Examining the needs of caregivers of people with head injuries after discharge and the extent of their fulfillment in patients referring to Porsina Medical Training Center in Rasht, 2019-2019

Dissertation for Master's Degree in Nursing Education

(Internal Surgery)

Abstract:

Introduction: Traumatic brain injury (TBI) is one of the most important public health issues that has a strong social impact on The incidence and mortality rate of the population. Since people with TBI often lose their functional abilities and have a dependent life, as a result, these patients will need caregivers for care and support, so families are at the forefront of many challenges and stress.

Purpose: The purpose of the present study is to determine the needs of caregivers of people with head injuries after discharge and the extent to which they are met in patients referred to the Porsina Therapeutic Training Center in Rasht in 1992-1991.

Materials and methods: This research is a cross-sectional study of a descriptive and analytical type that was conducted on 51 family members of head injury patients who were selected using the full number of available samples in 1991-92. In this study, in order to achieve the goals, two questionnaires of demographic characteristics and standard questionnaire of family needs (FNQ) were used. The data was analyzed with SPSS 18 software and with t-test, analysis of variance, Fisher's exact test and chi-square. Findings: The highest level of importance of needs was related to the subscale of health information and the lowest was related to involvement in care. A statistically significant difference was observed between the importance of caregivers' needs with caregivers' employment status (P<0.046), patients' age groups (P<0.023) and patients' clinical status (P<0.042). The highest level of needs fulfillment is related to the subscale of social support network and health information and the lowest level is related to instrumental support. A statistically significant relationship (P<0.044) was observed between meeting needs in all areas and the existence of health insurance for patients.

Conclusion: The most important needs of the family were related to the health information subscale, which were often met. Understanding the needs and problems of caregivers leads to an increase in the awareness of nurses and other health care providers about the need to help caregivers of people with head injuries. It is recommended that this tool be used for head trauma patients and their caregivers.

Key words: head injury, caregivers' needs, family

Brain injuries are one of the most common injuries that occur due to exposure to brain trauma and often as a result of accidents. Traumatic head injury [1] (TBI) is one of the most common causes of death after accidents (1).

In a study conducted on 8927 TBI patients in 46 countries, it was determined that a quarter of these people died within 6 months after TBI occurred (2). Each year, more than one million people in the United States suffer from traumatic brain injury. Of these, 52,000 die and 800,000 become permanently disabled, at a cost of over $40 billion (3). Statistics show that head trauma occurs at any age, but it is more common in the ages of 15 to 24 years and more than 75 years and also in men (4). Statistics show that Iran is among the first countries in the world in terms of accidents and accidents, and unfortunately, the most injuries with 31% of cases are related to head and neck and concussions (5). Only in Gilan Province, Porsina Educational and Therapeutic Hospital in Rasht city, during 1984 and 1985, out of 5256 trauma patients, 3396 head injury patients were admitted (6). Neuropsychological changes after TBI are many and diverse and are generally divided into three categories: emotional, cognitive, and behavioral disorders, which lead to frequent visits of these patients to psychologists (7). Complications after TBI include neurological disorders (epilepsy, headache, and sleep disorders) in addition to neurodegenerative diseases (decreased cognitive function, Alzheimer's, and Parkinson's disease), neurohormonal disorders (hypophysial hypophysis syndrome).. Complications after TBI include neurological disorders (epilepsy, headache, and sleep disorders) in addition to neurodegenerative diseases (decrease in cognitive function, Alzheimer's, and Parkinson's disease), neurohormonal disorders (post-traumatic pituitary hypofunction syndrome), psychological disorders (affective disorders, anxiety, depression, and obsessive-compulsive disorders); Non-neurological disorders also include (sexual dysfunction, urinary and intestinal incontinence, and skeletal muscle) in addition to the possibility of metabolic dysfunction, which may remain with the affected person for months or years (8).

Since people with TBI often lose their functional abilities and live a dependent life, as a result, they will need a caregiver for care and support. Therefore, families are at the forefront of many challenges and stress (9). On the other hand, according to the data of the health organization and the service system for TBI survivors of New Jersey, between 1999 and 2005, nearly 65% ??of TBI patients were transferred from the hospital to home despite the existence of many problems, and nearly 20% of them were directed to rehabilitation centers or other care (10). Therefore, there is no doubt that TBI affects not only the person but also his family, and therefore his family can be considered as TBI victims more than the affected person (11). Although in the studies of recent years, many researchers have addressed the problems of these families, but for many years, the main focus has been on the victim himself (12,13,14). Now, if the family cannot deal with this stress, it will lead to a crisis (16) and people affected by this crisis may go into depression, severe anxiety, substance abuse, etc. be pushed (15). The family of a person with TBI is in a severe crisis, because this event affects the person's environment, aspirations, and the life they have planned for themselves (17). According to studies, brain injuries caused by trauma lead to countless results on families, the most important of which are stress and sadness (13), guilt and agitation (18), problems in marital relationships (19), Anxiety (20), mental disorders (21) and reduced quality of life (22).

Seeing your loved one in a life-threatening situation and the special care required and the technology used to care for these patients are all factors that double the psychological pressure of the family. In such situations, due to the extreme fear and anxiety that occurs in them, most of the family members ignore their essential and basic needs and only think about the patient and related issues (23). The factors that cause anxiety in the family should be effective (24).  Recently, using the Family Needs Questionnaire [2], Columbia researchers investigated the needs of 29 families caring for a person with TBI, whose most important needs according to the questionnaire included health information, social support network, and the need for defense and assistance from the care team members (25). According to the research of Seyed Hassan et al. [3], the main needs of families include health and rehabilitation information, financial assistance and advice, social and emotional support, and positive psychological encouragement (9). The results of Hora and Souza's study [4] also showed that usually families receive little or no guidance on how to understand their current complex conditions (26). The family experiences countless needs at the beginning of the acute period after the occurrence of TBI, which may not be recognized by the care team, but due to the long-term effects of this condition on the patient, the evaluation and investigations of him and his family, who are responsible for his care, are needed over a long period of time (25).