Bidwell Julie T, Lyons Karen S, Lee Christopher S
Julie T. Bidwell, RN, BSN PhD Student, School of Nursing, Oregon Health & Science University, Portland. Karen S. Lyons, PhD Associate Professor, School of Nursing, Oregon Health & Science University, Portland. Christopher S. Lee, PhD, RN Associate Professor, School of Nursing, Oregon Health & Science University, and Oregon Health & Science University Knight Cardiovascular Institute, Portland.
J Cardiovasc Nurs. 2017 Jul/Aug;32(4):372-382. doi: 10.1097/JCN.0000000000000350.
Despite evidence from the broader caregiving literature about the interdependent nature of the caregiving dyad, few studies in heart failure (HF) have examined associations between caregiver and patient characteristics.
The aim of this study is to quantitatively synthesize the relationships between caregiver well-being and patient outcomes.
The MEDLINE, PsycINFO, and CINAHL databases were searched for studies of adult HF patients and informal caregivers that tested the relationship between caregiver well-being (perceived strain and psychological distress) and patient outcomes of interest. Summary effects across studies were estimated using random effects meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
A total of 15 articles meeting inclusion criteria were included in the meta-analysis. Taking into account differences across studies, higher caregiver strain was associated significantly with greater patient symptoms (Fisher z = 0.22, P < .001) and higher caregiver strain was associated significantly with lower patient quality of life (Fisher z = -0.36, P < .001). Relationships between caregiver psychological distress and both patient symptoms and quality of life were not significant. Although individual studies largely found significant relationships between worse caregiver well-being and higher patient clinical event-risk, these studies were not amenable to meta-analysis because of substantial variation in event-risk measures.
Clinical management and research approaches that acknowledge the interdependent nature of the caregiving dyad hold great potential to benefit both patients and caregivers.
尽管在更广泛的护理文献中有证据表明护理二元组具有相互依存的性质，但很少有关于心力衰竭（HF）的研究探讨护理人员与患者特征之间的关联。
本研究的目的是定量综合护理人员幸福感与患者结局之间的关系。
检索MEDLINE、PsycINFO和CINAHL数据库，查找关于成年HF患者和非正式护理人员的研究，这些研究测试了护理人员幸福感（感知压力和心理困扰）与感兴趣的患者结局之间的关系。按照系统评价和Meta分析的首选报告项目（PRISMA）指南，使用随机效应Meta分析估计各研究的汇总效应。
共有15篇符合纳入标准的文章纳入Meta分析。考虑到各研究之间的差异，护理人员较高的压力与患者更严重的症状显著相关（Fisher z = 0.22，P < .001），护理人员较高的压力与患者较低的生活质量显著相关（Fisher z = -0.36，P < .001）。护理人员心理困扰与患者症状和生活质量之间的关系不显著。尽管个别研究大多发现护理人员幸福感较差与患者较高的临床事件风险之间存在显著关系，但由于事件风险测量存在很大差异，这些研究不适合进行Meta分析。
承认护理二元组相互依存性质的临床管理和研究方法具有使患者和护理人员都受益的巨大潜力。
