| Objective To investigate the status and the influencing factors of family caregivers accompanying and nursing guidance in Hepatobiliary Surgery ward,explore the influence of families accompany on the quality of life in patients with liver cancer,provide reference basis for the medical staffs to accurately guide the family members and give full play to the role of family and social support,improve the quality of life in the patients with liver cancer.Methods This research is a cross-sectional survey and correlation study,in this study,a convenience sampling method was used for questionnaire survey.The research instruments included the quality of life scale and 3 kinds of self-designed questionnaires(the patients',the accompanying family members' and the medical staffs' respectively)on the status quo of the family caregivers accompanying in the wards.First,the 3 different self-designed questionnaires were adopted to assess the present condition of the family members accompanying care in the Hepatobiliary Surgery wards,137 resident patients with liver cancer,189 cases of accompanying family members and 70 cases of nurses and doctors in the first and second department of hepatobiliary surgery of Tumor Hospital of the Guangxi Medical University from September2015 to January 2017 were recruited to this study by convenience sampling method.We used the questionnaires of patients' and accompanying family members' to investigate the details of accompanying demands,accompanying cognition and behaviors and the effects of accompanying care and the guidance needs among the patients and their accompanying family members.And the accompanying care questionnaires of medical stuffs were used to understand doctors and nurses' views and evaluation to the accompanying care of family members,and to understand the status quo of accompanying guidance among them.On this basis,101 hospitalized patients with liver cancer who matched with the accompanying family members were picked to assess the quality of life by the European of the Quality of Life Questionnaire-Carcinoma30(EORTC QLQ-C30)and the Quality of Life Questionnaire-Hepatocellular Carcinoma18(QLQ-HCC18).The data was analyzed using the SPSS statistical Version 22.0,Statistical method include descriptive statistics,Chi-square test,Rank-sum test and Spearman single factor correlation analysis.ResultsAmong the accompanying family members,56.1% were single caregivers,85.2% were the direct relatives of the patients,61.4% were 24 hours full-time caregivers,and 65.5% had no previous nursing experience.More than 99.5% of the accompanying family members were willing and feel that they have the responsibility to accompany patients,more than 86% of the patients believed that their families have the responsibility to accompany themselves,and indicated that accompanying care gived by family members would be of great benefit to their recovery.The things accompanying family members do most is totake care of their patients' daily living.The proportion of accompanying family members who talked with the patients only 2.1~4 hours per day accounted for the most(38.1%,72/189).The proportion of accompanying family members who could often encourage patients to pour out their inner thoughts,eating together with the patients,said very understand the inner feelings of the patients were about 60%respectively,and 50.8% of the families often gazed at the patients' face/eyes,but only about 10% of the families could effective in relieving the patients' depression and anger.There were about 85%respectively of accompanying family members could greatly assist patients with infusion,treatment,closely observed the patients' condition and report timely when it became abnormal,however,the proportion of the families who little know about the pressure sore,hospital infection,the curative effect of the disease were reach 81%,84.6% and 58.7% respectively.The proportion of doctors,nurses,patients and their families who very satisfied with the family caregivers accompany effect were 3.2%,0%,55.5% and 13.2%respectively.the difference was statistically significant(P < 0.05).The families caregivers are the patients' children,come from county / City,aged less than 38 years,college degree or above,annual income more than 40 thousand yuan,workers and institutions of civil servants and soldiers,with some caring experience,per patient had one accompanying family caregivers at least,caregivers daily chat with patients > 4h,24 hours escort were relevant with good accompanying effect,and the difference was statistically significant(P< 0.05).Whether on the patients' first day of admission or duration of hospital stay,about 70% of nurses communicated with the patients or the accompanying families less than or equal to 10 minutes per day.There were 45% of doctors communicated with the patients in 10~20 minutes on the first day of admission,about 60% communicated with the patients or the accompanying family members less than 10 minutes per day on the duration of hospital stay.61.5% of nurses and 51.6% of doctors could often provide guidance for the patients' accompanying family caregivers.The most common ways of accompany guidance used in doctors and nurses were face to face instruction such as bedside instruction on the patients and on-site demonstration or office talk.The least frequently used methods were push knowledge by QQ/We Chat or play instructional videos.Comparison of two and rank sum test revealed that the doctors and nurses had low satisfaction on their accompany guidance,the medical staff,patients and especially patients' families members think accompanying guidance is essential;doctors and nurses with different education,gender,occupation,professional title,work experience were affect to their cognition of guiding accompanying difficulties,the best accompanying ways of guidance and optimal guidance content,the difference was statistically significant(P< 0.05).The total score of quality of life(QOL)in patients with liver cancer was(53.3 ±27.24),the score of social function was(53.14 ± 30.43),The gender,age,origin,nationality,education level,annual income and accompanying behavior of the patients with liver cancer were significantly affected by the quality of life(QOL)and symptom scores of the patients with liver cancer(P<0.05).The factors associations with the high QOL scores of inpatients with liver cancer were : the accompanying families' gender,education level,origin,age,and the accompanying behaviors including eat together,daily time of accompanying care,watching with accompanying eye / face,irritability and depression remission in patients with emotional effect,or to urge patients back /massage / bath / brush your teeth / hair / nails etc.ConclusionThe hospitalized patients with liver cancer had strong demands for accompanying care gived by their family members.The present effect of family members' accompanying care in the Hepatobiliary Surgery wards was unsatisfactory.The family members' demographic characteristics,previous experience in accompanying care,the daily accompany time,the daily chat with the patients' time and the number of daily accompanying family caregivers werethe main influencing factors.The professional training for the accompanying family caregivers in the Hepatobiliary Surgery wards was ineffective,there is a significantly needs about give accompany guidance to the families.The medical staffs' demographic factors and length of service affect the effect of accompany guidance in the wards,optimizate and integrate the human resources of the medical staffs can improve the efficiency of accompany care guidance.The overall quality of life in the hospitalized patients with liver cancer were poor,specially in social function areas.The accompanying family members' demographic variables,the families' accompany cognition and behaviors,and the families' consciousness,behavior and effect of psychological counseling to the patients are the influencing factors of quality of life in patients with liver cancer.Improving the accompany guidance in the wards and the effect of family caregivers' accompanying would improve the quality of life of the patients with liver cancer. |
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