Iran Journal of Nursing

fa تأثیر الگوی توانمندسازی خانواده محور بر خستگی افراد مبتلابه بیماری مزمن انسدادی ریه بستری در بیمارستان‌های وابسته به دانشگاه علوم پزشکی شهرکرد در سال 1397 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) پرستاری nursing پژوهشي Research <div style="text-align: justify;">زمینه و هدف: خستگی در بیماران مزمن انسدادی ریه بهره‌وری شغلی، توانایی تمرکز، قوای جنسی و عملکرد بیمار را کاهش داده و فرد را به سمت سستی و بی‌حال سوق می‌دهد. غلبه بر این امر نیازمند مشارکت بیمار و خانواده در امر مراقبت و مدیریت بیماری است. هدف از این مطالعه تأثیر الگوی توانمندسازی خانواده محور بر خستگی افراد مبتلابه بیماری مزمن انسدادی ریه است. روش بررسی: در مطالعه کار آزمایی بالینی حاضر تعداد 72 بیمار نارسایی مزمن انسداد ریه همراه با مراقب خانوادگی آنها به روش نمونه‌گیری آسان انتخاب و سپس به روش تصادفی در دو گروه 36 نفره مداخله و کنترل تقسیم شدند. برنامه آموزشی مبتنی بر الگوی توانمندسازی خانواده محور در چهار جلسه 90 دقیقه‌ای مبتنی بر چهار گام تهدید درک شده، مشکل‌گشایی، مشارکت آموزشی و ارزشیابی در گروه‌های 10 تا 15 نفره با حضور اعضای خانواده به صورت پانل برای گروه مداخله ارائه گردید. سپس به مدت 3 ماه گروه مداخله توسط تیم تحقیق پیگیری شد و به سئوالات و مشکلات مراقبتی و دانش مورد نیاز مراقبتی آنها پاسخ داده شد. ارزشیابی نهایی پس از گذشت سه ماه از اجرای مداخله با تکمیل مجدد پرسشنامه خستگی انجام شد. داده‌ها توسط آزمون‌های تی زوجی، تی مستقل، آزمون دقیق فیشر و مجذور کای توسط نرم‌افزار SPSS نسخه 16 تحلیل شدند. یافته‌ها: در بدو مطالعه دو گروه مداخله و کنترل، تفاوت معنی‌داری از نظر میانگین نمره خستگی نداشته اند )5/0  (P=. بعد از مداخله، میانگین نمره خستگی گروه مداخله نسبت به گروه کنترل تفاوت معنی‌داری داشته است )01/0 (P=. در گروه مداخله میانگین نمره خستگی بعد از مداخله نسبت به قبل از مداخله، کاهش معنی‌داری داشته است )01/0 (P=. نتیجه‌گیری کلی: نتایج مطالعه بیانگر آن بوده که توانمند کردن اعضای خانواده مسئول مراقبت بیمار نارسایی مزمن ریه باعث کاهش سطح خستگی در بیماران شده است، بنابراین برنامه‌های مراقبتی و درمانی بیماران مزمن علاوه بر توجه به بیمار باید به مراقبین بیمار نیز توجه کنند.  </div> <div style="text-align: justify;">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.  </div> بیماری مزمن انسدادی ریه, توانمندسازی خانواده محور, خستگی Chronic Obstructive Pulmonary Disease, Family-oriented Empowerment, Fatigue 30 40 http://ijn.iums.ac.ir/browse.php?a_code=A-10-107-2&slc_lang=fa&sid=1 A Hassanpour Dehkordi علی حسن پور دهکردی 10800319475328460024801 10800319475328460024801 No Associate Professor, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran دانشیار، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهرکرد، شهرکرد، ایران F Soleymani فرشاد سلیمانی 10800319475328460024802 10800319475328460024802 No MS Student in Nursing, Kashani Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran دانشجوی کارشناس ارشد پرستاری، بیمارستان کاشانی، دانشگاه علوم پزشکی شهرکرد، شهرکرد. ایران Z Habibi زهرا حبیبی 10800319475328460024803 10800319475328460024803 No Assistant Professor, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran استادیار، دانشکده پزشکی،دانشگاه علوم پزشکی شهرکرد، شهرکرد، ایران S Kheiri سلیمان خیری 10800319475328460024804 10800319475328460024804 No Professor, School of Health, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran استاد، دانشکده بهداشت، مرکز تحقیقات مدلسازی در سلامت، دانشگاه علوم پرشکی، شهرکرد، ایران SH Salehitali شهریار صالحی تالی 10800319475328460024805 10800319475328460024805 Yes Assistant Professor, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran (*Corresponding author) Tel: 0913183518 Email: sh.salehitali@skums.ac.ir استادیار، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهرکرد، شهرکرد، ایران. (*نویسنده مسئول) شماره تماس: 09131835118 Email: sh.salehitali@skums.ac.ir