'm not…’ I encourage
them to cry.” (Interview 3/Nurse 2). In addition, when the family
member was alone and sad, it was easier to give them emotional
support.
Giving time described listening, “walking beside” the family mem-
bers and pacification. Listening reflected how important it was for
family members that they had enough time to discuss matters with
the nurses, and at the same time felt that they were cared for and
noticed. When the family members were confused and frantic, the
best help was a sensitive nurse who spent time with them and lis-
tened. Nurses said that in phone conversations with family members,
their listening process was more private and intense than when talk-
ing face to face. It was also easier to talk with family members when
some time had passed after the patient had become ill. “Walking
beside” the family member reflected the nurses’ experiences about
their readiness to be present, to listen and to give support to the
family members. It reflected how the nurses shared positive aspects
and hopes for good outcomes with the family members. Nurses also
referred to situations where the patient was in a bad condition, and
the nurse was empathetically engaged with the family members in
their sorrow. Pacification reflected those situations where the nurse
was with the family members and spoke calmly and comforted them.
One nurse described this: “…maybe it is just that you can imagine
yourself in somebody else's situation. I could be the wife of this man
and the children could be mine too. There have been those kinds of
situations…” (Interview 1/Nurse 2).
This was typical in caring situations when the family member
needed information about the prognosis of the patient's condition.
Permit interaction between the family members and the patient
described giving time for the patient and the family members to be
together, permission to give information about the patient's situation
and the provision of guidance. Giving time for the patient and the fam-
ily members to be together reflected those moments when the nurse
noticed that it was important for the family members and the patient
to have enough time to be together, and also situations where there
was a need for them to have privacy. This was needed because it
strengthened their mutual relationship and made possible to the
family members to give support to the patient too. “If there are fam-
ily members with the patient, it is not easy to meet them if they
want to be together.” (Interview 4/Nurse 3) Nurses accepted this
and noticed the situations where their attendance was not needed.
Permission to give information about the patient's situation
reflected that the nurses knew they had to be very sensitive when
giving information about the patient's condition to family members
and did it only with the patient's permission when it was possible.
Some of the patients had signed consent for the provision of the
information for the situations where they cannot give permission to
give information about their own situation. Provision of guidance
reflected how nurses were pleased to give any kind of guidance
related to patient care. Some family members wanted to learn
| 7
nursing tasks, for example give an injection or bladder catheterisa-
tion. This helped them during patient's rehabilitation at home. After
provision of guidance, family members were very pleased and they
felt themselves stronger and very necessary in provision of care also
with the nurses.
Nurses build trust for the future of the family members described
looking at the future for a moment at a time, showing possibilities and
supporting. Looking at the future for a moment at a time reflected
how nurses build trust for the future of the family members by giv-
ing information about the patient's condition in difficult situations,
when he or she was in bad condition. It was really important to fam-
ily members that the nurse offered some hope for the future, even
though it was well acknowledged that it was not possible to give
any promises about the patient's prospects of recovery. It was also
felt to be important that the nurse spoke honestly and told the
truth. When feeling that their confidentiality was respected by the
nurse, the family members felt safe. This was especially enhanced
when the nurse looked them in the eye and made it clear that she
was genuinely there for them. Showing possibilities referred to situa-
tions where the nurse pointed out possibilities of how the family
members could participate and be active in the rehabilitation of the
patient from the outset. This also strengthened their mutual relation-
ship and enhanced feelings of confidentiality. Supporting reflected
those situations when the family members had to be supported by
the nurse. It was also clear that when the patient strengthens, there
were more possibilities for the nurse to pay attention to the family
members. The nursing environment featured as a very important part
of Caring Interactions. When the patient's situation was stable,
nurses were able to conduct themselves in a more peaceful manner,
and this could be felt by the family members. They were very sensi-
tive to the atmosphere in the patient's room. The nurses described
their experiences in this way: “Nurses ought to tell the family mem-
bers that it is not the end for the patient when they leave the hospi-
tal. We don't know what their future will be, but those patients who
are admitted to the rehabilitation ward are lucky.” (Interview 2/Nurse
1).
Patients’ admission to the rehabilitation ward after the acute
phase of care gave also more emotional support to the family mem-
bers because they felt that the patients were better cared for.
A main category concerned the Family members’ experiences
about the care given by nurses and reflected participating in the care
of the patient and feeling trust towards the nurse.
Participating in the care of the patient includes when nurses pro-
posed meeting the doctor, and the family members felt that this
helped take care of their needs. They also thought that it was easier
to make contact with the nurses than the doctors. The initiative to
arrange meetings with the doctor was mostly instigated by the
nurses. Family members were very careful and sensitive to ask for
the meetings with doctors. Most of them wanted only to attend.
Asking family members to take part in a care meeting reflected the sit-
uation where the nurses encouraged family members to attend
meetings arranged by a multiprofessional team to discuss the
patient's care. “We were feeling quite excluded, but the nurses
8 |
asked me to take part in the care planning for the patient. It hap-
pened when I was on the ward and it was possible for me to
attend.” (Family member 7).
Especially, the family members felt that these meetings were
occasions where they were listened to, and there was a chance to
address specific issues, for example as to what would happen when
the patient came home. These were also situations where the family
members felt themselves useful. They felt that the real reason to
attend was extremely important while their opinions were asked
about patients’ care. Taking care of the personal welfare of family
members referred to situations when the family members felt a need
to rest, but still wished to stay near the patient. “So, one of these
nurses came and asked: ‘Have you got anything to eat and drink?’
Again, there was someone who took care of us. These are little
things, but just at that moment, it was really important.” (Family
member 4).
There were also some recollections of when a nurse had advised
the family member to go home, when the nurse felt it to be the best
action for a family member who was tired and exhausted. The
nurses told family members they could phone the ward at any time
in order to ask about the patient's condition, day or night. Small
things were important to the family members such as a sense of
feeling valued, and manner in which nurses approached them could
help them to feel better and prompt them to get emotional support.
Usually, family members felt themselves to be very comfortable in
the ward setting, and one family member recalled: “I was given a
morning coffee. I found this very friendly as they served this
because the cafeteria was still closed.” (Family member 11).
Feeling trust towards the nurse described aspects of telling the
truth and feeling safe. Telling the truth reflected how important family
members felt it that the nurse should tell them the truth, and this
caused them to feel safe and secure at the same time. Sometimes
there might be sensitive or difficult things to be relayed about the
patient's condition, and the manner in which the nurse told them
was felt to be important. The fact that the nurse looked them in the
eyes when they spoke strengthened their feelings of confidentiality.
There were sometimes things that were left unsaid; however, this
often saved the family members from extra worry. The family mem-
bers felt that a feeling of trust was especially important when receiv-
ing emotional support. Feeling safe reflected the feelings of family
members when the patient was well and they felt more confident in
the nurses’ actions. In this situation, nurses have more time to be
with family members and that is why the family members also felt
they received more emotional support in this situation. One family
member described feeling safe as a “warm sense of well‐being which
one could sense around the patient.” They also felt they could
detect from the atmosphere in the ward whether everything was
fine, if the nurses behaved calmly. When leaving the ward, the family
members were confident that everything possible was being done
for the patient's safe care, and that the nurses were expert in their
duties. When the patient got better and their rehabilitation moved
forward, the family members felt safe and they felt that they had
received appropriate emotional support.
LEHTO ET AL.
4 | DISCUSSION
In this study, the results indicate how many sensitive and specific
matters are involved in the provision of emotional support. From
both perspectives, the emotional support given by nurses to family
members includes many kinds of feelings. It is also noticed that the
emotional support interactions between family members and nurses
sometimes do not require words to be effective.
The core category of a caring approach of nurses interacting with
family members reflected emotional support in the care of family
members of working‐aged stroke survivors. The results of this study
show that staying calm in difficult situations was a relevant issue
when nurses gave emotional support to family members. Also, when
family members experienced this sense of calm, it gave them a safe
and reassuring feeling. It was important to the nurses that family
members showed their feelings, and according to Åstedt‐Kurki et al.
(2008), concentrating on family members requires being present at
just the right moment.
In this study, nurses and family members found it important that
nurses looked family members in the eye when talking to them, and
this also helped family members to feel trust towards the nurse. It
also made family members feel confident that the nurse told them
the truth. The way the nurse did this was also important. When the
atmosphere was calm and peaceful in the ward, the nurse's beha-
viour was friendly and not tense, then the family members felt more
confident. This also conveyed a feeling that everything was under
control in regard to the patient situation, and was reflected in a calm
atmosphere being sensed on the ward. In an earlier study on stroke
patients’ families, Cecil et al. (2010) discovered that family members
really appreciated nurses who were present and listened to them.
According to this study, giving time to family members and listening
to them carefully were also recognised as important factors. In a
study that focused on patients’ and family members’ experiences of
effective nursing support, Mattila et al. (2014) found that although
family members had confidence in the care patients received, this
was enhanced when they received emotional support from the
nurses. Specifically, confidence was developed in family members
when the nurses’ attitude towards the patient was respectful, and
the nurses’ care was seen as professional and responsible.
In this study, the fact that nurses felt useful in their profession
reflected the manner in which they engaged with the family mem-
bers. Intuition was needed in many cases when making independent
decisions in caring situations, and also when encountering family
members. In earlier research, Coco et al. (2013) found that acknowl-
edging family members’ individuality and granting them respect were
integral elements of providing emotional support. A family member's
emotional state was one of the most important factors in Caring
Interactions, and nurses showed real care about the family members’
life situations by interpreting their body language and being “silently
present.”
“Walking beside” and “pacification” were important concepts
that were present in the nurses’ experiences of giving emotional
support in Caring Interactions. However, it was not always necessary
LEHTO ET AL.
to be face to face with family members, and intimate feelings were
also able to be conveyed and perceived in phone conversations. Dis-
cussions between family members and nurses were seen to be more
fruitful when they were felt to be private, and thoughts and feelings
about both joy and sorrow were able to be changed. Mattila et al.
(2014) found similar results in their study focusing on the support of
the family members of cancer patients, where nurses tried to
empathise with the family members’ situation and let them express
their feelings about delight and sorrow, in a care‐oriented relation-
ship.
5 | CONCLUSIONS
This research has demonstrated that the caring approach of nurses
interacting with family members includes many sensitive factors
which are important to both family members and nurses. Nurses rea-
lised that interaction with the family members needed understanding
and listening, and during the interviews, both nurses and family
members felt that it was important to speak about emotional sup-
port and its’ necessity, even during acute phase of patients’ care.
The research showed that it is important that nurses use their intu-
ition in providing holistic care, and the family members felt that trust
towards the nurse was the most important issue, and led to them
feeling safe during what is an emotional and difficult time.
This study provides an explanation of the interaction process
between family members and nurses. It helps family members and
nurses to better understand each other. Although the data were col-
lected 5 years ago, it is assumed that the interaction between family
members and nurses has not changed during these years remarkably.
6 | RELEVANCE TO CLINICAL PRACTICE
Family members are in a key position to participate in the care of
stroke patients. However, they also need the support of nurses
when their close ones are in the acute phases of care. High‐quality
interactions between family members and nurses is an important fac-
tor in providing emotional support. According to the family members
and nurses who participated in this research, emotional support was
seen as the caring approach of nurses interacting with family members.
Nurses can develop themselves in this area, and their professional
experience and acting in line with the nursing vocation has a strong
influence on how nurses interact with family members. This is an
extremely important aspect to teach young nursing students, and
there is always a moment where nurses have time to take family
members into account—it takes only a few minutes.
ACKNOWLEDGEMENTS
The authors confirm that each author has contributed to the follow-
ing categories in the process of writing this manuscript: (1) study
design; (2) data collection and analysis; and (3) manuscript
| 9
preparation. The authors would like to thank the Otsakorpi Founda-
tion, and the family members and nurses who participated in this
research.
CONFLICT OF INTEREST
No conflict of interest has been declared by the authors.
CONTRIBUTION
Study design: BL, JK and P Å-K; Data collection: BL and analysis;
BL/ JK and P Å-K; Manuscript preparation: BL, JK and P Å-K
ORCID
Birgitta Lehto http://orcid.org/0000-0002-5579-2653
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How to cite this article: Lehto B, Kylmä J, Åstedt-Kurki P.
Caring Interaction with stroke survivors’ family members—
Family members’ and nurses’ perspectives. J Clin Nurs.
2018;00:1–10. https://doi.org/10.1111/jocn.14620