| Objective To study the state of Self-management in maintenance hemodialysis patients, and to explore the application and effects of collaborative care in continuing care of patients with maintenance hemodialysis and the Self-management, quality of life, compliance to fluid intake, physical functioning, so as to provider the reference basis of elevating Self-management behaviors and improve the quality of life.Methods Conveniently, ninety MHD patients were extracted as a sample from hemodialysis treatment center in Changsha city from August 2013 to January 2014. And then the samples were randomly divided into a intervention group and a control group equally(n=45). The control group received the conventional hemodialysis care, while on the basis of the conventional hemodialysis care, the intervention group also received collaborative care and continuing care of 6 months. All patiens in the sample were asked to complete the Self-management Scale, complianceto fluid intake, blood pressure value and biochemical values, Kideney disease quality of life Short Form(SF-36 and KDTA) before the intervention, 3 months after intervention and 6 months after intervention subsequently. The data were analyzed by the following statistical methods such as the Description Analyze, Independent t-test and the Chi-square Test with SPSS18.0.Results 1 The total score of self-management was(45.38±4.21). Four dimensions were respectively partnership, self-care, problem solving skill and emotion management, their scores were respectively(10.13±1.69),(15.80±2.21),(11.47±1.54) and(9.48±2.20), it were located on middle position. 2 Before intervention, the score of self-management, the compliance to fluid intake, the blood pressure value, biochemical value and the score of quality of life SF-36 and KDTA between intervention and control group were not statistically significant(P﹥0.05). 3 After 3 months, the total score of self-managemnet in intervention groups were(58.91±4.41), higher than the control groups(49.02±2.09), there were significance difference(P﹤0.05); After 6 months, the total score of self-managemnet were(68.30±3.69), higher than the control groups(53.91±2.17), there were significance difference(P﹤0.05); Repeated measure ANOVA reaveald significant group maineffect and time effect on the score of the self-management(P﹤0.05). 4 After 3 months intervention, the compliance to fluid intake in intervention groups higher than the control groups, there were significance difference(P ﹤ 0.05); After 6 months intervention, the compliance to fluid intake in intervention groups higher than the control groups, there were significance difference(P﹤0.05). 5 After 3 months intervention, the SCr in intervention group were(512.49±5.80), lower than the control groups(536.96±5.80), there were significance difference(P﹤0.05); the Hb in intervention group were(96.67±1.02), higher than control group(90.76±0.93), there were significance difference(P﹤0.05); After 6 months intervention, the SBP and the SCr in intervention group were(134.23±9.62),(483.01±7.76), lower than control group(164.42±8.34),(528.62±6.01), there were significance difference(P﹤0.05); the Hb in intervention group were(97.19±1.08), higher than control group(91.45±0.97), there were significance difference(P﹤0.05); Repeated measure ANOVA reaveald significant group main effect and time effect on the blood pressure value and biochemical value(P﹤0.05). 6 After 3 months intervention, the score of SF-36, KDTA in intervention groups were(58.63±9.13),(64.86±7.64), higher than the control groups(51.79±8.75),(59.76±7.93), there were significance difference(P﹤0.05); After 6 months intervention, the score of SF-36,KDTA in intervention groups were(58.86±7.98),(66.04±9.75), higher than the control groups(50.97±11.34),(60.78±7.61), there were significance difference(P﹤0.05); Repeated measure ANOVA reaveald significant group main effect and time effect on the score of the quality of life(P﹤0.05).Conclusions The self-management behaviors of patients with maintenance hemodialysis were lower. The nursing intervention which based on the collaborative care and continuing care can promoted the self-management behaviors, strengthened the compliance to fluid intake, increased the physical functioning and improved the quality of life of patients with maintenance hemodialysis. |
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