Effect of an Educational Support Programme on Caregiver Burden Among the Family Members of Patients Undergoing Coronary Artery Bypass Graft Surgery

Does a multimedia education program work as a remedy for stress and burden in family caregivers of elderly heart attack patients? A clinical trial study

BACKGROUND

Supportive care has been found to improve quality of life and reduce the disease burden for aging individuals. After a heart attack, elderly patients often require a caregiver. In developing communities, caregiving responsibilities frequently fall on family members. Accordingly, we designed a randomized controlled clinical trial to assess the effect of an educational program on perceived stress and care burden among family caregivers of elderly heart attack patients.

METHOD

In this clinical trial (IRCT20220905055894N1, 01/02/2023), family member caregivers were the study participants, assigned to either intervention or control groups using a simple random sampling method. The control group received only routine in-home caregiving information, without additional nurse training or support, whereas the intervention group received multimedia-based training, monitoring, and communication support from a trained nurse over one month. Perceived stress levels and caregiving burden were measured using the Perceived Stress Scale (PSS) and the Caregiving Burden Inventory, respectively.

RESULTS

Before the intervention, a high level of caregiving stress (34.07 ± 8.61 in the control group vs. 34.17 ± 8.62 in the intervention group) and burden (77.7 ± 15.51 in the control group vs. 79 ± 15.6 in the intervention group) was observed. After one month of intervention, the average scores of stress and burden remained unchanged in the control group, whereas the intervention group showed a significant reduction (P < 0.001). The inter-group comparison revealed lower levels of stress and care burden in the intervention group (P < 0.001).

CONCLUSION

A brief multimedia education intervention could help alleviate the stressful conditions experienced by family caregivers of elderly heart attack patients. Future studies could investigate whether a more extended educational program would have more lasting effects.

A Prospective Study on Activities of Daily Living, Comfort, Body Image, and Cardiac Symptoms in Coronary Artery Bypass Patients

BACKGROUND

A coronary artery bypass graft procedure reduces mortality for cardiovascular patients, but those undergoing it often face negative body perception, loss of daily activities, and lingering symptoms, hindering full functional recovery and comfort.

AIM

To compare the comfort level, activities of daily living, and body image based on certain characteristics of patients at baseline, (ii) Evaluate changes over time in levels of discomfort, activities of daily living, body image, and cardiac symptoms before and after CABG surgery within three months.

METHOD

This descriptive prospective cohort study comprised 50 patients scheduled for coronary artery bypass surgery. The study examined cardiac symptoms, comfort levels, daily activities, and multidimensional body-self relationships as its outcomes.

RESULTS

A Friedman test revealed that patients' body image, comfort levels, activities of daily living, and each heart symptom were significantly influenced by the time of day. According to this study, patients most frequently reported experiencing exhaustion, depression, and worry as cardiac symptoms. Only the comfort level exhibited a high correlation with each heart symptom, as indicated by Spearman's rho analysis.

CONCLUSION

The body image, comfort level, activities of daily living, and cardiac symptoms of patients changed over time. Therefore, regular assessments of these symptoms during the pre- and post-operative periods could offer valuable insights into patients' needs. This information can be instrumental in developing interventions that address patients' well-being and may positively impact patient outcomes.

Status quo and factors influencing dyadic disease appraisal in chronic heart failure based on latent profile analysis in Northern Sichuan Province, China

PURPOSE

This study explored potential categories of dyadic disease appraisal differences among patients hospitalized with chronic heart failure (CHF) in China and analyzed the main factors influencing these categories.

METHODS

A survey was conducted using various tools and scales, including the Chinese version of the Memorial Heart Failure Symptom Appraisal Scale, Heart failure self-care index scale, Social Support Rating Scale, Zarit burden interview, and Self-rating anxiety scale. The data was collected from patients who were hospitalized with CHF in the cardiology department of one of two tertiary hospitals in Nanchong City, China. The dyadic disease appraisal categories were identified using latent profile analysis (LPA). Multiple logistic regression analysis was also employed to analyze the factors influencing the formation of potential categories of differences in dyadic disease appraisal in CHF patients.

RESULTS

A total of 262 pairs of hospitalized CHF patients and their caregivers participated in this study. The dyadic disease appraisal of CHF patients was potentially categorized as the "negative difference group" (28 individuals, 10.7%) and the "positive or convergence group" (234 persons, 89.3%). The results showed that the factors influencing the categorization of dyadic disease appraisal differences included the patient's social support, disease progression, and Caregivers anxiety level, burden, gender, educational attainment, and age (p < 0.05).

CONCLUSION

The study findings demonstrated heterogeneity between the two groups of CHF patients in the dyadic disease appraisal. Therefore, it is necessary to focus on patients who have a brief duration of illness and limited social support. Specifically, it is important to prioritize support for female caregivers who are 65 years or older, have lower levels of educational attainment, and experience a significant burden and anxiety. Regular implementation of support person-bilateral co-management strategies can effectively reduce differences in how the disease is perceived and enhance the overall well-being of both caregivers and patients.

Experiences of family members when accompanying patients in intensive care units: A qualitative study

BACKGROUND

Family members of Intensive Care Unit (ICU) patients encounter numerous challenges while providing companionship to their hospitalized loved ones.

AIM

This study aims to explore the experiences of family members with loved ones hospitalized in ICUs.

STUDY DESIGN

Qualitative research was conducted using a content analysis approach. Ten family members of ICU patients were recruited using purposive sampling. Data were collected through semi-structured, in-depth interviews and analysed following Graneheim and Lundman's suggested steps.

FINDINGS

Analysis of interviews with ten family members of ICU patients revealed a theme of "challenging companionship on an obscure path," encompassing four categories (1-4) and nine subcategories (a, b and c). These included (1) the interplay between the patient and the family: a. family affected by the patient's condition; b. patient affected by the family's condition; (2) mixed emotions of apprehension and anticipation regarding ICU admission: a. fear of ICU hospitalization; b. hope for ICU hospitalization; (3) unaddressed needs and concerns: a. pressure from the ICU's visiting limitations; b. lack of a resting room to settle; c. vague information about the patient's condition; (4) two-way care suffering for families a. direct suffering associated with companionship; b. indirect suffering while observing the patients' suffering.

CONCLUSIONS

Families of ICU patients encounter various challenges, revealing the complex interplay of emotions, needs and challenges within the ICU. This highlights the intricate dynamics in this critical health care environment.

RELEVANCE TO CLINICAL PRACTICE

A holistic and empathetic approach in clinical practice is crucial in ICU care, particularly during the challenging journey patients and their families undergo in this critical setting. Health care systems and providers should adapt ICU rules to address evolving needs, alleviate concerns and enhance the overall family experience during their loved one's hospitalization in the ICU.

Perspectives of patients, families and nurses on pain after cardiac surgery: A qualitative study

BACKGROUND

Post-cardiac surgery pain affects patients, family caregivers and nurses. The pain experiences of patients, caregivers and nurses remain largely unknown. Therefore, it is important to examine the experiences of patients, caregivers and nurses in depth to ensure effective pain management.

AIM

The aim of this study is to examine post-cardiac surgery pain from the perspectives of patients, caregivers and nurses.

STUDY DESIGN

A descriptive qualitative research design was used. The study was carried out in the cardiovascular surgery ward of a tertiary hospital in Türkiye between June and December 2022. The data-driven triangulation method was used in the research. The study sample consisted of eight patients who had undergone cardiac surgery in the tertiary hospital, eight family caregivers and nine nurses who provided care for these individuals. A 'semi-structured interview form' was used to collect data through face-to-face and in-depth interviews. The data were analysed using the thematic analysis method. The COREQ checklist was used for reporting the study.

RESULTS

As a result of the interviews, six themes were elicited from the data. These themes were 'explaining pain', 'assessment of pain', 'responses to pain', 'effect of pain on activities of daily living', 'expectations in painful situations' and 'pain management'.

CONCLUSIONS

This study revealed the differences between pain perceptions and coping processes of patients who experienced pain after cardiac surgery, their caregivers and nurses.

RELEVANCE TO CLINICAL PRACTICE

Considering the experiences of patients, caregivers and nurses in pain management after cardiac surgery, applications that will ensure joint participation in care practices should be planned.

Caregiver burden, family adaptation, partnership, growth, affection, and resolve, anxiety levels, and perceived social support in relatives of patients with open heart surgery

OBJECTIVE

The aim of this study was to examine the relationship between caregiver burden, family adaptation, partnership, growth, affection, and resolve score, anxiety levels, and the perceived social support of the relatives of patients who had open heart surgery.

METHODS

Volunteers among the relatives of patients who had open heart surgery in our cardiovascular surgery clinic and were followed up in the first 3 months were included in the study. The cardiovascular surgeons recorded the sociodemographic data of the relatives of the patients and directed them to a psychiatry clinic for further evaluation. The caregiver burden scale, family adaptation, partnership, growth, affection, and resolve scale, anxiety level scale, and perceived social support scale were applied to the relatives of the patients who participated in the study.

RESULTS

Within the scope of the study, a total of 51 individuals, 29.4% (n=15) men and 70.6% (n=36) women, were included in the evaluation. The participants' ages ranged from 32 to 68 years, with an average age of 48 years. There was a statistically significant relationship between the caregiving burden scale score and the scale scores other than age (p<0.05). There was a statistically significant difference in terms of caregiving burden scale score, working status, physical and psychological problems, changes in home life, and changes in family relationships (p<0.05).

CONCLUSION

The fact that the need for security and intimacy is related to anxiety and depression can be interpreted as the caregiving problems of the relatives of the patients who think that their patients are safe and feel closer to the intensive care personnel will decrease. Their depression and anxiety levels will also decrease.

Effect of teaching health-promoting behaviors on the care burden of family caregivers of hemodialysis patients: a four-group clinical trial

INTRODUCTION

Chronic kidney disease could have a profound effect on the life of patients and family caregivers. The caregivers' care burden increases as the disease progresses. Interventions reducing care burden should be investigated. Educational interventions could affect family caregivers' care burden among hemodialysis patients. However, most studies and interventions have focused on caregivers. Therefore, this study aims to compare the effect of teaching Health-promoting behaviors on the care burden of family caregivers of hemodialysis patients.

MATERIALS AND METHODS

This trial was conducted using a pretest-posttest design and follow-up after one month. Hemodialysis patients and their family caregivers were selected using convenience sampling method. In total, 124 patient-caregiver pairs were divided into four groups of patient-centered education, caregiver-centered education, Patient and caregiver education and control by block randomization (15 blocks of 8 members and 1 block of 4 members) (n = 31 pairs per group). The intervention (teaching health-promoting behaviors) was performed in 8 sessions using the teach-back method, except for the control. The data were collected by patient and caregiver demographic forms and Novak and Guest care burden inventory as well as following the treatment regimen in three stages (before, immediately after and one month after the intervention). Demographic variables were compared among the four groups using ANOVA, Kruskal-Wallis and Chi-square test. The intragroup comparison of the main variables was made using the repeated measures ANOVA with modified LSD post hoc test. The intergroup comparison was made by one-way ANOVA with LSD post hoc test.

RESULTS

Out of 124 caregivers participating in the study, 68 (54.8%) were female. Also, out of 124 patients participating in the study, 86 (69.4%) were male. The mean age of the caregivers and patients was 39.2 ± 11.31 and 54.23 ± 14.20 years old, respectively. There was a statistically significant difference in the mean total care burden scores of the pre-test and post-test between the four groups (p < 0.001). The total care burden decreased in patient-centered, caregiver-centered and Patient and caregiver education groups. However, this reduction in the caregiver-centered and Patient and caregiver education groups was significantly higher than the patient-centered education group (p < 0.001).

CONCLUSION

The results revealed teaching health-promoting behaviors reduced care burden. Moreover, caregiver-centered approach could reduce care burden more than patient-centered approach. Therefore, this could be used as a supportive method to improve the health of patients and caregivers.

TRIAL REGISTRATION NUMBER (TRN)

IRCT20090522001930N4.

DATE OF REGISTRATION

2021-11-12.

Caregiver Distress and Coronary Artery Disease: Prevalence, Risk, Outcomes, and Management

PURPOSE OF REVIEW

Caregivers of patients with coronary artery disease (CAD) are integral to the health care system and contribute substantially to patients' management. The purpose of this review is to provide a narrative synthesis of existing research on caregiving for patients who experienced an acute coronary syndrome (MI/unstable angina) and/or coronary revascularization (PCI/CABG).

RECENT FINDINGS

Thirty-one articles are included in this review. Overall, caregiver distress is low to moderate, ranging from 6 to 67% of caregivers, and seems to dissipate over time for most caregivers. Interventions have demonstrated success in reducing the distress of caregivers of patients with CAD. Due to the heterogeneity in study samples, measurements used, and timing of assessments and programming, these results are far from definitive. Although evidence is accumulating, further advancement in caregiving science and clinical care is required to adequately understand and respond to the needs of caregivers throughout the patient's illness trajectory.