| Objective Understanding the reasons and influence factors of quality of life and exploring the intervention of transitional care on Maintenance hemodialysis patient.Methods Firstly, a qualitative research method was used to interview the 14 MHD patients about the attitude and experience of outpatient hemodialysis and then refined the themes. Secondly,92 MHD patients who met the inclusion criteria were recruited to the experimental study, and were completely random divided into two groups. The control group was 47 cases, and the intervention group was 45 cases. The control group received the MHD routine clinical care, and the intervention group received transitional care based on the routine clinical care. Serum phosphorus, calcium, calcium phosphorus product, and parathyroid hormone were collected at baseline,3 and 6 months after the intervention. The two groups were both investigated by KDQOL-36TM, MHLC scale, the self-management behavior questionaire of hemodialysis patients, nursing satisfaction questionnaire before the intervention,3 and 6 months after the intervention. The qualitative research datas were analyzed by Colaizzi method and then refined the themes. The quantitative datas were analysed with descriptive statistics. The repeated measurement of variance analysis was used to compare the self-management behavior questionaire of hemodialysis patients before and after intervention. The compare of the clinical index, function index, satisfaction index between the two group after intervention, if it accord with normal distribution was used two independent t test, otherwise used Mann-Whitney U test; and before and after intervention, if it accord with normal distribution was used paired design t test, otherwise used Wilcoxon test.Results The attitude to outpatient HD treatment among Chinese MHD patients could be extracted 2 themes:recognition, feeling helpless. The feel and experience of outpatient HD during treatment could be classified into 5 themes including feeling fear and depression, constriction, lack of effective communication between patients and low identity, easy to give up to change lifestyle habits, expect more HD models to choose. In the experimental study, there was no significant difference (P>0.05) between the two groups on general population, clinical index, function index, satisfaction index Before and after the intervention, self management behavior showed rise trend in both the intervention group and the control group. The time effect, group effect and interaction effect all had statistical significance in self management behavior, with the scores in the intervention group were significantly higher than those in the control group(P<0.05).6 months after intervention, all dimensions of the quality of life, the total of self management behavior and health locus of control in the intervention group were all higher than those in the control group, the difference were statistically significant (P< 0.05). As well as the level of serum phosphorus (PO4), Ca x PO4 products, parathormone (PTH) in the interventional group were significantly lower than that in the control group(P<0.05) after 6-month intervention, but no significant differences were found serum levels of calcium(Ca), (P>0.05). For the experimental group:the serum phosphorus, Ca × PO4 products and PTH at 3 and 6 months post-intervention were lower, and there was significant difference between pre and post-intervention(P< 0.05); in the 3 and 6 month after intervention, there was no statistical significance pre and post-intervention (P>0.05); the point of the serum phosphorus, Ca × PO4 products and PTH in the control group patients had no statistically significant pre and post-intervention (P>0.05).Conclusions MHD patients attitude and experience is multi-dimensional. Medical personnel should have a full assessment of the cognition and needs, made targeted comprehensive health care model. Transitional care achieves good effectiveness on the clinical index, function index, satisfaction index and than improve the quality of life in patients with MHD. However, the effects of this transitional care on serum levels of calcium and the long-term effect are needed to be assessed in future study. |
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