Effect Of Self-management Education Interventions On Elderly Patients Treated With Hemodialysis

Hemodialysis is a treatment for patients with renal failure to maintain life, the patients need to continue homodialysis all their life. As dialysis sustained, the physiology condition of patients declined, pruritus, osteoporosis, anemia and other complications of dialysis gradually increased. Patients treated with hemodialysis not only a serious decline in individual quality of life but also impose a heavy economic burden on their families and society, suffer torture from both physical and mental. They often lose confidence of themselves. If they aren’t unefficient and prompt dialysis their condition will more serious and formed a vicious spiral. The conditions in the elderly patients were more salient. The concept of self-management was proposed by professor Creer from Ohio University in United States in the nineteen seventies. It means that under the guidance of health care staff, patients take the ability to solve the physical and psychological problems caused by disease rely on their own, so as to improve their skills of handling unexpected. Self management education can improve the compliance of patients than traditional health education. At present, several researches used self-management intervention on the emotion and behavior for patients with chronic disease both at honme and abroad, and achieved good results. The elderly patients treated with hemodialysis had low self-care ability, low therapy and self-management ability. Our research aimed at improve the quality of life, evaluate predictors of dialysis elderly patients, and reduce the emergency to hospital and medical expenses among elderly patients by use self-management education intervention, which not only can improve their survival skills, but also can provide references on intervention to patients in dialysis centers.Objective:(1) In order to explore the condition of self-management ability of elderly patients treated with hemodialysis in Xi’an city,we investigated the self-management ability of these patients, and then analyzed it’s predictors.(2) To estimate the self-management education interventions for elderly patients treated with hemodialysis.Methods:(1) By clustering sampling, a total of200elderly patients were taken from dialysis centers of5hospitals in Xi’an city, such as Xi Jing hospital, Tang Du hospital. All the elderly patients were investigated by the Scale of Psychological State(SPS), Self-Rating Anxiety Scale (SAS),and the Scale of Self-management Behavior(SSB),at last we surved200patients. We established the database by Epidata3.1. And the SPSS17.0software package was used for data analysis. Descriptive analysis,l-test, Chi-square test, Analysis of Variance were used to describe self-management ability. Multivariate Stepwise Regression(MSR) was used to analyze the effectors of self-management on elderly patients treated with hemodialysis.(2)The older patients treated with hemodialysis in Xi Jing Hospital were recruited for intervention. The patients were divided into interventional group and control group,32patients recieved intervention, and31patients were in the control group. The interventional group received self-management education and routine nursing.Self-management education were like this:each patient were gaven one class(about30minutes) every week in continuous7weeks. The contents were refered to what the patients have not known, and were given suggestions suited. Patients in the control group were only given routine nursing, questionnaires were again. To evaluate the effects of self-management education for improving self-management ability the questionnaires were investigated again.Results:(1) The ability of self-management of elderly patients treated with hemodialysisThe scores of self-management in the200old patients were low. The total of positive emotion scores were140, patients’scores range from43to138, the average scores were100.10±21.25, patients who got higher scores than the average were110(55%),; The total of negative emotion scores were80, patients’scores range from20to51, the average scores were30.26±6.56, patients who got lower scores than the average were117(58.5%); The total exercise scores were30, patients’scores range from0to26, the average scores were6.31±4.49, patients who got higher scores than the average were78(39%); The total of cognitive symptom management scores were30, patients’scores range from0to20, the average scores were9.71±4.87, patients who got higher scores than the average were96(48%); The total scores of communication with doctors were15, patients’scores range from0tol4, the average scores were6.95±3.37, patients who got higher scores than the average were87(43.5%). The ratio of self-management ability to total scores range from21.0%to71.5%. Their ability of management from high to low were:emotion management, the ability of communication with doctors, cognitive symptom management, exercise management. Their emotion management ability was average, and their ability of communication with doctors, cognitive symptom management, exercise management was poor.(2) The predictors of self-management ability of elderly patients with hemodialysisThe results of multiple stepwise regression analysis indicated that the influencing factors of patients’positive emotions were:economic pressure, hobbies, satisfaction of living conditions for children, sleeping time, paths of learning; the influencing factors of patients’negative emotions were:sleeping time, education degree, interests, other chronic diseases, economic pressure; the impact factors for cognitive symptom management ability were:satisfaction for living conditions of children, ways of learning; influencing factors of communication between patients and doctors were as follows:ways of learning, satisfaction for living conditions of children.(3) Effect of self-management intervention for self-management ability on old patientsAfter the patients of interventional group received self-management education intervention for7weeks, their self-management ability had improved. Positive emotion scores, cognitive symptom management scores, scores of communication with doctors had improved, negative emotion scores had decreased, the difference have significant (P<0.01). Exercise scores were also increased, however, the differences have no statistically significant(P>0.05).26of them proved effective,the rate was81.3%.Conclusions:(1) The ability of self-management of old patients with hemodialysis need to improve, especially their management for exercise.(2) The major factors affecting self-management ability on old patients with hemodialysis were:economic pressure, learning ways and number of other chronic diseases.(3) Self-management education can effectively improve the old patients’ability of self-management. The patients of the interventional group have more efficient measures on emotion management, exercise, cognition sympotom and communication with doctors.(4) We consider that individual intervention were suitable for elderly patients with dialysis.