| Summary: | 碩士 === 國防醫學院 === 護理研究所 === 107 === Background: Stroke has always been the third to fourth leading cause of death in Taiwan. The incidence rate is 230-330 cases per 100,000 person-years and the prevalence rate is about 19.3 cases per 1000 person-years, with the standardized mortality ratio reported in 2018 is 27.5 cases per 100,000 person-years. This leads to many stroke survivors return to home care after discharge, but in view of the high disability caused by the disease, returning the stroke survivors to family care may expose the entire family to a stressful and difficult situation because of the care burden, further affecting the prognosis of the stroke survivors. How to improve the prognosis has always been an important part of the follow-up care of patients with stroke. Family resilience can help families to cope with the stress in life, develop their ability to overcome difficulties, finally able to pass and survive the crisis. However, there is currently no research on the relationship between family resilience and prognosis of stroke. Therefore, it is necessary to conduct in-depth research to explore the relationship between family resilience and prognosis of stroke survivors and its influencing factors, which can be used as a strategic basis for improving the quality of care for stroke survivors.
Purpose: The purpose of this study was to investigate not only the family resilience and prognosis trajectory changes after discharge in stroke survivors but also the correlation and related factors that affect the correlation between them.
Methods: This study was designed as a prospective longitudinal study. Using convenient sampling, the cases were recruited from the neurology、neurosurgical clinics and wards of a medical center in Taipei.
A total of 25 patient’s families agree to participate in disease prognosis tracking and structured data collection. The disease prognosis included stroke severity and daily life function in the study；the structured questionnaire included basic information, Family Resilience Assessment Scale–Chinese Version (including "Overall family resilience" and " Family Communication and Problem Solving ", "Utilizing social resources", " Maintaining a Positive Outlook "subscale), Family Function Assessment scale (including "Overall family function" and "Cohesion", "Conflict", "Emotional Involvement", " Expressed Emotion ", "Communication" "Question Resolution", "Independence", "Family Responsibility" subscale), and Modified Barthel index., which was filled out by the major caregivers at the time of discharge, one month after discharge, three months after discharge. Data statistics were analyzed and processed by SPSS 23 statistical software using descriptive statistics, and generalized estimation equations, p<0.05 was considered as the statistically significant level.
Result: The results showed that (1) not only the family resilience and daily life function of stroke survivors gradually increased but also the stroke severity gradually decreased over time, that is, the family resilience and disease prognosis of stroke survivors improved over time；(2) in the stroke prognosis, the stroke severity is associated with the time change, religious beliefs, family income, rehabilitation forms, the severity of hospital admission and family resilience; the daily life function is associated with the time change, age of the patient, religious beliefs, other caregivers, rehabilitation forms, the severity of hospital admission and family function.
Conclusion: According to the results of this study, the trajectory changes of stroke survivor’s family resilience and prognosis improve overtime and the prognosis is related to family resilience and family function. This result can be used as a reference not only in the policy but also be used by nursing staffs in building more appropriate education and care strategies to improve nursing education and clinical care.
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