The Development and Evaluation of Navigation Program for Caregivers of Stroke Patients Admitted to a Rehabilitation Centers: A Pilot Study

Nam Hee Kim; Young Sook Tae

doi:10.7475/kjan.2018.30.3.277

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Kim and Tae: The Development and Evaluation of Navigation Program for Caregivers of Stroke Patients Admitted to a Rehabilitation Centers: A Pilot Study

Original Article

Korean J Adult Nurs 2018;30(3):277-289.

Published online: 21 June 2018

DOI: https://doi.org/10.7475/kjan.2018.30.3.277

The Development and Evaluation of Navigation Program for Caregivers of Stroke Patients Admitted to a Rehabilitation Centers: A Pilot Study

Nam Hee Kim¹, Young Sook Tae^2,

¹College of Nursing, DongEui Institute Technology University, Busan, Korea

²College of Nursing, Kosin University, Busan, Korea

Corresponding author: Tae, Young Sook https://orcid.org/0000-0002-8331-0471 College of Nursing, Kosin University, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea. Tel: +82-51-990-3956, Fax: +82-51-990-3031, E-mail: taehope@kosin.ac.kr

Received 2 February 201823 May 2018 Accepted 5 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to develop a navigation program for family caregivers of stroke patients admitted to a rehabilitation hospital and evaluate differences in caregiver outcomes before and after the intervention.

Methods

The navigation program consists of education, demonstration and return demonstration. To evaluate the program, we conducted a quasi-experimental study in 44 caregivers (22 experimental group received the navigation program vs. 22 controls group did not received). Caregivers completed the burden, anxiety, depression, self efficacy, caregiving mastery, quality of life, and patient's Activities of Daily Living (ADL). Data were collected using self-report structured questionnaires. The data were analyzed using the SPSS/WIN 21.0 with the x²-test, and independent t-test.

Results

Compared with the control group, caregivers who received the navigation program reported significant decrease in caregiver burden, depressive symptoms and anxiety and significant improvement in their mastery, self-efficacy, quality of life and patient's ADL.

Conclusion

Delivering the navigation program to family caregivers of stroke patients in a rehabilitation hospital setting was feasible. Our results provide preliminary support for the navigation program to reduce negative outcomes (e.g., burden, anxiety, depression) and improve positive outcomes (e.g., mastery, self efficacy, quality of life, patient's activities of daily living) in family caregivers who experience first stroke diagnosis of their loved one.

Keywords: Rehabilitation centers, Caregivers, Stroke, Educational activities, Program

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Table 1.

Contents of the Navigation Program

Session	Theme	Conceptual Framework of Navigation	Activity	Contents of Intervention	Min
1	Primary caregiver' improvement in self-caring and fatigue management	- Encouragement	Education & Demonstration & return demonstration	․ To give gift following pre-survey	60
		- Support		․ Relaxation training
				․ Fatigue management (stretching), (aromatic hand massage)
				․ Self-exercise for relieving low back pain
2	Primary caregiver's psychological stress management	- Information continuity	Education & Demonstration & return demonstration	․ To introduce Strategies to improve positive psychology	20
		- Encouragement		․ To write positive cover letter
		- Positive coping - Support		․ To record three things that I can do right now to become happier than now
		- Support
	Understanding of stroke	- Information continuity	Education	․ To start post-stroke rehabilitative therapy and its intensity	50
		- Management continuity		․ To evaluate patient's functioning before starting rehabilitative therapy
				․ Post-stroke physical and occupational therapy
				․ To manage complications of stroke
3	Primary caregiver's improvement in positive psychology	- Information continuity	Education & Demonstration & return demonstration	․ To introduce methods of stress management ․ Training in optimism	20
		- Encouragement		․ Happiness journal (task notes)
		- Positive coping
		- Support
	Improvement in caring mastery	- Information continuity	Education & Demonstration & return demonstration	․ To demonstrate and practice Body mechanics ․ Safety precautions in home environment	30
		- Management continuity		․ Correct procedure of Endotrachial suction	20
		- Encouragement		․ Prevention of aspiration pneumonia
		- Positive coping
4	Primary caregiver's improvement in positive psychology	- Encouragement	Education & Demonstration & return demonstration	․ Identifying individual strengths and weaknesses	20
		- Support - Positive coping		․ To apply behavioral value scale to evaluate strengths	20
				․ To keep happiness and appreciation journals (task notes)	30
	Improvement in caring mastery	- Information continuity - Management	Education & Demonstration & return demonstration	․ To learn exercises for stroke patients (to improve muscle strength, manipulation, gross motor skills, and movements in daily living)	30
		continuity - Encouragement	Education & Demonstration & return demonstration	․ Methods of improving activities of daily living for stroke patients	20
		- Positive coping		․ Methods of training in instrumental activities of daily living and precautions
				․ Cognitive disorder (orientation, concentration, memory, performance)
				․ Language impairment (symptoms of language impairment for stroke patient, use of communication board for aphasic)
				․ Self-training for effective communication
5	Primary caregiver's improvement in positive psychology	- Information	Education & Demonstration & return demonstration	․ To introduce and practice positive talk	20
	Primary caregiver's improvement in positive psychology	continuity - Encouragement - Positive coping - Support	Education & Demonstration & return demonstration	․ To record at least 1 case of positive talk application (task notes)	20
	Improvement in caring mastery	- Information continuity	Education & Demonstration & return demonstration	․ Exercise for dysphagia patient	30
	Improvement in caring mastery	- Information continuity		․ Guidelines for eating with dysphagia
		- Management continuity - Encouragement		․ L-tube & PEG management
		- Management continuity - Encouragement		․ Definition and prevention of bedsore	20
		- Encouragement - Positive coping		․ To introduce tools helpful in preventing bedsore	20
6	Primary caregiver's improvement in positive psychology	- Encouragement	Education & Demonstration & return demonstration	․ To explain benefits of appreciation	20
		- Positive coping		․ To write appreciative letter
		- Support
	Improvement in caring mastery	- Information	Education & Demonstration & return demonstration	․ Symptoms of stroke (FAST)	50
	Improvement in caring mastery	continuity - Management		․ Methods of coping with emergency and contact information about relevant institutions
		continuity - Encouragement		․ To understand need of CPR for people in general through images
		- Positive coping		․ To learn CPR through instructor's demonstration
				․ To practice CPR
7	Primary caregiver's improvement in positive psychology	- Encouragement - Positive coping	Education & Demonstration & return demonstration	․ To deliver benefits of forgiveness and share experiences of forgiveness	20
	Primary caregiver's improvement in positive psychology	- Support	Education & Demonstration & return demonstration	․ Forgiveness training and activity	20
	Understanding of social welfare system and resources for stroke patients	- Information	Education	․ CVA grade	50
		continuity		․ Language impairment grade
		- Management		․ Assisting device prescription
		continuity		․ Longterm care insurance for the aged
		- Support		․ Means of transportation
8	Evaluation of improvement in positive psychology and consolidation	- Encouragement - Support	Evaluation & Completion	․ Evaluation of effects of psychological and emotional nursing in this program ․ Evaluation of changes in one's own behavior after completion of program ․ To keep rolling paper for encouragement ․ To deliver certificate of completion	30
	Consolidation of entire program	- Management continuity	Consolidation	․ Complete checking and counseling about contents of training	60
		- Encouragement		․ To give gift following post-survey
		- Support		․ To write impression after application of program

PEG=percutaneous endoscopic gastrostomy.

FAST=face, arms, speech, time; CPR=cardiopulmonary resuscitation; CVA=cerebrovascular accident.

Table 2.

Homogeneity of General Characteristics between Experimental Group and Control Group (N=44)

Subjects	Characteristics	Categories	Exp. (n=22)	Cont. (n=22)	x²	p
Subjects	Characteristics	Categories	n (%)	n (%)	x²	p
Caregivers	Gender^†	Men	1 (4.5)	1 (4.5)	0.00	.999
	Gender^†	Women	21 (95.5)	21 (95.5)
	Age (year)	50	2 (9.0)	4 (18.2)	0.78	.676
		50~59	7 (31.9)	6 (27.3)
		60~64	13 (59.1)	12 (54.5)
	Family relation to patient	Spouse	20 (91.0)	16 (72.8)	3.64	.162
		Children	0 (0.0)	3 (13.6)
		Others	2 (9.0)	3 (13.6)
	Education	≤ Elementary school	5 (22.7)	6 (27.3)	1.12	.772
		Middle school	7 (31.8)	6 (27.3)
		High school	6 (27.3)	8 (36.4)
		≥ College	4 (18.2)	2 (9.0)
	Job^†	Yes	2 (9.0)	3 (13.6)	0.23	.999
	Job^†	No	20 (91.0)	19 (86.4)
	Economic status	Usual	10 (45.4)	7 (31.9)	1.62	.445
		Little difficulty	6 (27.3)	10 (45.4)
		Very difficulty	6 (27.3)	5 (22.7)
	Religion	Christianity	3 (13.6)	3 (13.6)	0.13	.988
		Buddhism	12 (54.6)	13 (59.1)
		Others	1 (4.5)	1 (4.5)
		No	6 (27.3)	5 (22.8)
	Current period of caregiving (month)	≤12	9 (40.9)	14 (63.6)	2.28	.131
	Current period of caregiving (month)	＞12	13 (59.1)	8 (36.4)
	Alternate caregiver^†	Yes	1 (4.5)	3 (13.6)	1.10	.607
	Alternate caregiver^†	No	21 (95.5)	19 (86.4)
	Caregiving time (hour/day)	≤20	1 (4.5)	1 (4.5)	0.00	.999
	Caregiving time (hour/day)	＞20	21 (95.5)	21 (95.5)
	Affection with the patient	Good	7 (31.9)	8 (36.4)	0.11	.948
		Moderate	13 (59.1)	12 (54.6)
		Poor	2 (9.0)	2 (9.0)
	Health status	Good	14 (63.6)	11 (50.0)	0.83	.361
	Health status	Poor	8 (36.4)	11 (50.0)
Stroke Patient	Gender^†	Men	22 (100.0)	17 (77.3)	4.64	.088
	Gender^†	Women	0 (0.0)	5 (22.7)
	Age (year)	50	3 (13.6)	5 (22.7)	1.59	.663
		50~59	5 (22.7)	4 (18.2)
		60~69	11 (50.0)	8 (36.4)
		≥70	3 (13.6)	5 (22.7)
	Level of consciousness	Alert	13 (59.1)	17 (77.3)	2.23	.329
		Drowsy	8 (36.4)	5 (22.7)
		Coma	1 (4.5)	0 (0.0)
	Cognitive impairment	Normal	5 (22.7)	9 (40.9)	2.01	.365
		Moderate	10 (45.5)	9 (40.9)
		Severe	7 (31.8)	4 (18.2)
	Paralysis^†	Quadriplegia	2 (9.1)	1 (4.5)	0.36	.999
	Paralysis^†	Hemiplegia	20 (90.9)	21 (95.5)

Exp.=experimental group; Cont.=control group;

^† Fisher's exact test.

Table 3.

Homogeneity Test of Dependent Variables between the Experiment and Control Groups (N=44)

Variables	Exp. (n=22)	Cont. (n=22)	t (p)
Variables	M± SD	M± SD	t (p)
Caregiver burden	97.70±9.14	92.45±14.31	1.57 (.149)
Anxiety	15.91±2.93	15.36±3.32	0.58 (.566)
Depression	16.45±2.43	15.59±2.79	1.10 (.279)
Self efficacy	48.95±8.62	53.27±13.48	-1.27 (.213)
Caregiving mastery	27.73±4.74	32.23±6.89	-2.02 (.055)
Quality of life	67.55±7.38	72.50±14.63	-1.42 (.164)
ADL of patient	38.00±24.99	42.18±28.83	-0.51 (.610)

Exp.=experimental group; Cont.=control group; ADL=activities of daily living.

Table 4.

Effects of Navigation Program on Dependent Variables between the Two Groups (N=44)

Variables	Groups	Pretest	Posttest	t (p)
Variables	Groups	M± SD	M± SD	t (p)
Caregiver burden	Exp.	97.77±9.14	78.64±9.69	-9.99 (＜.001)
	Cont.	92.45±14.31	95.95±10.44
Anxiety	Exp.	15.91±2.93	6.14±1.78	-7.88 (＜.001)
Anxiety	Cont.	15.36±3.32	14.23±4.00
Depression	Exp.	16.45±2.43	8.82±1.97	-10.24 (＜.001)
Depression	Cont.	15.59±2.79	16.05±3.51
Self efficacy	Exp.	48.95±8.62	63.27±7.40	8.66 (＜.001)
Self efficacy	Cont.	53.27±13.48	49.41±12.01
Caregiving mastery	Exp.	27.73±4.74	41.09±4.52	8.82 (＜.001)
Caregiving mastery	Cont.	32.23±6.89	30.50±5.66
Quality of life	Exp.	67.55±7.38	78.59±8.03	4.50 (＜.001)
Quality of life	Cont.	72.50±14.63	69.41±10.22
ADL of patient	Exp.	38.00±24.99	44.14±27.13	2.89 (.006)
ADL of patient	Cont.	42.18±28.83	42.73±29.19

Exp.=experimental group (n=22); Cont.=control group (n=22); ADL=activities of daily living.

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