Eight-week telenursing trial reports improved caregiver outcomes in a small Egyptian sample

An eight-week, nurse-led psychiatric telenursing program was associated with lower caregiver burden and higher psychological resilience and rewarding feelings among 70 family caregivers of people with bipolar disorder in a two-arm randomized controlled trial conducted at a psychiatric hospital in Egypt. Participants receiving the intervention had significantly better outcomes than those receiving usual psychiatric care immediately after the program, with all reported group differences at p < 0.001. The study enrolled primary family caregivers who had provided continuous care for a person with bipolar disorder for at least six months.

Eligible participants were at least 18 years old and had access to a mobile phone and internet. Individuals with a diagnosed psychiatric disorder, sensory impairments that could interfere with participation, or major psychological stress during the preceding six months were excluded. Caregivers were recruited by convenience sampling at the hospital and randomly allocated in a 1:1 ratio to the intervention or control group, with 35 participants in each arm.

All 70 randomized caregivers completed the pre-intervention and post-intervention assessments, with no withdrawals. The intervention was delivered through weekly Zoom sessions lasting 60 to 90 minutes, supported by telephone follow-up and WhatsApp messages between sessions. Its content combined psychoeducation, cognitive-behavioral strategies, stress management, coping-skills training, mindfulness, resilience-building activities, communication-skills training, problem solving, and recognition of positive caregiving experiences.

Arabic multimedia materials and examples of caregiving situations in Egyptian families were used to make the program culturally relevant. The intervention was manualized and structured around the Transactional Model of Stress and Coping, cognitive-behavioral theory, positive psychology, and family-centred care. Caregivers in the control group received the hospital’s usual psychiatric care for eight weeks, including standard outpatient follow-up, medication management by the treating psychiatrist, and nursing care under routine clinical procedures.

They did not receive the structured psychoeducational sessions, telenursing follow-up, stress-management training, coping-skills training, mindfulness activities, resilience-building strategies, or additional psychosocial support provided to the intervention group. Both groups completed the same outcome measures before and immediately after the study period. Caregiver burden was measured with the 10-item Modified Zarit Burden Interview, on which scores range from 0 to 40, with higher scores indicating greater perceived burden.

Psychological resilience was assessed with the 25-item Connor–Davidson Resilience Scale, ranging from 0 to 100, with higher scores indicating greater resilience. The 10-item Positive Aspects of Caregiving Questionnaire measured rewarding feelings on a 0-to-40 scale, including personal satisfaction, accomplishment, and emotional closeness. The instruments had internal consistency coefficients of 0.87, 0.90, and 0.85, respectively, and were reviewed for clarity and cultural appropriateness by five psychiatric nursing experts.

The primary analysis used separate repeated-measures analyses of variance for the three outcomes. These results indicated different patterns of change between the groups, with greater reductions in burden and increases in resilience and rewarding feelings among intervention participants. Independent-samples t-tests also found significantly lower post-test burden and higher post-test resilience and rewarding feelings in the intervention group than in the control group, again with all reported p-values below 0.001.

Separate analyses of covariance confirmed that the between-group differences in post-test burden, resilience, and rewarding feelings remained significant after adjustment for the corresponding baseline scores. The reported group-effect statistics were F = 58.43 for burden, F = 54.76 for resilience, and F = 65.28 for rewarding feelings, with p < 0.001 in each case. At post-test, burden was negatively correlated with resilience at r = −0.604 and with rewarding feelings at r = −0.519, while resilience and rewarding feelings were positively correlated at r = 0.703; all correlations were significant at p < 0.001.

Exploratory multiple regression analysis found that psychological resilience and caregiving rewarding feelings were independently associated with lower post-test caregiver burden. Together, the two variables explained 51% of the variance in burden, with an adjusted R² of 0.49. The overall model was significant at F(2,67) = 34.87 and p < 0.001.

These analyses establish statistical associations rather than causal or mediating mechanisms. The study also did not isolate which individual component of the multicomponent intervention was responsible for the observed differences. The findings require cautious interpretation because the trial was conducted at one Egyptian hospital and used convenience sampling, limiting generalizability to other caregiver populations and healthcare settings.

Outcomes were self-reported and assessed only immediately after the intervention, so response and social-desirability biases were possible and the durability of the effects could not be established. The small sample also limited statistical power for smaller effects, while the absence of blinded outcome assessment may have introduced detection bias. Because the control group received usual care without an attention-control condition, nonspecific effects of contact and attention cannot be excluded.

The trial was also registered retrospectively, and the effect-size assumption used in its original sample-size calculation was not retained. The authors therefore call for larger multicenter trials with more diverse samples, longer follow-up, and assessment of feasibility and cost-effectiveness before conclusions about routine implementation can be drawn.

Subject of Research: Effects of an eight-week nurse-led telenursing intervention on burden, resilience, and rewarding feelings among Egyptian family caregivers of people with bipolar disorder

Article Title: From caregiver burden to psychological resilience and positive emotional outcomes: the effectiveness of innovative psychiatric nursing intervention among family caregivers of patients with bipolar disorder

Article References: Alhalawany, R. M., Khatatbeh, Y. M., Mansour, O. Z., & Hashem, S. R. (2026). From caregiver burden to psychological resilience and positive emotional outcomes: the effectiveness of innovative psychiatric nursing intervention among family caregivers of patients with bipolar disorder. BMC Nursing, 25(1), Article 996. https://doi.org/10.1186/s12912-026-05326-z

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05326-z

Keywords: bipolar disorder, family caregivers, caregiver burden, psychological resilience, rewarding caregiving feelings, telenursing, psychiatric nursing, psychoeducation, randomized controlled trial, Egypt, caregiver, burden