พฤติกรรมก้าวร้าวของผู้ป่วยภายหลังบาดเจ็บสมอง การเผชิญปัญหาและภาระการดูแลตามการรับรู้ของญาติผู้ดูแล

Abstract

This study aimed to describe the severity of aggression behaviors of patients after traumatic brain injury, coping strategies, and caregiving burden perceived by family caregivers, and to examine the relationships among severity of aggressive behaviors of patients after traumatic brain injury, coping strategies, and caregiving burden. One hundred and thirty family caregivers of patients with traumatic brain injury from the southern region of Thailand were purposively recruited. Data were collected using questionnaires comprising 4 parts: 1) The General Data Form of patients and family caregiver; 2) The Modified Version of the Overt Aggression Scale; 3) The Jalowiec Coping Scale; and 4) The Zarit Burden Interview. These questionnaires had been tested for validity by three experts. The reliability of questionnaire part two was tested using test- retest and analyzed by intraclass correlation coefficient, yielding a value of .91. The reliabilities of questionnaires parts three and four were tested using Cronbach's alpha coefficient and yielded values of .81 and .94, respectively. The data were analyzed using descriptive statistics and Spearman rank correlation coefficient. The results showed the following: 1. The family caregivers perceived that patients after traumatic brain injury showed an overall severity of aggressive behaviors, mostly with a low level (n = 124, 95.3%). When considering each type of aggressive behaviors, patients expressed severe verbal aggressive behavior, mostly with a low level (n = 114, 96.6%), followed by severe aggressive behavior toward others (family caregivers), mostly with a low level (n = 14, 63.7%). 2. The family caregivers used three coping methods. Confrontive coping was used at the highest level (Mdn = 58, IQR = 6). Palliative coping was used at a high level (Mdn = 44, IQR = 7) and emotive coping was used at a low level (Mdh = 16, IQR = 4). 3. Overall caregiving burden of family caregivers was at a low level (63.1%). Considering each dimension of caregiving burden, most caregivers perceived social, physical and psychological caregiving burden at low levels (73.1%, 70.0% and 66.9%, respectively), while most of them had financial caregiving burden at a high level (50.0%). 4. Overall severity of aggressive behaviors of patients after traumatic brain injury had a statistically significant positive correlation with caregiving burden (rs = .22, p = .01). 5. Confrontive coping had a statistically significant negative correlation with caregiving burden (r=-38, p < .01). Palliative coping and emotive coping had statistically significant positive correlations with caregiving burden (rs = .43, p < .001; rs = .64, p < .001), respectively. The findings of this study suggest that healthcare professionals should educate family caregivers about aggressive behaviors of patients after traumatic brain injury and methods of coping. They should coordinate with the organizations and networks in the community to continuously improve patients' physical, psychological, and occupational rehabilitation to reduce the caregiving burden in the long term.