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Nurses' discourse about knowing the patient emerged as a recurring theme in an interpretive phenomenological study of the development of expertise in critical care nursing. The purpose of this article is to present analyses related to the meaning of knowing the patient, and its role in everyday nursing practice. Informants in the study were 130 nurses who practiced in adult, pediatric and newborn intensive care units of eight hospitals in three metropolitan areas. The data were group interviews in which nurses gave narrative accounts of exemplars from their practice; in addition, a sub-sample of 48 nurses were observed in their practice and participated in intensive personal history interviews. Knowing the patient means both knowing the patient's typical pattern of responses and knowing the patient as a person. Knowing the patient is central to skilled clinical judgment, requires involvement, and sets up the possibility for patient advocacy and for learning about patient populations.

Confucianism is the central philosophic background for much of the culture in East Asia (EA), particularly for understanding family and social context. The purpose of this article is to examine more fully Confucianism as a conceptual framework for understanding EA family processes and health practices. Confucianism stresses the traditional boundaries of ethical responsibility and the ideal of good human life as a whole. Embedded within Confucian values are five principal relationships, through which each person defines a sense of identity, duty, and responsibility. Current studies of EA families that consider Confucianism as a theoretical base focus almost exclusively on filial piety and collectivism. Focusing only on these two aspects prevents scholars from exploring more complex interpretations of EA family life. A broader inclusion of multiple concepts from Confucianism can provide guidance in exploring the complex and multidimensional aspects of EA family life and allow for broader articulation of family processes.

The central aim of this article is to examine the evidence that family interventions improve health in persons with chronic illness and their family members, across the life span. The review focuses on recent meta-analyses of randomized controlled trials of family intervention research. In adults, evidence supports the salutary effects of family interventions versus usual medical care for patient health and mental health, and for family member health. In children, robust evidence supports family-based multimodal interventions for obesity treatment. Reasonable evidence supports family approaches to type 1 diabetes treatment in children. Nurses led the research or were members of interdisciplinary research teams in several of these literatures, representing one quarter to one third of the research cited, but were absent in other literatures, such as family treatment of childhood obesity.

OBJECTIVEAlthough Asians demonstrate elevated levels of type 2 diabetes, little attention has been directed to their unique cultural beliefs and practices regarding diabetes. We describe cultural and family challenges to illness management in foreign-born Chinese American patients with type 2 diabetes and their spouses.RESEARCH DESIGN AND METHODSThis was an interpretive comparative interview study with 20 foreign-born Chinese American couples (n = 40) living with type 2 diabetes. Multiple (six to seven) semistructured interviews with each couple in individual, group, and couple settings elicited beliefs about diabetes and narratives of care within the family and community. Interpretive narrative and thematic analysis were completed. A separate respondent group of 19 patients and spouses who met the inclusion criteria reviewed and confirmed the themes developed from the initial couples.RESULTSCultural and family challenges to diabetes management within foreign-born Chinese American families included how 1) diabetes symptoms challenged family harmony, 2) dietary prescriptions challenged food beliefs and practices, and 3) disease management requirements challenged established family role responsibilities.CONCLUSIONSCulturally nuanced care with immigrant Chinese Americans requires attentiveness to the social context of disease management. Patients' and families' disease management decisions are seldom made independent of their concerns for family well-being, family face, and the reciprocal responsibilities required by varied family roles. Framing disease recommendations to include cultural concerns for balance and significant food rituals are warranted.

Four broad groups of factors have been linked with self-management behavior in type 2 diabetes over time: (1) characteristics of patients, (2) amount and management of stress, (3) characteristics of providers and provider-patient relationships, and (4) characteristics of the social network/context in which disease management takes place. Of these four, social network/context has received the least amount of study and has been described in terms not easily applicable to intervention. In this paper, we identified the social network/context of diabetes management as residing within the family. We defined the family for clinical purposes, reviewed the literature concerning what is known about the link between properties of the family context of care and outcomes in type 2 diabetes and other chronic diseases, and identified areas of family life that are relevant to diabetes management. This information was then used to demonstrate how a family context of care can serve as a clinical framework for integrating all four groups of factors that affect disease management. Implications of this approach for practice and research are described.

R E S U LT S -Both sex and the three domains of family life were related to disease management, but the results varied by ethnic group. For EA patients, sex, family world view, and family emotion management were related to disease management (scores for Family Cohere n c e w e re negatively associated with HbA 1 c level and depression, and poor scores for Conflict Resolution were linked with high depression); for Hispanic patients, sex and family s t ru c t u re / o rganization were related to disease management (high scores for Organized Cohesiveness were associated with good diet and exercise, and high scores for Family Sex-Role Tr aditionalism were related to high quality of life). No significant interactions with sex occurre d . C O N C L U S I O N S -Characteristics of the family setting in which disease management takes place are significantly linked to patient self-care behavior, and these linkages vary by patient e t h n i c i t y. A family' s multiple independent dimensions provide multiple targets for interv e n t i o n , and diff e rences in family norms, stru c t u res, and emotion management should be considere d to ensure that interventions are compatible with the setting of disease management.

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