Influencing Factors on Self-care Behavior in Hemodialysis Patients

Abstract

The purpose of this study is to examine factors affecting the self-care behavior of patients with hemodialysis in order to improve the self-care behavior for patients with hemodialysis. The study subjects were 118 patients aged over 19 with end-stage renal failure who were regularly undergoing hemodialysis at two General hospital located in Gyeonggido. For data collection, convenience sampling had been performed from Aug. 20 to Sep. 30, 2019, with the use of structured questionnaire. This researcher used the self-care behavior measurement instrument for hemodialysis patients developed by Song Mi-Ryeong(1999) and changed by Cho Mi-Kyoung(2008). Resilience was assessed using the Korean Version of Conner-Davidson Resilience Scale (K-CD-RISC) tool of Conner-Davidson Resilience Scale (CD-RISC), developed by Conner and Davidson(2003). As for social support, Multidimensional Scale Perceived Social Support(MSPSS) developed by Zimet, Dahlem, Zimet and Farley(1988) and translated by Shin Joon-seob and Lee Young-boon(1999) was used for the analysis. Depression was assessed using the Patient Health Questionnaire 9 (PHQ-9) questionnaire developed by Spitzer, Kroenke and Williams(1999) and translated by Park Seung-jin(2010). Using the SPSS 25.0 program, the collected data analyzed for the frequency, percentage, mean and standard deviation, Independent t-test, one-way ANOVA, Pearson’s Correlation coefficient and multiple regression and we presented the analysis result. The results of the study are as follows: 1. Self-care behavior of hemodialysis patients was 3.57±0.49 points on average. In the seven sub categories, medication had 4.42 points; fistula management had 4.20 points; management of physical problem had 3.96 points; exercise and rest had 3.44 points; diet management had 3.27 points; blood pressure and weight management had 2.79 points; and social adjustment had 1.92 points. 2. The resilience of hemodialysis patients had average 61.33±17.87 points out of 100 points. Depression of hemodialysis patients was 5.50±4.33 points on average. The normal group was 1.91 ± 1.39 points with 55 people(46.6 %), the mild depression group was 4.60 ± 1.50 points with 43 people(36.4%), and the severe depression group was 13,00 ± 2.43 points with 20 people(16.9%). Social support of hemodialysis patients was 41.19±10.20 points on average. In the three sub categories, family support had 15.62 points; medical support 13.03 points and friend support 12.54 points. 3. Analyzing of the relationship between resilience, social support, depression and self-care behavior of hemodialysis patients, self-care behavior of hemodialysis patients were shown to be a significant correlation between resilience(r=.478, p<.001) and social support(r=.410, p<.001), and a significant negative correlation with depression(r=-.298, p=.001). 4. The differences in self-care behavior were not statistically significant in terms of the general and disease-related characteristics of hemodialysis patients. 5. As a result of multiple linear regression analyzing, resilience(β=.33, p=.001) and social support(β=.22, p=.025) have appeared to be the variables influencing self-care behavior, and the explanatory power of this model was 26.7%. In conclusion, it was identified that resilience and social support had significant influence on the hemodialysis patients’ self-care behavior. Accordingly, intervention studies that improve resilience and social supports for encouraging hemodialysis patients’ self-care behavior.

본 연구는 혈액투석환자의 자가간호행위에 영향을 미치는 요인을 파악하여 자가간호행위를 증진시키기 위한 기초자료로 제공 하고자 시도되었다. 자료수집 기간은 2019년 8월 20일부터 9월 30일까지이며, 연구대상자는 경기도에 위치한 2개의 종합병원에서 정기적으로 혈액투석치료를 받고 있는 만 19세 이상의 말기신부전 환자 118명이었다. 자가간호행위는 송미령(1999)이 개발하고 조미경(2008)이 수정 보완한 자가간호행위 측정도구를 사용하였고, 회복탄력성은 Conner와 Davidson (2003)이 개발한 Conner-Davidson Resilience Scale (CD-RISC)의 한국형 회복탄력성 도구로 측정하였다. 사회적 지지는 Zimet ,Dahlem, Zimet과 Farley(1988)가 개발한 Multidimensional Scale of Perceived Social Support(MSPSS)를 신준섭과 이영분(1999)이 번안한 사회적 지지 도구로 측정하였다. 우울은 Spitzer, Kroenke와 Williams(1999)가 개발하고 박승진 등(2010)이 번안한 Patient Health Questionnaire 9(PHQ-9)로 측정하였다. 수집된 자료는 SPSS 25.0 프로그램으로 빈도와 백분율, 평균과 표준편차, Independent t-test, one-way ANOVA, Pearson’s correlation, Multiple regression을 이용하여 분석하였다. 본 연구결과를 요약하면 다음과 같다. 1. 혈액투석환자의 자가간호행위는 5점 만점에 평균 3.57±0.49점으로 나타났으며, 7개의 하위영역에서 약물복용 4.42점, 혈관관리 4.20점, 신체관리 3.96점, 운동과 휴식 3.44점, 식이관리 3.27점, 혈압과 체중 2.79점, 사회활동 1.92±0.76점 순으로 나타났다. 2. 혈액투석환자의 회복탄력성은 100점 만점에 평균 61.33±17.87점이었고, 우울은 27점 만점에 평균이 5.50±4.33점으로 나타났다. 정상군은 55명(46.6%)으로 1.91±1.39점이었고, 경한 우울군은 43명(36.4%)으로 6.60±1.50점, 중증 우울군은 20명(16.9%)으로 13.00±2.43점이었다. 사회적 지지는 60점 만점에 평균 41.19±10.20점이었으며, 3개의 하위영역에서 가족지지가 15.62점, 의료인지지가 13.03점, 친구지지가 12.54점 순으로 나타났다. 3. 혈액투석환자의 회복탄력성, 사회적 지지, 우울과 자가간호행위 간의 상관관계를 분석한 결과, 혈액투석환자의 자가간호행위는 회복탄력성(r=.478, p<.001)과 사회적 지지(r=.410, p<.001)와 유의한 양의 상관관계, 우울(r=-.298, p=.001)과는 유의한 음의 상관관계로 나타났다. 4. 혈액투석환자의 일반적 특성과 질병관련 특성에 따른 자가간호행위의 차이는 통계적으로 유의하지 않았다. 5. 혈액투석환자의 자가간호행위에 영향을 미치는 요인을 다중회귀분석으로 분석한 결과, 자가간호행위에 영향을 미치는 변수는 회복탄력성(β=.33, p=.001)과 사회적 지지(β=.22, p=.025)이었고 모형의 설명력은 26.7%이었다. 이상의 연구결과를 통해 혈액투석환자에게 있어 회복탄력성과 사회적 지지는 자가간호행위를 증진하는 중요한 변수로 작용함을 알 수 있었다. 따라서 혈액투석환자의 자가간호행위를 증진시키기 위해 대상자의 회복탄력성과 사회적 지지를 증진시켜 주는 중재연구가 필요할 것으로 사료된다.