| Maintenance hemodialysis is the most important renal replacement therapy for patients with end-stage renal disease.Long-term and frequent treatment causes the physical symptom,huge economic burden and mental pressure.Therefore,patients are prone to series of psychological disorders,such as anxiety,depression,lacking of self-confidence,pessimism,etc..Current researchs often take anxiety,depression as the breakthrough point to use the traditional clinical psychological intervention to reduce patients' psychological distress,but with ignoring its inherent positive psychological quality,the effect of psychological nursing need to be improved.Positive psychology is a psychological science that studies human power and virtue.Many studies have shown that positive psychological intervention can improve patients' positive emotions and inner strength.However,positive psychological intervention was very few in maintenance hemodialysis patients.Therefore,the application of positive psychological intervention in maintenance hemodialysis patients is of great value to improve the psychological nursing quality.Objectives1.To investigate the current state and influencing factors of self-perceived burden,self-efficacy,positive and negative affect and optimism in maintenance hemodialysis patients,to provide scientific basis for implementation of a targeted psychological intervention.2.To test the effect of positive psychological intervention on self-perceived burden,self-efficacy,positive and negative affect and optimism through a clinical trial,and provide scientific and practical guidance for clinical psychological nursing.Methods1.The level of self-perceived burden,self-efficacy,positive and negative affectand optimism were evaluated by Self-Perceived Burden Scale,General Self-efficacyScale,Positive and Negative Affect Scale and Optimism Scale among maintenance hemodialysis patients from three first-class ternary hospitals.2.Based on the positive psychological intervention,extensive literature,and consultation from experts such as clinical psychology,applied psychology,nursing psychology,we formed a comprehensive positive psychological intervention.3.The psychological intervention for maintenance hemodialysis patients consists of the traditional health education,positive psychological interventions.The statistical analysis was carried out with SPSS 19.0.Chi-square test,Independent Sample t-Test,Paired-Sample t-Test,one-way ANOVA,LSD,Pearson correlation analysis,and ANOVA with repeated measures were used in the process of analyzing.There was a significant difference at the 0.05 level(2-tailed).Results1 The current state and influencing factors of self-perceived burden,self-efficacy,positive and negative affect and optimism in maintenance hemodialysis patients.1.1 The current state of self-perceived burden,self-efficacy,positive and negative affect and optimism in maintenance hemodialysis patients.1.1.1 Positive and negative affect: Among the 402 patients in this study,positive affect score was(21.64±4.79)and the negative affect score was(26.11±4.82).Self-efficacy,marriage state and self-perceived health are the influencing factors of positive affect,optimism and working condition are the influencing factors of negativeaffect.1.1.2 General self-efficacy: Among the 402 patients,138(34.3%)of them in a low level,227(56.5%)of them in a middle level,31(9.2%)of them in a high level.Personal month income,Self-perceived health and optimism are the influencing factors of self efficacy.1.1.3 Self-perceived burden: Among the 402 patients,311(77.4%)of them suffuring self-perceived burden,with mild 194(48.3%),moderate 92(22.9%)and severe 25(6.2%)cases.Age,hemodialysis age,personal month income,health state of caregiver and optimism are the influencing factors of Self-perceived burden.1.1.4 Optimism: The average score of Optimism was(120.66±16.11),with the median score(M=121)as a critical value,there were 204 cases higher than the critical value as high level of optimistic,and 198 cases lower than the critical value as the low level of optimistic.Self-perceived health,Self-perceived economic burden,health state of caregiver,Self-perceived burden and self efficacy are the influencing factors of optimism.1.2 The relationship between self-perceived burden,self-efficacy,positive and negative affect and optimism in maintenance hemodialysis patients.There is a positive correlation between positive affect and general self-efficacy(r=0.479,p<0.01)and optimism(r=0.298,p<0.01).There is a positive correlation between negative affect and self-perceived burden(r=0.184,p<0.01).There is a negative correlation between negative affect and general self-efficacy(r=-0.115,p<0.05),optimism(r=-0.314,p<0.01);Self-perceived burden and general self-efficacy(r=-0.248,p<0.01)and optimism(r=-0.525,p<0.01)were negatively correlated.General self-efficacy was positively correlated with optimism(r=0.442,p<0.01).2 The positive psychological intervention for maintenant hemodialysis patients.2.1 The formation of positive interventionBased on the positive psychological intervention,extensive literature,and consultation from experts such as clinical psychology,applied psychology,nursing psychology,we formed a comprehensive positive psychological intervention.2.2 The positive psychological intervention for maintenant hemodialysis patients2.2.1 The effect of positive psychological intervention on positive and negative affectPositive affect: Before the intervention,the positive affect score of the experimental group was(23.75±4.10),and the control group was(22.48±4.17),there was no significant difference between the two groups(t=1.234,p=0.222).After the intervention,the experimental group scored(27.69±3.63),and the control group scored(23.27±3.45).After 1 month of intervention,the experimental group scored(26.06±3.77),and the control group scored(21.24±3.69),the scores of the two groups were statistically significant(p<0.01).The score difference of the test group before intervention,after intervention,after 1 month intervention was statistically significant(p<0.01).Negative affect: Before the intervention,the negative affect score of the experimental group was(21.19±4.73),and the control group was(22.48±4.17).There was no significantly difference between the two groups(t=1.234,p=0.222).After the intervention,the experimental group scored(16.44±3.77),while the control group scored(21.30±3.97).After 1 month of intervention,the score of the experimental group was(18.03±3.84),while the score of control group was(22.67±4.05).The scores of the two groups were statistically significant(p<0.01).The score difference of the test group before intervention,after intervention,after 1 month intervention was statistically significant(p<0.01).2.2.2 The effect of positive psychological intervention on general self-efficacyBefore the intervention,the general self-efficacy score of the experimental group was(2.12±0.48),and the score of control group was(1.99±0.44),there was no significant difference between the two groups(t=1.410,p=0.164).After the intervention,the experimental group scored(2.50±0.43),and the control group scored(2.14±0.48).After 1 month of intervention,the experimental groupscored(2.33±0.39),and the control group scored(1.85±0.44).The scores of the two groups were statistically significant(p<0.01).The score difference of the test group before intervention,after intervention,after 1 month intervention was statistically significant(p<0.01).2.2.3 The effect of positive psychological intervention on self-perceived burdenBefore the intervention,the self-perceived burden score of the experimental group was(21.69±3.87),and the score of the control group was(21.61±3.18),there was no significant difference between the two groups(t=0.093,p=0.926).After the intervention,the experimental group scored(15.32±3.02),and the control group scored(19.94±4.30).After 1 month of intervention,the experimental group scored(19.28±4.20),and the control group scored(24.15±3.87).The difference between the two groups were statistically significant(p<0.01).The score difference of the test group before intervention,after intervention,after 1 month intervention was statistically significant(p<0.01).2.2.4 The effect of positive psychological intervention on optimismBefore the intervention,the optimism score of the experimental group was(102.50±8.76),and the control group was(103.82±8.58),there was no significant difference between the two groups(t=0.382,p=0.704).After the intervention,the experimental group scored(124.80±9.95),the control group scored(108.73±10.26).After 1 month of intervention,the experimental group scored(111.34±10.27),while the control group scored(104.52±8.36),and the scores of the two groups were statistically significant(p<0.05).The score difference of the test group before intervention,after intervention,after 1 month intervention was statistically significant(p<0.01).Conclusions1.The negative affect score was higher than the positive affect,self-efficacy,marriage state and self-perceived health are the influencing factors of positive affect,optimism and working condition are the influencing factors of negative affect.2.90.8% of patients with a low level self-efficacy,personal month income,Self-perceived health and optimism are the influencing factors of self efficacy.3.77.4% of MHD patients were suffuring self-perceived burden,age,hemodialysis age,personal month income,health state of caregiver and optimism are the influencing factors of Self-perceived burden.4.There were about 49.3% patients with a low level optimistic,Self-perceived health,Self-perceived economic burden,health state of caregiver,Self-perceived burden and self efficacy are the influencing factors of optimism.5.There is a correlation between the self-perceived burden,general self-efficacy,affect and optimism of MHD patients.6.Positive psychological intervention program can effectively improve patients' self-perceived burden,negative affect,self-efficacy,and optimism. |
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