The Development Of Intervention Plan For The Caregiver Burden Of Family Caregivers In Patients With Liver Cirrhosis

Objective:The quantitative study was to designed to evaluate the status of caregiver burden,to explore the relationship between caregiver burden and caregiver reaction,sense of coherence,perceived social support,depression and quality of life,and to define predictors of caregiver burden of family caregivers of family caregivers in patients with liver cirrhosis.The qualitative study was designed to describe the care experience and supportive care needs of family caregivers of patients with liver cirrhosis under the unique social and cultural background in China.Based on the results of quantitative and qualitative studies,an intervention scheme to reduce caregiver burden of family caregivers in patients with liver cirrhosis was initially constructed.Methods:Mixed methods combined quantitative study with qualitative study was used to explore caregiver burden of family caregivers in patients with liver cirrhosis.A crosssectional descriptive study was conducted with 300 family caregivers in patients with liver cirrhosis in the Liaoning Liver Disease Center between October 2016 and November 2018.Participants were assessed with the Zarit Caregiver Burden Interview(ZBI),Caregiver reaction assessment(CRA),Sense of Coherence(SOC-13),Perceived Social Support Scale(PSSS),Center for Epidemiologic Studies Depression Scale(CES-D)and the Short Form-36 Health Survey(SF-36),and general information questionnaire.Descriptive statistics,bivariate analyses,multiple stepwise regression and path analysis were conducted to explore predictors for caregiver burden.The qualitative description was carried out from November 2017 to October 2018.Purposive sampling was used to recruit 18 family caregivers in patients with liver cirrhosis.Information was collected through in-depth individual interviews which were tape-recorded and subsequently transcribed.Thematic analysis was used for data analysis.The third part is based on the transformation theory of Meleis,combining the results of quantitative and qualitative studies,referring to the results of literature analysis and the recommendations of expert seminars,to initially construct the intervention plan for the caregiver burden of family caregivers of patients with liver cirrhosis.Results: Quantitative study results:(1)The average score for ZBI was 32.63±15.04.(2)Two hierarchical regression analyses were conducted to explore the effect of caregiver burden on depression and quality of life,which indicated caregiver burden positively predicted depression and negatively predicted quality of life.(3)Times of hospitalizations in the past 1 year,severity of disease,self-care ability,abnormal behavior,caregiver's age,working status,perceive economic pressure,relationship to patient,cumulative care time,daily care time,and travel mode showed statistically significant differences in the level of caregiver burden(P ?0.05).(4)Multiple stepwise regression analysis with the total score of the scale indicated that caregiver reaction,severity of disease,self-care ability,abnormal behavior,and times of hospitalizations in the past 1 year,sense of coherence and relationship to patient significantly affected caregiver burden and explained 46.9% of the total variance in caregiver burden.Multiple stepwise regression analysis with scores of each dimension of the scale indicated that severity of disease,self-care ability,times of hospitalizations in the past 1 year,disrupted schedule,lack of family support,selfesteem,sense of understanding and sense of control significantly affected caregiver burden and explained 52.3% of the total variance in caregiver burden.(5)Caregiver burden can directly affect depression and quality of life of family caregivers of patients with liver cirrhosis,and can also affect depression and quality of life through sense of coherence.Sense of coherence plays a mediating role between caregiver burden,depression and quality of life,and the mediating effect accounts for 30.2% and 34.9% of the total effect.(6)Perceived Social Support can directly affect depression and quality of life of family caregivers of patients with liver cirrhosis,and can also affect depression and quality of life through sense of coherence.Sense of coherence plays a mediating role between caregiver burden,depression and quality of life,and the mediating effect accounts for 16.5% and 49.6% of the total effect.Qualitative study results:(1)Caregiver burden of family caregivers with cirrhosis includes physiological burden,psychological burden,economic burden and social burden.The physiological burden includes fatigue,insomnia and chronic diseases.Psychological burden includes worry and tension,grievance,anxiety and depression;Social burden includes social loneliness,limited entertainment and other social role weakening.(2)Positive factors for the transition of family caregivers in patients with liver cirrhosis include clear consciousness and clear purpose,loving family members and positive attitude,adequate income of the nuclear family,learning knowledge and making plans,and various kinds of social support.Social support includes family support,friend support and professional support.(3)Negative factors for the transition of family caregiver in patients with cirrhosis include lack of awareness of the need for change,effects of familism,reduced income and lack of support,poor communication and negative coping,fear of rejection and lack of support.(4)Supportive care needs of family caregivers in patients with cirrhosis include the need for knowledge or education,psychological guidance,financial burden relief and medical convenience.Knowledge or educational needs include disease-related knowledge,knowledge of daily care,and reliance on formal access.Psychological guidance needs include the need to talk and scientific relief of psychological pressure.The third part constructs the intervention program results: based on the Meleis transformation theory,combining the results of quantitative and qualitative studies,the results of literature content analysis and the recommendations of expert discussion,initially constructs the intervention program for the care burden of family caregivers of patients with liver cirrhosis.The intervention program aims to reduce the caregiver burden of family caregivers of patients with liver cirrhosis,improve their mental health and quality of life,and promote the quality of family care for patients with liver cirrhosis.Teaching knowledge,training skills and psychological intervention as the intervention content.The intervention team consisted of 1 liver disease expert,1 psychologist,1nutrition expert,1 pharmacist,2 clinical nurses and the researcher himself.In order to further test the application effect of the intervention program in the follow-up study,a preliminary research plan was developed.Conclusion:(1)In China,caregiver burden of family caregivers for patients with liver cirrhosis is at a moderate level,so it is very important to construct an intervention plan to reduce caregiver burden of family caregivers for patients with liver cirrhosis.(2)Sense of coherence is a protective factor of family caregivers' caregiver burden in patients with liver cirrhosis and can be cultivated in the process of family caregivers' care of patients.Clinical nurses should explore the psychological motivation of family caregivers,pay attention to the burden of caregivers,and promote their mental health and quality of life.(3)Based on the Meleis' transformation theory,combined with the results of quantitative and qualitative research,the results of literature content analysis and the recommendations of expert discussion,the intervention plan for the care burden of family caregivers of patients with liver cirrhosis was preliminarily constructed.The intervention plan was based on theoretical basis and fully considered the needs of family caregivers of patients with liver cirrhosis.Therefore,it is expected that this intervention program can provide reference for clinical nurses to formulate intervention measures to reduce the caregiver burden of family caregivers of patients with liver cirrhosis,and play a positive role in promoting the mental health and life quality of family caregivers of patients with liver cirrhosis and improving the care quality of patients with liver cirrhosis.