Nurses’ positive attitudes toward families within nursing care: a scoping review protocol


Mayckel da Silva Barreto1, Verônica Francisqueti Marquete1, Camila Wohlenberg Camparoto1, Mara Cristina Ribeiro Furlan2, Cristina Garcia-Vivar3, Sonia Silva Marcon1


1 State University of Maringá, PR, Brazil

Federal University of Mato Grosso do Sul, MS, Brazil

Public University of Navarra, Pamplona, Spain



Objective: to map the factors associated with nurses’ positive attitudes toward the families of patients cared for in different healthcare settings reported by studies adopting the Families’ Importance in Nursing Care  Nurses’ Attitudes and/or Family Nursing Practice Scale. Method: scoping review protocol developed according to the guidelines provided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and the steps proposed by the Joanna Briggs Institute (JBI). Three independent reviewers will identify the documents in the following databases: PUBMED/Medline, LILACS, BVS, PsycInfo, Academic Google, SCOPUS, and CINAHL, using the instruments’ titles and/or their acronyms located in the documents’ titles and/or abstracts. The primary studies’ references will also be consulted. After applying eligibility criteria, relevant information will be systematically recorded and analyzed. Finally, the results will be described and tabulated to meet the objective proposed. 


Descriptors: Review; Family Nursing; Nursing Care.



Recent scientific evidence shows that acute or chronic diseases affect not only an individual but also his/her entire family system(1,2). The reason is that vulnerable situations influence a family’s functioning, dynamics, and coping and also how each family member perceives, interacts with, and deals with adversities(3,4) In this sense, involving families in health treatments is valuable for patients and family members, considering the need to acknowledge the challenges a disease represents for a family system, including relationships, coping strategies, and understanding(5).

The primary changes experienced by families living with diseases, especially chronic diseases, include role changes; changes in relationships and social support networks; decreased family income and unexpected financial demands; and feelings such as grief, helplessness, uncertainty, suffering, and concerns(6). These changes affect a family’s wellbeing, the internal cohesion of family members, and interpersonal relationships(7). Therefore, it is vital that nurses show positive attitudes toward individuals and their families because positive attitudes reflect the type of relationships that will be established between the parties(8). Furthermore, maintaining empathetic and supportive attitudes is an indispensable prerequisite for inviting and engaging families in the care process, and these attitudes can encourage co-participation between nurses and families(6)

The attitudes of nurses toward families in healthcare delivery are evidenced by the nursing literature and in the establishment of public health policies(9). The term “attitude” comprises “affective, cognitive, and behavioral aspects” and configures a response to a stimulus. The presence of families in health services is a stimulus that triggers attitudes in nurses, attitudes that are based on feelings and emotions (affective aspect), thoughts and beliefs (cognitive aspect), and tendency to act (behavioral aspect)(10).

Studies show that the nurses’ attitudes toward families condition the nursing care process(7,11). Due to a growing emphasis on acknowledging and improving the relationship between nurses and families, various instruments have been developed, refined, translated, adapted, and validated to identify the attitudes, beliefs, and practices of nurses among the families of patients in various settings and contexts where care is provided. A literature review analyzed five of these instruments. It verified that the Families’ Importance in Nursing Care  Nurses’ Attitudes (FINC-NA) and the Family Nursing Practice Scale (FNPS) obtained the best psychometric assessments, and therefore, seem to be the most appropriate to measure the attitudes of nurses toward patients’ families during care delivery(8).

These instruments have been used in the most varied settings where care is provided, from Primary Health Care(9) to hospital care(3), including Intensive Care Units(12), addressing different specialties such as pediatrics(10) and mental health(11). When results are compared with personal, sociodemographic, educational, or occupational variables, factors associated with positive attitudes toward families can be identified. Additionally, compiling the results in a review can be helpful and show the profile of nurses that is more favorable to involve families in the clinical practice in different care settings and social contexts.

A search was performed to identify other potential reviews, but no bibliometric analysis was found mapping studies addressing the profile of nurses concerning positive attitudes toward patients’ families. This lack of reviews, by itself, justifies a scoping review.

Additionally, by shedding light on this issue, gaps can be found, and a new systematic review can be planned to understand how effective are these “important” variables for the outcome and/or construction of an explanatory model to identify the relationship between the profile of nurses and positive attitudes toward patients’ families.

Given the previous discussion, we ask: what factors are associated with nurses’ positive attitudes toward the inclusion of the families of patients in nursing care according to studies adopting FINC-NA and/or FNPS? Hence, this review was designed to map the factors associated with nurses’ positive attitudes toward patients' families in different care settings according to studies that adopted the Families’ Importance in Nursing Care  Nurses’ Attitudes and/or Family Nursing Practice Scale.



This scoping review is intended to synthesize evidence selected according to the specific nature of the object under study. Unlike a systematic review, a scoping review is intended to map basic concepts, enabling synthesizing evidence and identifying gaps in research and/or policies about a specific field(13). Hence, a scoping review is intended to map the literature and provide an overall view of the studies in a given field, listing research priorities to advance scientific knowledge(14).

The nine steps proposed by the Joanna Briggs Institute (JBI)(15) were adopted in this review: 1) defining and aligning the study’s objective and question; 2) developing and aligning inclusion criteria with the study’s objective and question; 3) describing the approach planned for the search, selection, extraction, and presentation of data; 4) searching for evidence; 5) selecting evidence; 6) extracting evidence; 7) analyzing evidence; 8) presenting results, and 9) summarizing evidence concerning the review’s objective and discussion implications of results. Note that the JBI approach for scoping reviews expands what is proposed by Arksey and O’Malley(16) and Levac et al(17)

The PCC (Population, Concept, and Context) strategy was used to establish the guiding question (Figure 1).


Question: What are the factors associated with the positive attitude of nurses toward the inclusion of patients’ families in nursing care according to studies adopting the FINC-NA and/or FNPS?


Studies addressing nurses working in clinical practice, regardless of their degree;


Studies exploring the factors associated with nurses’ positive attitudes toward the inclusion of the patients’ families in nursing care using the FINC-NA and/or FNPS;


Studies conducted in different health settings (e.g., hospitals, primary health care services, outpatient clinics, etc.) using the FINC-NA and/or the FNPS, and sociodemographic questionnaires (addressing occupational and/or educational background) to interview nurses.

Figure 1 – Presentation of the PCC strategy applied in this scoping review

Source: Elaborated by the authors, 2021.


Protocol and Registering

To ensure methodological rigor when developing the protocol, we adopted the principles provided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)(18). Additionally, this protocol was revised by the research team and three external experts in literature reviews and/or the FINC-NA and/or FNPS. Finally, the protocol was registered in the Figshare platform (DOI: 10.6084/m9.figshare.14374502).


Eligibility criteria

Eligibility criteria and the rational analysis implemented to include and exclude studies are summarized in Figure 2.









Inclusion criteria


Rational Analysis

Quantitative studies or mixed methods addressing nurses (population) working in different health settings, e.g., hospitals, primary health units, outpatient clinics, schools, etc. (context), employing the FINC-NA and/or FNPS, sociodemographic questionnaires, or questionnaires addressing occupational and/or educational background, using statistics to identify the factors associated with the outcome (concept); 

Enables us to meet the review’s objective.

Studies published in peer-reviewed journals from 2006 onwards for the FNPS and 2008 onwards for the FINC-NA, up to June 2021;

2006 and 2008 are the years when the instruments were published(19-20). Peer-review configures prior verification of the quality of studies.

Studies published in Portuguese, Spanish, or English;

These are some of the languages used in the nursing academic milieu mastered by the authors.

Full texts available online (abstracts published in congresses or conferences will not be selected).

Full texts enable to more comprehensively analyze the studies’ results.






Exclusion criteria

Studies addressing nurse professors or nursing students not directly involved with care provided to patients and their families;


The roles performed by these nurse professors may influence the factors associated with attitudes toward families. Additionally, the instruments were designed to assess the attitudes of graduate nurses.

Intervention studies only addressing changes in the nurses’ attitudes toward families, in pre- and post-tests.

The results of the instruments are correlated with an increase in the nurses’ positive attitudes toward families, instead of the nurses’ characteristics.

Methodological studies addressing the presentation, refinement, translation, adaptation, or validation of instruments.

In these cases, only data concerning the instruments’ psychometric assessments are presented. 

Figure 2 – Presentation of eligibility criteria and rational analysis used to select the studies

Source: Elaborated by the authors, 2021.


Sources of information

The search will be implemented according to three stages to identify relevant documents. In the first stage, already performed, an initial search was restricted to three databases (PUBMED/Medline, CINAHL, and Scopus). This search was followed by an analysis of the words contained in the studies’ titles and abstracts and index terms.

In the second stage, a search was conducted in all databases: PUBMED/Medline; LILACS; Virtual Health Library; PsycInfo; Academic Google; SCOPUS and CINAHL, using all the keywords and index terms previously identified. Because this scoping review’s objective was to map studies adopting two specific instruments, after discussing with the research group and consulting with a librarian, we decided to include the titles and/or acronyms of the two instruments (FINC-NA and FNPS). Additionally, very comprehensive descriptors, keywords, and subject headings (e.g., family nursing; attitudes; nurses; nursing care) did not support the identification of studies specifically adopting these two instruments. Therefore, the search will include the title of the instruments and/or their acronyms using the Boolean term “OR”: ((“Families’ Importance in Nursing Care  Nurses’ Attitudes”) or (“FINC-NA”) or (“Family Nursing Practice Scale”)) contained in the studies’ titles and/or abstracts. Table 3 presents the final search strategy adopted for the PUBMED/Medline.

The reference lists of the papers identified will also be consulted in the third stage to identify potential new studies.

The search will be independently conducted at the end of the first semester, 2021, by three research team members. Next, the three researchers will discuss the studies identified and apply inclusion and exclusion criteria. Finally, divergences will be discussed with two senior researchers to obtain a consensus.



Figure 3 presents the complete electronic search strategy to be used in the PUBMED/Medline databases. 



Search Strategy

Additional details


((Families' Importance in Nursing Care  Nurses' Attitudes [Title/Abstract]) OR (FINC-NA[Title/Abstract])) OR (Family Nursing Practice Scale[Title/Abstract])

Three research team members and a librarian independently carried out the search and discussed the results. 

Figure 3 – Complete search strategy for the primary database

Source: Elaborated by the authors, 2021.


Selection of Evidence Sources and Data Items

After including the original studies, the material will be read in detail, and data will be extracted. Three research team members will independently carry out this procedure. After the two first analyses, these researchers will meet and discuss the instrument used to extract data, the quality of the review, and potential divergences. Next, divergences in data extraction will be discussed with the senior researchers until consensus is obtained.

The instrument intended to collect data will include variables concerning the characterization of studies (year of publication, funding agency, periodical, and authors’ background); contextual characterization (country of origin, the nurses’ health setting – primary health care, outpatient clinic, hospital, or emergency room; specialty – mental health care, pediatrics, cancer, or maternal-infant, among others); methodological characterization (sample, sample representativeness, statistical tests); characterization of outcome to extract the results (primary factors associated with nurses’ attitudes toward families, such as sex, marital status, training programs addressing family nursing, years of experience, complementary academic training, among others). Note that this instrument may change after discussions with the researchers and be updated as needed during data extraction.


Graphic Development

Data from the eligible studies will be described, and resources will be used to visually present data, including tables and an explanatory diagram presenting the primary factors associated with the outcome.


Ethical Considerations

This scoping review will identify, analyze, and summarize the studies’ primary results relevant to the topic of interest. Hence, there are no ethical issues, and there is no need to submit it to an Institutional Review Board.




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Submission: 04/14/2021

Approved: 09/27/2021


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