| Maintenance hemodialysis is one of popular therapies for patients with end-stage renal disease. During the long-term hemodialysis, the progressive loss of physical and social function make patients feel exhaust and hopeless. Some patients therefore withdraw from the hemodialysis and loose the chance of survival. Therefore, the focuses of nursing are not only to prolong patients' lives but also to help patients to establish hope and improve their quality of lives. Hope is the self-improving feeling or sensation released from distress, which has been proved a helpful factor for patients to adapt to disease and to improve physical and mental health. Hope can be affected by different factors. Therefore, to make effective hope intervention measures it is necessary to know patients' hope status and understand the mechanism of its affecting factors. Although researches on factors affecting hope have been studied,there are few studies explaining which factors have the direct effect on hope and which factors have the indirect effect on hope. Furthermore, there are no data corresponding or establishing the relationship among factors affecting hope in Chinese patients receiving maintenance hemodialysis.Objectives:The purpose of this study was to explore the hope status in patients receiving maintenance hemodialysis and to test a model on factors affecting hope. Such model can be helpful for making hope intervention measures and improving patients'physical and mental health by suggesting the processes that link hope and its affecting factors.1. To explore the hope status, social support, coping style and the symptom distress in patients receiving maintenance hemodialysis and to understand the relationship between hope level and those factors, making references for clinical practice.2. Based on the clinical knowledge and the understanding of the relationship between hope level and those factors, we established a model on factors affecting hope in patients receiving maintenance hemodialysis to explain mechanisms that which factors have the direct effect on hope and which factors have the indirect effect on hope. Such model could be helpful to give scientific references for taking hope-enhancing measures and improving patients' physical and mental health.Methods:1. This cross-sectional survey was performed from February 2011 to May 2011 in three outpatient dialysis facilities in Guangzhou. By using convenience sampling,patients were investigated with the self-designed questionnaire, Herth hope scale,social support scale, simplified coping scale and dialysis symptom index to explore patients' social demography, hope status, social support, coping style and symptom distress. The hope status of maintenance hemodialysis patients was described and the hope levels in different patients were compared. The social support status and the social support levels in different patients were described. In addition, the difference between patients' social support and the Chinese norm was analyzed. The situation of patients' coping style and the popular coping style in patients were described and the difference between patients' coping style and the Chinese norm was also analyzed.Meanwhile, we also analyzed patients' symptom distress and found out most popular and most severe symptoms in patients. The scores of symptom distress in different patients were compared. Furthermore, correlation analysis was used to analyze the relationship among hope, social support, coping style and symptom distress and multiple stepwise regression analysis was used to analyze the factors affecting hope.2. Based on the clinical knowledge and the understanding of the relationship between hope level and those factors, a theoretical structural equation model on factors affecting hope in patients receiving maintenance hemodialysis was hypothesized. The data from investigation were used to establish the structural equation model on factors affecting hope in maintenance hemodialysis patients. The scores of the positive and negative coping style were independent manifest variables and the social support and symptom distress were dependent latent variables and the score of hope was the dependent manifest variable. The variables from el to e5 were the error variables. The model was tested with maximum likelihood method to evaluate the fit and the model was continuously modified according to the modification indicators.3. The statistical package for the social sciences (SPSS) software 13.0 was used for all data entry and analysis. Cronbach's a and Content validity statistical analyses were employed to evaluate the content validity and reliability of the questionnaire.Descriptive and basic statistical analysis of the data were performed and the Pearson correlation analysis was used to analyze the relationship between hope level and social support, coping style and symptom distress. One way ANOVA was used to compare the hope level, social support, coping style and symptom distress in different patients. One sample T test was used to compare the difference of social support and coping style between maintenance hemodialysis patients and Chinese norm.Multiple linear regression was employed to analyze the factors affecting hope. And Analysis Moment Structures (AMOS) Graphics Version 17.0 software were used to construct structural equation model of hope Level and its affecting factors in maintenance hemodialysis patients.Results1. Of the 206 questionnaires distributed, there were 182 valid surveys, and the return rate was 88.4%. The 182 patients were aged between 20 and 85 years, with the average age of 59.99 ±14.52 years. Males accounted for 48.4%,and females accounted for 51.6%. The educational level: 52.2% of patients were graduated form below primary school or middle school, 29.7% of patients were graduated from high or secondary school, 9.9% of patients were graduated college, 8.2% of patients were graduated from university. 14.3% of patients worked full-time, 59.9% were retired,and 25.8% were unemployed. Monthly income: 22.5% of patients were more than 3000 RMB, 51.1% of patients were between 2000 and 3000 RMB, 14.8% of patients were between 1000 and 2000 RMB, 6.0% of patients were between 500 and 1000 RMB, and 5.5% of patients were less than 500 RMB. Marital status: 4.4% of sample were single, 86.8% married, 8.8% divorced or widowed. Medical payment: 14.3% of patients were at government expense, 8.2% of patients enjoyed medical care insurance, 14.3% of patients were at their own expense, 62.1% of patients were comprehensive arrangement for serious disease and 1.1% of patients reimbursed at the new rural cooperative medical system. The length of time on hemodialysis: 24.2%of patients were less than 24 months, 41.2% of patients were between 24 and 48 months, 19.8% of patients were between 49 and 120 months and 14.8% of patients were more than 120 months. The frequency of hemodialysis: 25.3% of patients were once per week, and frequency at twice per week and three times per week accounted 37.4% respectively. Comorbid condition: 62.1% of patients had diabetes, 79.1% of patients had hypertension and 55.5% of patients had heart disease.2. Hope status in maintenance hemodialysis patients. The average total score of hope in 182 patients is 31.83 ±3.69, with the maximum of 42 and the minimum of 22.Of all the patients, 17 patients(9.34%) had high level of hope, 160 patients(87.91%)had moderate level of hope, and 5 patients(2.75%) had low level of hope. The score of "temporarily and future" was 10.20±1.53, the score of "positive readiness and expectancy" was 11.09±1.62, and the score of "interconnectedness" was 10.56±1.22.There were no significantly difference in the hope score of married patients and single patients (P>0.05). But there were significantly difference in the hope score of patients married and patients divorced and widowed(P<0.05), and the Post Hoc test showed that the score of hope in patients divorced and widowed was significant lower than married patients (P=0.002) and single patients (P=0.009) . There were no significantly difference in the hope score of retired patients and unemployed patients(P>0.05). But there were significantly difference in the hope score of employed patients and unemployed patients and retired patients(P<0.05), and the Post Hoc test showed that the score of hope in employed patients was significant higher than that of unemployed patients (P=0.044) and retired patients (P=0.032) . There were significantly difference in the hope score of patients enjoyed different monthly income(P<0.05) and with the increase of the monthly income, the score of hope significantly improved.3. Social support status in maintenance hemodialysis patients. The total score of social support is 42.24±4.09, with subjective support score of 23.72±2.33, objective support score of 10.82 ±2.26, and support utilization score of 7.70 ±1.36. The total score and score of objective support and support utilization in maintenance hemodialysis patients were significant lower than Chinese norm (P<0.05) . There were no significantly difference in the total social support score of married patients and single patients (P>0.05). But there were significantly difference in the total social support score of patients divorced or widowed and patients married (P<0.05), and the Post Hoc test showed that the total social support score in patients divorced or widowed was significant lower than married patients (P=0.012) and single patients(P=0.046) . There were significantly difference in total social support score of patients enjoyed different monthly income(P<0.05) and with the increase of the monthly income, the score of social support significantly improved.4. Symptom distress status in maintenance hemodialysis patients. The content validity of the symptom distress index in maintenance hemodialysis patients was 0.939, the Cronbach'a coefficient was 0.923 and test-retest is 0.843. The total score of symptom distress was 48.71 ±23.93, with the score of symptom number of 13.44±5.63 and the symptom severity score of 35.27± 18.51. The most popular and severe symptoms in maintenance hemodialysis patients were dry skin and itching. There were significantly difference in the score of symptom number of patients with different marital status, work status, monthly income and frequency of hemodialysis(P<0.05). The Post Hoc test showed that the score of symptom number in patients divorced or widowed was significant higher than that of married patients(P=0.001) and single patients (P=0.005) . The score of symptom number in employed patients was significant lower than that of unemployed patients (P=0.021)and retired patients (P=0.031) . The score of symptom number in patients enjoyed monthly income 500 RMB was significantly higher than that in patients enjoyed monthly income 500?1000 RMB,1000?2000 RMB,2000?3000 RMB and above 3000 RMB (P=0.000) . The score of symptom number in patients experienced once hemodialysis per week was lower than that in patients experienced hemodialysis three times per week (P =0.014).5. Coping style status in maintenance hemodialysis patients. The average score of active coping style was 2.15 ± 0.28, and the average score of passive coping style was 1.56 ±0.33. The most popular coping style in patients were "seeking suggestions from relatives, friends, classmates and colleagues", "releasing trouble by talking to others" and the lest popular coping style in patients were "releasing trouble by smoking,drinking,eating and forgetting". The score of active coping style in maintenance hemodialysis patients was significantly higher than Chinese norm(P=0.000).6. The factors affecting hope level in maintenance hemodialysis patients. The factors affecting hope level in maintenance hemodialysis patients are: monthly income, the score of symptom distress, active coping style and passive coping style,and social support. The structural equation model showed that active coping style had a direct positive effect on hope level (?=0.171, P<0.01) as well as an indirect positive effect on hope level (?=0.552,P<0.01) ,while passive coping style had a direct negative effect on hope level (?=-0.105 , P<0.01) and as well as an indirect negative effect on hope level (?=-0.147, P<0.01) . Symptom distress had a direct negative effect on hope level (?=-0.735, P<0.01) . Social support had an indirect positive effect on hope level (?=0.728, P<0.01).Conclusion:1. Hope level in maintenance hemodialysis patients is moderate. The social support, coping style, symptom distress are factors affecting the hope level.2. Social support has an indirect positive effect on patients' hope level. The social support in maintenance hemodialysis patients are poor because the total score and score of objective support and support utilization in maintenance hemodialysis patients are significantly lower than Chinese norm.3. Active coping style is a protective factor for hope level, which has a direct and indirect positive effect on hope level. Passive coping style is a risk factor to hope level, which has a direct and indirect negative effect on hope level. In stead of passive coping style, patients are prone to take active measures to deal with problems in life.4. Symptom distress is a risk factor for hope level,which can decrease the hope level in maintenance hemodialysis patients. Symptoms in maintenance hemodialysis ·patients are popular. Symptoms such as dry skin and itching give great burden for maintenance hemodialysis patients.5. The direct pathway to hope level in maintenance hemodialysis patients. The active coping style and the passive coping style have the direct positive and direct negative effects on hope level respectively. The pathway are: active coping style?hope level; passive coping style? hope level.6. The indirect pathway to hope level in maintenance hemodialysis patients. In addition to the direct pathway to hope level, active coping style and passive coping style have effects on hope level by social support and symptom distress. The pathway are: active coping style?ocial support?symptom distress?hope level; passive coping style?social support?symptom distress?hope level. |
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