| Objective To analysis the psychological health status and the related factors of the negative psychological of diabetic nephropathy?DN?patients with maintenance hemodialysis?MHD?.The intervention effect,which was of the therapeutic communication system based on mobile nursing of DN patients with hemodialysis?HD?,were discused.Method Firstly,from July 2018 to August 2018,the general data questionnaire,the Self-Rating Axiety Scale?SAS?,the Self-Rating Depression Scale?SDS?and the Positive and Negative Affect Scale?PANAS?were were used to investigate in 310patients with diabetic nephropathy who underwent maintenance hemodialysis in 11Grade 3A general hospitals in 9 cities of Fujian Province.296 valid questionnaires were collected,and the effective recovery rate was 95.48%.Secondly,according to the inclusion and exclusion criteria,127 diabetic nephropathy patients receiving maintenance hemodialysis in 4 health education bases for blood purification in Fujian Province from October 2018 to September 2019 were selected as study subjects,and they were divided into the intervention group of 63 cases and the control group of 64cases by random number table method.The control group used routine nursing of hemodialysis,and the intervention group implemented therapeutic communication system based on mobile nursing on the basis of routine nursing,including to establish the interdisciplinary therapeutic communication team,build mobile platform,develop individualized nursing plan,implement therapeutic communication system and recycle effect evaluation in intervention.Before and after the intervention 6 months and 12months,with the Self-Rating Axiety Scale?SAS?,the Self-Rating Depression Scale?SDS?,the Positive and Negative Affect Scale?PANAS?,the Kidney Diseases Quality Of Life Questionnaire(KDQOL-36TM)and related clinical inspection indexes were evaluated for two groups patients.Results Firstly,92.91%of patients with diabetic nephropathy were willing to communicate.There were high incidence of anxiety?71.96%?and depression?76.35%?,moderate anxiety?36.49%?and mild depression?38.18%?were the most common.The scores of anxiety?53.79±11.28?,depression?55.90±10.06?and negative affect?28.38±6.65?were statistically significant compared with the routine maintenance hemodialysis group?t=16.947,P<0.001;t=20.019,P<0.001;t=21.251,P<0.001?.The scores of positive affect?24.66±5.15?was not significantly different from that of the conventional maintenance hemodialysis group?t=-1.574,P=0.117?.The multiple linear regression analysis showed that the gender??=0.142,P<0.001?,marital status??=0.113,P=0.007?,work status??=0.241,P<0.001?,average monthly incomes??=-2.288,P=0.023?,primary caregivers??=0.324,P<0.001?and religious belief??=0.287,P<0.001?had statistically significant effect on the negative affect of patients.Secondly,there were comparable on baseline levels of the two groups?P>0.05?.After 6months of intervention,the scores of anxiety,depression and positive emotions in the intervention group were significantly different from the control group?P<0.05?,while the scores of negative affect were not significantly different from the control group?P>0.05?;after 12 months of intervention,there were statistically significant differences on the scores of various indicators of psychological health status between the intervention group and the control group?P<0.05?.The comparison of scores of repeated measures of psychological status indicators showed that both the time effect and the grouping effect were statistically significant?P<0.05?;the interactions of anxiety,depression and negative affect were statistically significant?P<0.05?,the interaction of positive affect was not statistically significant?P>0.05?.After 6 months of intervention,the scores of physical activity and psychological status of nephropathy in the intervention group were significantly different from those in the control group?P<0.05?;after 12 months of intervention,the total score of quality of life and scores of all dimensions were significantly different from the control group?P<0.05?.After 6 months of intervention,the hemoglobin A1c,hemoglobin and serum phosphorus level in the intervention group was significantly different from that in the control group?P<0.05?;after 12 months of intervention,there were statistically significant differences in the clinical indicators between the intervention group and the control group?P<0.05?.Conclusion The diabetic nephropathy patients with maintenance hemodialysis had a strong willingness to communicate.There were high incidence of anxiety and depression,and high score of the negative affect,which was related to a host of influencing factors.The therapeutic communication system based on mobile nursing breaked through the limitation of traditional communication methods,significantly alleviated the negative psychology of diabetic nephropathy patients with maintenance hemodialysis,and improves their clinical index level and quality of life. |
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