Research Of Intervention Based On The “Timing It Right” Framework On Care Burden And Quality Of Life Among Stroke Caregivers

Purpose The purpose of this study is to establish a nursing intervention model for stroke caregivers based on the “Timing it right” framework,and to study the influence of the intervention model based on the “Timing it right” framework on care burden,depression level and quality of life of stroke caregivers at different times,which will provide theoretical and practical basis for extending nursing services to families and communities.Method A total of 102 caregivers of stroke patients hospitalized in the department of neurology of one tertiary hospital in Qingdao from January 2018 to May 2018 were selected with convenient sampling method.According to the sequence of admission,they were divided into control group and intervention group by the random number table method.Routine nursing and discharge guidance were given in control group.Intervention model based on the “Timing it right” framework was given in intervention group,which can be divided into five stages,including diagnosis period(1~3 days after admission),stability period(4~10 days after admission),hospital preparation period(1~2 days before discharge),adjustment period(within 3 months after discharge)and adaptation period(6 months after discharge).The TIR health education manual is distributed to caregivers in all periods.The first three periods of the intervention were completed during hospitalization: including daily face-to-face teaching,skill guidance,and emotional communication.The last two periods of the intervention were performed after discharge,including regular telephone follow-ups and 3 and 6-month in-patient visits.Zarit Caregiver Burden Interview(ZBI),Self-rating Depression(SDS)and the Mos 36-item Short Form Health Survey(SF-36)were evaluated to caregivers before discharge,3 and 6 months after discharge,and the recurrence rate of stroke patients was evaluated 6 months after stroke.Statistical software SPSS 21.0 was used to analyze and process the data.Descriptive analysis,two-independent sample t test and repeated measurement analysis of variance were used to analyze the influence of the intervention based on the timing theory on the care burden of stroke caregivers,depression level,quality of life and the recurrence rate of stroke patients 6 months after stroke.Results 1.There was no statistically significant difference in two groups in the baseline data of demographic and sociological information,care burden,depression level quality of life before intervention(P>0.05).2.The ZBI total score and each dimension score :(1)The results of repeated measurement anova showed that the time effect,intervention effect and interaction effect of the total score of care burden,individual burden dimension score and responsibility burden dimension score were statistically significant(P<0.05).It shows that the time factor has an effect on the total score of care burden and the score of each dimension,and decreases with the increase of intervention time.Intervention factors had an effect on scores,and at different time points,the scores of the intervention group were lower than those of the control group,with statistically significant differences(P<0.05).There was an interaction between the time factor and the intervention factor,and the two groups had different scoring trends at different time points.(2)There was a statistical difference in the composition ratio of care burden between the two groups at 6 months after discharge(P<0.05).3.The SDS depression scores of the two groups of subjects:(1)The results of repeated measurement analysis of variance showed that the time effect,intervention effect and interaction effect of SDS depression score were statistically significant(P< 0.05).It indicates that time factor has an effect on SDS depression score and decreases with time.Intervention factors had an impact on scores,and at different time periods of intervention,the SDS depression score of the intervention group was lower than that of the control group,with statistically significant differences(P< 0.05).There was an interaction between the time factor and the intervention factor,and the two groups had different scoring trends at different time points.(2)There was a statistical difference in the incidence of depression between the two groups,at 6 months after discharge(P < 0.05).4.The SF-36 quality of life scores of the two groups of subjects were shown by repeated measurement analysis of variance:(1)The differences of time effect,intervention effect and interaction effect of total PCS score,total MCS score and RP,VT,SF,RE and MH dimension scores of the two groups were statistically significant(P<0.05).It indicates that the time factor has an effect on the scores,and the scores tend to increase with the extension of time.Intervention factors had an impact on the scores.At different time points,the scores of the intervention group were significantly higher than those of the control group(P<0.05).The interaction between the intervention factor and the time factor was significant(P<0.05),indicating that at different time points,the change trend of the scores of the two groups was different.(2)Only the time effect of PF,BP and GH dimension scores were statistically significant(P<0.001).Further analysis showed that the scores of the two groups increased with the extension of time.5.The recurrence rate of stroke patients at 6 months after stroke of the intervention group was lower than that of the control group after the end of the intervention(?~2=4.358,P <0.05)?Conclusion 1.Intervention based on the “Timing it right” framework can significantly reduce the care burden and depression level of stroke caregivers and effectively improve the quality of life,but has little impact on physiological function and general health.2.Intervention based on the “Timing it right” framework can significantly reduce the recurrence rate of stroke patients at 6 months after stroke.