Stress and Coping among family caregivers of patients with Myocardial Infarction- Descriptive cross sectional study

 

Isha M. Aboobacker

Assistant Professor, Department of Medical Surgical Nursing, MOSC College of Nursing, Kolenchery.

*Corresponding Author Email: isha84isha@gmail.com

 

ABSTRACT:

Aim: A descriptive study was conducted to assess the level of stress and coping among family caregivers of patients with myocardial infarction in selected hospitals. Background: Self-care management of myocardial infarction is complex and demanding. Therefore, many patients with heart diseases rely on family members to provide care, such as medication administration, symptom monitoring and management, meal preparation, bathing, and transportation. Family caregivers experience various levels of stress and may seek different strategies to cope with the stress. Influence of stress on the level of coping experienced by the caregivers would help to evaluate and plan effective programmes that address their needs and teach them adaptive mechanism of coping. Methods: A descriptive correlational research design with purposive sampling technique was used to collect data from family caregivers. The study was conducted among100 family caregivers of patients with myocardial infarction for a period of one month. Data was collected by using standardized tools, Appraisal of caregiving scale and Ways of coping scales. Data was analyzed using descriptive and inferential statistics. Results: Two third of the subjects (62) had severe stress and minority (38) had moderate stress on “threat subscale”. Majority of the subjects (90) experienced severe stress on “benign subscale”. More than half  of subjects (59) had moderate stress on “benefit subscale”. The coping scores showed that majority of subjects had poor coping in “distancing”(76), “self controlling”(81),” “accept responsibility”(98) and “escape Avoidance” (77) subscales, whereas least number of subjects had good coping on “distancing” (7), “seek social support” (7) and “planful problem solving” (10) subscales. A negative correlation exist between the subscales of stress and coping. The “threat subscale” of stress was significantly and negatively correlated with “distancing”(r =-0.335), “self controlling” (r = -0.352), “seek social support” (r =-0.415), “accept responsibility” (r= -0.254), “escape avoidance” (r = -0.298), “planful problem solving” (r =-0.348), and “positive reappraisal” (r =-0.393) subscales of coping. The “benign subscale” of stress was significantly and low negatively correlated with “distancing” (r = -0.234), “self controlling” ( r = 0.245), “seek social support” (r =-0.272), “accept responsibility” (r = -0.272), “escape avoidance” (r = -0.342), “planful problem solving” (r = -0.221) and “positive reappraisal” (r = -0.331) subscales of coping. The “benefit subscale” of stress was Correlated with “distancing” (r = -0.335), “self controlling” (r= -0.323), and “accept responsibility” (r = -0.253) subscales of coping. Conclusion: Findings of the study showed that, family caregivers of patients with myocardial infarction had severe to moderate stress on subscale of stress. Caregiver uses various copying strategies in order to cope up with the stresses of caregiving. A significant negative correlation exists between level of stress and coping among family caregivers of patients with myocardial infarction.

 

KEYWORDS: Stress, Coping, Family caregivers, Myocardial infarction.

 

 

INTRODUCTION:

Every person experiences various forms of stress throughout his or her life.1 Stressful events are the result of an interaction between the individual and the environment, and stress is mediated by the person’s appraisal of the situation and his or her perceived resources available to deal with stress.2 Self-care management of myocardial infarction is complex and demanding. Therefore, many patients with heart diseases rely on family members to provide care, such as medication administration, symptom monitoring and management, meal preparation, bathing, and transportation. Providing care to the chronically ill patient can cause stress for family members.3-4The influence of stress on the level of coping experienced by the caregivers would help to evaluate and plan effective programmes that address their needs and teach them adaptive mechanism of coping. Hence the present study was carried out to assess the stress and coping among family caregivers of patients with Myocardial Infarction.

 

MATERIALS AND METHODS:

A descriptive correlational study was done among family caregivers of patients with myocardial infarction in selected tertiary care hospitals. Hundred family caregivers of patients diagnosed with myocardial infarction who were in the age group of 18-65 years were enrolled to the study by using non probability purposive sampling.  After obtaining IEC, formal administrative permission and informed consent, data were collected using self report technique in a single appointment. Family caregivers stress was assessed by using Appraisal of caregiving scale5 and coping were assessed by using ways of coping scales6. Data were coded in Microsoft excel and analyzed using SPSS version 20.

 

RESULTS:

Section A: Distribution of demographic variables.

Among the 100 subjects, nearly half of subjects (42) were aged 42-55 years and least (15) were in 54-65 years. Two third of the subjects (62) were females. Nearly half of the subjects (47) belonged to the religion Christian and least (21) were Muslims. Majority of the subjects (84) were married. A quarter of subjects (25) had high school education and more than one third the subjects (34) were skilled workers. One third of the subjects (35) had family income of Rs. 8,000-10,999. Highest number of the caregivers (41) with the patient was spouses while least (5) were in-laws. More than three quarter of the patients (77) was hospitalized only once and least (2) were hospitalized thrice. Most of the patients (74) was on their second day of illness.

 

Section B: Description of level of stress of family caregivers of patients with myocardial infarction.

 

Table 2: Frequency distribution of subjects according to the level of stress on three subscales                                                        n=100

Level of stress

Sub scales of stress

Threat

Benign

Benefit

Mild

-

-

-

Moderate

38

10

51

Severe

62

90

49

 

Table 4 shows that two third of the subjects (62) had severe stress and least (38) had moderate stress on “threat subscale”. Majority of the subjects (90) experienced severe stress on “benign subscale”. More than half of subjects (59) had moderate stress on “benefit subscale”.

 

Section C: Description of level of coping of family caregivers of patients with myocardial infarction. n=100

 

Figure 1: Composite bar diagram showing the family caregivers level of coping on ways of coping scales.

 

Figure 1 shows that majority of subjects had poor coping in “distancing”(76), “self controlling”(81),” “accept responsibility”(98) and “escape Avoidance” (77), scales whereas least number of subjects had good coping on distancing (7), seek social support (7) and  planful problem solving (10) scales.

 

Section D: Correlation between stress and coping of family caregivers of patients with myocardial infarction.

To find the correlation between the level of stress and coping among the family caregivers of patients with myocardial infarction, the following null hypothesis was formulated:

 

H01: There will be no significant relationship between the level of stress and coping among family caregivers of patients with myocardial infarction.

 

The correlation between sub scales of stress and scales of coping was tested using Karl Pearson’s Correlation Coefficient.

Table 3: Correlation between subscales stress and coping scales among family caregivers of patients with myocardial infarction. n= 100

 

 

 

 

 

Scales of coping

 

 

Sub scales of stress

 

Confrontive

Distancing

Self

controlling

Seek social

support

Accept

responsibility

Escape

Avoidance

Problem

solving

Positive re

appraisal

Threat

r

-0.158

-0.335***

-0.352***

-0.415***

-0.254*

-0.298**

-0.348***

-0.393***

 

p

0.117

0.001

0.001

0.001

0.011

0.003

0.001

0.001

Benign

r

-0.160

-0.234*

-0.245*

-0.272*

-0.272*

-0.342***

-0.221*

-0.331***

 

p

0.111

0.019

0.014

0.006

0.006

0.001

0.027

0.001

Benefit

r

0.073

-0.335***

-0.323***

-0.175

-0.253*

-0.278`

-0.031

-0.165

 

p

0.471

0.001

0.001

0.082

0.011

0.005

0.760

0.102

P<0.05 significant

 

The table 3 shows the correlation between stress subscales and coping scales. The “threat subscale” of stress was significantly and negatively correlated with 7 scales of coping i.e; “distancing” (r= -0.335), “self controlling” (r= -0.352), “seek social support” (r= -0.415), “accept responsibility” (r= -0.254), “escape avoidance” (r= -0.298), “planful  problem  solving” (r= -0.348), and “positive reappraisal” (r= -0.393) scales of coping.

 

The “benign subscale” of stress was significantly and negatively correlated with 7 scales of coping i.e;“distancing” (r= -0.234), “self controlling” (r= 0.245), “seek social support” (r= -0.272), “accept responsibility” (r= -0.272), “escape avoidance” (r= -0.342), “planful problem solving” (r= -0.221) and “positive reappraisal” (r= -0.331) scales of coping.

 

The “benefit subscale” of stress was Correlated with “distancing” (r= -0.335), “self controlling” (r= -0.323), and “accept responsibility” (r= -0.253) scales of coping.

 

DISCUSSION:

Family caregivers of patients with myocardial infarction suffer severe to moderate stress on subscales of stress. This might be because stress places a heavy demand on a person, and if the person is unable to deal with it, illness can result. There are additional demands like caregiving responsibilities, financial hardships, and lack of information e.t.c which can cause severe stress in caregivers. Ineffective management of stress may lead to maladaptive coping and unrelenting suffering.

 

Caregivers use various coping strategies in order to cope up with the stressors of caregiving. Many different methods of coping with a situation are possible and, in general can be considered either adaptive or maladaptive in nature.

 

A negative correlation was found between subscales of stress and coping i.e. If the stress increases coping decreases and vice versa. Nurses can play an important role in identifying caregivers who are at risk for negative appraisal which can impact coping and subsequent adaptation to caregiving stress. Caregivers, who may be more vulnerable to adverse consequences, may require additional support, education, and other targeted interventions to assist them in the challenging role of caregiving.

 

ACKNOWLEDGEMENT:

Here we extend our sincere thanks to the administrative authorities of study settings, IEC members and study participants.

 

CONFLICT OF INTEREST:

The authors declare no conflict of interest in the study.

 

REFERENCE:

1.      Baron A, Robert. Health, stress and coping.3rd ed. New Delhi: Prentice Hall of India Private Limited; 2002:503-04.

2.      Eric A, Diane B, Laura N. Depression and coping in Heart Failure patients: A review of the literature. Journal of cardiovascular nursing; 24 (2): 106-17

3.      Bennett SJ, Sauvé MJ. Cognitive deficits in patients with heart failure: a review of the literature. Journal of Cardiovascular Nursing. 2003 Jul 1;18(3):219-42.

4.      Carlson B, Riegel B, Moser DK. Self-care abilities of patients with heart failure. Heart & Lung. 2001 Sep 1;30(5):351-9.

5.      Carey PJ, Oberst MT, McCubbin MA, Hughes SH. Appraisal and caregiving burden in family members caring for patients receiving chemotherapy. InOncology nursing forum 1991 Nov 1 (Vol. 18, No. 8, pp. 1341-1348).

6.      Vitaliano PP, Russo J, Carr JE, Maiuro RD, Becker J. The ways of coping checklist: Revision and psychometric properties. Multivariate behavioral research. 1985 Jan 1;20(1):3-26.

 

 

 

Received on 31.12.2021         Modified on 07.05.2022

Accepted on 01.09.2022        ©A&V Publications All right reserved

Asian J. Nursing Education and Research. 2022; 12(4):402-404.

DOI: 10.52711/2349-2996.2022.00085