本文關鍵詞： 老年 血液透析 照顧者 需求 自主支持 干預　出處：《鄭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的1.調查老年血液透析患者主要照顧者的需求情況并分析影響因素。2.探討基于照顧者需求的自主支持性干預對老年血液透析患者及其主要照顧者的影響。方法1.調查階段:選取鄭州市某兩家三級甲等醫(yī)院血液凈化中心進行長期血液透析治療的60歲以上的患者及其主要照顧者作為研究對象,對其進行問卷調查,調查內容為老年血液透析患者及其主要照顧者一般資料、主要照顧者需求情況、自我效能水平,并分析照顧者需求的影響因素。收集的數(shù)據(jù)采用SPSS 21.0統(tǒng)計軟件進行統(tǒng)計分析,采用描述性統(tǒng)計、Pearson相關性分析、單因素方差分析、t檢驗,多重線性回歸等統(tǒng)計分析方法對所收集的資料進行統(tǒng)計分析,檢驗水準α=0.05。2.干預階段本研究屬于類實驗性研究,在第一部分研究的基礎之上,從調查對象中選取鄭州市某家三級甲等醫(yī)院血液凈化中心進行長期血液透析治療且自愿參與干預的84名照顧者及其患者進行干預,采用拋硬幣的方式將在周一、周三、周五進行透析的41對患者及其主要照顧者分為干預組,在周二、周四、周六進行透析的43對患者及其主要照顧者分為對照組。對照組照顧者接受常規(guī)教育,干預組照顧者接受基于需求的自主支持性干預,干預時間為四個月,對照顧者采用自我效能量表、總體幸福感量表、照顧者負擔量表進行測量,患者則通過測量透析間期體重增長值來檢驗干預效果。所收集的資料采用描述性統(tǒng)計,t檢驗、卡方檢驗、秩和檢驗等方法對數(shù)據(jù)進行統(tǒng)計與分析。結果1.調查階段本研究共完成調查問卷140份,其中有效問卷131份,有效率達93.6%。(1)本組老年血液透析患者主要照顧者需求總得分為(55.98±4.40)分,得分范圍為42~68分,平均各條目得分為(2.80±0.25);其中各維度條目平均得分情況為:生理需求維度(2.90±0.43)分;醫(yī)訊需求維度(2.75±0.22);心理需求維度(2.63±0.26)分;條目平均得分最高的維度為生理需求維度。(2)通過Pearson相關性分析、單因素方差分析、t檢驗等統(tǒng)計方法篩選老年血液透析患者主要照顧者需求的影響因素,以老年血液透析患者主要照顧者需求總得分為因變量,以照顧者自我效能、年齡、文化程度、與患者關系、照顧者健康狀況為自變量,采用多重線性回歸進行分析,結果顯示,照顧者自我效能水平、文化程度、健康狀況為照顧者需求的重要影響因素。2.干預階段干預過程中共失訪3對老年血液透析患者及其主要照顧者,完整完成干預的老年血液透析患者及其主要照顧者共81對,干預組40對,對照組41對。(1)干預前后老年血液透析患者主要照顧者自我效能得分情況比較:兩獨立樣本t檢驗分析顯示,干預組照顧者自我效能得分高于對照組,差異有統(tǒng)計學意義(P0.01),配對樣本t檢驗分析顯示,干預組照顧者干預后自我效能得分高于干預前,差異有統(tǒng)計學意義(P0.01)。(2)干預前后老年血液透析患者主要照顧者主觀幸福感得分情況比較:兩獨立樣本t檢驗分析顯示,干預組照顧者除幸福感總得分高于對照組,差異有統(tǒng)計學意義(P0.01),配對t檢驗分析顯示,干預組照顧者干預后除精力維度得分雖略高于干預前但差異無統(tǒng)計學意義(P0.05)外,幸福感總分以及其它各維度得分均高于干預前,差異有統(tǒng)計學意義(P0.05)。(3)干預前后老年血液透析患者主要照顧者負擔得分情況比較:兩獨立樣本t檢驗分析顯示,干預組照顧者負擔總得分低于對照組,差異有統(tǒng)計學意義(P0.01),配對t檢驗分析顯示,干預組主要照顧者干預后負擔總分及時間依賴性負擔得分、發(fā)展受限性負擔得分、社交性負擔得分、情感性負擔得分均低于干預前(P0.01),身體性負擔得分與干預前比差異無統(tǒng)計學意義(P0.05)。(4)干預前后老年血液透析患者透析間期體重增長值比較:兩獨立樣本t檢驗分析顯示,干預組患者透析間期體重增長值低于對照組,差異有統(tǒng)計學意義(P0.05),配對t檢驗分析顯示,干預組患者干預后透析間期體重增長值比干預前降低0.35kg,差異有統(tǒng)計學意義(P0.01)。結論1.本研究老年血液透析患者主要照顧者需求中,生理需求維度得分最高。2.本研究老年血液透析患者主要照顧者需求受照顧者一般資料、照顧者自我效能水平的影響。3.基于照顧者需求的自主支持性干預可提高照顧者的自我效能、主觀幸福感,減輕照顧者負擔。4.基于照顧者需求的自主支持性干預可提高患者的照護質量,降低患者透析間期體重增長值。
[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.

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.5

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