Application Research Of Family-centered Care Intervention Based On “Timing It Right” In Patients With Acute Myocardial Infarction And Their Caregivers

Objective: To explore the care needs of caregivers of patients with AMI(acute myocardial infarction) in different phases based on TIR( “Timing It Right” framework), and analyze the dynamic change. Then making need-oriented family-centered care interventions based on the results of the qualitative research to investigate the effectiveness of care ability of caregivers and the prognosis of patients.Methods: Mixed methods research was used in the study. Part I: Qualitative study based on TIR framework. Phenomenological approach and purposive sampling method were used and 61 family caregivers from 5 different phases divided by TIR in the hospital of Suzhou participated in the semi-structured interview individually. Then making need-oriented family-centered care interventions based on the results. Part II: Implementation of TIR family-centered care interventions. A randomized controlled and single-blind trial was performed. Convenient sampling method was used and the recruited patients and their caregivers were spilted into 2 groups by randomized table. Control group received usual care, while intervention group received usual care and TIR family-centered care intervention, which included individual face-to-face program to both patients and caregivers during the stay in hospital, and receiving telephone and home visiting after discharge. Caregivers’ care ability, patients’ compliance, life quality and readmission rate were compared between those two groups at enrollment, before discharge, 3 month after discharge and 6 month later. SPSS 17.0 was utilized to analyze all the data.Results: Part I: Based on TIR framework, different care needs in five phases of AMI were extracted. They were(1)Emotional and mental support, family support, information about illness and treatment, disease knowledge and care skills and communication with the medical in diagnosis period;(2)Operational information, preoperative preparation, postoperative care skills, rehabilitation guidance and sharing the care with other family in perioperative of PCI;(3)The discharge process, follow-up treatment information, rehabilitation plan outside the hospital, guidance of patients’ role transformation and social economic aid in the discharge preparation;(4)Adjust home rehabilitation, reexamination guidance, need for continuity of nursing, knowledge about households save and buddy aid in adjustment period after discharge;(5)Continued home-visiting, community medical support, knowledge about disease prevention and aid to return to society in adaptation period. Part II: 101 patients with 51 in control group and 50 in intervention group in the end remained. All data at baseline were no statistical significant difference between those two groups. Intervention outcome shows as follows:(1)Care ability of caregivers in intervention group was significantly better than control group at all measuring times(P< 0.001); The graph of care ability in control group appeared rising in the first stage and then decrease, the other group still kept rising;(2)Patients’ compliance in intervention group significantly enhanced compared with control group(P<0.05) at all measuring times, but except alcohol(P>0.05);(3)Patients’ quality of life in both groups had improved at 3 month after discharge, however, there were statistical difference between those two groups(P< 0.001), and the quality of life in control group appeared downtrend later, the other group still kept rising;(4)Patients’ readmission rate in intervention group was lower than control group as time went on(P<0.05).Conclusions: The study indicated that family caregivers’ needs are different in different phases of AMI, and is dynamic changed. The TIR family-centered care intervention can effectively improve caregivers’ care ability, patients’ compliance and quality of life, and also decrease readmission rate.