血液透析病患靈性安適與生活品質之相關及其相關因素之初探

Exploring the association between spiritual well-being and quality of life and the effect of related factors of spiritual well-being

邱佩歆(Pei-Hsin Chiu)

指導教授 ： 張睿詒

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2021年)

https://doi.org/10.6342/NTU202101898

摘要

研究背景：在台灣，末期腎臟疾病發生率及盛行率極高，大多病患都在全民健保的給付下採取透析治療的方式以延續生命，直至2020年，台灣的透析盛行率高達0.34%，其中約九成病患施以血液透析療程。血液透析病患除了要面對生理上的不適、飲食及日常活動的控制之外，由於需要頻繁進出醫院規律接受透析治療，活動範圍及時間分配的自由都受到限制，生活自主權被大大的削弱，在此同時，還需要隨時面對不確定感以及死亡的威脅。持續改變的身體症狀、心像改變及無法治癒的疾病感受對其身體、日常生活、社會家庭、工作都會造成衝擊，也因此，過去許多研究指出血液透析患者的自評生活品質明顯低於一般健康族群，如何協助病患在此般狀態下提升其生活品質，是過去許多研究探討的方向。過去針對血液透析病患，有許多國內外研究支持不同因素對生活品質有顯著的影響，對臨床醫護人員制定照護計畫有很大的幫助，而近來，國外有越來越多研究探討靈性安適與生活品質之相關，但台灣目前仍缺乏相關研究，提升病患的靈性安適是否可以成為促進生活品質的策略或是方向仍需要本土性研究進一步探討。其次，個人的靈性安適會受到不同因素影響，過去國外曾有研究分別指出病患的感受性社會支持、自我效能以及所受到的靈性照護對靈性安適皆有正面的影響，為了進一步了解影響個人靈性安適的相關因素，本研究將上述變項納入研究模型，進行多元變項的探討。
研究目的：探討靈性安適與生活品質、社會支持、自我效能、靈性照護之相關性；另外，根據文獻回顧建立模型檢驗上述變項間的關係。
研究設計：本研究為橫斷性研究，採問卷調查法，以一對一面訪進行問卷資料蒐集，問卷發放採立意取樣，研究對象為接受血液透析治療達三個月以上之病患，來自嘉義基督教醫院、花蓮慈濟醫院以及天主教聖馬爾定醫院。測量工具包含靈性安適量表（FACIT-Sp-12）、一般癌症治療功能狀態評估量表（FACT-G）、社會支持量表（ISSB）以及透析病患自我效能量表（PKDSMS），共計發放300份有效問卷，並以結構方程模型檢驗研究假說。
研究結果：本研究結果支持血液透析病患靈性安適與生活品質間有正向相關（p＜0.001），靈性照護（p＜0.01）、社會支持（p＜0.001）以及自我效能（p＜0.001）對於靈性安適皆有顯著相關，且可透過靈性安適影響生活品質。社會支持可直接對生活品質造成影響，亦可經由靈性安適或自我效能對生活品質造成間接影響；在考量靈性安適後，自我效能對於生活品質則沒有直接影響。
結論：靈性安適對生活品質有顯著正向相關，而社會支持、自我效能以及靈性照護皆對靈性安適有顯著正向相關。提升血液透析病患之靈性安適可以做為促進其生活品質之策略，而增加個人的感受性社會支持、自我效能，以及提供合適的靈性照護，對提升靈性安適都會有正向影響，是未來制定照護計畫時可以參考的方向。

關鍵字

血液透析 ； 靈性安適 ； 健康相關生活品質 ； 社會支持 ； 自我效能 ； 靈性照護

並列摘要

Background：The incidence and prevalence rate of end-stage renal disease in Taiwan is extremely high. To extend their lives, most patients take dialysis treatment under the payment of National Health Insurance. By 2020, the prevalence rate of dialysis in Taiwan is as high as 0.34%,about 90% of the patient were treated with hemodialysis. Hemodialysis patients have to face many difficulties, including the physical discomfort, diet and daily activity control, due to the need to frequently visit the hospital for regular dialysis treatment, the scope of activities and the freedom of time allocation are restricted. Their life autonomy is greatly weakened, and also need to face uncertainty and the threat of death at any time. Constantly changing physical symptoms, mental images, and the feelings that the disease cannot be cured will have an great impact on their body, daily life, society, family, and work. Therefore, many previous studies have pointed out that the health-related quality of life of hemodialysis patients is significantly lower than the general healthy group. How to help patients improve their quality of life is the direction of many studies in the past.
Many domestic and foreign studies support that different factors have a significant impact on the quality of life of hemodialysis patients, the results of these studies are of great help to clinical doctors and nurses in making care plans. Recently, there are more and more studies abroad that explore the relationship between spiritual well-being and quality of life, but there is still a lack of relevant research in Taiwan. Local research is still needed to further explore whether improving the spiritual well-being of patients can be a strategy to promote the quality of life. In addition, people’s spiritual well-being will be affected by different factors. In the past, foreign studies have pointed out that patients’ perceived social support, self-efficacy, and spiritual care have a positive impact on spiritual well-being. In order to explore the relevant factors that affect spiritual well-being, this study integrates the above factors into the research model to explore the relationship between multiple variables.
Objectives：Explore the relationship between spiritual well-being and quality of life, social support, self-efficacy, and spiritual care; in addition, establish a model based on literature review to test the relationship between the above variables.
Method：This is a cross-sectional study, the questionnaires were collected by a single interviewer by face-to-face interview. The subjects of this study were patients who had received hemodialysis treatment for more than three months at Ditmanson Medical Foundation Chia - Yi Christian Hospital, Buddhist Tzu Chi Medical Foundation Hualien Tzu Chi Hospital and St. Martin De Porres Hospital. The measurement tools include The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale 12 Item Scale (FACIT-Sp-12), Functional Assessment of Cancer Therapy-General (FACT-G), Inventory of Socially Supportive Behaviors (ISSB) and Perceived Kidney/Dialysis Self-management Scale (PKDSMS). A total of 300 valid questionnaires were distributed, structural equation models is used for hypothesis verification.
Results：The results of this study support that there is a positive correlation between spiritual well-being and quality of life in hemodialysis patients (p<0.001). In addition, spiritual care (p<0.01), social support (p<0.001), and self-efficacy (p<0.001) are all significantly related to spiritual well-being, and can affect the quality of life through spiritual well-being. Social support can directly affect the quality of life, or indirectly affect the quality of life through spiritual well-being and self-efficacy. After considering the spiritual well-being, self-efficacy has no direct impact on the quality of life.
Conclusion：Spiritual well-being has a significant positive correlation with quality of life, while social support, self-efficacy, and spiritual care all have a significant positive correlation with spiritual well-being. Improving the spiritual well-being of hemodialysis patients can be considered as a strategy to promote their quality of life, and increasing personal perceived social support, self-efficacy, and providing appropriate spiritual care will have a positive impact on spiritual well-being, it is the basis that can be used as a reference when developing care plans in the future.

並列關鍵字

hemodialysis ； spiritual well-being ； health-related quality of life ； social support ； self-efficacy ； spiritual care

參考文獻

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