自我效能训练对血液透析患者液体摄入的影响

目的 探讨自我效能训练对维持性血液透析患者液体摄入的影响.方法 根据自我效能理论,对54例血液透析患者进行干预,观察干预后患者自我效能、透析间期体质量增加及患者满意度评价效果.结果 干预后患者自我效能得分、透析间期体质量增加值、透析相关并发症发生次数及患者满意度得分与干预前比较差异有统计学意义.结论 自我效能干预能显著提高血液透析患者的自我效能水平和液体摄入依从性,值得临床推广应用.     

Effects of an adaptation training programme for patients with end-stage renal disease

AIMS: This paper reports a study investigating the effectiveness of an adaptation training programme (ATP) to help patients with end-stage renal disease (ESRD) to cope with illness-related stresses and, thus, to alleviate depression and improve quality of life. BACKGROUND: Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors. The ability of these patients to cope with and adapt to these stresses, whether related to their medical regimen or to the demands of daily life, has an important influence on physical and psychological well-being. METHODS: The study was a randomized controlled trial using a convenience sample of 57 eligible, fully informed and consenting patients with ESRD who were assigned to experimental (ATP plus usual care) or control (usual care) groups. Participants in the ATP took part in weekly small group sessions over an 8-week period and monthly follow-up to help them to cope with stressors. A clinical nurse specialist and an experienced psychotherapist led them in three small groups (8-10 per group). Participants in the usual care group received routine care. Instruments comprised the Haemodialysis Stressor Scale, Beck Depression Inventory and Medical Outcomes Study SF-36. Data were collected at baseline and at three months following the intervention. RESULTS: The major stressors for these patients were limitations on time and place related to employment, limitations on fluid intake, transport difficulties, loss of bodily function, length of dialysis treatment, and limitation of physical activities. The ATP had a beneficial effect on perceived stress (P = 0.005), depression (P = 0.001) and quality of life (P = 0.02) 3 months after the intervention. CONCLUSIONS: This study supports the effectiveness of an ATP to decrease stress and depression levels, and to improve the quality of life of ATP patients receiving haemodialysis.     

Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease

BACKGROUND: Traditional Chinese acupressure is a noninvasive technique that employs pressure and massage to acupoints in order to stimulate the balance of life energy that promotes health and comfort. Sleep disturbance is common in patients with end-stage renal disease but no intervention studies have addressed this problem. Aim. The purpose of the present study was to test the effectiveness of acupoints massage for patients with end-stage renal disease and experiencing sleep disturbances and diminished quality of life. METHODS: The study was a randomized control trial. A total of 98 end-stage renal disease patients with sleep disturbances were randomly assigned into an acupressure group, a sham acupressure group, and a control group. Acupressure and sham acupressure group patients received acupoints or no acupoints massage three times a week during haemodialysis treatment for a total of 4 weeks. The measures included the Pittsburgh Sleep Quality Index, Sleep Log, and the Medical Outcome Study - Short Form 36. FINDINGS: The results indicated significant differences between the acupressure group and the control group in Pittsburgh Sleep Quality Index subscale scores of subjective sleep quality, sleep duration, habitual sleep efficiency, sleep sufficiency, and global Pittsburgh Sleep Quality Index scores. Sleep log data revealed that the acupressure group significantly decreased wake time and experienced an improved quality of sleep at night over the control group. Medical Outcome Study - Short Form 36 data also documented that acupressure group patients experienced significantly improved quality of life. CONCLUSION: This study supports the effectiveness of acupoints massage in improving the quality of sleep and life quality of end-stage renal disease patients, and offers a noninvasive therapy for sleep-disturbed patients.     

Evaluation of a training program to assist care staff to better recognize and manage depression among palliative care patients and their families

This study was designed to evaluate the effectiveness of a training program to improve the knowledge, attitudes, and self-efficacy of palliative care staff and thus enable them to better detect and manage depression among palliative care patients and their families. Participants were 90 professional carers who completed a four-session training program. Knowledge, attitudes, self-efficacy, and barriers to working with depressed patients were assessed preintervention, post-intervention, and at a three-month follow-up. The results demonstrated that compared to the control group, the intervention group had improved in all of these areas. Improvements were maintained at the three-month follow-up in all areas except attitudes. The results of this study indicate the importance of training in managing depression among palliative care staff. Booster sessions will likely be needed to ensure that training program gains are maintained.     

Fluid compliance among patients having haemodialysis: can an educational programme make a difference?

Title. Fluid compliance among patients having haemodialysis: can an educational programme make a difference? Aim. This paper is a report of a study to examine the effectiveness of a patient education programme on fluid compliance as assessed by interdialytic weight gain, mean predialysis blood pressure and rate of fluid adherence. Background. Patients with end stage renal disease who receive haemodialysis are often non‐compliant with their treatment regime, especially adherence to fluid restrictions. Method. An exploratory study was conducted in 2004–05 using a quasi‐experimental, single group design to examine the effectiveness of patient education on fluid compliance in a dialysis centre located in a major teaching hospital in Kuala Lumpur, Malaysia. Twenty‐six patients with an interdialytic weight gain of greater than 2·5 kg were identified as non‐compliant and recruited to the study. The intervention was carried out over a 2‐month period and included teaching and weekly reinforcement about diet, fluids and control of weight gain. Findings. Patients’ mean interdialytic weight gain decreased following the educational intervention from 2·64 kg to 2·21 kg (P < 0·05) and adherence to fluid restrictions increased from 47% to 71% following the intervention. Predialysis mean blood pressure did not improve following the intervention, although the maximum recording for predialysis systolic pressure dropped from 220 mmHg to 161 mmHg. Whilst no statistically significant associations were detected between interdialytic weight gain and age, educational level, marital status or employment status, women demonstrated a greater decrease in mean interdialytic weight gain than men. Conclusion. Nephrology nurses often have long‐term relationships with their patients and are ideally placed to provide ongoing education and encouragement, especially for those experiencing difficulties in adhering to fluid and dietary restrictions.     

Empowerment of patients with end-stage renal disease--a randomized controlled trial

The purpose of the study is to investigate the effectiveness of an empowerment program on empowerment level, self-care self-efficacy and depression in patients with end-stage renal disease. The study was a randomized controlled trial; qualified patients in two dialysis centers of major hospitals in southern Taiwan were randomly assigned into an empowerment group (n=25) and a control group (n=25). The empowerment program included identification of problem areas for self-management; exploration of emotions associated with these problems; development of a set of goals and strategies to overcome these problems to achieve these goals; creation and implementation of behavioral change plans; and stress management.The outcomes measured were the Empowerment Scale, the Strategies Used by People to Promote Health and the Beck Depression Inventory. Data were collected at baseline and 6 weeks following intervention. Primary statistical analysis was by means of t-test and analysis of covariance. The results indicated that scores of the empowerment (t(48)=6.54, p<0.001), self-care self-efficacy (F(1,47)=10.82, p=0.002) and depression (t(48)=2.49, p=0.03) in the empowerment group have a significantly greater improvement than the control group.     

终末期肾病患者自我感受负担与自我效能、 焦虑抑郁的相关性分析

目的 探讨终末期肾病患者自我感受负担(self-perceived burden,SPB)与自我效能、焦虑抑郁的相关性,为护理人员为患者实施心理护理、相应护理提供依据.方法 便利抽样296例终末期肾病患者为调查对象,采用自我感受负担量表、自我效能感量表和医院焦虑抑郁量表对其问卷调查,评估终末期肾病患者自我感受负担与自我效能、焦虑抑郁之间的相关性.结果 96.62%终末期肾病患者普遍存在自我感受负担,其平均(29.75±5.41)分,自我感受负担处于中度水平;患者自我效能平均(16.04±2.96)分,总体处于中等偏低水平,患者自我效能与自我感受负担呈负相关(P<0.05);有39.19%患者可疑存在/必定存在焦虑情绪,有41.89%患者可疑存在/必定存在抑郁情绪,其焦虑、抑郁与自我感受负担呈正相关(P<0.05).结论 终末期肾病患者自我感受负担与自我效能、焦虑抑郁存在不同程度的相关性,护理人员可通过激励、心理疏导等方式,提高患者自我效能感、减轻其焦虑抑郁情绪来降低其自我感受负担.     

责任个体化护理模式对肾衰竭患者自我管理能力及生活质量的影响

目的:探讨责任个体化护理模式对肾衰竭患者自我管理能力及生活质量的影响。方法:将2018年1月1日~2019年1月31日收治的92例肾衰竭患者按照随机数字表法分为研究组和对照组各46例,对照组实施常规护理,研究者在常规护理基础上采用责任个体化护理模式;比较两组干预前及干预3个月后自我管理能力(采用血液透析自我管理行为问卷)、自我效能[采用慢性病自我效能量表(CDSES)]、负性情绪[采用医院焦虑抑郁量表(HADS)]、生活质量[采用肾病相关生存质量量表(KDQOL-SFTM)]水平,比较两组随访3个月时间内并发症(血压异常、失衡综合征、心律失常、发热、感染)发生情况。结果:干预3个月后,两组自我管理能力、CDSES、KDQOL-SFTM评分较干预前升高(P<0.05),且研究组高于对照组(P<0.05);干预3个月后,两组HADS评分较干预前降低(P<0.05),且研究组低于对照组(P<0.05)。两组血压异常、失衡综合征、心律失常、发热、感染发生率比较差异无统计学意义(P>0.05)。结论:责任个体化护理模式能够有效提升肾衰竭患者的自我管理能力、自我效能及生活质量,缓解负性情绪。     

同伴互助情感支持对初次连续性肾脏替代治疗患者的影响

目的:探讨同伴互助情感支持对初次连续性肾脏替代治疗(CRRT)患者的影响。方法:将2018年1月1日~2020年1月1日收治的120例初次CRRT患者按照随机数字表法分为研究组和对照组各60例,对照组实施常规护理干预,研究组实施同伴互助情感支持方案;在干预前后采用社会支持评定量表和一般自我效能量表评价两组社会支持和自我效能。结果:干预后,两组社会支持评分和自我效能评分均高于干预前(P<0.05);且研究组高于对照组(P<0.05)。结论:将同伴互助情感支持方案应用于初次CRRT患者中,能提高患者获得的社会支持度,且能强化患者参与疾病的自护能力。     

Problems experienced by haemodialysis patients in Greece

Even though Greece has a disproportionate number of haemodialysis stations for the treatment of end-stage renal disease (ESRD), and a rapidly rising number of patients on dialysis, there has been no study of the lived experience of haemodialysis treatment in Greece. ESRD and dialysis drastically impact patients' everyday life, therefore expectations and desires play a major role in adapting to alterations and restrictions. An understanding of these culturally-influenced expectations and desires is essential for the delivery of holistic nursing care. This study aimed to explore how Greek patients receiving long-term haemodialysis perceived their problems and to describe the impact of haemodialysis on their lives. Using a grounded theory approach, 23 patients with ESRD receiving haemodialysis were purposively recruited from two hospital dialysis centres in Athens, Greece. Data were collected during 2006 by personal interviews. Given a distinctive patient experience of haemodialysis, some insight into their common concerns can facilitate provision of healthcare services that adequately meets their needs. By developing an understanding of the experience of renal illness and therapy for a group of people using dialysis, this study was intended as a contribution towards enabling healthcare professionals to provide more effective support to people who are living with this chronic condition.