| Summary: | 碩士 === 國立臺灣大學 === 護理學研究所 === 98 === Statistical data from Department of Health, Executive Yuan show that cerebral vascular disease (CVA) was the third leading cause of death in 2009 in Taiwan. After stroke, patients suffered different degree of disabilities in physical such as hemiplegia or communication such as aphasia. Besides the in-patient treatment in the acute stage, care should be extended to home. Thus burdens were resulted on family caregivers. This study was aimed at investigating the changes of family caregivers’ needs and related factors in different stages from the hospitalized period to the three months after the stroke patients were discharged. The family’s needs were studied through the following four stages: before the transfer from intensive care unit (ICU) to general ward, before discharged, two weeks after discharged, and three months after discharged to follow up the needs of family caregivers. The design of this study was based on longitudinal research, and the participants were family caregivers of stroke patients in the ICU of a medical center in Taipei. During Jan. 2006 to Jan. 2009, sixty family caregivers were recruited in this study. Structural questionnaires, including Caregiver Burden Scale, Chinese Health Questionnaire (CHQ-12) and Stroke Patient’s Family Caregiver Needs Scale were used for data collection.
It was found that there was significant difference in different stages for numbers of care needs of the family caregivers in total scales (F=187.03, p=0.00) as well as care needs of the family caregivers subdimensions. On the aspect of unmet care needs of the family caregivers, there was a significant difference in different stages for numbers of unmet care needs in total scale (F=140.12, p=0.00) as well as care need subdimensions. The result indicated that throughout the four stages, there were most care need items of the family caregivers before the transfer from ICU to general ward, while there were least care need items on three months after the patients were discharged. Thus the numbers of family caregivers’ care need items decreased gradually as the time after the patients discharged from the hospital increased. Care needs of the family caregivers in four different stages were followed.
First stage: Before the transfer from ICU to general ward
The major care need subdimensions of the family caregivers were health
information and professional support. The most care need items of the family caregivers were “To have information on patients’ disease and care”, “To have my questions answered honestly” and “To have information on patients’ rehabilitation or educational progress”. Meanwhile, the most unmet care need subdimensions of the family caregivers were also health information and professional support. The most unmet care need items of the family caregivers of the family caregivers were “To have information on patients’ rehabilitation or educational progress”, ”To have complete information on patients’ thinking” and “To be told how to deal with emergency events of patients”.
Second stage: Before discharged
The major care need subdimensions of the family caregivers were professional support and health information. The most care need items of the family caregivers were “To have information on patients’ disease and care”, ”To have complete information on patients’ physical problems” and “To be told how to deal with emergency events of patients”. The most unmet care need subdimensions of the family caregivers were professional support and instrumental support. The most unmet care need items of the family caregivers were “To have information on patients’ rehabilitation or educational progress”, “To have information on patients’ homecare” and “To get a break from my problems and responsibilities”.
Third stage: Two weeks after discharged
The major care need subdimensions of the family caregivers were community support network and professional support. The most care need items of the family caregivers were “To be told how to deal with emergency events of patients”, “To have complete information on patients’ physical problems” and “To have complete
information on drug and treatment”. The most unmet care need subdimentions of the family caregivers were professional support and instrumental support. In this stage, the most unmet care need items of the family caregivers were significantly less than the previous two in-patient stages, which were “To have enough resources for the patient e.g. rehabilitation programs, physical therapy” and ”To be shown what to do when the patients is upset or acting strange”.
Fourth stage: Three months after discharged
The major care need subdimensioms of the family caregivers community support network and professional support, the most care need items of the family caregivers were “To be told how to deal with emergency events of patients”, ”To be shown what to do when the patients is upset or acting strange” and ”To have complete information on patients’ physical problems”. The most unmet care need subdimensions of the family caregivers were community support network and emotional support. During this stage, the unmet care need items of the family caregivers were significantly decreased. The main unmet care need items of the family caregivers were “To discuss my feelings about the patient with other friends or family”, “To have information on patients’ homecare” and “To have information on patients’ rehabilitation or educational progress”.
When the patients had higher NIHSS (National Institutes of Health Stroke Scale) scores at admission, longer hospital stays, more complications during hospital stays or/and developed more physical dependence, the care needs level of the family caregivers would be higher. Family caregivers also realized that their care needs increased when they perceived worse health status and higher care burden. This study found that during the stage of being in hospital, the care needs of the family caregivers were mainly information about disease and helping from professionals. However, the family caregivers’ health status, anxiety level and care burden should also be taken into account seriously. The clinical nurses should conduct comprehensive assessment on the care needs of the family caregivers and offer individualized guide, along with making an individualized educational CD-ROM. In addition, the clinical practice could set up a support group to provide opportunities for experience sharing and offer socio-psychological support. Before the patients are discharged, chances should be taken to assess the possible care needs in homecare stage that family caregivers believe they may experience. Relevant information and a channel for counseling should be provided to the family caregivers so that they can acquire the information and help, as well as socio-psychological support, when they have the need.
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