末期腎臟病前期患者復原力及其相關因素探討

研究背景:慢性腎臟病(CKD)已成為嚴重危害國人健康新國病，對民眾健康和國家經濟之衝擊不容小覷。由於腎臟病無法治癒，患者若能以正向心態及行為，積極參與醫療計畫，則可延緩腎衰竭及避免面臨透析治療。因此，探討末期腎臟病前期(pre-ESRD)患者的復原力及其相關因素是一重要議題。研究設計:採橫斷式研究設計，共收案201人，研究工具包括人口學特性、因應行為量表、自我效能量表及復原力量表。研究結果:(一)患者之性別、共病症數、運動次數和月收入狀況在因應行為、自我效能及復原力呈現顯著差異﹔(二)整體患者多採用解決問題之行為，具有中等程度的自我效能和復原力。腎功能較佳者其適應性行為和復原力較高；(三)問題取向因應與自我效能和復原力呈正相關，逃避行為與自我效能和復原力呈負相關；(四)自我效能是復原力重要的預測變項，意即增強患者自我效能可提昇其復原力。結論與建議:提升患者解決問題能力可促進其發展復原力，因此護理衛教應納入提昇患者自我效能策略，引導其承擔自我照顧責任。此外，護理人員是CKD患者第一線的照顧者，若能將自我效能訓練納入在職教育課程，引領護理人員重視患者的檢驗數據外，也需重視心理照顧，則能改善慢性腎臟病患者的照顧品質，並擴展護理人員之角色功能。

關鍵字

末期腎臟病前期患者；復原力；因應行為；自我效能

並列摘要

Background: Chronic kidney disease (CKD) has become Taiwan’s new national diseases. It’s not only seriously effect people’s health, but also on public health and the national economy. Since kidney disease cannot be cured, patients are encouraged to face it with positive attitude and participate the medical programs actively to slow down the rate of renal failure and avoid dialysis treatment. Therefore, it is necessary to discuss the resilience and other factors of patients with pre-ESRD . Design: This was a cross-sectional correlation study. Two hundred and one patients were included . The research tools consisted of demographic characteristics, Revised Ways of Coping checklist, The chronic kidney disease self-efficacy instrument, and Resilience scale. Results: We found that: (1) The patient's gender, comorbidity, exercise frequency, and monthly income status were significantly different in coping behavior, self-efficacy and resilience; (2) The overall patient often adopted problem-solving behaviors, with moderate self-efficacy and resilience. Patients with better renal function had higher adaptive behavior and resilience; (3) Problem-focused coping was positively correlated with self-efficacy and resilience, escape behaviors was negatively correlated with self-efficacy and resilience; (4) Self-efficacy was the strongest predictive factor of resilience. Enhancement of the patient's self-efficacy can increase his/her resilience. Conclusion/ recommendations: Improving the patient's problem-solving ability can promote their resilience. Therefore, nursing health education should incorporate strategies that could improve patient's self-efficacy and guide them to take responsibility for self-care. In addition, the nursing staff is the first-line caregiver of CKD patients. If self-efficacy training can be incorporated into the in-service program, instructing nursing staff to pay attention to both the patient's laboratory report and mental care.It would improve the quality of CKD care and expand the role of nurses.