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1.
腹膜透析病人的应对方式及其影响因素   总被引:2,自引:0,他引:2  
程云  田菁  张静  黄琦 《护士进修杂志》2002,17(7):490-492
目的探索长期腹膜透析病人的应对方式及其影响因素。方法描述相关性研究设计 ,采用Jalowiec应对方式量表对 4 1例腹膜透析病人的应对方式及其影响因素进行调查分析。结果乐观应对方式为本组研究对象应用最多的方式 ,其次为悲观应对、面对应对、自信应对、情绪化应对、寻求帮助、逃避和姑息缓解压力应对方式。乐观应对受年龄和并发症的影响 (P <0 .0 1) ;逃避应对受年龄的影响 (P <0 .0 5 ) ,6 0岁以上的老年人此方式应用程度不如中青年人群 (P <0 .0 0 5 ) ;自信应对方式的采用受疾病的严重程度和研究对象所受的教育程度的影响 (P <0 .0 5 ) ;寻求帮助应对方式的采用与研究对象的职业相关 (P <0 .0 5 ) ;姑息缓解压力方式的采用受疾病的严重程度和医疗费用的支付方式影响 (P <0 .0 5 )。悲观应对为本组女性研究对象第二位常用的方式。结论透析病人的应对方式呈多样性 ,透析病人的应对方式可受文化水平、年龄、职业、医疗费用的支付方式等影响 ,通过探究透析病人的应对方式 ,医护人员有责任制定相应的措施 ,帮助病人 ,采用积极的应对方式来应对透析这个压力源。  相似文献   

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harwood l., wilson b., sontrop j. & clark a.m. (2012)?Chronic kidney disease stressors influence choice of dialysis modality. Journal of Advanced Nursing68(11), 2454-2465. ABSTRACT: Aim. This article is a report of a study examining the relationships between chronic kidney disease stressors and coping strategies with dialysis modality. Background. People with chronic kidney disease are given information to enable dialysis modality choice. This education increases awareness and may alleviate concerns and stress. Disease-related stressors and coping may affect dialysis selection. Understanding the influence of stress and coping on dialysis choices will assist in providing responsive programmes. Reducing stress and encouraging coping may increase home dialysis which, despite economic and patient benefits, remains underused. Design. A prospective correlational design was used. Methods. Information was obtained from the Chronic Kidney Disease Stress Inventory and the Jalowiec Coping Scale in 223 individuals not on dialysis between the years 2005-2007. Data were recorded with respect to modality at dialysis initiation (n?=?76) from 2005-2010. The effects of stress, coping and patient parameters on modality selection were compared using bivariate and multivariate analyses. Results. Individuals on home dialysis vs. in-centre haemodialysis reported significantly fewer pre-dialysis stressors. Coping was not associated with dialysis modality. Individuals on in-centre haemodialysis had a lower serum creatinine, less advanced kidney disease and weighed more than those who started on a home therapy. Physiological stressors were most common and are amenable to interventions. Conclusion. Pre-dialysis stress levels predicted dialysis modality. Interventional studies are recommended to address chronic kidney disease stressors with the outcome of improving home-dialysis usage.  相似文献   

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Stressors, coping and depression in haemodialysis patients   总被引:2,自引:0,他引:2  
BACKGROUND: Depression is common in persons receiving outpatient haemodialysis, but little work has been done to explore the variables associated with depression. AIMS: The primary purposes of this study were to (i) examine relationships among stressors, coping and depression and (ii) test the mediating role of coping. DESIGN/METHODS: Data were collected at two points in time, three months apart in 1995/1996. The final convenience sample at Time 2 was 86 participants from two United States midwestern, inner-city dialysis units. Structured interviews were conducted using the Centre for Epidemiologic Studies Depression Scale, the haemodialysis stressor scale (HSS) and the coping strategy indicator. RESULTS: At Time 1 more psychosocial stressors were associated with greater use of problem-solving, social-support and avoidance coping. Both avoidance coping and more psychosocial stressors at Time 1 were related to depression at Time 2. Finally, avoidance coping was found to explain much of the relationship between psychosocial stressors and depression. CONCLUSIONS: Research is now needed that explicates the causal relationships among stress, coping and depression in haemodialysis patients.  相似文献   

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The purpose of the study was to determine the stressors and coping methods of chronic haemodialysis patients in Hong Kong. Relationships among treatment-related stressors, coping methods and length of time on haemodialysis were explored. Fifty subjects completed the Haemodialysis Stressor Scale (HSS) and Jalowiec Coping Scale (JCS). Results revealed that limitation of fluid was the most frequently identified stressor, followed by limitation of food, itching, fatigue and cost. The most common coping methods are 'accepted the situation because very little could be done', followed by 'told oneself not to worry because everything would work out fine' and 'told oneself that the problem was really not that important.' It was found that the traditional philosophies of the Chinese--Confucianism, Buddhism, and Taoism--share an approach to the understanding and management of life stressors as different from that adopted by Western philosophies. The findings of this study can further facilitate nurse practitioners in providing support, information, and alternative solutions when assisting patients in coping with long-term haemodialysis.  相似文献   

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目的探讨持续非卧床腹膜透析患者应对方式和生存质量状况及其相关关系。方法采用医学应对问卷(medical copingmodes questionnaire,MCMQ)及生存质量量表(medical outcomes study 36-item short form survery,SF-36)分别对腹膜透析治疗超过3个月患者进行调查。了解患者应对方式和生存质量状况及其相关关系。结果腹膜透析患者应对方式中的"面对"维度得分为(18.28±3.86)分,低于常模,"回避"与"屈服"维度得分分别为(15.74±2.61)分与(11.10±4.77)分,高于常模,组间比较,差异具有统计学意义(均P〈0.05)。腹膜透析患者生存质量得分低于正常人群,组间比较,差异具有统计学意义(均P〈0.05)。相关性分析表明:生存质量与应对方式中的"面对"维度呈正相关,而与"屈服"维度呈负相关(均P〈0.05)。结论腹膜透析患者倾向于采取"屈服"的应对方式,其生存质量低于正常人群;采用"面对"应对方式者,其生存质量较好,采用"屈服"应对方式,其生存质量较差。教育患者应采用"面对"应对方式,提高其生存质量。  相似文献   

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Turkey is the fifth country in Europe with regard to the number of patients receiving haemodialysis (HD). However, only a limited number of studies have comparatively investigated the factors that affect quality of life in haemodialysis and peritoneal dialysis (PD) patients in Turkey. The purpose of the study was to investigate the factors that affect quality of life in haemodialysis and peritoneal dialysis patients, as well as providing a comparison of quality of life between these groups. In this cross‐sectional study, Quality of Life Scale and a data form was completed by 300 dialysis patients who received treatment at five hospital‐based dialysis units in Istanbul, Turkey. The data were evaluated using arithmetic mean values, standard deviations, minimums, maximums, percentages, independent groups t‐tests, Spearman correlation analyses and one‐way variance analyses. The quality of life values in peritoneal dialysis patients were found to be higher than those of haemodialysis patients (P < 0.05). It was concluded that the quality of life in chronic dialysis patients was affected by various factors.  相似文献   

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Quality of life of patients having renal replacement therapy   总被引:6,自引:0,他引:6  
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ObjectiveTo compare satisfaction with life and quality of life in patients receiving continuous ambulatory peritoneal dialysis (CAPD) and hospital hemodialysis (HHD) and to analyze their relationship with coping strategies.MethodsWe performed a cross-sectional study in 61 patients aged<70 years old under HHD and 32 patients receiving CAPD. We applied the Charlson Index, the State-Trait Anxiety Inventory (Stai-R), the Perceived Stress Scale (PSS), the MOS Social Support Survey, and the Short-Form 36 questionnaire for quality of life. Coping strategies, perceived control and satisfaction with life were also analyzed. Statistical analyses were adjusted by differences in age and sex.ResultsWomen accounted for 35.5% of the patients. The mean age was 54 years. The CAPD group was younger and had a higher proportion of women. Charlson Comorbidity Index scores were similar in patients receiving HHD and in those receiving CAPD. The use of psychoactive drugs was higher in the CAPD group than in the HHD group (38% vs. 13%; p<0.01). The CAPD group scored significantly higher in strategies of seeking help, emotional regulation skills, problem resolving and distraction. No differences were found in social support between the two groups.No significant differences were found in the physical or mental components or in the seven dimensions of the SF-36. Satisfaction with life was higher in the CAPD group (7.12 versus 6.21; p=0.07).ConclusionsNo differences in the perception of quality of life were found between patients receiving the two modalities. The CAPD group tended to show greater satisfaction with life and more adaptive coping strategies (emotional regulation and search for meaning), suggesting that these patients may have greater acceptance and control over the disease process.  相似文献   

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This study investigated the sociotropic and autonomous personality characteristics and perceived problem solving ability of continuous ambulatory peritoneal dialysis (CAPD) patients, and their relationship with quality of life. The study included 14 CAPD patients and 54 healthy volunteers. Sociotropy and autonomy scores were significantly higher in CAPD patients than in the healthy control group. Among CAPD patients, there was a significant correlation between problem solving and serum phosphate, parathormone levels and erythrocyte sedimentation rate. There was a negative correlation between total dialysis time and sociotropy in CAPD patients, and a positive correlation between general health/pain perception and autonomy. Appropriate medical management, time on dialysis and positive self-perception of health were correlated with better problem solving ability and higher autonomous but lower sociotropic personality styles.  相似文献   

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目的 了解连续性非卧床腹膜透析(CAPD)患者的抑郁状况及社会支持,并探讨二者之间的相关性.方法 采用描述性相关性研究,对136例CAPD患者进行抑郁状况和社会支持两方面的问卷调查,并分析其相关性.结果 CAPD患者抑郁发生率为31.62%;抑郁组患者的社会支持低于无抑郁组;经多元逐步回归分析显示,经济收入、社会支持是CAPD患者合并抑郁的影响因素.结论 CAPD患者发生抑郁较常见,抑郁状况与社会支持密切相关,护理人员应重视社会支持系统对改善患者抑郁状况的作用,并加以有效利用,以提高其生活质量.  相似文献   

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1. The role of the large intestine in the maintenance of K+ balance in uraemic patients established on long-term dialysis was studied with a rectal dialysis technique in 14 normal subjects, ten normokalaemic patients undergoing chronic ambulatory peritoneal dialysis (CAPD), and seven patients undergoing haemodialysis. Dietary K+ intakes in the normal subjects, CAPD patients and haemodialysis patients were 80-100 mmol/24 h, 70-80 mmol/24 h and 60-70 mmol/24 h, respectively. 2. At an initial intraluminal K+ concentration of 45 mmol/l, rectal K+ secretion in the CAPD patients (2.4 +/- 0.4 mumol h-1 cm-2) was greater than in normal subjects (1.2 +/- 0.2 mumol h-1 cm-2, P less than 0.02). Under similar conditions, rectal K+ secretion was also greater in the haemodialysis patients than in normal subjects, both predialysis (3.7 +/- 0.4 mumol h-1 cm-2, P less than 0.001) and postdialysis (2.4 +/- 0.5 mumol h-1 cm-2, P less than 0.05), even though haemodialysis decreased plasma K+ concentration from 5.3 +/- 0.1 mmol/l to 3.5 +/- 0.2 mmol/l (P less than 0.001). 3. There were no significant differences in rectal Na+ absorption, rectal potential difference, plasma aldosterone concentration, or total body K+ content (measured by whole-body counting of 40K), between the normal subjects and either the CAPD or the haemodialysis patients. 4. These results indicate that K+ homoeostasis is maintained in uraemic patients undergoing long-term dialysis by a combination of K+ losses during dialysis, and enhanced large intestinal K+ excretion.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

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Elevated serum lipoprotein(a) is an independent risk factor for coronary artery disease, and C-reactive protein (CRP) is a general and cardiovascular marker in haemodialysis patients. We studied lipoprotein(a) and CRP levels in 48 haemodialysis and 24 continuous ambulatory peritoneal dialysis (CAPD) patients and 20 healthy individuals, after a 12 h fast. Serum lipoprotein(a) levels were elevated in 31.3%, 66.7% and 5% of haemodialysis and CAPD patients and control subjects, respectively. The difference between all groups was significant. Serum CRP levels were high in 43.8%, 58.4% and 5% of haemodialysis and CAPD patients, and healthy subjects, respectively. The mean serum CRP level was significantly different between all groups. Both protein levels were higher in CAPD patients than haemodialysis patients, suggesting that CAPD patients should be more closely monitored for coronary artery disease.  相似文献   

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Continuous ambulatory peritoneal dialysis: three years' experience   总被引:3,自引:0,他引:3  
We review the experience of the Renal Unit at Newcastle upon Tyne over the three years 1979-1981, during which 122 patients with chronic renal failure were treated by continuous ambulatory peritoneal dialysis (CAPD). Advantages of the technique included wide acceptability to a cross-section of patients reaching the renal unit, including the elderly and diabetics. Patients who experienced both techniques preferred CAPD to haemodialysis because of the greater freedom and sense of well-being. Patient survival was 94 per cent at two years and rehabilitation was as good as could be expected for the age and primary medical complications of the patients. Control of plasma potassium and phosphate was easier than with haemodialysis. Renal osteodystrophy responded well to a combination of CAPD and alfacalcidol therapy over the two year period for which we have performed serial bone biopsies. Serum aluminium was slightly raised as a result of consumption of phosphate binders and presumed uptake from dialysis fluid but no aluminium related disease has yet been encountered. Anaemia was partly corrected by CAPD with haemoglobin rising to about 10 g/dl on average. CAPD was less costly than home haemodialysis over the first three years and has been adopted as our standard treatment for patients who can expect an early transplant. Disadvantages were persisting problems with peritonitis which still occurred at an incidence of one attack per 39 patient weeks over the last two years, and an actuarial success rate for the technique of only 63 per cent at two years. Twenty patients developed hernias. Weight gain was common and occasionally gross. There was a significant rise in serum cholesterol. The arrival of CAPD has allowed us to increase the intake to our renal failure programme by 50 per cent. However, continued expansion of the technique demands advances in prevention of peritonitis, adequate facilities for admission and particularly an expanding hospital haemodialysis programme to accept the less successful patients from CAPD.  相似文献   

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In the study reported here 55 spouses of patients living with end-stage renal disease (ESRD) were investigated with respect to coping strategies and health-related quality of life. Findings from the study were compared to two random samples of the Swedish general population (n = 454, and n = 1200). The study design was correlational and comparative. Coping was measured by the Jalowiec Coping Scale, and quality of life (QoL) by the Swedish Health-Related Quality of Life Survey (SWED-QUAL). Data were analysed using a number of statistical tests including Pearson's product moment correlations, Student's t-test and two way ANOVAs. The combined sample of spouses used significantly more optimistic and palliative coping than the general population, but less confrontative, self-reliant, evasive and emotive coping. In the study fatalistic, evasive and emotive coping was associated with low perceived efficiency in handling various aspects of the partners' situation. The male spouses used significantly less optimistic, supportive and palliative coping than did the female spouses. The spouses of transplant patients had better overall quality of life than the continuous ambulatory peritoneal dialysis and haemodialysis spouse groups, most likely due to the lower age of the former group. The study findings suggest that emotive, evasive and fatalistic coping are less than optimal ways to deal with problems occasioned by the partner's treatment.  相似文献   

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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.  相似文献   

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目的探讨接受持续性非卧床腹膜透析(CAPD)患者抑郁症状的发病情况及CAPD患者抑郁情绪与营养状况及炎症状态的关系,评估该类患者的生活质量。 方法选取腹膜透析龄>3个月的患者105例,填写Zung自评抑郁量表(SDS)及生活质量量表(SF-36),SDS标准分≥53分为抑郁,记录CAPD患者一般情况及生化指标,依据是否白蛋白水平<38 g/L,降钙素原水平>0.05 ng/ml进行赋值分组。 结果CAPD患者抑郁的发生率为58.1%(61/105),男性为21.9%(23/105),女性为36.2%(38/105);与非抑郁组患者比较,抑郁组患者年龄偏大、女性较多、白蛋白水平减低、降钙素原水平增高、血红蛋白水平降低、β2微球蛋白水平增高、透析龄长(P<0.05)。同时存在血清白蛋白水平<38 g/L,降钙素原水平>0.05 ng/ml两个因素的患者发生抑郁的风险有所增加。 结论终末期肾脏病患者接受CAPD治疗后抑郁的发生率较高,女性患病率高于男性;发生情绪障碍的CAPD患者生活质量下降;营养状况、炎症状态是腹膜透析患者发生抑郁的危险因素。  相似文献   

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Title.  Relationships among coping, comorbidity and stress in patients having haemodialysis.
Aim.  This paper is a report of a study to examine relationships among stress, coping and comorbidity and test the interaction effect of comorbidity.
Background.  Haemodialysis imposes a variety of physical and psychosocial stressors that challenge patients. Comorbidity is a risk factor for many health outcomes. Research on how comorbidity influences the relationship between coping and stress is limited.
Method.  In this cross-sectional study, conducted from October 2002 to January 2003, 2642 patients, who had been having haemodialysis for at least 3 months, were interviewed by nursing managers in the 27 participating centres. The Haemodialysis Stressor Scale measured stressors and the Jalowiec Coping Scale were used to measure coping strategies. Hierarchical regression was used to analyse the data.
Results.  Haemodialysis patients with comorbidities were found to have higher levels of stress. Comorbidity had a moderating effect between choice of problem-oriented responses and isolated thoughts as coping strategies. These findings show that haemodialysis patients with comorbidities often choose positive coping strategies.
Conclusion.  Comorbidity not only has a direct impact on stress but also has a moderating effect on the relationship between coping and stress. Comorbidity may hold the key to healthcare professionals' understanding of why patients having haemodialysis perceive different levels of stress and use various coping strategies. A personalized programme may be needed for each patient based on their different levels of comorbidity.  相似文献   

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