Evaluation Study On Home Care Quality Of Stroke Victims In Fuzhou

Objectives:(1) To develope and test the Home Care Quality Scale for Stroke Victims to provide a quality evaluation instrument on home care.(2) To explore home care quality of stroke victims and its related factors.(3) To propose countermeasures for quality improvement of stroke victims'home care.Methods:There were two parts in the study:(1) Developement and test of Home Care Quality Scale for Stroke Victims: The scale was developed by revising the Family Care Quality Scale with Maslow's Human Needs as the basis. Content validity of the scale was evaluated by seven specialists. Construct validity and internal consistency were tested at the base of an investigation on 173 stroke victims in community, while interrater reliability was tested by the data of 50 subjects among those.(2) Exploration of home care quality and its related factors of stroke victims in Fuzhou:A convenient sample of 166 stroke victims discharging from two provincial and three municipal general hospitals from 2003 to 2006 was taken. The study last from October, 2006 to January, 2007. Data was collected by Barthel Index, the Chinese version of Caregiver Stress Index, Home Care Quality Scale for Stroke Victims and two self-made questionnaires of general information. The descriptive statistics and stepwise regression analysis were adopted.Results:(1)An evaluation scale with 5 dimensions was shaped, including 27 items. Content validity index of the scale was 0.97. With the method of factor analysis dimension by dimension, three factors were extracted in the physiological dimension----"personal hygiene and grooming","nutrition, hydration and skin integrity"and"functionality problem treatment"; and two factors extracted in the safety dimension----"medical treatment"and"home environment"; and one factor each in the love and adscription, self-esteem and self-actualization dimension. It was consistent with the original scheme on the whole. The internal consistency (Cronbach's alpha) of the scale was 0.9135, and the interrater reliability was 0.851.(2)The total score of home care quality was 74.52±12.14 points. Among the 5 dimensions, the score of safety care was the highest, while those of self-actualization care and love and adscription care were the lowest. Among the 27 care items, the first 5 items in score were"family medication","head and face cleanness","security of lying in bed","sleeping space"and"bedroom neatness and security"; while the last 5 items in score were"hydration","expression","relapse prevention of stroke","meeting friends or others", and"social adjustment".(3)It showed by stepwise regression analysis that the home care quality was negatively related to stroke victims'age and primary family caregivers'caregiving stress; and positively related to victims'education level, cooperation level, economic status, and to primary caregivers'specialized guidance quantity, co-caregiver quantity and physical status.(4)Of 166 stroke victims, 60.8% had hemiplegia, and 25.3% had aphemia. Most of them were slightly dependent (about 53.6%). 16.8% victims didn't cooperate with their caregivers well.(5)Of 166 primary caregivers, 60.2% were the stroke victim's spouse; 76.5% had junior high school education or lower; 44.0% had no specialized guidance; 39.2% had no co-caregivers; 39.2% had caregiving stress; 28.9% were not in good physical status.Conclusions:(1)This study showed that Home Care Quality Scale for Stroke Victims had good reliability and validity. It could be used to evaluate home care quality of stroke victims. (2)Stroke victims'psychosocial needs, especially love and adscription needs and self-actualization needs were not well satisfied, which affected the whole quality of home care for stroke victims.(3)Stroke victims'age, education level, cooperation level, economic status, and primary caregivers'caregiving stress, specialized guidance quantity, co-caregiver quantity and physical status were significant related factors of stroke victims'home care quality.(4)Nurses could provide specialized guidance for family caregivers to strengthen their care knowledge and skill, help caregivers assess stroke victims'needs and their satisfaction, and assist caregivers to get attending resource from social support so as to improve quality of home care for stroke victims.