Iran Journal of Nursing

fa ارتباط رفتارهای خودمراقبتی با اضطراب، حمایت خانواده و وضعیت ناخوشی در بیماران مبتلا به نارسایی قلبی دارای دیابت نوع دو بستری در مرکز آموزشی- درمانی شهید چمران اصفهان در سال 1397 Evaluation of the Relationship between Self-care Behaviors and Anxiety, Family Support and Disease State in Patients with Heart Failure and Type II Diabetes Mellitus Admitted to Chamran Teaching Health Center in Isfahan, Iran in 2018 پرستاری nursing پژوهشي Research <div style="text-align: justify;">زمینه و هدف: نارسایی قلبی یکی از شایع‌ترین بیماری‌های مزمن در کشورهای در حال توسعه است. یکی از علل مهم نارسایی قلبی بیماری دیابت نوع دو می‌باشد. از مهم‌ترین روش‌های کنترل این دو بیماری مشارکت فعالانه فرد بیمار در مراقبت از خود است. هر چند زمانی که نارسایی قلبی و دیابت با یکدیگر همراه شوند، رفتارهای خودمراقبتی بسیار پیچیده و مشکل خواهد شد. از این رو، شناسایی عوامل مرتبط با رفتارهای خودمراقبتی حائز اهمیت می‌باشد. در نتیجه هدف از این مطالعه تعیین ارتباط رفتارهای خودمراقبتی با اضطراب، حمایت خانواده و وضعیت ناخوشی در افراد مبتلا به نارسایی قلبی دارای دیابت نوع دو بود. روش بررسی: این پژوهش یک مطالعه توصیفی- همبستگی می‌باشد که در سال 1397 بر روی 158 بیمار مبتلا به نارسایی قلبی دارای دیابت نوع دو که به بیمارستان چمران اصفهان مراجعه کرده بودند، انجام شد. این نمونه‌ها به روش مستمر انتخاب شده بودند. در این مطالعه داده‌ها با استفاده از پرسشنامه‌های اروپایی رفتارهای خودمراقبتی در نارسایی قلبی، بیماری‌های همراه Charlson، وضعیت عملکرد شناختی، حمایت اجتماعی (مقیاس خانواده)، اضطراب Spielberger و اطلاعات جمعیت شناختی جمع آوری شد. سپس داده‌ها با استفاده از آمار توصیفی (فراوانی، درصد فراوانی، میانگین و انحراف معیار) و همچنین آمار استنباطی (تی تست و آنالیز واریانس) در نرم افزار SPSS نسخه 16 تحلیل شدند. یافته‌ها: نتایج نشان داد که بیشتر نمونه‌ها (6/88 درصد) رفتار خودمراقبتی در سطح متوسط داشتند و میانگین و انحراف معیار آن به ترتیب 76/4 ± 37/38 به دست آمد. در این مطالعه بین هیچ کدام یک از عوامل جمعیت شناختی، بیماری، وضعیت عملکرد شناختی، حمایت خانوادگی و اضطراب با رفتارهای خودمراقبتی ارتباط معنی‌داری یافت نشد (05/0P>). نتیجه‌گیری کلی: با توجه به یافته‌ها، مطالعات همچنان باید بر روی عوامل مرتبط با رفتارهای خودمراقبتی ادامه یابد تا از این طریق در سبک زندگی مبتلایان به نارسایی قلبی دارای دیابت نوع دو تغییراتی رخ دهد تا این دو بیماری به نحوی مناسب کنترل شوند و از عوارض ناشی از آن‌ها پیشگیری شود. </div> <div style="text-align: justify;">Background & Aim: Heart failure is a prevalent, chronic disease in developing countries, and type II diabetes mellitus is considered to be a major cause of heart failure. In addition to increasing atherosclerosis and contributing to hypertension, diabetes changes heart function and structure, which results in heart failure. An effective approach to the control of these diseases is the active participation of patients in self-care since it will improve the participation, satisfaction with treatment, and quality of life of patients while decreasing their anxiety levels. Self-care behaviors are extremely important in patients with chronic diseases since they empower patients in terms of performance and increase their ability to deal with problems and have a healthy lifestyle. However, self-care can be affected by factors related to the patient, community, and environment. These factors can include social support and medical staff care. In patients with heart failure, self-care is often affected by various factors, which can be used to describe and determine this complicated syndrome. However, the concurrence of heart failure and diabetes is associated with complex and difficult self-care behaviors. Therefore, it is essential to identify the influential factors in self-care behaviors. The present study aimed to assess the correlations between self-care behaviors and anxiety, family support, and disease state in patients with heart failure and type II diabetes.  Materials & Methods: This descriptive-correlational study was conducted on 158 patients with heart failure and type II diabetes mellitus referring to Chamran Hospital in Isfahan, Iran in 2018. The patients were selected via continuous sampling, and inclusion criteria were age above 18 years, diagnosis of heart failure by a cardiologist based on echocardiography, lack of experience of acute coronary syndromes in the last three months, and obtaining a score above 10 in mini-mental state examination test (MMSE). Data were collected using the European heart failure self-care behavior scale (EHFSCB), Charlson comorbidity index (CCI), MMSE, Perceived Social Support from Family (PSS-Fa), and Spielberger state-trait anxiety inventory (STAI) on the last day of hospitalization (before discharge). Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, frequency percentage, mean, and standard deviation), inferential statistics (t-test and analysis of variance), Pearson’s correlation (to determine correlation), and Kolmogorov-Smirnov test (to determine the normal distribution of the data). Results: In this study, 8.2% of the subjects had poor self-care behaviors, whereas 88.6% and 3.2% had moderate and good self-care behaviors, respectively. In this regard, the mean and standard deviation of self-care was reported to be 38.37 and 4.76, respectively, which demonstrated that the mean self-care scores were at a moderate level. According to the results, there was no significant correlation between the demographic and disease characteristics of the patients and self-care behaviors (P>0.05). Moreover, most participants received a disease status score of three-four, and the mean disease status score was estimated at 4.69 ± 1.91. Furthermore, we detected no significant relationship between disease status score and self-care behaviors (P=0.55). According to the results, the majority of subjects (47.5%) had a moderate cognitive performance state and their scores were in the range of 10-20. In addition, the mean cognitive performance score of the subjects was reported to be 19.16 ± 4.82, and no significant association was found between the mentioned variable and self-care behaviors. According to the results of the present study, the highest percentage frequency in the area of obvious anxiety was related to moderate-low anxiety (25.3%). On the other hand, no significant correlation was observed between obvious anxiety and self-care behaviors. Regarding latent anxiety, the highest frequency (29.1%) was related to moderate-high anxiety, and no significant association was observed between hidden anxiety and self-care. Furthermore, the mean family support was estimated at 11.61 ± 5.35, and no significant relationship was found between the foregoing variable and self-care behaviors.  Conclusion: According to the results, the self-care scores of the subjects were at a moderate level, and no significant correlation was observed between demographic and disease variables of the participants and their self-care behaviors. Our findings were also indicative of no significant relationship between disease status and self-care behaviors, and other variables affected self-care behaviors with the exception of other illnesses. We found no relationship between cognitive performance status and self-care behaviors. According to the results, there was no correlation between self-care behaviors and the variables of anxiety and family support. In the present study, a few participants had good self-care behaviors, which requires healthcare team members, especially nurses, to make efforts in the area of patient education and following up the performance of these behaviors in order to reduce mortality rates and treatment costs in this group of patients. In the current research, we found no association between demographic and disease variables, disease status, cognitive performance status, anxiety, and family support with self-care behaviors. Given the fact that self-care is the most important strategy for disease control and the key to successful treatment in patients with heart disease and type 2 diabetes, and since any progress in the treatment depends on the patient’s self-care and treatment outcome management abilities, investigations must continue on the influential factors in self-care behavior in order to change the attitudes of patients in this regard. </div> خودمراقبتی, نارسایی قلبی, دیابت نوع دو, اضطراب, حمایت Self-care, Heart Failure, Type II Diabetes Mellitus, Anxiety, Support 26 40 http://ijn.iums.ac.ir/browse.php?a_code=A-10-2193-2&slc_lang=fa&sid=1 T Najafi Ghezeljeh طاهره نجفی قزلجه 10800319475328460026774 10800319475328460026774 No Associate Professor, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran دانشیار، مرکز تحقیقات مراقبت‌های پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی و خدمات بهداشتی درمانی ایران، تهران، ایران A Ghasemi عطیه قاسمی 10800319475328460026775 10800319475328460026775 Yes MS in Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel:09376443016 Email: atiyeghasemi16@yahoo.com کارشناس ارشد پرستاری مراقبت ویژه، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی و خدمات بهداشتی درمانی ایران، تهران، ایران (*نویسنده مسئول) شماره تماس: 09376443016 Email:atiyeghasemi16@yahoo.com M Rasouli محبوبه رسولی 10800319475328460026776 10800319475328460026776 No Assistant Professor, Department of Statistics, Iran University of Medical Sciences, Tehran, Iran استادیار، گروه آمار، دانشگاه علوم پزشکی و خدمات بهداشتی درمانی ایران، تهران، ایران M Garak Yaraghi محمد گرک یراقی 10800319475328460026777 10800319475328460026777 No Professor, Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran استاد، گروه قلب و عروق، دانشگاه علوم پزشکی و خدمات بهداشتی درمانی اصفهان، اصفهان، ایران