Iran Journal of Nursing

fa بررسی توان خودمراقبتی و عوامل مرتبط با آن در بیماران همودیالیزی Self-care Agency and Its Influential Factors in Hemodialysis Patients پرستاری nursing پژوهشي Research <div style="text-align: justify;">زمینه و هدف: امروزه همودیالیز یکی از رایج‌ترین روش‌های درمانی به دنبال نارسایی مزمن کلیه می‌باشد. بیماران تحت درمان با همودیالیز دچار محدودیت‌هایی در عملکرد جسمی، روانی و اجتماعی خود می‌گردند و فعالیت‌های خود‌مراقبتی در این بیماران می‌تواند نقش مؤثری در سازگاری آن‌ها با فرآیند بیماری داشته باشد. این مطالعه با هدف تعیین توان خودمراقبتی و عوامل مرتبط با آن در بیماران همودیالیزی انجام شده است. روش بررسی: پژوهش حاضر مطالعه‌ای مقطعی است که بر روی بیماران مراجعه کننده به بخش همودیالیز مرکز آموزشی درمانی رازی شهرستان رشت در سال 1396 انجام گرفت که در آن 126 بیمار با روش نمونه‌گیری تصادفی انتخاب شدند. ابزار گردآوری داده‌ها در این پژوهش پرسشنامه‌ی دو بخشی شامل اطلاعات فردی– اجتماعی و شکل تعدیل یافته نسخه چینی مقیاس 28 گویه‌ای ارزیابی توان خودمراقبتی بود. اطلاعات پس از جمع‌آوری با آماره‌های توصیفی (میانگین، انحراف معیار، درصد، فراوانی) و آزمون‌های تحلیلی (تی تست مستقل، ضریب همبستگی، آنالیز ئاریانس و رگرسیون لجستیک) مورد تجزیه و تحلیل قرار گرفت. یافته‌ها: حدود 4/71 درصد از بیماران دارای توان خود‌مراقبتی مطلوب بودند. ارتباط آماری معنی‌داری بین سن با توان خود‌مراقبتی وجود داشت (013/0P=). همچنین سطح تحصیلات با توان خودمراقبتی ارتباط آماری معنی‌ داری داشت (0001/0˂P) .در بررسی به عمل آمده بر اساس مدل رگرسیون لجستیک نتایج نشان داد که هرچه سن بیماران از میانگین سنی کل بیماران مورد مطالعه بالاتر بود توان خودمراقبتی این بیماران به میزان 5/1 برابر کاهش پیدا کرده بود. نتیجه‌گیری کلی: اگر چه در مطالعه‌ی حاضر بیشتر بیماران تحت درمان با همودیالیز دارای توان خودمراقبتی مطلوبی بودند اما نتایج این مطالعه نشان می‌دهد که این بیماران به علت افزایش سن، فرایند درمانی و مشکلاتی که ناشی از بیماری برای آن‌ها ایجاد می‌شود، دچار محدودیت‌هایی در مراقبت از خود می‌گردند. بنابراین توصیه می‌شود تا به منظور هرچه بهتر شدن توان خودمراقبتی این بیماران، تدابیری در برنامه‌های مراقبتی آنان گنجانده شود تا بیمار به عنوان عضوی از تیم مراقبتی در مراقبت از خود مشارکت کامل داشته باشد.</div> <div style="text-align: justify;"> <big>Background & Aims: Chronic kidney disease is a destructive and irreversible process, which reduces glomerular filtration, decreases the ability of the kidneys to retain fluids and electrolytes, and disrupts water and urea balance, thereby leading to uremia. This disease is accompanied by constant hospitalization, reduced quality of life, high mortality, and extreme medical costs. End-stage kidney disease refers to the irreversible loss of the renal function, in which case the kidneys are unable to support the life of the patient, and kidney transplantation is considered to be the treatment of choice. Due to the unevenness of this process, the majority of the patients in the world must remain under hemodialysis treatment until the kidney transplant is performed. Today, hemodialysis is a common treatment for chronic kidney failure. The patients receiving hemodialysis experience limitations in their physical, mental, and social functioning and self-care activities in patients; this could play a key role in their adaptation to the disease process, improving the quality of life, and reducing the number of hospitalizations, length of hospital stay, treatment costs, and mortality. Given the importance of self-care in hemodialysis patients and the need for care and treatment planning, the present study aimed to assess the ability of self-care and its influential factors in hemodialysis patients.</big> <big>Materials & Methods: This cross-sectional study was conducted with the permit of the Ethics Committee of Guilan University of Medical Sciences, Iran (IR.GUMS.REC.1395.310), starting in January 2016 until November 2017. The sample population included the patients referring to the hemodialysis ward of Razi Hospital in Rasht, who were selected via simple random sampling. Based on the Morgan table, the number of the sample was determined per 187 dialysis patients at this center to be 126. In order to compensate for the possible loss of the patients, 137 patients were enrolled in the study. During the study, four patients were excluded due to unwillingness to continue participation, and seven patients were excluded due to weakness and lethargy while completing the questionnaire; finally, 126 patients were evaluated. The inclusion criteria were the age of 18-75 years, ability in self-care, minimum dialysis history of three months, willingness to participate, and absence of physical and motor disabilities, mental retardation, and mental disorders. The exclusion criteria were weakness, lethargy, restlessness, and withdrawal from the study. Data were collected using a questionnaire consisting of two sections; the first section included individual-social data, and the second section was the modified form of the 28-item Chinese version of the self-care ability assessment, scored based on a five-point Likert scale (Not at All=1, Rarely=2, Usually=3, Often=4, Always=5). The final score was within the range of 28-140, and the higher score than 84 indicated desirable self-care ability. The reliability of the tool has been confirmed using the test-retest method at the Spearman's correlation-coefficient of 0.85 and internal consistency at the Cronbach's alpha of 0.83 in previous studies. The reliability of the instrument in the present study was obtained with 20 pilot samples at the Cronbach's alpha of 0.80. Data analysis was performed in SPSS version 16 using descriptive statistics (mean, frequency, percentage) and analytical tests (independent t-test, correlation-coefficient, analysis of variance, and logistic regression).</big> <big>Results: The mean age of the participants was 54.9 ± 16.1 years, and the mean duration of hemodialysis was 35.72 ± 33.35 months. The mean score of self-care capacity in the patients was 94.63 ± 21.57, and 71.4% of the patients had optimal self-care capacity. No significant correlation was observed between gender and self-care capacity, while men had a higher mean self-care score compared to women. Pearson's correlation-coefficient indicated an inverse, significant correlation between age and self-care ability, so that the older patients had lower self-care capacity (P=0.013; r=-0.22). In addition, a significant association was denoted between education level and self-care capacity based on the variance analysis, so that the patients with higher education levels had a higher self-care ability (P<0.0001; F=9.53). No significant associations were observed between smoking habits and alcohol consumption, marital status, and duration of hemodialysis with the self-care capacity of the patients. Based on the multivariate regression model and using the backward method, the results indicated that age was an important influential in the factor reduction of the self-care capacity of the hemodialysis patients, and the increased age of the patients than the total mean age was associated with their lower self-care ability by 1.5 times (β=-0.786; df=1; RR=0.456; CI=0.204-1.018). Conclusion: Although the majority of the patients undergoing hemodialysis had favorable self-care capacity, the findings indicated that these patients faced limitations in self-care due to aging, the treatment process, and the problems resulting from the disease. Given the importance of self-care in improving the conditions of patients and preventing and controlling the complications of diseases and treatment methods, it is recommended that educational and counseling measures appropriate to the age of patients be taken in their care program in order to improve their self-care capacity, so that they would be fully involved in self-care as a member of the healthcare team. In addition, nurses should take steps toward educating patients individually as an important nursing task by applying the necessary changes in the training programs for hemodialysis patients in order to change the state of self-care in these patients.  </big> </div> توان خود‌مراقبتی, همودیالیز, نارسایی مزمن کلیه Self-care Agency, Hemodialysis, Chronic Renal Disease 93 103 http://ijn.iums.ac.ir/browse.php?a_code=A-10-1588-3&slc_lang=fa&sid=1 M Soodmand مصطفی سودمند 10800319475328460027109 10800319475328460027109 No MS in Internal-Surgical Nursing, Student Research Committee, Shahid Beheshti School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran کارشناسی ارشد پرستاری داخلی و جراحی، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی شهید بهشتی، دانشگاه علوم پزشکی گیلان، رشت، ایران G Ghasemzadeh گلشن قاسم زاده 10800319475328460027110 10800319475328460027110 No BS in Nursing, Student Research Committee, Shahid Beheshti School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran کارشناس پرستاری، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی شهید بهشتی، دانشگاه علوم پزشکی گیلان، رشت، ایران S Mirzaei Dahka سمانه میرزایی دهکا 10800319475328460027111 10800319475328460027111 No MS Student in Nursing, Student Research Committee, Shahid Beheshti School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran دانشجوی کارشناسی ارشد پرستاری داخلی و جراحی، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی شهید بهشتی، دانشگاه علوم پزشکی گیلان، رشت، ایران M Mohammadi محسن محمدی 10800319475328460027112 10800319475328460027112 No MS Student in Nursing, Student Research Committee, School of Nursing and Midwifery, Ardebil University of Medical Sciences, Ardebil, Iran دانشجوی کارشناسی ارشد پرستاری داخلی و جراحی، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی اردبیل، اردبیل، ایران N Amoozadeh Lichaei نسیم عموزاده لیچایی 10800319475328460027113 10800319475328460027113 No BS Student in Nursing, Student Research Committee, Shahid Beheshti School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran دانشجوی کارشناسی پرستاری، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی شهید بهشتی، دانشگاه علوم پزشکی گیلان، رشت، ایران A Monfared آرزو منفرد 10800319475328460027114 10800319475328460027114 Yes PhD. Candidate in Nursing, Guilan University of Medical Sciences, Lecturer, Department of Nursing, Islamic Azad University, Rasht Branch, Rasht, Iran (*Corresponding author) Tel: +98 (911) 3479959 Email: a.monfared88@gmail.com دانشجوی دکترای پرستاری، دانشگاه علوم پزشکی گیلان، مربی، گروه پرستاری، دانشگاه آزاد اسلامی واحد رشت، رشت، ایران (*نویسنده مسئول) شماره تماس: 09113479959 Email: a.monfared88@gmail.comM