Valoración de enfermería en atención domiciliariaun instrumento de evaluación de sobrecarga del cuidador informal

Zusammenfassung

ABSTRACT Objective: The objective of this research was to generate and validate an instrument for measuring informal caregiver overload, based on predictors and caregiver overload symptoms that can be measured during the nursing assessment process. Methodology: The study responds to a modality of empirical-descriptive research and the design attends to a mixed type methodology. The study sample consisted of 14 nurses from three Primary Care Centers in the L'Hospitalet de Llobregat area (Barcelona) and 296 caregivers. The variables of analysis were the symptoms and predictors of overload associated with the caregiver and the patient. First, data collection was carried out through a bibliographic review and 18 semi-structured interviews prepared ad hoc for healthcare professionals and caregivers. Next, the instrument was constructed using a mainly inductive analysis model and subjected to validation tests. Results: The instrument, known as CESC (Caregiver Overload Assessment Questionnaire), consisted of 16 items that measured the load objectively and subjectively. In the validity of content, by means of the Individual aggregates method, a total percentage of agreement among experts of 83% was obtained. Feasibility was evaluated through an opinion and satisfaction survey administered to professionals. In general, it is important to highlight the high average scores, the elements that were best evaluated being those referring to the content and design of the questionnaire. In terms of criteria validity, both tests (CESC and Zarit) presented a positive linear relationship, with a Pearson correlation value of 0.79, which allows us to speak of a considerable correlation. Regarding reliability, the analysis of the items applying the KR-20 calculation to the CESC revealed an acceptable level of reliability with the 16 items of the instrument, obtaining a value of 0.72 (positive correlation). Finally, regarding the validity of the construct, it was found that the matrix of the data was adequate for the factorial analysis (KMO = 0.744). Also, Bartlett's sphericity test yielded a significant value (χ² (105) = 857.233, p = 0.000). Being less than p <0.05 indicates that the factorial analysis was adequate, since it is considered that the variables are sufficiently interrelated to perform it. In the analysis of the diagonal of the anti-image matrix, it was observed that the items presented good levels of adequacy with values in general higher than 0.60, this being a positive indicator of the data matrix. The factor analysis revealed 5 factors and the solution explained 58.99% of the variance. The Kaiser-Guttman rule allowed to identify these five factors with latent roots or eigenvalues greater than one. Specifically, factor 1, "emotional expression", includes psychological aspects, factor 2, "quality of life", refers to physical problems, as well as convivial aspects; factor 3, "functional and cognitive impairment", describes the patient's level of dependence and cognitive impairment; factor 4, "support network", refers to social and family support resources; finally, factor 5, "social development", includes socioeconomic aspects. Subsequently, a multinomial logistic regression model was constructed, incorporating as a dependent variable the level of caregiver overload, and as independent variables the symptoms and predictors of overload that compose each of the five factors. Conclusion: The results confirm the importance of the various symptoms and predictor factors in the level of caregiver overload, highlighting the preeminence of the emotional factor over the rest of the variables related to overload. The study of multinomial logistic regression reveals that the predictor variables and symptoms of overload used in the CESC correspond to those usually handled in the nurse assessment of the home patient and his/her caregiver, allowing their systematic use in the care practice. The main contributions of the study consist in overcoming some of the deficiencies presented by other instruments, since the CESC is characterized by its brevity, ease of use and satisfaction, in addition to increasing the detail in the level of overload. These results will allow for a change in the caregiver overload assessment, more in line with the nursing care and assessment framework.