The mediating effect of psychological resilience between caregiver burden and quality of life of caregivers of tuberculosis patients

doi:10.19982/j.issn.1000-6621. 20210442

Abstract

Abstract:

Objective: To explore the relationship among the caregiver burden, psychological resilience and quality of life in caregivers of pulmonary tuberculosis patients. Methods: From May to June 2021, the caregivers of tuberculosis patients hospitalized in Hebei Chest Hospital were selected as the research subjects by cluster random sampling method. The maximum number of items in this survey was 25, to assure the sample size to be 5-10 times the maximum number of items, and considering 20% questionnaires to be invalid, the sample size was estimated to be 150-300. The final sample size was 200. The researchers collected general information questionnaire, ZBI, CD-RISC and the FAMQOL. Results: Finally, 200 questionnaires were obtained. After removing 22 invalid questionnaires, the score of caregiver burden of 178 subjects was 36.50±12.77, the score of quality of life was 52.74±9.46 and the resilience was 57.51±15.91. Pearson correlation analysis showed that caregiver burden was negatively correlated with quality of life and resilience (r=-0.463, P<0.001; r=-0.400,P<0.001); quality of life was positively correlated with resilience (r=0.522, P<0.001). Resilience played a partial mediating effect between caregiver burden and quality of life (β (95%CI)=-0.119(-0.176--0.069)). Multiple linear regression analysis showed that the patient self-care ability (t=2.985, P=0.003), patients with chronic diseases (t=3.230, P=0.001), the caregiver’s education level (t=-2.146, P=0.033), financial level (t=-2.209, P=0.029), accompanying chronic diseases (t=3.286, P=0.001), and care time (t=2.458, P=0.015) were influencing factors of care burden. Conclusion: The caregivers of pulmonary tuberculosis patients had caregiver burden, medium level of psychological resilience and quality of life. Resilience played a partial mediating effect. Therefore, the caregiver burden in clinical nursing work should arouse attention, and positive psychological interventions can be taken to improve the psychological coping and adaptability of caregivers, reduce the level of caregiver burden, and improve quality of life.

Key words: Tuberculosis, Nursing care, Quality of life, Resilience,psychological, Mediating effect

AN Xin, LI Yu-zhuo, ZHANG Dan, WANG Qiu-shuang, WANG Jian-mei, MA Jing-hua. The mediating effect of psychological resilience between caregiver burden and quality of life of caregivers of tuberculosis patients[J]. Chinese Journal of Antituberculosis, 2022, 44(1): 83-90. doi: 10.19982/j.issn.1000-6621. 20210442

Figures/Tables 8

项目	得分(分, $x ¯$ ±s)
照顾负担总分	36.50±12.77
个人负担	20.46±6.94
责任负担	9.37±4.48
心理弹性总分	57.51±15.91
力量	19.24±5.88
坚韧	29.58±8.45
乐观	8.69±2.67
生活质量总分	52.74±9.46
生理维度	15.16±2.87
社会维度	12.90±2.60
精神维度	13.31±3.44
心理维度	11.36±2.88

项目	人数[例/名(构成比,%)]	得分(分, $x ¯$ ±s)	统计检验值	P值
患者一般资料
性别			1.545^a	0.124
男性	92(51.7)	37.92±13.67
女性	86(48.3)	34.97±11.61
年龄组(岁)			0.529^b	0.663
0~18	15(8.4)	38.80±14.98
19~44	83(46.6)	36.62±13.22
45~59	42(23.6)	37.26±14.00
60~90	38(21.4)	34.47±9.14
文化程度			2.167^b	0.094
小学及以下	27(15.2)	36.70±8.52
初中	66(37.1)	33.50±11.55
高中	52(29.2)	39.02±14.69
本科及以上	33(18.5)	38.36±13.96
自理能力			5.828^b	0.004
完全自理	116(65.2)	35.26±11.72
部分自理	56(31.5)	37.78±13.09
完全不能自理	6(3.3)	52.16±19.07
病程(月)			0.531^b	0.589
≤6	157(88.2)	36.74±12.69
7~12	12(6.7)	32.83±14.65
>12	9(5.1)	37.11±12.23
项目	人数[例/名(构成比,%)]	得分(分, $x ¯$ ±s)	统计检验值	P值
是否伴有其他慢性疾病			3.954^b	0.009
无	102(57.3)	34.03±12.67
1种	53(29.8)	38.33±11.24
2种	19(10.7)	42.73±13.75
≥3种	4(2.2)	45.25±16.50
照顾者一般资料
性别			-0.640^a	0.523
男性	76(42.7)	35.78±11.34
女性	102(57.3)	37.03±13.76
年龄(岁)			4.395^b	0.014
19~44	100(56.2)	34.70±11.48
45~59	66(37.1)	40.03±14.41
60~90	12(6.7)	32.08±9.26
文化程度			5.576^b	0.001
小学及以下	18(10.1)	38.33±9.17
初中	70(39.3)	40.25±13.69
高中	48(27.0)	35.43±12.45
本科及以上	42(23.6)	30.66±10.67
经济水平(元/月)			2.337^a	0.021
≤3000	111(62.4)	38.22±12.85
>3000	67(37.6)	33.65±12.20
是否伴有其他慢性疾病			10.707^b	0.000
无	93(52.3)	35.13±12.07
1种	59(33.1)	33.86±11.28
2种	19(10.7)	43.95±13.15
≥3种	7(3.9)	56.71±8.94
照顾时长(h/d)			4.276^b	0.016
≤6	60(33.7)	33.22±12.35
7~12	67(37.6)	36.10±10.51
>12	51(28.7)	40.88±14.78
与患者关系			2.388^b	0.071
夫妻	66(37.0)	39.05±12.67
父母	46(25.9)	32.61±10.38
子女	46(25.9)	36.35±14.23
其他^c	20(11.2)	37.40±13.25

自变量	s $x ¯$ 值	β值	t值	P值
常数项	5.188	-	5.176	<0.001
患者
自理能力	1.567	0.202	2.985	0.003
伴有慢性病情况	1.135	0.222	3.230	0.001
照顾者
文化程度	0.937	-0.145	-2.146	0.033
经济水平	0.897	-0.151	-2.209	0.029
伴有慢性病情况	1.155	0.245	3.286	0.001
照顾时长	1.054	0.160	2.458	0.015

项目	标准化效应值	s $x ¯$ 值	95%CI值		相对效应值(%)
项目	标准化效应值	s $x ¯$ 值	下限	上限	相对效应值(%)
总效应(C)	-0.343	0.047	-0.428	-0.249	-
直接效应(c')	-0.224	0.043	-0.308	-0.136	65.30(-0.224/-0.343)
中介效应(a×b)	-0.119	0.027	-0.176	-0.069	34.69(-0.119/-0.343)

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患者自理能力分级	定义	生理方面	心理方面
完全自理	能够独立完成日常生活活动的六项内容	长期陪床,根据患者需求帮助患者进行日常生活活动及医疗护理任务	以陪伴和聊天的方式倾听患者负性情绪表达,给予患者心理慰藉及情感支持
部分自理	可独立完成部分日常生活活动的六项内容,仍需他人辅助,如有明显临床症状的活动性肺结核患者	(1)辅助患者完成吃饭、穿衣、上下床、上厕所、洗澡及室内走动的日常生活活动;(2)协助患者进行用药、皮肤护理、口腔护理、缴费等医疗护理任务;(3)对于有咳痰症状的患者,其痰液具有传染性,照顾者需帮助进行防护性痰液处理;(4)对于有咯血症状的患者,照顾者需时刻关注咯血情况并给予帮助	倾听患者负性表达情绪,尤其是患有咯血症状的患者,患者担心疾病预后存在焦虑抑郁情绪,照顾者需给予患者心理及情感支持。另外照顾者更加担忧肺结核患者咯血症状恢复情况,心理压力增大,在为患者提供心理支持前需自我调适
完全不能自理	日常生活活动的六项内容全部需他人辅助,如绝对卧床或认知功能障碍的患者	(1)完全帮助患者完成吃饭、穿衣、上下床、排泄、洗澡等日常生活活动;(2)完全帮助患者进行用药、护理、缴费等医疗护理任务;(3)对于有咯血咳痰的患者,照顾内容同部分自理能力的患者	特别是意识清楚的患者,照顾者通过语言、肢体、表情等措施与患者建立沟通,并通过交流掌握患者面部表情、语调,以及肢体动作等行为表达的含义,给予患者心理慰藉及情感支持