團體衛教合併行為改變策略對血液透析病患知識、體重、血壓及身心狀況之成效

本研究目的在探討團體衛教合併行為改變策略對血液透析病患知識、體重、血壓及身心狀況之成效。採類實驗研究設計，以立意取樣方式，收案南部某醫學中心和區域醫院之血液透析病患共55位，包括實驗組24位，控制組31位。實驗組於透析日之透析前1小時，或透析後1小時，進行每週1次，每次約30 — 40分鐘，為期四週之團體衛教，期間再以自我監控、建立新目標、刺激控制及行為增強之方法，使病患感受自我的進步與改變，最後達成行為改變的目標。於團體衛教合併行為改變策略之介入措施前、執行介入措施四週後，以及不執行介入措施第五週至第八週後，分別評估實驗組與控制組病患之知識、二次透析間體重增加之乾重比、血壓，以及身心狀況之差異。所得資料以SPSS10.0版統計軟體進行卡方檢定、獨立樣本t檢定、配對t檢定，以及重複量數雙因子變異數分析(repeated measures two — way ANOVA)來進行統計與分析。研究結果顯示，團體衛教合併行為改變策略能增進血液透析病患之知識，降低血液透析病患二次透析間體重增加之乾重比，降低血液透析病患透析前之平均動脈壓，於執行介入措施一個月後進行後測，與二個月後進行後後測，亦能維持相同水平，因此具延宕效果(p＜ .05)。控制組在知識、二次透析間體重增加之乾重比，以及透析前平均動脈壓之前、後測與後後測上，並未呈現顯著差異。此外，實驗組與控制組在身心狀況與透析中第1、2、3、4小時平均動脈壓之前、後測及後後測上，均呈現顯著差異(p＜ .05)。本研究結果可提供腎臟衛教課程設計之參考，藉此推廣與應用，以增加護理之專業能力。在臨床照顧方面，可將團體衛教合併行為改變策略整合入病患照護活動中，協助病患建立自主與自信，促使其回歸社會，以提升血液透析病患之生活品質。

關鍵字

血液透析；團體衛教；行為改變策略

並列摘要

The purposes of the study is to evaluate the effect of combined group education and behavioral modification strategies on the control of knowledge, interdialytic weight gain, blood pressure and symptom experiences in hemodialysis patients. Materials included 55 purposively selected Chinese hemodialysis patients from two hospital, in southern Taiwan. This study was based on a quasi-experimental design. The design consisted of a 4-week baseline phase, a 4-week intervention phase, and another 4-week follow-up phase. Patients were assigned into the experimental group and control group, 24 and 31 patients respectively in each group. All participants received three hemodialysis treatments per week for the duration of study. Interventions included group education, self-monitoring, goal setting, stimulus control, positive reinforcement and weekly feedback about interdialytic weight gain (IDWG). The group education program focused on the utilization of salt-limited diet and fluid limitation to control their IDWG and blood pressure. Only the experimental group was taught to use the self-evaluating sheet to record their IDWG, blood pressure and symptom experiences three times per week. The experimental group received group education once a week , 30 — 40 minutes, at one hour before or after dialysis therapy. The control group received routine care. Before starting any program and also after 4 and 8 weeks, each subject was requested to complete the knowledge scales and symptom experiences questionnaires. IDWG and blood pressure were calculated for each participant during all phases. The data were analyzed by using chi-square, t-test, paired t-test and repeated measures two-way ANOVA. There were statistically significant differences of knowledge, IDWG, predialysis mean arterial pressure and symptom experiences between the baseline and intervention phases, and also between the baseline and follow-up phases. While this program was effective in improving patient’s knowledge, reducing IDWG rate, predialysis mean arterial pressure and symptom experiences, no significant differences were found for the intradialytic and postdialysis mean arterial pressure. The findings may serve as references in the courses of nephrology teaching program. The combined group education and behavioral modification strategies for hemodialysis patients could be coordinated into the clinical practice in order to enhance the quality of care.