Symtom Experience, Self-care Behavior and Quality of Life in Hemodialysis Patients

Abstract

This study was conducted to look into the symptom experience, self-care behavior, and quality of life among hemodialysis patients and to examine the factors influencing their quality of life. The subjects of this study were 136 patients on hemodialysis at a university hospital and 2 local hemodialysis centers located at S City in Gyeonggi-do. The data were collected by using the self-administered questionnaires in a survey performed from August 30, 2019 to September 15, 2019. The symptom experience was measured by using the 'Dialysis Symptom Index (DSI)', the self-care behavior was measured by using the the self-care behavior tool, and the quality of life was measured by using the 'Korean version of WHOQOL-BREF'. The collected data were analyzed through the descriptive test, t-test, ANOVA, Scheffé test, Pearson's correlation coefficient, and hierarchical analysis. The major results of this study are as follows. 1. The mean score on the symptom experience of subjects was 27.63±1.55 points(score range: 0~150 points), and the mean score on the self-care behavior of subjects was 126.31±1.59 points(score range: 35~175 points). Meanwhile, the mean score on the quality of life in subjects was 81.32±1.13 points(score range : 26~130 points). 2. The difference in the quality of life was analyzed by general characteristics of subject. The results showed that there was statistically significant difference, depending on the presence of spouse (t=2.82, p=.006), education level (F=3.77, p=.026), financial conditions (F=8.73, p<.001), types of medicare (t=3.78, p<.001), causal diseases of end-stage renal disease(F=7.72, p<.001), and presence of concurrent diseases (t=-2.96, p=.004). 3. The quality of life in subjects showed significant negative correlation (r=-.25, p=.005) with physical symptom experience and emotional symptom experience (r=-.45, p<.001) and significant positive correlation (r=.31, p<.001) with self-care behavior. The self-care behavior of subjects showed significant negative correlation (r=-.23, p=.009) with emotional symptom experience, but did not show any significant difference (r=-.06, p=.495) from physical symptom experience. 4. Regarding the factors influencing the quality of life in subjects, emotional symptom experience (β=.15, p=.004) and self-care behavior (β=.24, p=.003) were found to be the significant influential factors when physical symptom experience, emotional symptom experience, and self-care behavior were input in the first stage of hierarchical analysis. The explanatory power was the model was found to be 24.6%. In the second stage, the emotional symptom experience (β=-.32, p<.001), self-care behavior (β=.20, p=.012), education level-bachelor's degree or higher (β=-.22, p=.024), and causal diseases of end-stage renal failure-glomerulonephritis (β=.25, p=.002) were found to be significant when the factors, which exhibited significant difference from the quality of life, were input. The explanatory power was the model was 44.1%, while the variation of explanatory power was 19.4%. Based on aforesaid results of this study, the factors influencing the quality of life in the hemodialysis patients were found to be the emotional symptom experience, self-care behavior, education level(high school diploma or higher), and causal diseases of end-stage renal disease (glomerulonephritis). Thus, it would be necessary to implement the education on diseases and treatments and manage the complications caused by the underlying diseases such as diabetes, and such endeavor is expected to increase the quality of life in hemodialysis patients. Moreover, it would be necessary to evaluate the emotional symptom experience, as well as physical symptom experience, and furthermore, develop and apply the nursing intervention programs that can help improve the self-care behavior.

본 연구는 혈액투석환자의 증상경험, 자가간호이행과 삶의 질의 정도를 확인하고, 삶의 질에 미치는 영향요인을 규명하기 위한 서술적 조사연구이다. 본 연구의 대상자는 경기도 S시 소재 일개 대학병원과 2개의 전문 혈액투석센터에서 혈액투석을 받고 있는 환자 136명을 대상으로 하였으며, 2019년 8월 30일부터 9월 15일까지 자가 보고식 설문지를 이용하여 자료를 수집하였다. 증상경험은 Weisbord 등(2004)이 개발한 Dialysis Symptom Index (DSI)를 임은지(206)가 한국어로 번안한 도구를, 자가간호이행은 송미령(1999)이 개발하고 조미경(2008)이 수정·보완한 도구를, 삶의 질은 세계보건기구(1994)에서 개발하고 민성길 등(2000)이 수정·보완한 도구(한글판 WHOQOL-BREF)를 사용하여 측정하였다. 수집된 자료는 실수와 백분율, 평균과, 표준편차, t-test, ANOVA, Scheffé test, Pearson’s correlation coefficient, 위계적 회귀분석을 통해 분석하였다. 본 연구의 주요결과는 다음과 같다. 1. 대상자의 증상경험은 평균 27.63±1.55점(점수범위: 0~150점), 자가간호이행은 평균 126.31±1.59점(점수범위: 35~175점), 삶의 질은 평균 81.32±1.13점(점수범위: 26~130점)으로 나타났다. 2. 대상자의 일반적 특성에 따른 삶의 질의 차이를 분석한 결과, 배우자의 유무(t=2.82, p=.006), 교육수준(F=3.77, p=.026), 경제상태(F=8.73, p<.001), 의료보장 종류(t=3.78, p<.001), 말기신부전의 원인질환(F=7.72, p<.001), 동반질환의 유무(t=-2.96, p=.004)에 따라 통계적으로 유의한 차이가 있었다. 3. 대상자의 삶의 질은 신체적 증상경험(r=-.25, p=.005), 정서적 증상경험(r=-.45, p<.001)과 유의한 음의 상관관계로 나타났으며, 자가간호이행과 유의한 양의 상관관계로 나타났다(r=.31, p<.001). 대상자의 자가간호이행은 정서적 증상경험과 유의한 음의 상관관계로 나타났으나(r=-.23, p=.009), 신체적 증상경험과 유의한 차이가 없었다(r=-.06, p=.495). 4. 대상자의 삶의 질에 영향을 미치는 요인은 위계적 회귀분석의 1단계에서 신체적 증상경험, 정서적 증상경험, 자가간호이행을 투입하였을 때, 정서적 증상경험(β=.15, p=.004), 자가간호이행(β=.24, p=.003)이 유의하게 나타났으며, 모형의 설명력은 24.6%이었다. 2단계에서는 단변량 분석에서 삶의 질과 유의한 차이를 나타낸 요인을 투입하였을 때, 정서적 증상경험(β=-.32, p<.001), 자가간호이행(β=.20, p=.012), 교육수준-대졸 이상(β=-.22, p=.024), 말기신부전 원인질환-사구체신염(β=.25, p=.002)이 유의하게 나타났으며, 모형의 설명력은 44.1%, 설명력 변화량은 19.4%이었다. 이상의 연구 결과를 바탕으로 혈액투석환자의 정서적 증상경험, 자가간호이행, 교육수준(대졸이상), 말기신부전 원인질환(사구체신염)이 삶의 질의 영향요인으로 확인되었다. 이에 혈액투석환자의 삶의 질 향상을 위해서 임상현장에서 정기적으로 신체적 증상경험 뿐만 아니라 정서적 증상경험을 사정하여 치료를 제공하여야 할 것이다. 또한 혈액투석환자의 자가간호이행을 향상시킬 수 있는 실제적인 중재프로그램의 개발 및 적용이 필요하다.