Application Of IKAP Theory And Transitional Care Intervention In Self-management Among Young Hemodialysis Patients

ObjectiveTo investigate the current status of the self-management ability and the quality of life in the young hemodialysis patients,and to explore the influence of continuing nursing intervention based on“Information-Knowledge-Attitude-Practice(IKAP)”on self-management behavior,quality of life,biochemical results such as Hb and so on of young hemodialysis patients,so as to provide reference for improving patients'self-management and nursing behavior to improve their quality of life.MethodsThis study was a quasi-experimental study.From June 2018 to December 2018,94 hemodialysis patients aged 18-44 years were selected by convenience sampling from hemodialysis department at a top-level hospital in Changsha city.They were randomly divided into intervention group(47person)and control group(47 person)according to randomized numbers.The same group was arranged in the same ward so as to minimize the contaminative effects.According to the physical and mental characteristics of young hemodialysis patients,IKAP continuing nursing intervention program was formulated by the researcher.The control group was given routine health guidance,based on the conventional hemodialysis health guidance,the intervention group was received 6 months IKAP continuous nursing intervention.The patients in the two groups were assessed with objective physiological indicators such as self-management scale for hemodialysis patients,quality of life scale for renal diseases and laboratory examination before the intervention,3 months after and 6 months after the intervention.SPSS21.0 was used for statistical analysis,the collected data statistical analysis methods includec~2 test,independent sample t test,repeated measurement variance analysis and so on.Results(1)The total score of self-management in the young hemodialysis patients was(48.17±3.07),the score of each dimension were as follows:problem-solving score was(12.02±1.47),self-care score was(15.95±1.43),partnership score was(10.99±2.03),emotional processing score was(9.22±1.26),all of which were in the middle level.The highest score was partnership(2.75±0.51),while the lowest was self-care(2.28±0.20).Before intervention,there were no significant difference between the intervention and the control group in general demographic data,scores of self-management behavior,laboratory biochemical results and scores of quality of life(P>0.05).(2)After 3 months of intervention,the self-management score of the control group(50.59±2.60)was lower than intervention group(57.17±3.11),and the difference was statistically significant(P<0.05).After six months of intervention,intervention group of young hemodialysis patients'self-management score(68.76±2.34)was significantly higher than the control group(55.36±3.34),intervention group's four dimension scores were:problem solving(17.45±2.21),partnerships(16.33±2.12),the protection act(25.66±2.19),emotion management(13.45±1.33).Compared with control group,the difference was statistically significant(P<0.05).The young hemodialysis patients'self-management score of repetitive measure analysis of variance showed,according to the results of time factor(F=219.186,P<0.001),the factor between groups(F=269.650,P<0.001)difference had statistical significance(P<0.001),time effect and intervention effect have interactions between groups(F=124.680,P<0.001).(3)After 3 months of intervention,the score of quality of life in the intervention group(58.91±1.90)was better than that of the control group(47.39±1.70),(P<0.05).Six months after intervention,the total score of quality of life among the young hemodialysis patients was(62.85±1.87)in the intervention group(50.04±1.89),which was superior to that of the control group(P<0.05).The results of repeated measures analysis of variance(Anova)for the total score of quality of life of the two groups of young hemodialysis patients showed that there was an interaction between time effect and intergroup effect(P<0.001),and the difference was statistically significant(P<0.001).(4)After 3 months of intervention,the serum biochemical test results of albumin and hemoglobin in the two groups of young hemodialysis patients showed that the values of potassium,phosphorus,hemoglobin and albumin in the intervention group were better than those in the control group,and the difference was statistically significant(P<0.05).After 6 months of intervention,the values of potassium,phosphorus,calcium,hemoglobin and albumin in the intervention group were better than those in the control group,and the difference was statistically significant(P<0.05).ConclusionsThe self-management level of young hemodialysis patients was at a moderate,in the four dimensions,the highest score was partnership and the lowest was self-care.IKAP continuous nursing intervention can improve the level of young hemodialysis patients'self-management and the quality of life.