自我管理方案對於血液透析病人自我效能提昇與改善憂鬱之成效

Effectiveness of Self-Management Program on Improving Self-Efficacy and Depression in Patients with Hemodialysis

李梅琛(Mei-Chen Lee) ； 盧國城(Kuo-Cheng Lu) ； 吳淑芳(Shu-Fang Vivienne Wu) ； 謝湘俐(Hsiang-Li Hsieh) ； 劉月敏(Yueh-Min Liu)

《北市醫學雜誌》 13卷4期 (2016/12) Pp. 516-525

https://doi.org/10.6200/TCMJ.2016.13.4.05

摘要

目的：評價血液透析患者運用「自我管理方案」介入後自我效能提昇與憂鬱狀況改善之成效。方法：採前、後測控制組設計(pretest-posttest control group design)，於北部某區域教學醫院血液透析中心收案，採單盲設計隨機分組，實驗組（自我管理方案）30位及對照組（常規方案）30位介入前進行前測，自我管理方案介入共四週，再於六個月後做進行後測，得有效個案實驗組28人、對照組26人；問卷包括慢性腎臟病自我效能量表及貝克憂鬱量表。結果：自我管理方案介入後患者可提昇自我效能(z=-5.13, p＜.001)，及可改善憂鬱狀況(z=-2.21, p=.027)。結論：結果證實以自我管理方案介入血液透析患者可有效提升其自我效能、改善憂鬱狀況，能進一步提升其疾病自我管理的自信心，故應推廣自我管理方案在臨床實務情境，以供臨床照護人員除常規衛教方式外另一選擇。

關鍵字

自我管理方案 ； 血液透析 ； 自我效能 ； 憂鬱

並列摘要

Objective: This study assessed the effectiveness of intervention of self-management program on improving self-efficacy and depression in patients with hemodialysis. Methods: This study used pretest-posttest control group design to enroll 60 subjects at the hemodialysis center of regional teaching hospitals in northern Taiwan. The Chronic Kidney Disease Self-efficacy Instrument and Beck Depression Inventory were used to assess the subjects at the baseline, and demographic data was collected. Single-blinded randomization was used to divide the subjects into the experimental group (30 subjects; self-management program) and control group (30 subjects; routine program) after the pretest. The experimental group received the intervention of self-management program for 4 weeks. A posttest was conducted after 6 months in 28 subjects of the experimental group and 26 subjects of the control group. Results: The intervention program improved patients' self-efficacy (z = -5.13, p＜ .001) and reduced depression (z = -2.21, p = .027) significantly. Conclusion: The self-management program can improve patients' self-efficacy and reduce the level of depression in hemodialysis patients. It can further enhance their self-confidence in self-management of the disease. The self-management program may be promoted as a routine program in addition to the empirically based routine program.

並列關鍵字

self-management program ； hemodialysis ； self-efficacy ； depression