Based On Elderly Hemodialysis Patients Primary Caregivers' Needs: The Effect Of Autonomy-supportive Intervention

Objective1.To investigate the situation of elderly hemodialysis patients primary caregivers' needs,and analyse the influence of their needs.2.To evaluate the effect of autonomy-supportive intervention based on elderly hemodialysis patients primary caregivers' needs.MethodsThis study was included in two stages: Inventory survey and Intervention study.1.Inventory survey: We selected older hemodialysis patients above 60 years old and their primary caregivers in two third-grade class-A hospitals.Investigated the situation of the patients and their caregivers' general disease characteristics,and caregivers' self-efficacy,then analyzed the influence factors of their needs.The data collected were analyzed by SSPS 21.0,and the statistic methods included descriptive statistical analysis,Pearson correlation analysis,one-way analysis of variance,t-test and muliple linear regression analysis.2.Intervention study: This stage was a experimental research and based on first stage,84 patients and their primary caregiversin in a third-grade class-A hospital who want to join the intervention were selected,They were divided into intervention group(41 patients and primary caregivers who treated on Monday,Wednesday and Friday)and control group(43 patients and primary caregivers who treated on Tuesday,Thursday and Saturday).The control group' primary caregivers received regulation health education,the intervention group received autonomy-supportive health education.The intervention lasted for 4 months.Before and after intervention,we used general self-efficacy scale,general well-being schedule and caregiver burden inventory to evaluate the intervention effect on caregivers,and we collect patients' interdialytic weight to evaluate the patients care quality.The data was analyzed by descriptive statistical,Chi-square analysis,rank-sum test and t-test.Results1.Inventory survey: In the study,a total of 140 questionnaires granted,included 131 effective questionnaires,so the effective rate is 93.6%.(1)In this study,the score of older hemodialysis patients primary caregivers' needs is(55.98±4.40),rage 42~68,the average score of each items is(2.80±0.25);The average score of each dimension: Physiological needs dimension(2.90±0.43),Medical News dimension(2.85±0.22),Psychological needs dimension(2.63±0.26),the “Physiological needs dimension” scored highest.(2)Using Pearson correlation analysis,one-way analysis and t-test to select analy the influence factor of older hemodialysis patients primary caregivers' needs.The Multiple linear regression analysis showed thaht caregivers' self-efficacy,degree of education and health condition have a singnificant influence on the older hemodialysis patients primary caregivers' needs.2.Intervention study: During the intervention,we lost 3 patients and their caregivers,one patient received kidney transplant,two patients transfered to another hospital,the patients and their caregivers who completed the entire research were divided into intervention group(40 patients and their caregivers)and control group(41 patients and their caregivers).(1)Independent t test show that there were statisyically difference(P<0.01)in older hemodialysis patients primary caregivers' self-efficacy in the pre-post test between two group,and intervention group's score was higher then control group.Paired t test show that their was tatisyically difference(P<0.01)in caregivers' self-efficacy of intervention group in the pre-post test.(2)Independent t test show that there were statisyically difference(P<0.01)in older hemodialysis patients primary caregivers' happiness in the pre-post test between two group,and intervention group's score was higher then control group.Paired t test show that there was tatisyically difference(P<0.05)in caregivers' happiness total score,interest and satisfaction in life dimension,care for health dimension,melancholy or pleasant mood dimension,control of emotion and behavior dimension and relaxation and tension dimension of intervention group in the pre-post test,there was no tatisyically difference(P>0.05)in energy dimension.(3)Independent t test show there was tatisyically difference(P<0.01)in caregivers' burden total score in the pre-post test between two group,and intervention group's score was lower then control group.Paired t test show that there was tatisyically difference(P < 0.01)in caregivers' burden total score,time dependent burden dimension,limited of development burden dimension,social burden dimension and emotional burden dimension of intervention group in the pre-post test,there was no tatisyically difference(P>0.05)in physical burden dimension.(4)Independent t test show that there were statisyically difference(P<0.05)in older hemodialysis patients interdialytic weight increase value in the pre-post test between two group,and intervention group's nterdialytic weight was lower then control group.Paired t test show that there was tatisyically difference(P<0.01)in patients' interdialytic weight of intervention group in the pre-post test,compare to pretest,the patients' interdialytic weight lost 0.35 kg.Conclusions1.In the score of older hemodialysis patients primary caregivers' needs the “Physiological needs dimension” scored highest.2.Older hemodialysis patients primary caregivers' needs were affected by their general characteristics and self-efficacy.3.Autonomy-supportive intervention can improve the level of older hemodialysis patients primary caregivers' self-efficacy and happiness,reduce their burden.4.Autonomy-supportive intervention can improve the quality of patients' care,reduce their interdialytic weight increase value.