Staff-family cooperation in caring for elders in nursing homes is recommended but poorly understood. Family involvement and staff-family interactions in nursing homes with differing family orientations were investigated. Friedemann's (1995) system-based family theory guided the study. Of all 208 licensed nursing homes in southern Michigan, 143 completed a survey about their family-oriented practices. Family orientation was ranked accordingly. Twenty-four nursing homes were randomly selected to conduct semistructured telephone interviews with 177 family members. Data were analyzed by thematic interpretation. Findings showed a wide range of involvement patterns that promoted family connectedness, maintenance of control, growth, and learning. Families desired various types of staff cooperation and were given such opportunities in homes with high family orientation.

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This qualitative study was conducted to gain an understanding of the experiences of persons with chronic pain and their relationships with family members and the family as a whole. The framework of systemic organization was used to define the areas of investigation guiding the formulation of broad questions relative to family functioning. Thirty persons with chronic pain (age 31-82 years, 73% women, 83% married, 83% European-American, 17% African-American) participated in the study. A semi-structured interview was conducted to elicit narrative descriptions of the participants' perspective of the pain experience and family functioning. The data were analysed using a constant comparison method of analysis described by Strauss. The dominant themes that emerged included: (i) emotional distress, (ii) distancing from family members, (iii) inability to share difficult feelings, (iv) intense mutual involvement with family members and identification with others' problems, (v) family isolation from community, and (vi) attempt at healing. A mid-range theory developed out of the data and explicated with the framework of systemic organization, was one of balancing and counterbalancing connectedness (spirituality) with personal autonomy or separateness (control) in order to find congruence for the family and individuals within. The pain sometimes acted as a mechanism regulating the distance and closeness among family members. Based on this information, nurses can facilitate better understanding among family members, encourage autonomy, assist individuals to express feelings and needs more directly, and facilitate members to respond to each other.

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In clinical settings, nurses have observed a conflict within women who are expected to focus on caring for themselves, while their value lies in attending to the needs of others at the sacrifice of self. In this concept analysis of altruism, the term is defined and the critical attributes are identified. Model, borderline, related and contrary cases illustrate what the concept is and what it is not. The meaning of altruism is compared to self-neglect and co-dependence, which are two similar concepts. The antecedents and consequences of altruism are identified to further refine the critical attributes. Implications for research are discussed. This is a first step towards developing nursing theory that will give direction for providing more effective care to women within their value system.