Qom University of Medical Sciences Journal

Introduction
Chronic kidney disease is an irreversible and progressive loss of kidney function. It is also known as end-stage renal disease where high amounts of nitrogenous waste materials accumulate in the blood, and can cause death if there is no renal replacement therapy. Therefore, the need for dialysis or kidney transplantation is necessary at this stage. This disease can be treated with alternative treatments such as hemodialysis, peritoneal dialysis, and kidney transplantation. Of these, about 90.6% of patients prefer to use hemodialysis. Although this method increases the life span of patients, it can cause many problems. These patients suffer from a high degree of disability, loss of function and family dependence; weekly hemodialysis sessions weaken the patients and disrupt their functional independence; hence, they need more support from others, including caregivers. Family members have the greatest contribution in patient care and disease management, Caregivers devote most of their time to meeting the hemodialysis patient’s needs including drug prescription, assistance for hemodialysis, the necessity of lifelong hemodialysis, daily check-ups, compliance with personal hygiene, and having kidney-friendly diet, as well as frequent hospitalizations, which affect the social, economic and psychological status of caregivers and lead to their depression, reduced quality of life, and reduced resilience. Increasing awareness and empowering caregivers of hemodialysis patients can improve the resilience of caregivers and the physical and mental conditions of patients. This study aims to determine the effect of an intervention based on the family-centered empowerment model (FCEM) on the resilience of family caregivers of hemodialysis patients.
Methods
This is a randomized controlled clinical trial. Sixty family caregivers of patients in the hemodialysis department of Imam Khomeini Hospital in Kermanshah, Iran were selected by a random sampling method using a random number table. Then, they were randomly divided into two groups of intervention (n=30) and control (n=30). The inclusion criteria were: Caregiving for at least 4 hours a day and spending the most time with the patient (according to the patients’ reports), not having a medical profession or medical education, no mental illnesses or anxiety disorders, willingness to participate in the study, ability to learn, and age 18-65 years. Exclusion criteria were: Death of patient, absence from two intervention sessions, diagnosis of a new disease in the patient, and unwillingness to continue participation.
The assessment tools included a demographic form (surveying age, sex, marital status, educational level, frequency of hemodialysis, history of kidney transplant, caregiver’s relationship with the patient, place of residence, patient’s occupation) and the Connor-Davidson resilience scale. Descriptive and inferential statistics were used to analyze the collected data in SPSS software, version 18
Results
The results of independent t-test showed that the mean resilience score at baseline was not significantly different between the two groups (P=0.29). After the intervention, it was significantly increased in the intervention group compared to the control group (P<0.001). In addition, there was a statistically significant difference between pre- and post-intervention scores of resilience in the intervention group (P<0.001), but no significant difference was found in the control group (P=0.17).
Discussion
The results of the present study showed that, before the intervention, the mean resilience score of caregivers in the intervention and control groups was not significantly different; it was at a moderate level. After the intervention, it increased highly in the intervention group. Regarding the subscales of resilience, the results showed that the mean scores of personal competence, trust in one’s instincts, positive acceptance of change and secure relationships, spirituality and control before the intervention were not significantly different between the two groups. After the intervention, the mean scores of personal competence, trust in one’s instincts, positive acceptance of change and secure relationships and spirituality were significantly increased in the intervention group than in the control group. The difference in the control subscale score was not significantly different between the two groups. Furthermore, the results showed that the mean pretest and post-test scores of the subscales of personal competence, trust in one’s instincts, positive acceptance, spirituality, and control were significantly different in the intervention group, but no significant difference was found in the control group. This indicates that the FCEM-based intervention was effective in increasing the resilience of caregivers of hemodialysis patients. Therefore, it is recommended to pay attention to the empowerment of family members in the treatment of hemodialysis patients, and interventions such as education, counseling, family therapy should be used to increase resilience of caregivers to improve the quality of patient care and ensure the physical and mental health of caregivers.
Ethical Considerations
Compliance with ethical guidelines
This study has an ethical approval obtained from Islamic Azad University of Najafabad Branch (Code: IR.IAU.NAJAFABAD.REC.1400.165) and was registered by the Iranian Registry of Clinical Trials (Code: IRCT20211102052943N1).
Funding
This study was extracted from a thesis. It was not funded by any organizations.
Authors contributions
The authors contributed equally to preparation of this article.
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgements
The authors would like to thank the patients and families as well as the personnel of Imam Khomeini Hospital in Kermanshah city for their cooperation in this study.