A Study On Care-giving Competence, Care Burden And Care-related Education Needs Of The Primary Caregivers For The Patients After Major Surgery

Background:With the rapid development of medical technology, surgical complexity, technical difficulties, the risk degree of the surgery has been widely carried out, a large surgical patient increased year by year. Present in the control hospital costs and increase patient turnover trend, major surgery in patients with shorter hospital stay relatively in the past, making a large number of patients discharged from hospital after rehabilitation need to be completed. In addition, with the development of the social aging process, the proportions of elderly patients in the major surgery patients gradually increase. Therefore, regardless of the period of time during hospitalization or after discharge, the patient self-care ability of the surgical major surgery often fails to fully recover to need the care of others. Family member directly involved in the care of patients with disease duration is a Chinese tradition. In the rehabilitation process of patients discharged from hospital after major operation, family members of the patients are the main bearer of care work. There are many problems in family caregivers’ability to care and for their own emotional adjustment. The development of nursing gradually extended to communities and families from the hospital. The success of the operation does not mean the cure of disease, and postoperative care after discharge is equally important. In China, health care are still focused on hospitalized patients, and the research in the primary caregivers is still not deep enough. Therefore, the focus of care-giving competence, care burden and care-related education needs of the primary caregivers for the patients after major surgery has a vital role in the development of targeted interventions based on the ability to improve care for caregivers to promote caregiver well-being, and thus enhance the large level of support in patients undergoing surgery. This study aimed to assess the care-giving competence, care burden and care-related education needs of the primary caregivers for the patients after major surgery to explore the impact of the care load factors and the correlation between care-giving competence, care burden, and care-related education needs. Provide a theoretical basis for the provision of effective nursing interventions.Objectives:The objectives of this study are:(1) Developing Care-giving Competence Questionnaire (CCQ) in primary caregivers for patients after major surgery.(2) Investigating care-giving competence, care burden and care-related education needs of the primary caregivers for the patients after major surgery during hospitalization and after discharge.(3) Examining factors influencing care burden and care-giving competence.(4) Exploring the relationship among caregivers’care-giving competence, care burden, and care-related education needs.Methods:Based on a literature review, the framework of competency model, combined with our care and cultural background, the Care-giving Competence Questionnaire (CCQ) was developed and the reliability and validity of the questionnaire were examined. From July2010to January2011in two tertiary hospitals in ShaoXing City, the implementation of major surgery patients and their primary caregivers (350groups) for the survey. The primary caregivers’care-giving competence, care burden, and care-related education needs were assessed by Care-giving Competence Questionnaire (CCQ), Caregiver Burden Inventory (CBI) and Care-related Education Needs Questionnaire (CRENQ) during hospitalization and after discharge respectively.Results:1. When the care-related education needs (CREN) score index value is71.3%during the hospitalization; CREN after discharge index score is79.1%. CREN during the hospitalization focused on disease-related knowledge and understanding of surgery; CREN after discharge focused mainly on the communication with the medical staff, contacts, the construction and functional training and so on.2. Care-giving Competence Questionnaire (CCQ) showed good reliability and validity. The internal consistency determined by Cronbach a Coefficient was0.94. The split-half reliability was0.74. Index of content validity was0.89. four dimensions were determined by the measurement in construct validity of the questionnaire. The total score of Caregivers’Competence during hospitalization was51.07±14.16. The total score of Caregivers’ Competence after discharge was56.6±10.7. Witch was moderate."Surgery-related care knowledge" and "care-related technique" were the two dimensions scored relatively high, and "care behaviors and attitudes" and "decision-making and self-efficacy", the two dimensions of the relatively low scores.3. The total score of Caregivers’burden during hospitalization was44.86±15.42. The total score of Caregivers’burden after discharge was38.34±12.45. Primary caregivers for patients after major surgery are under moderate burden both during hospitalization and after discharge. The total score of Caregivers’burden after discharge period has been reduced than during hospitalization period. Whether during hospitalization or after discharge, caregivers’time-dependent load of the burden is the most serious, followed by the development limited load, the physiological load; social and emotional load are light.4. With different demographic characteristics of caregivers, their care burden, care-giving competence and CREN of the differences were statistically significant. Multiple linear stepwise regression analysis showed that human family support, number of days in ICU after surgery, and Caregivers’Competence after discharge were significant predictors of caregivers’burden. Different levels of CREN were of the different composition of their care-giving competences. There is significant correlation between the care-giving competence and the CREN. Care-giving competence and care burden were negatively correlated (r=-0.25, P<0.01).Conclusions:The results showed that self-developed Care-giving Competence Questionnaire (CCQ) has good reliability and validity. It showed moderate levels of burden in primary caregivers for patients after major surgery both during hospitalization and after discharge. The findings showed that the primary caregiver’competence were at the middle level, there was great room for improvement; caregiver’competence after discharge has increased over the period during hospitalization. The results also showed that there was a high CREN in the primary caregivers for patients after major surgery both during hospitalization and after discharge. Medical staff should treat the patients after major surgery and their caregivers as a "patient-caregiver dyad"; while the patients were given treatment and care, their caregivers’ competence, care burden and CREN should be concerned. To develop targeted interventions for caregivers, the procedure-related factors, family factors and the impact of demographic characteristics should take into account, so as to enhance the ability of caregivers, improve care for patients after major surgery and their quality of life.