Study On Symptom Burden And Its Associated Factors Of Immediate Family Caregivers Of NICU Patients

ObjectivesTo understand the immediate family caregivers’ symptom burden of neuro-intensive care unit(NICU)patients through filed investigation,and explore contributing factors and their interactions from fatigue,uncertainty in illness,and family function based on the theory of unpleasant symptoms(TOUS),so as to provide theoretical reference and practical approach for symptom burden assessment and precise nursing.MethodsThe immediate family caregivers of NICU patients from 2 tertiary level-A hospitals in Jinan were selected using convenient sampling.A questionnaire survey was conducted from March 1,2020 to August 31,2020,and from August 1,2021 to November 31,2021 for the immediate family caregivers who met the inclusion criteria.The questionnaire consisted of patients’and their immediate family caregivers’ basic information,Fatigue Scale-14,Parent’s Perception Uncertainty Scale-Family Members,Family APGAR Index,and Memorial Symptom Assessment Scale.SPSS 21.0 was used for statistical analysis which included descriptive analysis,independent-sample t test,analysis of variance,correlation analysis and multiple linear regression analysis.Amos software was conducted to establish the structural equation model and calculate the interaction coefficient.ResultsA total of 304 questionnaires were distributed and 282 were effectively received with an effective rate of 92.76%.The main results are as follows:1.Basic information of NICU patients and their immediate family caregiversThe study involved 282 NICU patients,including 208 males(75.69%)and 74 females(24.31%).Intracerebral hemorrhage accounted for the highest proportion(57.09%),followed by severe traumatic brain injury(23.40%)and cerebral infarction(18.09%).Among the immediate family caregivers surveyed,62.06%were female,88.07%were married,41.74%had received higher education(college ang above),and 66.51%were healthy.2.Immediate family caregivers’ symptom burden and related factors of NICU patientsImmediate family caregivers’symptom burden of NICU patients was(0.65±0.50).The top three symptoms of prevalence,concerns(96.33%),feeling sad(93.58%),feeling nervous(89.91%),were reported more than or close to 90%.The rankings of symptom burden were basically consistent with the incidence rates.The mean of physiological and psychological symptom was(0.57±0.55)and(1.67±0.86),respectively,and the total distress index was(1.22±0.70).The average scores of fatigues,uncertainty in illness and family function were(6.89±3.90),(87.02±14.85),and(7.86±2.51),respectively.3.Univariate analysis of immediate family caregivers’ symptom burdenImmediate family caregivers’ symptom burden of NICU patient was disparate in patients’marital status,physical condition,religious belief,monthly income,number of chronic diseases and sleep quality according to univariate analysis.4.Correlation analysis of related factors and symptom burdenIt was showed that symptom burden of immediate family caregiver was positively correlated with fatigue(r=0.532)and total score of uncertainty in illness(r=0.189),and negatively correlated with family function(r=-0.147),with statistical significance(all P<0.05).5.Multivariate linear regression of immediate family caregivers’ symptom burdenSymptom burden was shown to increase with fatigue(βstandardized=0.0.361)and uncertainty in illness(βstandardized=0.092)in multiple linear regression.The factors of Buddhism belief(βstandardized=0.147,no religious belied as reference),being not bad(βstandardized=0.104,healthy as reference),suffering from one or two chronic diseases(βstandardized=0.103～0.104,no chronic disease as reference),and sleeping less or worse since the patients transferred to ICU(βstandardized=0.226)positively predicted symptom burden(all P<0.05).However,patients being married(βstandardized=-0.197,unmarried as reference),immediate family caregivers earing 2000 to 2999 yuan per month(βstandardized=-0.142,earning less than 2000 yuan as reference)negatively predicted it(all P<0.05).These factors accounted for 41.45%of the immediate family caregivers’ symptom burden of NICU patients.6.Path effect of physiological,psychological,and environmental factors associated with symptom burdenThe higher fatigue score(βstandardized=-0.613)immediate family caregivers experienced,the heavier symptom burden they would suffer(P<0.001).The interaction between uncertainty in illness and family function significantly reduced symptom burden(βstandardized=-0.203,P<0.001).Conclusions1.Immediate family caregivers’ symptom burden of NICU patients was(0.65±0.50).Psychological symptoms were more common than physiological symptoms.The incidence of concerns was the highest,and the rankings of symptom burden and incidences were almost the same.2.Fatigue and uncertainty in illness increase symptom burden of NICU patients.Buddhism belief(no religious belief as reference),being not bad(healthy as reference),suffering from one or two chronic diseases(no chronic disease as reference),and poor sleep aggravate symptom burden,while patients being married(unmarried as reference)and immediate family caregivers earing 2000 to 2999 yuan per month(earning less than 2000 yuan as reference)alleviate it.This suggests that measures to relieve fatigue and uncertainty in illness and improve sleep quality may help reduce symptom burden.3.The interaction of uncertainty in illness and family care has a significant impact on symptom burden reduction.It is necessary to giving full play to the family functions in cooperation,undertaking and sharing to reduce symptom burden by eliminating or reducing the uncertainty in illness.