| OBJECTIVE To survey the family nursing's status quo of patients who received MHD ( maintenance hemodialysis ) ,problems caregivers meet, the mental state and quality of life of caregivers and their affect factors.METHODS To select 60 caregivers of patients who received MHD in Qianfoshan Hospital of Shandong Province and Qilu Hospital of Shandong University during March to May,2005.All caregivers' ages were over 18 years old and took care of MHD patients for over 3 months,with the exception of cancer ,severe disability, operations during the past 3 months, mental disorders and severe ears dysfunction. Also selected 60 normal people as control group .Using the scale of self-made "Questionnaire for the status quo of family nursing of MHD patients "to collect the basic information of patients,caregivers,charging family nursing programs ,opinions about family nursing service and future nursing plan. To evaluate the quality of life we used GQOLI-74,SAS and SDS to assess the mental status of caregivers and quality of their lives.The original data were put into the computer and the statisticaltool was SPSS10.0 and t-test ,X~2 test and multivariate stepwise regression analysis were used.RESULTS 1. The status quo of family nursing of MHD patients: Most of the caregivers were women with an average age of 49.67,usually poorly educated. About 50% of them had another job. Their monthly income were below average. The portions of patients-paid medical fee were 100% for 20 patients,80%~90% for 5 patients, 21%~79% for 20 patients and 10%~20% for 15 patients. Most of them hadlittle time to relax. 65% of the caregivers were the spouses of patients and 75% had uncomfortable symptoms and only 28.3% of them considered themselves in good condition.The support for them were mainly from their family members.90% of them felt tired about taking patients to receive MHD 2 or 3 times a week. Till now only 38.3% of the families had used charging family nursing programs.Only 26.1% were satisfied with current family nursing service.The reasons for not using charging nursing service included inconvenience Jack of safety and prices. The majority of the caregivers had resistance to family nursing workers and would get affected by the opinions of their relatives and neighbours.30% of them would continue family care while taking advantage of family nursing,26.7% of them hoped that patients would have special MHD wards but 43.3% wanted to maintain the status quo.2. Results of the assessment of quality of life of caregivers. Scores of SAS were significantly higher than that of the control group(.P<0.05). No Statistical difference existed between male and female caregivers (/>>0.05). The SDS scores of the caregivers also increased. Of the 60 caregivers 25 were free of depression, 12 suffered slight to medium depression and 23 with severe depression. No statistical difference existed between male and female caregivers. Results of GQOLI-74 indicated that the intervention group and the control group showed difference in total score, substantial wealth, physical function, psychological function and social function (PO.05) .Among the 20 single factors, all but housing, community service, living circumstance, self-respect and social support showed statistical difference.The dependent variables included the total score, substantial wealth, physical function, psychological function and social function.The independent variables included the ages, gender, education, employment, monthly income, social support, etc and the multivariate stepwise regression analysis was done. The results showed that the main 10 factors that affected the quality of caregivers' lives were degree of satisfaction to his own family responsibilities, communication with other family members, housework, relationships with around people, social support, respect frompeople around, the portion of patient-paid medical fee, with or without charging service, heath status of themselves and relationships with patients. CONCLUSIONS l.Many problems existed in the family nursing for MHD patients which included overload of caregiver and their health problems. The use ratio and satisfying ratio of existing family nursing service was low because of lower income ,distrust of family nursing workers and resistance to them.2. Caregivers have a certain degree of anxiety and depression and their quality of life were not as good as that of the control group. Multivariate stepwise regression analysis showed that the main 10 factors that affected the quality of caregivers' lives were degree of satisfaction to his own family responsibilities, communication with other family members, housework, relationships with around people, social support, respect from people around, the portion of patient-paid medical fee, with or without charging service, heath status of themselves and relationships with patients.
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