| Chronic kidney disease(CKD)is a lifelong disease with progressive and incurable damage to kidney structure or function caused by various reasons.CKD is another world public health problem that endangers human physical and mental health after cardiovascular disease,diabetes,and malignant tumors.In the treatment process of CKD,recurrent attacks and expensive treatment will lead to negative affect on patients.Each expression of negative affect and self-behavioral control will consume patients’ psychological resources and energy,resulting in ego depletion.Ego depletion is a state of self-control resource consumption in which the individual’s ability to cognition,decision-making and behavioral control will decline,which further affect self-management behavior.While most patients need home treatment,it is particularly important to rely on themselves to solve various physical and psychological problems,that is,self-management.And it has been found that in patients with early CKD,effective self-management behavior can significantly delay further damage to renal function,reduce the occurrence of complications,and effectively prevent the development of early CKD to the end stage.However,because the subjective symptoms of patients with early CKD are not obvious,patients do not pay enough attention to the disease,which affects the self-management behavior to a certain extent.In addition,the current studies on self-management behavior mostly adopt persuasion or imperative health education,and the attention,mining and flexible use of patients’ internal positive resources are not enough,which leads to the long-term effect is not ideal.Studies have found that psychological empowerment and stimulating patients’ motivation are conducive to supplementing psychological resources or energy,reducing ego depletion,and improving self-management behavior,but relevant studies have not been reported in patients with early CKD.How to tap the deep psychological potential of patients,fully mobilize their own psychological resources or energy,and fundamentally stimulate patients’ motivation to be responsible for health to improve self-management behavior has become an important issue for mental nursing in patients with early CKD.Therefore,this study group introduced affect and ego depletion into the study category to explore the mediating role of ego depletion between positive and negative affect and self-management behavior,and to verify the intervention effect of motivational interview based on psychological empowerment in patients with early CKD.Objectives1.To investigate the current status and related factors of positive and negative affect,ego depletion and self-management behavior,and to explore the mediating effect of ego depletion between positive and negative affect and self-management behavior in patients with early CKD.2.To verify the intervention effect of motivational interview based on psychological empowerment in improving the self-management behavior of patients with early CKD.3.To determine the deep reasons for motivational interview based on psychological empowerment in reducing ego depletion and improving self-management behavior of patients with early CKD.Methods1.In the cross-sectional study,the data of 383 patients with early CKD in three tertiary hospitals in Xi’an were collected by chronic kidney disease self-management instrument(CKD-SM),self-regulating fatigue scale(SRF-S)and positive and negative affect schedule(PANAS)from September 2021 to March 2022.SPSS26.0 and Mplus8.3 were used for statistical analysis,including descriptive analysis,independent sample t-test,one-way ANOVA,correlation analysis,multiple linear regression analysis and mediating effect analysis.The results help to understand the current status of positive and negative affect,ego depletion and self-management behavior and to explore the mediating effect of ego depletion between positive and negative affect and self-management behavior in patients with early CKD.2.In a single center,single-blind and randomized parallel controlled study,70 patients with early CKD were selected from the department of nephrology of the first affiliated hospital of Air Force Medical University and randomly divided into two groups with 35 patients in each group from March to November 2022.The control group was given routine clinical nursing,and the intervention group was given motivational interview intervention based on psychological empowerment on the basis of routine clinical nursing.Two groups of patients were tested by chronic kidney disease self-management instrument(CKD-SM),patient perception of empowerment scale(PPES),self-regulating fatigue scale(SRF-S)and positive and negative affect schedule(PANAS)before the intervention,after 4 weeks and12 weeks of the intervention and 4 weeks after the end of the intervention.Chi-square test,one-way ANOVA,independent sample t-test,paired sample t-test and repeated measurement ANOVA were used to examine the effect of motivational interview intervention based on psychological empowerment.3.Using the method of qualitative study design,14 patients with early CKD in the intervention group were interviewed 4 weeks after the end of the intervention by semistructured interview.The Colaizzi seven-step analysis method was used to deeply understand the real experience of patients’ participation and analyze the real reasons why motivational interview intervention based on psychological empowerment affected ego depletion and self-management in patients with early CKD.Results1.Mediating effect of ego depletion between positive and negative affect and selfmanagement in patients with early CKDA total of 412 questionnaires were distributed and 383 were valid with an effective recovery rate of 92.96%.(1)The status quo of self-management behavior,ego depletion,positive and negative affectSelf-management behavior: The total score of self-management behavior in patients with early CKD was 84.54±19.72,and the total average score of items was 2.92±1.06.According to the average score of each dimension,the order from high to low was selfintegration(3.09±0.74),adherence to recommended regimen(3.02±0.82),problem solving(2.86±0.86)and seeking social supports(2.55±0.86).In this study,the scoring rate of selfmanagement behavior of 227 patients with early CKD was less than 80%,that is,59.27%of the patients’ self-management behavior was at the low and middle levels.For selfmanagement behavior in patients with early CKD,there were significant differences in different ages,education levels,working status,places of residence,payment of medical expenses,family monthly income,course of disease,frequency of review,and the number of hospitalization(P(27)0.05).Regression analysis showed that age,frequency of review,places of residence and course of disease had predictive effects on self-management behavior.Ego depletion: The total score of ego depletion in patients with early CKD was43.66±8.07,and the total average score of items was 2.73±1.09.The average scores of each dimension from high to low were cognition(2.92±0.48),emotion(2.92±0.64)and behavior(2.60±0.76).Positive and negative affect: The total score of positive affect in patients with early CKD was 22.61±7.07,and the total average score of items was 2.51±0.79.The total score of negative affect was 18.55±4.91,and the total average score of items was 2.06±0.55.(2)Correlation analysis of self-management behavior,ego depletion and positive and negative affectThe total score of self-management behavior in patients with early CKD was negatively correlated with the total score and all dimensions of ego depletion(P(27)0.01).The total score of self-management behavior was positively correlated with positive affect(r=0.455,P(27)0.01)and negative affect(r=0.140,P(27)0.01).The total score of ego depletion was negatively correlated with positive affect(r=-0.442,P(27)0.01)and positively correlated with negative affect(r=0.270,P(27)0.01).(3)Influence of positive and negative affect and ego depletion on self-management behaviorsExcluding the influence of general information,positive affect still had a significant negative predictive effect on ego depletion,while negative affect still had a significant positive predictive effect on ego depletion(F=35.028,P(27)0.001);the positive and negative affect still had a significant positive predictive effect on self-management behavior,and ego depletion still had a significant negative predictive effect on self-management behavior(F=33.751,P(27)0.001).(4)Analysis of the mediating effect of ego depletionEgo depletion played a partial mediating role between positive affect and selfmanagement behavior(mediating effect = 0.248,95%CI:0.170～0.376,P(27)0.001),and the mediating effect accounted for 53.33% of the total effect.Ego depletion played a suppressing role between negative affect and self-management(suppressing effect =-0.191,95%CI=-0.310～-0.118,P(27)0.001),and the absolute value of the ratio of suppressing effect and the direct effect was 66.55%.2.Effects of motivational interview intervention based on psychological empowerment on positive and negative affect,ego depletion,perception of empowerment and self-management in patients with early CKDFor the motivational interview intervention based on psychological empowerment group and control group,the results were compared between groups and within groups at four time points respectively: before the intervention,after 4 weeks and 12 weeks of intervention and 4 weeks after the end of intervention.2.1 Comparison between groups(1)Before interventionThere was no significant difference in the score of positive and negative affect,ego depletion,perception of empowerment and self-management behavior between intervention group and control group(all P(29)0.05).(2)After 4 weeks of interventionThe positive affect,perception of empowerment and self-management behavior of the intervention group was significantly higher than that of the control group(P(27)0.001);the negative affect and ego depletion of the intervention group was significantly lower than that of the control group(P(27)0.001).(3)After 12 weeks of interventionThe positive affect,perception of empowerment and self-management behavior of the intervention group was significantly higher than that of the control group(P(27)0.001);the negative affect and ego depletion of the intervention group was significantly lower than that of the control group(P(27)0.001).(4)4 weeks after the end of the interventionThe positive affect,perception of empowerment and self-management behavior of the intervention group was significantly higher than that of the control group(P(27)0.001);the negative affect and ego depletion of the intervention group was significantly lower than that of the control group(P(27)0.001).2.2 Comparison in the groups(1)In the intervention groupAffect and ego depletion: The scores of negative affect and ego depletion before intervention were significantly higher than those after 4 weeks and 12 weeks of intervention and 4 weeks after the end of intervention(all P(27)0.05).There was no significant difference in the score of positive affect between the intervention group and control group before intervention,after 4 weeks and 12 weeks of intervention and 4 weeks after the end of intervention.Perception of empowerment and self-management behavior: The scores of perception of empowerment and self-management behavior before intervention were significantly lower than those after 4 weeks and 12 weeks of intervention and 4 weeks after the end of intervention(all P(27)0.001).(2)In the control group: There were no significant differences in the scores of positive and negative affect,ego depletion,perception of empowerment and selfmanagement behavior between the intervention group and control group before intervention,after 4 weeks and 12 weeks of intervention and 4 weeks after the end of intervention(all P(29)0.05).3.Analysis of the reasons for the improvement of self-management behavior by motivational interview intervention based on psychological empowermentThrough a semi-structured interview with 14 patients with early CKD,it was found that motivational interview intervention based on psychological empowerment could promote the transformation of self-cognition,improvement of emotion and establishment of healthy behavior,and had a positive influence on reducing ego depletion and improving self-management behavior.Conclusion1.59.27% of the self-management behavior in patients with early CKD was at the low and middle levels,which needed to be improved.Patients’ age,frequency of review,places of residence and course of disease were the influencing factors of self-management behavior.2.The self-management behavior in patients with early CKD was negatively correlated with ego depletion and its dimensions,and positively correlated with positive affect and negative affect.The ego depletion was negatively correlated with positive affect and positively correlated with negative affect.3.Ego depletion played a partial mediating role between positive affect and selfmanagement behavior while playing a suppressing role between negative affect and selfmanagement.4.The motivational interview intervention based on psychological empowerment could promote the transformation of self-cognition,improvement of emotion and establishment of healthy behavior.It had good immediate and delayed effects on increasing positive affect,reducing negative affect and ego depletion,improving perception of empowerment and self-management behavior in patients with early CKD. |
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