Iran Journal of Nursing

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Hassanpour Dehkordi A, Soleymani F, Habibi Z, Kheiri S, Salehitali S. The Effects of the Family-oriented Empowerment Model on the Fatigue Level of the Patients with Chronic Obstructive Pulmonary Disease Admitted to the Hospitals Affiliated to Shahrekord University of Medical Sciences, Iran (2018). IJN 2020; 32 (122) :30-40
URL: http://ijn.iums.ac.ir/article-1-3132-en.html

Background & Aims: Fatigue is the second most common symptom in patients with chronic obstructive pulmonary disease (COPD). Fatigue prevents carrying out individual and social roles and responsibilities and decreases people’s ability to work and make efforts to maintain natural life and perform favorite and enjoyable activities. Therefore, it has many negative effects on the economic status and quality of life of those with this condition. In addition, fatigue exacerbates the disease, increases the disease load, decreases occupational productivity, ability to concentrate, and sexual function. Overcoming these issues requires the participation of the patient and the family in the disease management and care process. Moreover, caregivers’ participation and ability will improve patients’ health. This study aimed to evaluate the effect of a family-centered empowerment model (FCEM) on the fatigue of individuals with COPD.
Materials & Methods: This clinical trial was performed on 72 patients with COPD accompanied by their family members. The subjects were selected by simple sampling and randomly divided into two intervention and control groups of 36. Inclusion criteria were COPD diagnosis by a physician, hospitalization of patients in internal medicine wards of hospitals affiliated to Shahrekord University of Medical Sciences, psychological health, the stability of physical condition, ability to participate in educational sessions, spirometry in the diagnostic file with FEV₁ level above 35%, and being literate. On the other hand, the exclusion criteria were lack of cooperation with the research, worsened clinical conditions, and inability to participate in sessions. Data were collected using a demographic characteristics questionnaire (age, gender, marital status, level of education, history of other chronic diseases, and FEV₁ index), and fatigue severity scale by Crop et al. The educational program was developed based on FCEM and included four steps of perceived threat, problem-solving, educational participation and assessment. In total, four 90-minute panels were held for groups of 10-15 participants in the intervention group in the presence of their family members. In the first and second sessions, group discussions were made based on the step of the perceived threat of FCEM. In the first session, information was provided about the disease and its process, prognosis, symptoms, complications, risk factors, and failure to follow the treatment plan. The second session included a description of COPD control and prevention methods, as well as self-care behaviors and their importance. Moreover, the second and fourth sessions focused on problem-solving stages, which included detecting the problem (disease process, causative agents of the disease, and complications caused by the disease) and analyzing the problem based on the causes of diagnosis, determining goals, providing solutions, selecting the best solution, and discussing how to carry out the solution to achieve the goal according to the abilities and facilities of patients and their family members. The evaluation of the process during the intervention was performed by the researcher in all sessions, in a way that the patient and family members were asked about learning the material presented and the content was repeated for those who needed more explanation. Afterwards, the intervention group was followed up by the research team for three months and the questions and problems of care and the knowledge required for their care were answered. The final assessment was performed three months after the intervention by completing the fatigue questionnaire. Data analysis was performed in SPSS version 16 using frequency and percentage indexes for qualitative variables and mean and standard indexes for quantitative data with a normal distribution. Other tests applied included Fisher’s exact test, Chi-square (for qualitative variables), and independent and paired t-test (for normal quantitative variables). Notably, a P-value of below 0.05 was considered statistically significant.
Results: In this study, the mean age of the participants in the intervention and control groups was 64.83 ± 11.97 and 62.11 ± 6.29 years, respectively. According to the independent t-test, there was no significant difference between the groups in terms of age (P=0.23). Moreover, the mean first-second rapid exhalation was reported to be 57.83 ± 9.64 and 58.46 ± 11.15 in the intervention and control groups, respectively. However, no significant difference was observed between the groups in this regard (P=0.8). overall, the two groups were homogenous in terms of gender, history of chronic diseases, and level of education. At the beginning of the study, the mean and standard deviation of fatigue score in the intervention and control groups was 41.10 ± 08.58 and 39.46 ± 9.67, respectively. In this respect, no significant difference was observed between the groups (P=0.5). After the intervention, the mean fatigue score was reported at 34.75 ± 6.25 and 41.7 ± 11.83 in the intervention and control groups, respectively, demonstrating a significant difference in this regard (P=0.01). According to the results, the mean fatigue score was significantly decreased in the intervention group after the intervention, compared to the control group (P=0.01).
Conclusion: According to the results of the study, the involvement of patients’ caregivers in understanding the threats perceived from the disease and increase of their knowledge about the disease and related care will not only enhance their cooperation in the process of patient care but also will pave the way for more effective care in patients. Empowering family members responsible for the care of patients with COPD reduces the level of fatigue in these individuals. Therefore, care and treatment programs for chronic patients pay attention to patients’ caregivers in addition to paying attention to the patients.