Development of Telenursing Based Caregiver Transitional Support Program for Thai Caregivers of Persons with Traumatic Brain Injury

Abstract

The purpose of the action research was to develop the telenursing based caregiver transitional support program for Thai caregivers of persons with traumatic brain injury (TBI). The study process was based on the transitional care concept and included three phases of action research; (1) reconnaissance phase; (2) spiral action research process to develop the Telenursing Based Caregiver Transitional Support Program (TCTS Program); and (3) final phase to evaluate the outcomes such as patients' complications, caregiver stress and caregiver burden. Data were obtained from focus group discussions and interviews among participants comprising of 14 persons with traumatic brain injury and their family caregivers, 9 nurses, from a tertiary hospital in a southern Thai province. Content analysis was used A for data analysis. Regarding the reconnaissance phase, the main barriers of TBI care in the transitional period were related to the caregiving support system at home such as a lack of time for giving advice, a lack of a discharge planner, and a lack of care coordination and communication. In addition, the family caregivers' felt a lack of confidence in caring, lacked resources (such as intermittent suction, air bed, and dressing set) for caring, and had no health care provider to consult in emergency situations. The TCTS program development was employed through the collaboration and communication among the researcher and nine nurses who acted as a core working group, including one head nurse, two discharge planner nurses, one community nurse and five nurses to consider appropriate activities and set priorities for practical activities. The tentative care model was implemented by integrating "We Care You" application to enhance caregiver's knowledge and skill in TBI care with the usual care plan in the transitional period. The model was refined in enhancing safely TBI care management at home. Three cycles were found as supportive system of TBI caregivers namely, enhancing and empowering the family caregiver, maximizing resources and care coordination, and supporting care management in emergency situations. In the outcomes, there was no patient's complication, less caregiver stress, and care burden after discharge home. The TCTS program focusing on empowering family caregivers' role and capability through "We Care You" application within adequate resources and supportive care at home is necessary. It is recommended for nurses in applying TCTS program, factors related to caregiver and community nurse's participation should always be considered such as arrangement of resources, continuing care coordination and communication in order to bridge the services at home and community which enable to increase both TBI caregiver's confidence and TBI patient's safety at home.