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As aging population and critical care technique improving, patients with prolonged mechanical ventilator use increased which insults in longer hospital stay and over one fifth of healthcare utilization. The growing cost in Taiwan compared with ten years ago, increased nearly 200%. Under the integrated delivery system (IDS) care model for prolonged ventilator use patients, they transferred from intensive care unit to the step down units, so sub-acute respiratory care center (RCC) plays an important role between acute intensive care and long term care. In this process, patient’s family encountered multiple dilemmas, such as role changes of becoming a major decision maker and primary caregiver, over expectation for respiratory training, and hesitation for subsequent care, etc. Most previous studies explored home ventilator used patients whose primary caregiver’s burden, care needs, role adaptation and life experiences, few studies investigate the family care needs, stress and depression status during hospitalization of RCC stay. So the purposes of this study will focus on primary caregivers of prolonged ventilator use patients during this stage, and explore their care needs, needs satisfaction, stress and depression status, and analyze the correlated factors of those variables.
Methods:
This is a prospective designed study, participants were caregivers of prolonged ventilator use patients, who were above 18 years old, willing to participate and signed the informed consent. After recruitment, questionnaires data were collected when patients were transferring in and out from RCC. Study instruments included caregivers’ demographic characteristics sheet, care needs questionnaire (researcher self-designed), perceived stress (Perceived Scale, PSS) and depression (Center for Epidemiological Studies Scale, CES-D Chinese version) questionnaire.
Results:
A total of 73 patients completed the questionnaire, 41 were males (56.2%), 53 were married (72.6%), 62 accepted the tracheostomy (84.9%), with mean age of 71.35 ± 12.59 years old. Disease severity (APACHE II scores) were 14.62 ± 5.00. Primary caregivers distributed in gender fairly, mainly were the children of patients (63%), with an average age of 52.27 ± 15.73 years old. The length of time of care the patients was average 5.85 years, 7.53 hours per day.
Primary caregiver’s self-reported health status when patient transferring into the RCC was 3.57 ± 0.87 on average, between the fair to good health. On the health care needs, the medical-related care needs were the highest one, followed by psychological needs. The medical-related care needs were also the most satisfied needs than others. The mean score of PSS was 28.71 ± 5.85, indicated caregivers have moderate level stress. The mean score of CES-D was 17.3 ± 7.55, indicated depressive tendency.
After transferring out from RCC, primary caregivers self-reported health status was 3.64 ± 0.82, slightly better than the scores while transferring into RCC. Medical-related care needs were still the highest care needs and also the most satisfied care needs. Perceived stress status (28.36 ± 5.18) was similar, still have moderate stress. CES-D scores (17.36 ± 8.24) were slightly higher, indicated remained depressive tendency.
Paired t test was used to test the changes of primary caregiver self-reported health status, care needs, satisfaction of care needs, stresses and depression status between transferring in and out of RCC. The data showed that only medical-related care needs decreased significantly.
The regression analysis was used to test the related factors of affecting caregivers’ care needs, needs satisfaction, stress and depression. The results showed that this regression model only 31.9 percent explanation power, adjusted R-square 11.8 percent, indicated no statistical significance (F(10,34 ) = 1.59, p = 0.152), represented that no related factors were found to affect care needs, needs satisfaction, stress and depression in this study.
Conclusion:
This study results showed that the highest care needs for caregivers of prolonged ventilator used patients were medical-related and psychological needs, which were also the most satisfied care needs. In addition, they encountered moderate stress and have depression tendency. Compared to the results of transferring in and out of RCC, only medical-related care needs decreased significantly. This result denotes that prolonged ventilator use is a long term problem for primary caregiver, it’s not can be changed in the short term while hospitalized in RCC. Even transferring out of RCC and receiving next stage care, such as long-term respiratory care ward or home ventilator care, primary caregivers still have to confront different problems. It is a long-term care issue. To solve the care needs of primary caregivers, stress and depression status, we suggest it should be proceed from the national health care policy and then really solve the problem.