Iran Journal of Nursing
نشریه پرستاری ایران
IJN
Medical Sciences
http://ijn.iums.ac.ir
108
journal108
2008-5931
2008-5931
10.52547/ijn
fa
jalali
1398
8
1
gregorian
2019
11
1
32
120
online
1
fulltext
fa
ارتباط بین اضطراب مرگ و کیفیت زندگی مرتبط با سلامت در مراقبین بیماران مبتلا به مالتیپل اسکلروزیس
Association of Death Anxiety and Quality of Life in the Caregivers of Patients with Multiple Sclerosis
پرستاری
nursing
پژوهشي
Research
<div style="text-align: justify;"><strong><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">زمینه و هدف</span></span></strong>: <span style="font-family:B Lotus;"><span style="font-size:10.0pt;">ماهیت پیشرونده و ناتوانکننده بیماری مالتیپل اسکلروزیس (</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">MS</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">) ابعاد مختلف زندگی بیمار و مراقبین را تحت تأثیر قرار میدهد. مراقبت از این بیماران ممکن است باعث ایجاد اضطراب مرگ و اختلال در کیفیت زندگی مراقبین بیمار شود. این مطالعه با هدف تعیین ارتباط بین اضطراب مرگ و کیفیت زندگی در مراقبین بیماران مبتلا به مالتیپل اسکلروزیس انجام شد.</span></span><br>
<strong><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">روش بررسی:</span></span></strong><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"> پژوهش حاضر یک مطالعه توصیفی از نوع همبستگی است. تعداد 200 نفر از مراقبین بیماران مبتلا به </span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">MS</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"> مراجعهکننده به انجمن حمایت از بیماران </span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">MS</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"> شهر تهران در سال 1397 به روش نمونهگیری در دسترس انتخاب شدند. ابزارهای پژوهش شامل پرسشنامه کیفیت زندگی (</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">SF36</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">) و پرسشنامه اضطرب مرگ</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">Templer </span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"> بود. دادهها</span></span> <span style="font-family:B Lotus;"><span style="font-size:10.0pt;">با استفاده از</span></span> <span style="font-family:B Lotus;"><span style="font-size:10.0pt;">نرم افزار </span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">SPSS</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"> نسخه 16 و آزمونهای آماری تی مستقل و شفه و ضریب همبستگی پیرسون مورد تجزیه و تحلیل قرار گرفت.</span></span><br>
<strong><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">یافتهها:</span></span></strong><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"> میانگین سنی افراد در این مطالعه 75/11 </span></span><span style="font-family:Cambria,serif;"><span style="font-size:10.0pt;">± </span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">39/40 سال بود. بیشتر مراقبین (5/58 درصد) در این مطالعه مرد بودند. میانگین نمره اضطراب مرگ و کیفیت زندگی در مراقبین بیماران به ترتیب 82/3 </span></span><span style="font-family:Cambria,serif;"><span style="font-size:10.0pt;">± </span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">92 /5 و 82/14 </span></span><span style="font-family:Cambria,serif;"><span style="font-size:10.0pt;">± </span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">42/55 بود. بین اضطراب مرگ با کیفیت زندگی همبستگی معکوس (42/0</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">r=</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">) و معنیدار آماری مشاهده گردید (05/0></span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">). اضطراب مرگ با متغیر</span></span> <span style="font-family:B Lotus;"><span style="font-size:10.0pt;">نسبت مراقب با بیمار (</span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">001/0</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span><span dir="LTR"><span style="font-size:10.0pt;"> =</span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">)</span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">، مدت زمان مراقبت از بیمار (036/0</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;"> =</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">)، شغل (021/0</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;"> =</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">)</span></span> <span style="font-family:B Lotus;"><span style="font-size:10.0pt;">و نوع بیمه (006/0</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;"> =</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">)</span></span> <span style="font-family:B Lotus;"><span style="font-size:10.0pt;">ارتباط معنیدار آماری داشت. همچنین کیفیت زندگی با سن (032/0</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;"> =</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">)، </span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">سطح تحصیلات (001/</span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">0</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;"> <</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">)</span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">، درآمد (001/0</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span><span dir="LTR"><span style="font-size:10.0pt;"> <</span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">)،</span></span> <span style="font-family:B Lotus;"><span style="font-size:10.0pt;">شغل (001/0</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;"> <</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">) و بیمه </span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">(</span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">001/0</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">P</span></span></span><span dir="LTR"><span style="font-size:10.0pt;"> <</span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">) </span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">ارتباط معنیدار آماری داشت</span></span><span dir="LTR"><span style="font-family:Times New Roman,serif;"><span style="font-size:10.0pt;">.</span></span></span><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"></span></span><br>
<strong><span dir="RTL"><span style="font-family:B Lotus;"><span style="font-size:10.0pt;">نتیجهگیری کلی:</span></span></span></strong><span dir="RTL"><span style="font-family:B Lotus;"><span style="font-size:10.0pt;"> نتایج این پژوهش نشان داد که با افزایش اضطراب مرگ مراقبین بیماران، کیفیت زندگی آنها کاهش مییابد. بنابراین پیشنهاد میشود در حیطه مدیریت و آموزش پرستاری و آموزش مداوم پرستاران به اهمیت موضوع مراقبت و مراقبین و لزوم توجه به این افراد با توجه به مشکلات و ناتواناییهایی که این افراد (بیماران و مراقبین) تجربه میکنند، پرداخته شود.</span></span></span></div>
<div style="text-align: justify;"><strong>Background & Aims:</strong> Multiple sclerosis (MS) is a disease that evolves into a chronic progressive phase and leads to a loss of muscular ability following the attack of the nervous system by the immune system. MS incidence has significantly increased in Iran and the world, and its disabling and progressive nature has affected various aspects of the life of patients and their caregivers. In fact, caregivers face the process of death, pain, and fear of mortality of patients during the care process, which may affect their quality of life. Therefore, given the direct impact of the caregivers’ quality of life on patients’ quality of life, more support of caregivers is of utmost importance. Since the care of patients might cause death anxiety and decrease the quality of life of caregivers, the present study aimed to determine the relationship between death anxiety and the quality of life of caregivers of MS patients.<br>
<strong>Materials & Methods:</strong> This descriptive and correlational study was performed on caregivers of MS patients who referred to Iran MS society in 2018. In total, 200 individuals were selected by convenience sampling after determining the sample size based on 95% confidence interval, 80% test power, and 0.2 correlation coefficient between death anxiety and quality of life of MS patients. The research was approved by the ethics committee of the Iran University of Medical Sciences (IR.IUMS.REC.1397.357). Data were collected using a demographic characteristics questionnaire for caregivers of MS patients (age, gender, level of education, marital status, economic status, occupational status, relationship with the patient, duration of care, and being responsible for care alone), the 36-item short-form health survey (SF-36), and Templer’s death anxiety scale. The latter instrument encompassed 15 items and was scored in a range of 0-15. In this regard, a score higher than eight was indicative of high death anxiety in the participants, whereas scores below seven showed low death anxiety. On the other hand, SF36 had eight dimensions of general health, physical performance, role limitations due to physical issues, role limitations due to emotional reasons, physical pain, social performance, joy, and psychological health. In the mentioned questionnaire, the lowest and highest scores were zero (worst case scenario) and 100 (best case scenario), respectively. In the end, higher scores demonstrated a better quality of life. Data analysis was performed n SPSS version 16 using descriptive (frequency, frequency percentage, mean and standard deviation) and inferential (analysis of variance, independent t-test, Scheffe’s test, and Pearson’s correlation coefficient) statistics.<br>
<strong>Results:</strong> In this study, the mean age of the participants was 40.39±11.75 years. The majority of the participants were male (58.5%) and married (64.4%). In terms of relationships with patients, 40% of the subjects were spouses of the patients, and 54.5% of them took care of the patients alone. The mean duration of patient care was 8.7±5.9, and most caregivers had a diploma degree (36.2%). Regarding residential status, 58.3% of the subjects had personal homes, and 44.2% of the participants had government jobs and a moderate economic status. In addition, about half of the people (50.8%) had social security insurance, and 54.5% of caregivers took care of the patients alone. According to the results, the mean death anxiety and quality of life scores of caregivers were estimated at 5.92±3.82 and 55.42±14.82, respectively. Moreover, 143 subjects (71.5%) received a low death anxiety score (in the range of zero-seven) while 57 of them (28.5%) a high score (above eight) in this respect. In the study of caregivers' quality of life, the highest and lowest mean and standard deviation were obtained in terms of physical performance and role limitations due to emotional reasons, respectively. The results showed a moderate quality of life in caregivers, and a significant, reverse correlation between death anxiety and quality of life (r=0.42) (P<0.05). In addition, there was a significant association between death anxiety and the variables of relationship with the patient (P=0.001), duration of care (P=0.036), occupational status (P=0.021), and type of insurance (P=0.006). Furthermore, a significant relationship was found between quality of life and the variables of age (P=0.032), level of education (P<0.001), income level (P<0.001), occupational status (P<0.001) and insurance (P<0.001).<br>
<strong>Conclusion:</strong> According to the results of the study, the majority of caregivers had low death anxiety. In addition, the mean score of death anxiety was estimated at 5.92 (out of 15), which demonstrated low death anxiety in these individuals. The results were indicative of a reverse correlation between death anxiety and quality of life and its dimensions. In other words, an increase in death anxiety led to a decrease in quality of life and its dimensions. Given the significant correlation between death anxiety and quality of life, it is recommended that more support be provided by healthcare providers to eliminate problems and decrease death anxiety in caregivers, especially those taking care of MS patients. Given the progressive nature of MS and its psychological outcomes, caregivers of these patients need ongoing psychological training to help them care for patients more effectively. Therefore, it is suggested that programs be designed to help caregivers and improve their quality of life in line with focusing on themselves and their needs. It is also recommended that more attention be paid to the importance of care and caregivers in the field of nursing management and continuous nursing education. It is also important to focus on the problems and disabilities of patients and their caregivers. For further research, it is suggested that the quality of life of caregivers be compared with the quality of life of patients and death anxiety in caregivers with death anxiety in patients.</div>
مالتیپل اسکلروزیس, مراقبین بیماران, کیفیت زندگی, اضطراب مرگ
Multiple Sclerosis, Caregivers, Quality of Life, Death Anxiety
1
13
http://ijn.iums.ac.ir/browse.php?a_code=A-10-2205-2&slc_lang=fa&sid=1
M
Seyedoshohadaee
مهناز
سیدالشهدایی
10800319475328460024922
10800319475328460024922
No
Instructor, Nursing Care Research Center, Department in Internal-Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
مربی، مرکز تحقیقات مراقبتهای پرستاری، گروه داخلی جراحی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی ایران، تهران، ایران
M
Bozorgi Matin
مریم
بزرگی متین
10800319475328460024923
10800319475328460024923
Yes
MS Student in Nursing, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: +98-9038228272 Email: mbozorgimatin@gmail.com
دانشجوی کارشناسی ارشد پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی ایران، تهران، ایران (*نویسنده مسئول) شماره تماس: 989038228272 mbozorgimatin@gmail.com Email:
H
Haghani
حمید
حقانی
10800319475328460024924
10800319475328460024924
No
Instructor, Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran
مربی، گروه آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی ایران، تهران، ایران