Iran Journal of Nursing

Introduction
Each year, 16 million people in the world suffer from stroke. This disease is considered the second leading cause of death and one of the main causes of disability in the world. A significant percentage of stroke patients face movement disorders due to the resulting disability and become dependent on others to perform many daily activities. After being discharged from hospital, they are taken care at home by their family members who are considered their family caregivers. Since the care needs of these patients are very high, their family caregivers feel high pressure or care burden. Care burden indicates the physical, mental and social problems of caregivers due to providing care to their patients such as anxiety, job burnout, and depression. Caregivers of patients are not ready to accept such responsibility and may experience a significant care burden during the patient care. In this regard, resilience is one of the components that can help them maintain their stability against the problems. Resilience increases a person’s ability to maintain emotional or physical health when faced with stressful conditions and can lead to more effective stress management. People with higher resilience can actively cope with and adapt to changes. The present study aims to determine the role of resilience in predicting the care burden in the family caregivers of stroke patients.

Methods 
This is a descriptive-correlational study with a cross-sectional design that was conducted from April to August 2023 in Besat Hospital, Hamedan, Iran. Participants were 194 family caregivers of stroke sufferers, who were selected by a convenience sampling method. The inclusion criteria for patients were: definite diagnosis of acute stroke based on the opinion of a neurologist, having speech ability and moderate level of disability, a score of 61-90 based on the Barthel index of physical disability, no history of previous stroke or other debilitating diseases requiring care by another person, and being discharged from the hospital for at least one month. The inclusion criteria for caregivers were: a written informed consent, being the main caregiver of the patient, having a relationship with the patient (the patient’s father, mother, wife, sister, brother, or child), and not taking care of another patient at the same time. Data collection tools included a demographic form, Novak and Guest’s care burden inventory, the Connor-Davidson resilience scale, and Barthel index of physical disability. Data analysis was done in SPSS software, version 25 using descriptive statistics, Pearson correlation test, and linear regression analysis.

Results
Most of the participants were male (n=101, 52%) with a mean age of 42.53±11.24 years. The total duration of caregiving was 36.04±2.92 days and the hours of caregiving per day was 8.66±2.33 hours. The mean disability score was 74.25±9.08. Also, most of the caregivers were the children of the patients (n=80, 41.2%) or their spouses (n=59, 30.4%). Also, most of them did not have health insurance and had no experience of patient care. The mean scores of care burden and resilience were 86.35±13.09 and 42.56±10.38, respectively. It was found that the relationship between care burden and resilience of caregivers was inverse and significant (r=-0.185, P<0.05). Resilience was one of the predictors of care burden (β=-0.233). 

Conclusion
Resilience is one of the predictors of the care burden among family caregivers of stroke survivors. It necessary to pay attention to the resilience of caregivers and its various effects in facilitating the patient care process. This factor can be strengthened in caregivers by using different educational methods, which requires the help of health care providers, especially nurses. It is necessary that healthcare systems, pay attention to the needs of their caregivers and support them, in addition to the needs of patients.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Hamedan University of Medical Sciences (Code: IR.UMSHA.REC.1401.1076).

Funding
This study was extracted from a research project, funded by Hamadan University of Medical Sciences (Grant No.: 14020212853).

Authors' contributions
Design: Sajjad Amiri Bonyad and Arezou Karampourian; data collection: Sajjad Amiri Bonyad and Faezeh Shamlou Hasani; data analysis: Behnaz Alafchi; editing and review: Sajjad Amiri Bonyad, Faezeh Shamlou Hasani, and Arezou Karampourian.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the Vice-Chancellor for Research and Technology of Hamadan University of Medical Sciences for their material and spiritual support and all participants for their cooperation in this study.

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