Caregivers of Prolonged Mechanical Ventilation: Mind-Body Interaction Model

描述(由申请者提供)：这项建议的长期目标是获得深入的生物行为研究经验，重点是改善长期机械通气(PMV)患者及其家庭照顾者的结果，以增强申请者开始竞争和独立研究生涯的能力。患有PMV的人在重症监护病房(ICU)存活后，往往会遭受长期的身体和心理后遗症，因此需要家庭照顾者的大量帮助。研究表明，患有慢性病(如痴呆症)的照顾者的负面心理和行为反应与照顾者的负面健康结果有关。尽管有关于PMV患者照顾者的心理痛苦和负担的报告，但对这种应激反应的程度，包括在疾病持续期间(ICU入院后)的心理、行为和生物反应，了解有限。这项使用多学科综合生物行为模型-匹兹堡心身中心模型的试点可行性研究的目的是：1)评估在PMV患者的照顾者中进行纵向生物行为研究的可行性；2)探索随着时间的推移，照顾者的心理(例如负担)、行为(例如睡眠)和生物(例如IL1)对急性和慢性压力的反应之间的交互作用，以及这些交互作用如何与照顾者的特征相关。采用纵向前瞻性描述性重复测量设计。总共有40对照顾者和接受PMV(护理接受者)的人在机械通气上花费了4天，将被纳入研究。数据收集将进行三次(基线[ICU入院]、ICU出院和ICU出院后2个月)。可行性将使用描述性统计数据进行评估，包括招募和保留率，以及照顾者对行为和生物数据收集的接受程度。为了探索照顾者反应的潜在纵向变化以及反应之间的关系，将使用描述性统计和相关系数的变化趋势。这项研究与NINR整合生物和行为科学、利用新技术研究问题、改进研究方法和培养未来科学家的使命是一致的。这项拟议的研究也符合NINR强调家庭照顾的研究领域之一。这项研究与公共卫生的相关性是确定特定的时间点来预防和干预，以改善照顾者的情绪和身体健康，而不是照顾者的疾病轨迹。改善护理者的情绪和身体健康也可能改善护理的提供以及护理接受者的生活质量。

DESCRIPTION (provided by applicant): The broad long-term objective of this proposal is to gain in-depth experience in biobehavioral research focusing on improving outcomes in persons on prolonged mechanical ventilation (PMV) and their family caregivers to strengthen the applicant's ability to launch a competitive and independent research career. Persons on PMV often suffer from long-term physical and psychological sequelae after surviving in the intensive care unit (ICU) and therefore require significant assistance from family caregivers. Research has shown that negative psychological and behavioral responses in caregivers of persons with chronic disease (e.g., dementia) are associated with negative caregiver health outcomes. Despite reports of psychological distress and burden in caregivers of persons on PMV, there is limited understanding of the extent of this stress responses, including psychological, behavioral and biological responses over the continuum of illness (ICU admission to post discharge). The purposes of this pilot feasibility study using a multidisciplinary, integrative biobehavioral model, the Pittsburgh Mind-Body Center Model are: 1) to evaluate the feasibility of conducting a longitudinal biobehavioral study in caregivers of persons on PMV and 2) to explore the interactions among caregivers' psychological (e.g., burden), behavioral (e.g., sleep) and biological (e.g., IL1) responses of acute and chronic stress over time and how those interactions are related to characteristics of care recipients. A longitudinal prospective descriptive repeated measure design will be used. A total of 40 dyads of caregivers and persons on PMV (care recipient) who spent >=4 days on mechanical ventilation will be enrolled in the study. Data collection will occur three times (baseline [ICU admission], ICU discharge, and 2 months after ICU discharge). Feasibility will be evaluated using descriptive statistics including recruitment and retention rates, and caregivers' acceptability of behavioral and biological data collection. To explore the potential longitudinal changes in caregivers' responses and relationships among responses, trends of changes in descriptive statistics and correlation coefficients will be used. This study is consistent with NINR's mission to integrate the biological and behavioral sciences, employ new technologies to research questions, improve research methods, and develop scientists of the future. The proposed research also meets one of NINR's areas of research emphasis on family caregiving. The relevance of this research to public health is to identify specific time-points to prevent and intervene to improve caregivers' emotional and physical health over the care recipient's illness trajectory. Improving caregivers' emotional and physical health may also improve the delivery of care as well as quality of life for the care recipient.