| Objective:1.To investigate the current situation of subjective well-being of uremic hemodialysis patients and analyze the factors affecting the level of subjective well-being of uremic hemodialysis patients.2.A structural equation model was established to explore the influence mechanism of symptom distress,social support and self-management on patients’ subjective well-being,and to quantitatively analyze the effect path and strength of various influencing factors on patients’ subjective well-being in the model.to provide empirical support for medical staff to implement psychological intervention to improve patients’ subjective well-being.Methods:1.In this study,using convenient sampling method,327 uremic hemodialysis patients from blood purification centers of two third-class hospitals in Shanxi Province were selected as research subjects.General data questionnaire,symptom distress scale of dialysis patients,self-management scale of dialysis patients,social support scale and overall well-being scale were used to investigate the subjects by on-the-spot survey.2.The measurement data are described by mean ± standard deviation((?)±s),and the counting data are described by the number of cases and constituent ratio.According to the data of normal distribution and homogeneity of variance,the differences of subjective well-being scores of dialysis patients with different characteristics were compared by two independent samples t-test and analysis of variance,and the data that did not accord with normality and homogeneity of variance were compared by nonparametric test.Mann-Whitney U test and Kruskal-Wallis H test were used to compare the differences of subjective well-being among different groups.Pearson correlation analysis was used to analyze the correlation between influencing factors and patients’ subjective well-being,and multiple stepwise regression was used to explore the influencing factors of patients’ subjective well-being.Structural equation model was used to analyze and verify the action path and effect of symptom distress,social support and self-management on patients’ subjective well-being,and the mediating effect of the model was tested by deviation correction percentile Bootstrap technique in AMOS.Results:1 Analysis of influencing factors of subjective well-being in uremic patients undergoing hemodialysi1.1 In terms of the current situation of subjective well-being: The overall score of the subjective well-being level is(71.02±17.42)points,the average score of the dimensions is(3.95±0.97)points,and the average scores of the 6 dimensions are: health worry(3.35±1.24)points,energy(4.28±1.01)Points,satisfaction and interest in life(2.61±0.95)points,happy or melancholic mood(4.94±1.31)points,control of emotions and behaviors(4.03±0.86)points,relaxation and tension(3.77±1.15)points.According to the relevant evaluation criteria of the scale,the subjective well-being of hemodialysis patients is less than 48 points(low level)36 people(11.01%),49-72 points(medium level)124 people(37.92%),73-96 Score(higher level)157 people(accounting for 48.01%),97-120 points(high level)10 people(accounting for 3.06%).1.2 In terms of the status of social support: the total score of social support for uremic hemodialysis patients is(34.62±8.58)points,and the average score is(3.46±0.86)points,of which the total score of subjective support is(19.04±4.82)points,and the total score of objective support is(19.04±4.82)points.It is divided into(9.63±2.94)points,the total score of social support utilization is(5.95±2.07)points,and the dimensional average points are(4.76±1.20)points,(3.21±0.98)points,and(1.98±0.69)points respectively.1.3 In terms of self-management status: the total score of self-management of uremic hemodialysis patients is(49.24±11.59)points,and the dimensions are equally divided into(2.46±0.58)points,four dimensions of partnership,self-care,problem solving,emotional processing The total scores are(7.83±2.67)points,(18.59±4.50)points,(13.89±2.94)points,(8.93±2.94)points,and the average points are(1.96±0.67)points,(2.66±0.64)points,(2.78±0.59)points,(2.23±0.74)points.1.4 In terms of the status quo of symptom distress: the total score of symptom distress in uremic hemodialysis patients is(20.50±14.76)points,and the average score of dimensions is(0.68±0.49)points.Among them,mental symptom distress score(3.30±5.09)points,mean dimensionality score(0.66±1.02)points;physical symptom distress score(17.20±11.15)points,dimensionality mean score(0.69±0.45)points;symptom presence or absence score(7.66±4.60)points,symptom distress score(12.84±10.60)points.1.5 The results of one-way analysis of variance show: different occupations,work status,marital status,education level,living status,disease understanding,family income per capita,medical insurance type,hobbies,lifestyle self-assessment,self-care ability,sleep status,and causes to the family The economic burden,nursing burden,and self-evaluation of life satisfaction of uremic hemodialysis patients have statistically significant differences in the level of subjective well-being(P<0.05).Multiple stepwise regression shows that satisfaction evaluation of life conditions,problem solving,total score of mental symptoms,self-perceived sleep status,utilization of social support,partnership,self-care ability,self-care,and objective support are included in the regression equation in turn.The above factors can explain The variation of the dependent variable was 73.80%(F=103.08,P<0.001).1.6 Pearson correlation analysis showed that symptom distress was significantly negatively correlated with social support,self-management,and subjective well-being(P<0.01),and the correlation coefficient r=-0.286,-0.391,-0.588;social support,self-management,and subjective well-being There was a significant positive correlation(P<0.01),and the correlation coefficient was r=0.638,0.616,0.640.2 Construction of structural equation modelThe structural equation model is constructed with symptom distress as an exogenous latent variable,subjective well-being as an endogenous latent variable,and social support and self-management as an intermediary variable.The results show that the modified model fits well,X~2=121.648,X~2/df=1.484,RMSEA=0.039,GFI=0.972,AGFI=0.947,NFI=0.972,RFI=0.964,IFI=0.991,TLI=0.988,CFI=0.991.Symptom distress(β=-0.501,P<0.001),social support(β=0.301,P<0.001),self-management(β=0.270,P<0.001)can directly affect subjective well-being,symptom distress can also be through social support(β=-0.126,P<0.001),self-management(β=-0.064,P<0.001),social support-self-management(β=-0.074,P<0.001)three paths indirectly affect subjective well-being.Conclusion:1.The subjective well-being of uremic hemodialysis patients is in the middle level,and the low and medium subjective well-being accounts for 48.93%.The subjective well-being of this kind of people needs to be further improved.Occupation,working status,marital status,education,living status,disease understanding,family per capita income,type of health insurance,hobbies,lifestyle self-assessment,self-care ability,sleep status,financial burden on the family,care burden and life satisfaction are the influencing factors.It is suggested that medical staff should intervene according to the relevant factors affecting the subjective well-being of dialysis patients,so as to improve their subjective well-being and further promote their mental health.2.The subjective well-being of uremic hemodialysis patients was positively correlated with social support and self-management,and negatively correlated with symptoms.Symptom distress,social support and self-management can directly predict the subjective well-being of dialysis patients,and symptom distress can also be mediated by social support and self-management.and the chain intermediary role of social support-self-management affects their subjective well-being.Therefore,caregivers and medical staff should give enough attention and support to patients to help patients maintain a good psychological state,improve their self-care ability,and promote the production of positive emotion and positive emotion. |
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