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Yu P, Zhang W, Li S, Luo X, Chen H, Mi J. Psychological resilience in the relationship between family function and illness uncertainty among family members of trauma patients in the intensive care unit. BMC Psychiatry 2024; 24:486. [PMID: 38961366 PMCID: PMC11223282 DOI: 10.1186/s12888-024-05883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Severe trauma accounts for a main factor inducing mortality for individuals aged < 45 years in China, which requires admission to intensive care unit (ICU) to receive comprehensive treatment. Family members of patients with unanticipated and life-threatening trauma during their ICU stays often experience psychosocial distress due to illness uncertainty. Previous research has shown that family function and psychological resilience are associated with illness uncertainty, respectively. However, little is known about the current situation and interacting mechanism between family function, psychological resilience, and illness uncertainty of family members for ICU trauma patients. Therefore, this study focused on exploring the current situation and relationships between these three factors in family members for ICU trauma patients. METHODS The convenience sampling approach was adopted in the present cross-sectional survey, which involved 230 family members for ICU trauma patients from 34 hospitals in Chongqing, China. Related data were extracted with self-reporting questionnaires, which included sociodemographic characteristic questionnaire, the Family Adaptability, Partnership, Growth, Affection and Resolve Scale (APGAR), the 10-item Connor-Davidson Resilience Scale (10-CD-RISC) and the Mishel's Illness Uncertainty Scale for Family Members (MUIS-FM). Pearson correlation analysis was conducted to examine the correlations between various variables. Additionally, a structural equation model was adopted to assess the mediating effect of psychological resilience on family function and illness uncertainty. RESULTS According to our results, family members for ICU trauma patients experienced high illness uncertainty with moderate family dysfunction and low psychological resilience. Family function directly affected illness uncertainty and indirectly affected illness uncertainty through psychological resilience in family members of ICU trauma patients. CONCLUSIONS Family function and psychological resilience are the protective factors for reducing illness uncertainty. Healthcare providers should take effective measures, including family-functioning improvement and resilience-focused interventions, for alleviating illness uncertainty in family members of ICU trauma patients.
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Affiliation(s)
- Peilin Yu
- The School of Nursing, Chongqing Medical University, Chongqing, China
| | - Wanzhu Zhang
- The School of Nursing, Chongqing Medical University, Chongqing, China
| | - Shijie Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuan Luo
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Mi
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- The School of Nursing, Chongqing Medical University, Chongqing, China.
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Thomas Hebdon MC, Cloyes KG, Vega M, Rosenkranz SJ, Reblin M, Tay D, Mooney K, Ellington L. Hospice Family Caregivers' Uncertainty, Burden, and Unmet Needs in Prospective Audio Diaries. J Hosp Palliat Nurs 2023; 25:321-329. [PMID: 37851960 PMCID: PMC10843703 DOI: 10.1097/njh.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Hospice cancer caregivers' (HCCs') burden and unmet needs are well documented in the literature through retrospective, standardized self-report surveys. Hospice cancer caregiver daily experiences of burden and unmet needs are rarely captured within a real-time context. The purpose of this secondary data analysis was to characterize HCCs' day-to-day burden and unmet needs with prospective HCC (N = 50) audio diary data between hospice enrollment and patient death. Uncertainty theory provided a framework for analysis. Diaries were transcribed, analyzed deductively and inductively, and organized thematically. Uncertainty in day-to-day experiences was an important driver of HCC burden and unmet needs. Unmet needs included unclear/unmet expectations regarding hospice care team support; not understanding the extent of HCC role and involvement; and communication challenges with hospice team members. Sources of HCCs' burden were dissonance between how they "should" feel and how they actually felt; feeling alone/having no outlet to express feelings; concerns about their own health and subsequent patient impact; and feeling helpless/occupying a liminal space. Uncertainty surrounding HCCs' experiences encompassed interactions with hospice care teams and the nature of end-of-life caregiving with symptom management, the dying process, and the HCC role. Hospice care teams can respond to uncertainty through assessment, understanding, and recognition of the daily context of HCCs.
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Affiliation(s)
| | | | | | | | | | - Djin Tay
- University of Utah, College of Nursing
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Kurtgöz A, Edis EK. Spiritual care from the perspective of family caregivers and nurses in palliative care: a qualitative study. BMC Palliat Care 2023; 22:161. [PMID: 37884938 PMCID: PMC10601296 DOI: 10.1186/s12904-023-01286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The palliative care period not only affects patients but also family caregivers in many ways. Palliative care units are places where the spiritual needs of family caregivers become important. According to a holistic care approach, palliative care nurses should determine the spiritual needs of family caregivers and help meet these needs. OBJECTIVE This study aims at exploring nurses' and family caregivers' experiences of spiritual care. METHODS A phenomenological study was designed in this qualitative research. A total of 10 nurses working in palliative care and 11 family caregivers participated in the study. Nurses' experiences of delivering spiritual care and family caregivers' experiences of receiving spiritual care were examined through the in-depth interviewing method on a one-to-one basis. The data were examined using thematic analysis. RESULTS Four main themes were obtained by the data analysis: (I) Impacts of being in a palliative care unit; (II) Coping methods; (III) Importance of spirituality and spiritual care; (IV) Spiritual care. The results were presented according to the COREQ criteria. CONCLUSION Although spiritual care is very necessary for family caregivers, it is not offered sufficiently due to nurse-and institution-related reasons. Palliative care nurses should determine the spiritual needs of family caregivers in line with the holistic care approach. Nurse managers should determine factors preventing nurses from offering spiritual care and create solutions for these factors. The lack of nurses' knowledge about spiritual care should be resolved by providing continuous training and therefore, nurses' competencies in spiritual care should be improved.
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Affiliation(s)
- Aslı Kurtgöz
- Department of Therapy and Rehabilitation, Sabuncuoglu Serefeddin Health Services Vocational School, Amasya University, Amasya, 05100, Türkiye.
| | - Elif Keten Edis
- Department of Nursing, Health Science Faculty, Amasya University, Amasya, Türkiye
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Yan J, Luo L. A Study on the Relationship between Sense of Disease Uncertainty and Family Strength and Mental Resilience in Guardians of Children with Inflammatory Bowel Disease. Emerg Med Int 2022; 2022:4797281. [PMID: 36275041 PMCID: PMC9581651 DOI: 10.1155/2022/4797281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Inflammatory bowel disease is difficult to cure, which seriously affects the physical and mental health of children and brings negative psychological stress to guardians. Uncertainty in illness of guardians reduces the ability of care and is not conducive to the treatment and recovery of children. Therefore, it is of great significance to explore the related factors of uncertainty in illness. Objective The aim of this study is to explore the relationship between sense of disease uncertainty and family strength and mental resilience in guardians of children with inflammatory bowel disease (IBD). Method A total of 146 guardians of 88 children with inflammatory bowel disease were investigated. The guardians' sense of disease uncertainty, family strength, and mental resilience were evaluated by Mishel uncertainty in illness scale-family member (MUIS-FM), family hardiness index (FHI), and Connor-Davidson resilience sca1e (CD-RISC), respectively. Spearman correlation was used for analyzing the correlation between the guardian's sense of disease uncertainty and family resilience. Results The guardian's MUIS-FM score from lowest to highest was complexity, unpredictability, lack of information, and uncertainty. The average scores of FHI and CD-RISC were lower than the average score of CD-RISC of the general community in China 65.4 (t = -4.36, P < 0.05). The score of MUIS-FM was significantly correlated with the scores of FHI and CD-RISC (P < 0.05). Multiple linear regression analysis showed that the challenge score in the FHI scale and the fortitude score and the strength score in the CD-RISC scale were the main influencing factors of guardians' sense of disease uncertainty in children with IBD (P < 0.05). Conclusion The guardians of children with IBD had a more serious sense of disease uncertainty, which was related to family strength and mental resilience.
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Affiliation(s)
- Jun Yan
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science&Technology, Wuhan 430014, China
| | - Lin Luo
- ICU, Fifth Hospital in Wuhan, Wuhan 430050, China
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Hedman R, Hillerås P, Tyrrell M. Living in uncertainty while a spouse is undergoing a cognitive assessment: Voices of women care partners. DEMENTIA 2022; 21:2631-2646. [PMID: 36131252 PMCID: PMC9583288 DOI: 10.1177/14713012221128448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Women often support partners with cognitive symptoms during the assessment process and when they are receiving a cognitive diagnosis. Living with a partner with cognitive symptoms can be stressful; however, there is limited insights into the specific experiences of older women during the assessment process. Previous research indicates that there are gender differences in the experiences of spousal caregiving; however, further research is needed in regard to the experiences of men and women as care partners. Therefore, the aim of the present study was to describe women's experiences of living with a partner undergoing a cognitive assessment. METHODS Semi-structured interviews were conducted with seven women when their male partners commenced a cognitive assessment and after the assessment had been completed. The interviews were analysed with abductive content analysis. FINDINGS Uncertainty permeated the women's experiences. Antecedents, attributes and strategies to manage the uncertainty were described. CONCLUSION The participants expressed informational and existential uncertainty when their partner underwent a cognitive assessment. A lack of knowledge regarding the assessment process and cognitive diagnoses, especially mild cognitive impairment, was identified. Further, there was a need to process existential uncertainty evoked by the situation.
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Affiliation(s)
- Ragnhild Hedman
- Department of Nursing Science, 25548Sophiahemmet University, Stockholm, Sweden
| | - Pernilla Hillerås
- Red Cross University College, Huddinge, Sweden.,Department of Neurobiology, Care Sciences and Society, 97092Karolinska Institutet, Stockholm, Sweden
| | - Marie Tyrrell
- Department of Nursing Science, 25548Sophiahemmet University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, 97092Karolinska Institutet, Stockholm, Sweden
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Li J, Sun D, Zhang X, Zhao L, Zhang Y, Wang H, Ni N, Jiang G. The relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer: a cross-sectional study. Palliat Care 2022; 21:30. [PMID: 35255876 PMCID: PMC8902770 DOI: 10.1186/s12904-022-00925-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022] Open
Abstract
Background Anticipatory grief has been shown to be highly prevalent among family caregivers of patients with advanced illness. Qualitative study suggests that illness uncertainty may be one of the core characteristics of anticipatory grief, but it has not been confirmed in quantitative studies. Therefore, the purpose of this study was to explore the relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer and to determine the factors influencing anticipatory grief. Methods This descriptive cross-sectional study used a convenience sampling method and recruited 254 inpatient family caregivers from the thoracic medicine ward of Liaoning Cancer Hospital & Institute in Shenyang, mainland China. Anticipatory grief (Anticipatory Grief Scale (AGS), illness uncertainty (Uncertainty in Illness Scale Family Caregiver Version) and sociodemographic information (Self-compiled general information questionnaire) were measured using validated self-report measures. Results Chinese family caregivers of patients with advanced lung cancer had high levels of anticipatory grief (73.5 ± 16.1). The results of the correlation analysis showed a positive association between anticipatory grief and illness uncertainty (r = 0.580, P < 0.001). The final linear regression model with anticipatory grief as the dependent variable included four variables: illness uncertainty (β = 0.674, P < 0.001), lack of informativeness (β = − 0.168, P = 0.08), monthly income (β = 0.139, P = 0.006), and caregiving burden (β = − 0.196, P < 0.001). Conclusions Illness uncertainty is probably an important factor affecting anticipatory grief. Excessive caregiving burden is associated with high levels of anticipatory grief. Improving illness uncertainty and caregiving burden may effectively reduce anticipatory grief among Chinese family caregivers.
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Haji Assa A, Umberger RA. A concept analysis of family caregivers' uncertainty of patient's illness. Nurs Forum 2022; 57:121-126. [PMID: 34463349 DOI: 10.1111/nuf.12645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
AIM To analyze and examine the concept of uncertainty of the patient's illness among family caregivers. BACKGROUND Promoting family caregivers' health is significant in nursing. Family caregivers may experience uncertainty related to their loved ones' illness. A lack of clarity exists regarding the uncertainty concept among family caregivers and its implications in nursing. DATA SOURCE A review of the literature that focused on family caregivers of adult patients using PubMed, CINAHL, and Scopus databases was completed. METHODS The Walker and Avant framework was applied to identify the attributes, antecedents, and consequences of family caregivers' uncertainty. RESULTS Eight articles were analyzed. Attributes of family caregivers' uncertainty included the patient's illness probability and family caregivers' perception of the illness. Antecedents included the characteristics of the patient's illness, factors associated with the family caregivers' perception of the illness, and family responsibilities of caregiving. The consequences included family caregivers' emotional, psychological, and financial outcomes. Family caregivers' uncertainty is defined as the perception of the inability to process information regarding the patient's illness trajectory when caring for significant others' illness. CONCLUSIONS Individuals can perceive uncertainty differently as a patient-facing uncertainty in illness versus a family caregiver facing uncertainty of their loved ones' illness.
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Affiliation(s)
- Amal Haji Assa
- Nursing Science PhD Program, College of Graduate Health Sciences, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Reba A Umberger
- Department of Acute and Tertiary Care, The University of Tennessee Health Science Cente, Memphis, Tennessee, USA
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Han ZT, Zhang HM, Wang YM, Zhu SS, Wang DY. Uncertainty in illness and coping styles: Moderating and mediating effects of resilience in stroke patients. World J Clin Cases 2021; 9:8999-9010. [PMID: 34786383 PMCID: PMC8567502 DOI: 10.12998/wjcc.v9.i30.8999] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 09/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stroke has a great influence on the patient’s mental health, and reasonable psychological adjustment and disease perception can promote the recovery of mental health.
AIM To explore the relationships among resilience, coping style, and uncertainty in illness of stroke patients.
METHODS A retrospective study was used to investigate 154 stroke patients who were diagnosed and treated at eight medical institutes in Henan province, China from October to December 2019. We used the Mishel Uncertainty in Illness Scale, the Connor-Davidson Resilience Scale, and the Medical Coping Modes Questionnaire to test the uncertainty in illness, resilience, and coping style, respectively.
RESULTS Resilience had a significant moderating role in the correlation between coping style and unpredictability and information deficiency for uncertainty in illness (P < 0.05). Further, the tenacity and strength dimensions of resilience mediated the correlation between the confrontation coping style and complexity, respectively (P < 0.05). The strength dimension of resilience mediated the correlation between an avoidance coping style and the unpredictability of uncertainty in illness (P < 0.05), as well as correlated with resignation, complexity, and unpredictability (P < 0.05).
CONCLUSION Resilience has moderating and mediating roles in the associations between coping style and uncertainty in illness, indicating that it is vital to improve resilience and consider positive coping styles for stroke patients in the prevention and control of uncertainty in illness.
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Affiliation(s)
- Zi-Ting Han
- School of Nursing, Xinxiang Medical University, Xinxiang 453000, Henan Province, China
| | - Hui-Min Zhang
- School of Nursing, Xinxiang Medical University, Xinxiang 453000, Henan Province, China
| | - Yi-Ming Wang
- School of International Education, Xinxiang Medical University, Xinxiang 453000, Henan Province, China
| | - Shan-Shan Zhu
- School of Nursing, Xinxiang Medical University, Xinxiang 453000, Henan Province, China
| | - Dong-Yang Wang
- Department of Nursing, School of Pharmacy, Changzhou University, Changzhou 213000, Jiangsu Province, China
- Faculty of Nursing, Mahidol University, Nakhon Pathom 73170, Thailand
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Arias-Rojas M, Carreño-Moreno S, Rojas-Reyes J. Uncertainty Towards the Disease of Family Caregivers of Patients in Palliative Care: A Scoping Review. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.3.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To know the development of the scientific evidence on the uncertainty towards the disease of family caregivers of patients in palliative care.
Materials and methods: A descriptive scoping review. A search was conducted in the Embase, ScienceDirect, Medline, Academic Search Complete, Scopus databases, during the 2000-2019 period. The following MeSH terms were used: uncertainty, palliative care, end of life, nursing and caregiver. Fifty articles were selected after the criticism process.
Results: Five thematic nuclei emerged: characterization of uncertainty in the caregiver, factors influencing uncertainty, resources to manage uncertainty, uncertainty assessment, and therapies and interventions to approach uncertainty. The higher scale of evidence is found in the characterization of uncertainty in the caregiver, and the voids direct the development of Nursing interventions on the uncertainty of the caregivers of individuals in palliative care.
Conclusions: Although the factors influencing uncertainty towards the disease of the caregiver are widely explored, the evidence on the interventions that may help to reduce uncertainty towards the disease is still limited.
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Liu J, Liu Q, Huang Y, Wang W, He G, Zeng Y. Effects of personal characteristics, disease uncertainty and knowledge on family caregivers' preparedness of stroke survivors: a cross-sectional study. Nurs Health Sci 2020; 22:892-902. [PMID: 32449839 DOI: 10.1111/nhs.12743] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
Family caregivers play an important role in the rehabilitation of stroke survivors. The aims of this study were to describe preparedness, uncertainty, and knowledge regarding stroke in family caregivers of people who have undergone strokes and to investigate factors influencing preparedness. A total of 306 caregivers completed the questionnaires, including the Caregiver Preparedness Scale, the Mishel Uncertainty in Illness Scale, and Knowledge of Stroke. The result showed that the mean score of the family caregivers' preparedness was 14.42, the mean score of disease uncertainty was 75.62, and the mean score of stroke knowledge was 10.41. Caregiver preparedness was negatively correlated with disease uncertainty and positively correlated with knowledge. Multivariate stepwise regression analysis showed that educational background, profession, caregiving experience and uncertainty degree of the family caregivers, gender, and age of stroke survivor could predict 45.90% of the total variation in preparedness. The findings suggest that demographic characteristics of stroke survivor and family caregiver, as well as caregivers' disease uncertainty, enable predict the level of caregiver preparedness. Medical professionals should pay attention to providing personalized and targeted approaches to maximize caregivers' preparedness.
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Affiliation(s)
- Juanjuan Liu
- School of Nursing, University of South China, Hengyang, China.,School of Rehabilitation Medicine and Health, Hunan University of Medicine, Huaihua, China
| | - Qi Liu
- School of Nursing, University of South China, Hengyang, China
| | - Yanjin Huang
- School of Nursing, University of South China, Hengyang, China
| | - Wen Wang
- School of Nursing, University of South China, Hengyang, China
| | - Guoping He
- School of Nursing, University of South China, Hengyang, China
| | - Ying Zeng
- School of Nursing, University of South China, Hengyang, China
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