基于老年血液透析患者主要照顾者需求的自主支持性干预研究

发布时间：2018-03-01 15:06

本文关键词： 老年血液透析照顾者需求自主支持干预　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的1.调查老年血液透析患者主要照顾者的需求情况并分析影响因素。2.探讨基于照顾者需求的自主支持性干预对老年血液透析患者及其主要照顾者的影响。方法1.调查阶段:选取郑州市某两家三级甲等医院血液净化中心进行长期血液透析治疗的60岁以上的患者及其主要照顾者作为研究对象,对其进行问卷调查,调查内容为老年血液透析患者及其主要照顾者一般资料、主要照顾者需求情况、自我效能水平,并分析照顾者需求的影响因素。收集的数据采用SPSS 21.0统计软件进行统计分析,采用描述性统计、Pearson相关性分析、单因素方差分析、t检验,多重线性回归等统计分析方法对所收集的资料进行统计分析,检验水准α=0.05。2.干预阶段本研究属于类实验性研究,在第一部分研究的基础之上,从调查对象中选取郑州市某家三级甲等医院血液净化中心进行长期血液透析治疗且自愿参与干预的84名照顾者及其患者进行干预,采用抛硬币的方式将在周一、周三、周五进行透析的41对患者及其主要照顾者分为干预组,在周二、周四、周六进行透析的43对患者及其主要照顾者分为对照组。对照组照顾者接受常规教育,干预组照顾者接受基于需求的自主支持性干预,干预时间为四个月,对照顾者采用自我效能量表、总体幸福感量表、照顾者负担量表进行测量,患者则通过测量透析间期体重增长值来检验干预效果。所收集的资料采用描述性统计,t检验、卡方检验、秩和检验等方法对数据进行统计与分析。结果1.调查阶段本研究共完成调查问卷140份,其中有效问卷131份,有效率达93.6%。(1)本组老年血液透析患者主要照顾者需求总得分为(55.98±4.40)分,得分范围为42~68分,平均各条目得分为(2.80±0.25);其中各维度条目平均得分情况为:生理需求维度(2.90±0.43)分;医讯需求维度(2.75±0.22);心理需求维度(2.63±0.26)分;条目平均得分最高的维度为生理需求维度。(2)通过Pearson相关性分析、单因素方差分析、t检验等统计方法筛选老年血液透析患者主要照顾者需求的影响因素,以老年血液透析患者主要照顾者需求总得分为因变量,以照顾者自我效能、年龄、文化程度、与患者关系、照顾者健康状况为自变量,采用多重线性回归进行分析,结果显示,照顾者自我效能水平、文化程度、健康状况为照顾者需求的重要影响因素。2.干预阶段干预过程中共失访3对老年血液透析患者及其主要照顾者,完整完成干预的老年血液透析患者及其主要照顾者共81对,干预组40对,对照组41对。(1)干预前后老年血液透析患者主要照顾者自我效能得分情况比较:两独立样本t检验分析显示,干预组照顾者自我效能得分高于对照组,差异有统计学意义(P0.01),配对样本t检验分析显示,干预组照顾者干预后自我效能得分高于干预前,差异有统计学意义(P0.01)。(2)干预前后老年血液透析患者主要照顾者主观幸福感得分情况比较:两独立样本t检验分析显示,干预组照顾者除幸福感总得分高于对照组,差异有统计学意义(P0.01),配对t检验分析显示,干预组照顾者干预后除精力维度得分虽略高于干预前但差异无统计学意义(P0.05)外,幸福感总分以及其它各维度得分均高于干预前,差异有统计学意义(P0.05)。(3)干预前后老年血液透析患者主要照顾者负担得分情况比较:两独立样本t检验分析显示,干预组照顾者负担总得分低于对照组,差异有统计学意义(P0.01),配对t检验分析显示,干预组主要照顾者干预后负担总分及时间依赖性负担得分、发展受限性负担得分、社交性负担得分、情感性负担得分均低于干预前(P0.01),身体性负担得分与干预前比差异无统计学意义(P0.05)。(4)干预前后老年血液透析患者透析间期体重增长值比较:两独立样本t检验分析显示,干预组患者透析间期体重增长值低于对照组,差异有统计学意义(P0.05),配对t检验分析显示,干预组患者干预后透析间期体重增长值比干预前降低0.35kg,差异有统计学意义(P0.01)。结论1.本研究老年血液透析患者主要照顾者需求中,生理需求维度得分最高。2.本研究老年血液透析患者主要照顾者需求受照顾者一般资料、照顾者自我效能水平的影响。3.基于照顾者需求的自主支持性干预可提高照顾者的自我效能、主观幸福感,减轻照顾者负担。4.基于照顾者需求的自主支持性干预可提高患者的照护质量,降低患者透析间期体重增长值。
[Abstract]:Objective to investigate 1. elderly hemodialysis patients take care of.2. main factors affect the demand situation and explore the self supportive care needs of the effect of intervention on elderly hemodialysis patients and their caregivers. Based on the method of 1. stage survey: over 60 years old were selected from the blood purification center of Zhengzhou City three Jiadeng hospital for two treatment of hemodialysis and their primary caregivers as the research object, the survey and questionnaire, investigation content for general information of elderly hemodialysis patients and their caregivers, caregiver needs, self-efficacy, and analyze the influencing factors of caregivers' needs. The collected data were analyzed by SPSS 21 statistical software, using descriptive statistics, Pearson correlation analysis, single factor variance analysis, t test, multiple linear regression analysis and other statistical methods to collect The data for statistical analysis, experimental study of this study belongs to a =0.05.2. level test intervention stage, on the basis of the first part of the study, 84 subjects selected from the blood purification center of Zhengzhou City, a three level of first-class hospital for long-term hemodialysis treatment and voluntary intervention for caregivers and patients will intervene on Monday, Wednesday by the toss of a coin, Friday 41 of dialysis patients and their primary caregivers were divided into intervention group, on Tuesday, Thursday, Saturday 43 of dialysis patients and their primary caregivers were divided into the control group. The control group received routine care education, intervention group caregivers receive self supportive intervention based on the demand, the intervention time was four months, favorers with self efficacy scale, general well-being scale, caregiver burden scale, patients are measured by dialysis The weight gain was to test the effect of intervention. The data collected by using descriptive statistics, t test, chi square test, rank sum test and other methods of statistics and analysis of data. Results of the 1. survey phase of this study completed a total of 140 questionnaires, 131 valid questionnaires, the effective rate was 93.6%. (1) of the elderly group the needs of primary caregivers of hemodialysis patients with total score was (55.98 + 4.40) points, the range is 42~68, the average score of each item is (2.80 + 0.25); the average score for each dimension entry: physiological needs dimension (2.90 + 0.43); medical demand dimensions (2.75 + 0.22); psychological needs dimensions (2.63 + 0.26); the average score of the dimension of entry for physiological needs dimension. (2) by Pearson correlation analysis, single factor analysis of variance, statistical method of t test screening in elderly hemodialysis patients mainly take care of factors affecting the needs of the elderly in the blood Dialysis patients caregivers demand total score as the dependent variable, the caregiver self-efficacy, age, education, and patient relationship, caregiver health status as independent variables, using multiple linear regression analysis results showed that the level of caregiver self-efficacy, culture degree, health status is an important influence on the needs of caregivers of factors.2. intervention stage intervention process of the lost 3 of elderly hemodialysis patients and their caregivers, complete intervention in elderly hemodialysis patients and their primary caregivers of a total of 81, 40 of the intervention group, the control group of 41. (1) before and after the intervention of elderly patients with hemodialysis caregiver self-efficacy score: two independent samples t test analysis showed that the intervention group care self-efficacy score higher than the control group, the difference was statistically significant (P0.01), paired samples t test analysis showed that the intervention group care intervention The self-efficacy score is higher than before the intervention, the difference was statistically significant (P0.01). (2) before and after the intervention of elderly patients with hemodialysis caregiver subjective well-being scores: comparison of two independent samples t test analysis showed that the intervention group in addition to caregiver well-being scores higher than the control group, the difference was statistically significant (P0.01), paired t analysis showed that the intervention group after intervention in caregivers of energy score is slightly higher than before the intervention but no statistically significant difference (P0.05), happiness scores and other scores were higher than those before intervention, the difference was statistically significant (P0.05). (3) before and after the intervention of elderly hemodialysis patients caregivers burden score: two independent samples t test analysis showed that the intervention group caregiver burden score lower than the control group, the difference was statistically significant (P0.01), paired t test analysis showed that the intervention group of primary caregivers The intervention of burden score and time dependency burden score, limiteddevelopment burden score, social burden score, emotional burden scores were lower than before intervention (P0.01), the body burden score before and after intervention than there was no statistically significant difference (P0.05). (4 years old) before and after the intervention of interdialytic weight gain value: two independent samples t test analysis showed that the patients in the intervention group IDWG is lower than the control group, the difference was statistically significant (P0.05), paired t test analysis showed that the patients in the intervention group after the intervention period of interdialytic weight gain after intervention decreased 0.35kg, the difference was statistically significant (P0.01). Conclusion: 1. the study of elderly patients with hemodialysis caregiver needs, physiological needs the highest score in the.2. elderly patients with hemodialysis needs of primary caregivers by caregivers of general information, caregiver self-efficacy The influence of.3. levels of autonomy support intervention based on the needs of caregivers can improve caregiver self-efficacy, subjective well-being, reduce the burden of caregivers of.4. self supportive intervention based on the needs of caregivers can improve the patient's quality of care, reduce patients IDWG value.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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