http://doi.org/10.33698/NRF0040- Kurdeep Kaur, Jogindra Vati, Raman Kalia
Abstract : Patients are admitted to hospital when they suffer from one or more health complaints. Usually informal caregivers stay with them, provide the required assistance and participate in care of their patients. The present study was undertaken with the objective to assess and describe the participation of patients and informal caregivers in measuring and keeping record of intake and output at Nehru Hospital, PGIMER, Chandigarh. Interview schedule was used to assess participation of 134 patients and 180 informal caregivers in measuring and keeping record of intake and output. Participation was assessed in terms of ‘always’, ‘most of the times’, ‘sometimes’, ‘rarely’ and ‘never’. informal caregivers were participating maximum in measuring than keeping record of intake and output, whereas patients were participating less in measurement and keeping record of intake and output.
Key Words :
Intake, output, patient, informal caregiver
Correspondence at :
Kuldeep Kaur,
National Institute of Nursing Education PGIMER Chandigarh, India
Introduction
Patients are admitted to hospital when they suffer from one or more health complaints. Usually informal caregivers stay with them and provide the required assistance to patients. The informal caregivers provide the care in the context of family or marital relationships and is provided on unpaid basis reflecting feelings of obligation and duty1.
During the past decade, there has been an increasing emphasis on patient involvement in care2. Patients themselves are becoming more involved in self-care as compared to the previous times. Previously, the informal caregivers were not much aware of their participation in patient’s care. Now a days informal caregivers are actively contributing to patient’s care and are well informed about the patient’s condition.
Informal caregivers spent a significant time in caring for their patients. The care provided by them ranges from assistance in activities of daily living to provide the emotional support to patients. Astedt-Kurki et al found that two-third (65%) of family members visited the hospital on daily basis, 18% 2-3 times a week, 14% once a week and 2% less than once a week. The majority of family members did not just stop by to say hello, but they spent several hours at hospital3
Andolsek et al surveyed randomly selected patients who were 40 years and older to determine the prevalence and extent of the care givers role among elderly relatives. It was found that one third of caregivers lived with the relative and the remaining two third visited their relative at least twice a week4. Eriksson and Lauri conducted study on 168 relatives of cancer patients from oncology wards all over Finland to see to what extent they actually take part in patient care. Finding revealed that over 80% of the relatives gave a considerable amount of suppor t to the patient5.
Perkins conducted a study on twenty- three parents of hospitalized or recently hospitalized children with cognitive impairments and a variety of disabling conditions by exploring parental caregiving experiences. Significant participation of parents was found in physical and emotional care of children6. In another similar study by Laitinen discovered the extent of participation of informal caregivers in activities of daily living. Results indicated that relatives and significant others visited elderly hospitalised patients often but their participation in activities of daily living in hospitals was limited. Mostly they gave emotional support and helped the patient to drink, stand up, get into bed and sit7.
Astedt-Kurki et al explored the experiences of 70 family members in their role of relative in a situation in neurosurgical wards. It was found that family members spent a lot of time at their relative’s bedside, most of them up to several hours a day. Over half of the family members said they were actively involved in caring for their relative. Only four per cent of the family members reported bad experiences of their visits to hospital3.
Investigator gained interest in this study from her clinical experience. Patients and their informal caregivers were found to participate in measuring and keeping record of intake and output. During review literature, investigator did not find many research studies related to par ticipation of patients and informal caregivers in measuring and keeping record of intake and output. Hence, an attempt has been made to study ,the particiption of patients and caregivers in maintenance of intake and output documents.
Objective
To assess and describe The present study was based on the concept of participation of patients and informal caregivers in measuring and keeping record of intake and out.
Material and Methods
This descriptive study was conducted at Nehru Hospital, PGIMER, Chandigarh. This is one of the major referral hospitals in North India providing diagnostic, therapeutic and rehabilitative services in various specialties and super-specialities. Nehru Hospital is having bed strength of about 1200 beds.
Participation of patients and informal caregivers in measuring and keeping record of Intake and Output was assessed in terms of ‘always’, ‘most of the times’, ‘sometimes’, ‘rarely’ and ‘never’. Using purposive sampling, patients and their informal caregivers were selected from general wards, specialized wards and critical care units.
The data was collected by conducting interviews in morning and evening hours for six consecutive days in a week. Data was collected with interview schedules developed for patients and informal caregivers. The tools were checked for validity by six experts from nursing, medicine and surgery departments. A pilot study was also conducted to check the feasibility of the study. A written permission was sought from the competent authority. Investigator prepared a list of patients with intake and output recording. All the informal caregivers (N=180) were interviewed. Only 134 patients could be interviewed. Other 46 patients were not interviewed due to medical problems. Thus, total 134 patients and 180 informal caregivers were interviewed. Data was analyzed by using descriptive statistics and presented through tables and figures.
Results
Socio demographic profile of patients and their informal caregivers
Table – 1 reveals that out of 180 patients included in the study one-fourth 43(23.9%) were of age group 41-50 years, 124(68.9%) were males, 43(23.9%) were illiterate followed by 41 (22.8%) who had completed education till matriculation level. Majority of them i.e., 158(87.8%)were married, two thrid of them 113(62.8%) had total monthly income of family less than Rs. 5000 and more than half 97 (53.9%) were residing in rural areas. Out of 180 informal caregivers 61(33.9%) were in the age group 31-40 years, 119(66.1%) were males, 50 (27.8%) had completed education till matriculation level, 145(80.6%) were married, more than half 106(58.9%) had total monthly income of family less than Rs. 5000 and more than half 94 (52.2%) were residing in rural areas. Among the patients as well as informal caregivers most of them were 139(77.2%) were Hindus.
Participation of patients in measuring and keeping record of oral intake and output
Table – 2 reveals that 105 patients were interviewed for identifying their partici- pation in measuring and keeping record of oral intake. It was found that only 4.8%
Table – 1: Socio-demographic profile of patients and informal caregivers.
Variables Age (in years)
Patients N=180 f (%)
Informal Caregivers
N=180 f (%)
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Habitat
Religion
Urban Rural Slum
81 (45.0)
97 (53.9)
02 (01.1)
84 (46.7)
94 (52.2)
02 (01.1)
| Hindu | 139 (77.2) | 139 (77.2) |
| Muslim | 10 (05.6) | 10 (05.6) |
| Sikh | 30 (16.7) | 30 (16.7) |
| Christian | 01 (00.6) | 01 (00.6) |
Patients Age Range = 14-85 yrs, Mean 42.43 and SD = 14.87
Total monthly income of family: Range = Rs. 1000-40000, Mean = 6316.38 and SD = 6082.94
Informal caregivers- Age: Range=16-70yrs, Mean=36.37 and SD=11.63
Total monthly income of family: Range= Rs.1000-32000, Mean=6119.16and SD=5225.08 patients were always measuring the food items (only liquids) and 2.9% patients were always keeping a record of oral intake. About 45.7%
patients were always informing the nurses regarding oral intake.
Number of patients participating
Table – 2 : Distribution of patients as per participation in measuring and keeping record of oral intake
| Variables | Always | Most of the times | Sometimes | Rarely | Never |
| F(%) | F(%) | F(%) | F(%) | F(%) | |
| Oral Intake (N=105)* | |||||
| Measuring food items** | 05(04.8) | – | – | 01(00.9) | 99 (94.3) |
| Keeping in record | 03(02.9) | – | 02(01.9) | – | 100 (95.2) |
| Informing the nurse | 48 (45.7) | 06(05.7) | 44(41.9) | 04(03.8) | 03 (02.9) |
| Output (N=134) | |||||
| Measuring the urine *** | 12 (09.0) | 03(02.2) | 10(07.5) | 11(08.2) | 98 (73.1) |
| Keeping in record | 05 (03.7) | – | 04 (03.0) | – | 125 (93.3) |
| Informing the nurse | 43(32.1) | 08(06.0)) | 28(20.9) | 01(00.7) | 54 (40.3) |
* Interviewed for participation in measuring and keeping record of oral intake
** These patients were measuring liquids only and always measured in a calibrated container.
*** Urine was always measured in a calibrated container.
All the patients were asked about urine output recording, It was found that 9% patients were always measuring urine passed by them. Only 3.7% patients were always keeping the record of urine passed. On the other hand, 32.1% patients were always informing the nurses about the frequency and amount of urine passed. It was found that none of them were keeping a record of stool passed by them. Regarding vomiting none of them were keeping record of vomiting, whereas 66.7% were always giving its account to nurses. For soakage of linen and clothes, none of them were keeping the record of soakage whereas all were always informing the nurses about it.
Participation of informal caregivers in measuring and keeping record of patient’s intake and output
- Intake
Table – 3 shows that only 105 patients were on oral intake and all informal caregivers were assisting the patients to feed. Among them only 5.7% were always measuring the food items (liquids) consumed by patient. Only 1.9% of them were always keeping record of food items and 36.2% of the informal caregivers were always informing the nurses about food items consumed by patient. Out of 83 patients who were being administered I/V fluids among them only 2.4% informal caregivers were sometimes administering the I/V fluids to patients.
Table – 3 : Distribution of informal caregivers as per participation in measuring and keeping record of patients oral, I/V and feeding tubes
Number of infromation caregivers participating
Variables Always Most of Sometimes Rarely Never the times
n F (%) F (%) F (%) F (%) F (%)
Oral Intake (N=105)
| Assisting patient to feed | 105 | 105 (100.0) | – – – – | |||||
| Measuring food items | 06 (05.7) | 01 (01.0) – – 98 (93.3) | ||||||
| Keeping in record | 02 | (01.9) | – | 01 (01.0) | – | 102 (97.1) | ||
| Informing the nurse | 38 | (36.2) | 04 (03.8) | 34 (32.4) | 06 (05.7) | 23 (21.9) | ||
| Intravenous Intake (N= 83) | ||||||||
| Administering I/V fluids | 83 | – | – | 02 (02.4) | – 81 (97.6) | |||
| Keeping a record | 2 | – | – – – 02 (100.0) | |||||
| Informing the nurse | 2 | 02 ( 100.0) | – – – – | |||||
| Feeding Tubes (N=40) | ||||||||
| Administering tube feed | 40 | 23 | (57.5) | 02 (05.0) | – | – | 15 | (37.5) |
| Measuring the feed | 25 | 17 | (68.0) | – – – 08 | (32.0) | |||
| Keeping a record | 25 | 01 | (04.0) | – – – 24 | (96.0) | |||
| Informing the nurse | 25 | 25 | (100.0) | – – – – | ||||
Variables Always Most of Sometimes Rarely Never the timesNumber of infromation caregivers participating
Oral Intake (N=105)
n F (%) F (%) F (%) F (%) F (%)
| Assisting patient to feed | 105 | 105 (100.0) | – – – – | |||||
| Measuring food items | 06 (05.7) | 01 (01.0) – – 98 (93.3) | ||||||
| Keeping in record | 02 | (01.9) | – | 01 (01.0) | – | 102 (97.1) | ||
| Informing the nurse | 38 | (36.2) | 04 (03.8) | 34 (32.4) | 06 (05.7) | 23 (21.9) | ||
| Intravenous Intake (N= 83) | ||||||||
| Administering I/V fluids | 83 | – | – | 02 (02.4) | – 81 (97.6) | |||
| Keeping a record | 2 | – | – – – 02 (100.0) | |||||
| Informing the nurse | 2 | 02 ( 100.0) | – – – – | |||||
| Feeding Tubes (N=40) | ||||||||
| Administering tube feed | 40 | 23 | (57.5) | 02 (05.0) | – | – | 15 | (37.5) |
| Measuring the feed | 25 | 17 | (68.0) | – – – 08 | (32.0) | |||
| Keeping a record | 25 | 01 | (04.0) | – – – 24 | (96.0) | |||
| Informing the nurse | 25 | 25 | (100.0) | – – – – | ||||
Note: 105 Patients were on oral intake, 83 patients were on I/V fluid and 40 patients were on tube feeding.
They were never keeping a record but were always informing the nurses about I/V fluids administered. Only 40 patients were getting tube feeding, among them 57.5% caregivers were always administering the tube feed to patient. Only 68% were always measuring the feed given, 4% were keeping the record of feed administered and all were always informing the nurses about it.
- Output
Data related to maintenances of output records reveals that about 71.7% informal caregivers were always measuring the urine passed by patient, 23.9% were always keeping the record of amount of urine passed and 73.3% were always informing the nurses regarding the amount of urine passed. Total 68 patients had drainage tubes, among them 89.7 % care givers were always emptying the fluid from drains of patients, 88.5% were always measuring the fluid emptied, 36.1% were keeping its record, whereas 72.1% were always informing the nurses about amount of fluid emptied. A total of 28 patients had nasogastric tube inserted for aspiration, among them 10.7% aspirating the fluid from nasogastric tube, were neither measuring the fluid and nor keeping a record, but all were always informing the nurses about its amount. (Table 4). None of informal caregivers were keeping a record of stool passed or not passed by patient but they were always informing the nurses about the same, Regarding vomiting, soakage of linen and clothes none of them were keeping a record of these whereas all of them narrated to nurse about them.
Table – 4 : Distribution of informal caregivers as per participation in measuring and keeping record of output through urine, drains and nasogastric tube aspirate
| Variables | n | Always | Most of the times | Sometimes | Rarely | Never | ||
| F (%) | F (%) | F (%) | F (%) | F (%) | ||||
| Urine (N=180) | ||||||||
| Measuring the urine | 129 (71.7) | 02 (01.1) | 10 (05.6) | 01 (00.6) | 38 (21.1) | |||
| Keeping a record | 43 (23.9) | – | 03 (01.7) | – | 134 (74.4) | |||
| Informing the nurse | 132 (73.3) | 01 (00.6) | 15 (08.3) | 04 (02.2) | 28 (15.6) | |||
| Drains (N=68) | ||||||||
| Emptying the fluid from drain |
68 |
61 (89.7) |
– – – |
07 |
(10.3) |
|||
| Measuring the fluid | 61 | 54 (88.5) | – – – | 07 | (11.5) | |||
| Keeping a record | 61 | 22 (36.1) | – – – | 39 | (63.9) | |||
| Informing the nurse | 61 | 44 (72.1) | – – – | 17 | (27.9) | |||
| Nasogastric tube aspirate (N=28) | ||||||||
| Aspirating the fluid | 28 | 03 (10.7) | – – – | 25 | (89.3) | |||
| Measuring the feed | 03 | – | – – – | 03 | (100.0) | |||
| Keeping a record | 03 | – | – – – | 03 | (100.0) | |||
| Informing the nurse | 03 | 03 (100.0) | – – – | |||||
discussion
The data revealed that about 95% patients were not measuring food items consumed by them and were also not keeping record of it, whereas only 45.7% patients were always informing the nurses regarding oral intake. Relevant literature was lacking for comparison of the findings. Where as more than 70% patients were not measuring the urine passed by them, more than 90% were not keeping record of it and only 32.1% patients were always informing the nurses regarding amount of urine passed. All the patients were not keeping record of stool passed or not passed, whereas 66.7% were narrating to nurses about vomiting (frequency, amount and colour) and soakage of linen and clothes.
As per par ticipation of informal caregivers 93.3% were never measuring food items and 97.2% were not keeping its record whereas 36.2% were always informing the nurses regarding patient’s oral intake. Two informal caregivers who were sometimes administering I/V fluids to patient were never keeping its record but always narrating to nurse regarding it. More than half of caregivers (57.5%) were administering tube feed to patients. Among them 68% were always measuring the feed administered and 96% were not keeping its record, whereas all were always informing the nurses about its amount. This indicates that the informal caregivers were also doing the nursing procedures. However, Laitinen8 had documented that the participation of relatives in activities of daily living in hospitals was limited. Mostly they gave emotional support and helped the patient to drink, stand up/get into bed and sit, whereas Kavic et al9 concluded that critically ill patients and their families are assuming an active role in EOL(End-Of-Life) care.
Astedt-Kurki et al3, in their study also revealed that family members spent a lot of time at their relative’s bedside and were actively involved in caring for their relatives whereas Eriksson & Lauri5 reported that 80% relatives were giving considerable support to patient, talked to them about their concerns and were near them whenever they felt they needed them. Where as in the present study informal caregivers were always measuring the urine passed by patient, and 29.3 % were keeping record, 73.3% were always informing the nurses about amount of urine passed. About 89% of informal caregivers who were emptying the fluid from drains of patients were always measuring its amount, more than 63.9% were never keeping its record and 27.9% were never informing the nurses about its amount. Three informal caregivers who were aspirating fluid from nasogastric tube were neither measuring it, nor were keeping its record but were always informing the nurses about its amount. All informal caregivers were always informing the nurses about vomiting (frequency, amount and colour) and regarding soakage of linen and clothes. Here again findings reveal that the informal caregivers are actively performing the procedures related to patient care.
So, overall informal caregivers were participating maximum in measuring than keeping record of intake and output, whereas patients were par ticipating less in measurement and keeping record of intake and output. It was recommended that nursing administrators should decide whether to promote or discourage the participation of patients and informal caregivers in measuring and keeping record of intake and output. If patients’ and informal caregiver’s participation in care giving activities is promoted, then they should be supervised as required and also orientation programmes can be planned for them. More stringent research can be carried out on a larger sample in a larger setting.
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