末期腎臟病前期患者之復原力及其相關因素探討

Resilience and Related Factors Among Patients with Pre- End Stage Renal Disease

10.3966/172674042020061901001

汪碧雲(Bi-Yun Wang)；吳宏蘭(Hung-Lan Wu)；張世沛(Shi-Pei Chang)；劉紋妙(Wen-Miao Liu)

末期腎臟病 ； 復原力 ； 因應行為 ； 自我效能 ； end-stage renal disease ； resilience ； coping behavior ； self-efficacy

臺灣腎臟護理學會雜誌

19卷1期（2020 / 06 / 01）

1 - 19

繁體中文

背景：慢性腎臟病是台灣地區重要的健康議題，若疾病控制不佳，將導致患者尿毒症透析治療，但國內顯少針對此族群的復原力及相關因素探討。目的：探討pre-ESRD患者復原力及其相關因素。方法：採橫斷式研究設計，以中區某醫學中心門診pre-ESRD照顧方案患者為對象，採結構式問卷包括人口學特性、因應行為量表、自我效能量表及復原力量表。結果：201位患者平均年齡63.95歲，男性居多。結果顯示整體復原力為中等程度。月收入狀況、腎臟病分期、問題取向因應和自我效能為復原力預測變項，具有58%解釋力。結論／實務應用：月收入狀況、腎臟病分期、問題取向因應和自我效能為pre-ESRD患者復原力重要影響因子。CKD護理人員宜重視pre-ESRD患者復原力及相關因素，建議將復原力理論納入在職教育（如復原力工作坊），提供護理人員學習如何增進患者因應技巧和自我效能的策略，有效促進患者執行居家自我照顧。

Background: Chronic kidney disease is an important health issue in Taiwan. If the disease is not well-controlled, it will lead to dialysis treatment for patients with uremia. However, there is little discussion on the resilience and related factors of this ethnic group in Taiwan. Purpose: To explore the resilience and related factors among patients with pre-ESRD stage renal disease. Methods: This was a cross-sectional correlation study. Target patients were in the pre- ESRD care program at a medical center in the Central District. The research tools consisted of demographic characteristics, Revised Ways of Coping checklist, chronic kidney disease self-efficacy instrument, and the Resilience scale. Result: A total of 201 patients who averaged 63.95 years of age and predominantly male were recruited. The result of the study showed that: (1) The overall patient had moderate resilience. (2) Monthly income status, kidney disease stage, problem-solving behaviors, and self-efficacy were predictive variables for resilience, and accounted for 58% of the total variation in resilience. Conclusion /Implications for Practice: Monthly income status, kidney disease stage, problem-solving behaviors, and self-efficacy were identified as the crucial predictive factors of resilience in pre-ESRD patients. CKD nursing staff should pay attention to the resilience and related factors of pre-ESRD patients. It is recommended that in-service education could incorporate resilience theory (such as resilience workshop) to provide nurses with communication skills in improving coping behaviors and self-efficacy among CKD patients, who then could effectively adapt positive strategies at home.

1. 王惠萍(2017)。長庚科技大學健康照護研究所。
   連結：
2. 何雅芳,楊慕慈,陳金順,胡方翔(2015)。長期血液透析病患血磷控制遵從行為相關因素之研究。臺灣腎臟護理學會雜誌，14(1)，1-18。
   連結：
3. 席美玲,沈永芳,陳意超,韓湘芳,鍾玉珠(2016)。血液透析病人規律運動行為及預測因子之探討。護理雜誌，63(1)，78-86。
   連結：
4. 高琳雅,陳秀蓉(2015)。血液透析患者在不同透析期間下資源流失、復原力與疾病因應間的關連。中華心理衛生學刊，28(2)，221-255。
   連結：
5. 曾文志(2006)。復原力保護因子效果概化之統合分析。諮商輔導學報：高師輔導所刊，14，1-35。
   連結：
6. 簡良霖,吳治勳,吳英璋(2016)。慢性病因應歷程中自我效能感與因應策略的作用與關係：兩種情緒聚焦因應的區辨。中華心理衛生學刊，29(4)，357-389。
   連結：
7. (2011).Resilience in aging.New York:Springer.
8. Bandura, A.(1986).Social foundations of thought and action: A social cognitive theory.Englewood Cliffs, NJ:Prentice-Hall.
9. Cal, S. F.,Sá, L. R. D.,Glustak, M. E.,Santiago, M. B.(2015).Resilience in chronic diseases: A systematic review.Cogent Psychology,2(1),1024928.
10. Connor, K. M.,Davidson, J. R.(2003).Development of a new resilience scale: The Connor Davidson resilience scale (CD RISC).Depression and anxiety,18(2),76-82.
11. De Pasquale, C.,Pistorio, M. L.,Corona, D.,Sinagra, N.,Giaquinta, A.,Zerbo, D.,Veroux, M.(2014).Role of "self-efficacy" in the process of long-term care in kidney transplant recipients.Transplantation proceedings,46(7),2235-2237.
12. Gheshlagh, R. G.,Sayehmiri, K.,Ebadi, A.,Dalvandi, A.,Dalvand, S.,Tabrizi, K. N.(2016).Resilience of patients with chronic physical diseases: A systematic review and meta-analysis.Iranian Red Crescent Medical Journal,18(7)
13. Guo, Y. J.,Tang, Q.,Gu, Y.(2017).Measurements of self-efficacy in patients with chronic kidney disease: a literature review.Nephrology Nursing Journal,44(2),159-176.
14. Ibrahim, N.,Chiew Thong, N. K.,Desa, A.,Razali, R.(2013).Depression and coping in adults undergoing dialysis for end stage renal disease.Asia Pacific Psychiatry,5(S1),35-40.
15. Kohlsdorf, M.(2015).Coping Strategies Adopted by Patients With Chronic Kidney Disease in Preparation for Transplant.Psychology, Community & Health,4(1),27-38.
16. Lazarus, R. S.,Folkman, S.(1984).Stress, appraisal, and coping.New York:Springer Pub. Co..
17. Li, M. H.(2008).Relationships among Stress Coping, Secure Attachment, and the Trait of Resilience among Taiwanese College Students.College Student Journal,42(2)
18. Lin, C. C.,Wu, C. C.,Anderson, R. M.,Chang, C. S.,Chang, S. C.,Hwang, S. J.,Chen, H. C.(2012).The chronic kidney disease self-efficacy (CKD-SE) instrument: development and psychometric evaluation.Nephrology Dialysis Transplantation,27(10),3828-3834.
19. Lindqvist, R.,Carlsson, M.,Sjödén, P. O.(2004).Coping strategies of people with kidney transplants.Journal of Advanced Nursing,45(1),47-52.
20. Ma, L. C.,Chang, H. J.,Liu, Y. M.,Hsieh, H. L.,Lo, L.,Lin, M. Y.,Lu, K. C.(2013).The relationship between health-promoting behaviors and resilience in patients with chronic kidney disease.The Scientific World Journal,2013,124973.
21. Miller, J. F.(1992).Coping with chronic illness: Overcoming powerlessness.Philadelphia, PA:FA Davis Company.
22. Müller, H. H.,Englbrecht, M.,Wiesener, M. S.,Titze, S.,Heller, K.,Groemer, T. W.,Maler, J. M.(2015).Depression, anxiety, resilience and coping pre and post kidney transplantation–Initial findings from the psychiatric impairments in kidney transplantation (PI-KT)-Study.Plos one,10(11),e0140706.
23. Niihata, K.,Fukuma, S.,Akizawa, T.,Fukuhara, S.(2017).Association of coping strategies with mortality and health-related quality of life in hemodialysis patients: The Japan Dialysis Outcomes and Practice Patterns Study.Plos one,12(7),e0180498.
24. Tan-Kristanto, S.,Kiropoulos, L. A.(2015).Resilience, self-efficacy, coping styles and depressive and anxiety symptoms in those newly diagnosed with multiple sclerosis.Psychology, health & medicine,20(6),635-645.
25. Tsay, S. L.,Hung, L. O.(2004).Empowerment of patients with end-stage renal disease: A randomized controlled trial.International Journal of Nursing Studies,41(1),59-65.
26. United States Renal Data System (2016). Morbidity and Mortality in Patients With CKD. Retrieved from https://www.usrds.org/2016/view/v1_03.aspx
27. Vitaliano, P. P.,Russo, J.,Carr, J. E.,Maiuro, R. D.,Becker, J.(1985).The ways of coping checklist: Revision and psychometric properties.Multivariate behavioral research,20(1),3-26.
28. Wagnild, G. M.,Young, H. M.(1993).Development and psychometric evaluation of the Resilience Scale.Journal of nursing measurement,1(2),165-178.
29. Weng, L. C.,Dai, Y. T.,Huang, H. L.,Chiang, Y. J.(2010).Self efficacy, self care behaviours and quality of life of kidney transplant recipients.Journal of advanced nursing,66(4),828-838.
30. White, C.,Gallagher, P.(2010).Effect of patient coping preferences on quality of life following renal transplantation.Journal of advanced nursing,66(11),2550-2559.
31. Wu, Z.,Liu, Y.,Li, X.,Li, X.(2016).Resilience and associated factors among mainland Chinese women newly diagnosed with breast cancer.Plos one,11(12),e0167976.
32. Yi, J. P.,Vitaliano, P. P.,Smith, R. E.,Yi, J. C.,Weinger, K.(2008).The role of resilience on psychological adjustment and physical health in patients with diabetes.British Journal of Health Psychology,13(2),311-325.
33. 王琡俐,童恒新,王曉暹,劉介宇,黃家倫,謝啟誠(2011)。良性前列腺增生症狀困擾，因應行為及生活品質之相關性探究。志為護理，11(2)，58-69。
34. 任怡潔(2006)。臺灣大學心理學研究所。
35. 何森森(2012)。國立陽明大學臨床暨社區護理研究所。
36. 李梅琛,盧國城,吳淑芳,謝湘俐,劉月敏(2016)。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。北市醫學雜誌，13(4)，516-525。
37. 林彥岑,翁麗雀,江仰仁,韓慧美,潘麗慧(2010)。腎臟移植病人的生活品質及影響因素之探討。長庚護理，21(1)，1-11。
38. 財團法人國家衛生研究院(2015).2015 臺灣慢性腎臟病臨床診療指引.台北:財團法人國家衛生研究院.
39. 許淑蓮,黃秀梨,林惠賢(1998)。急性心肌梗塞住院病人的不確定感與因應行為之探討。台灣醫學，2(5)，498-508。
40. 楊淄涵(2015)。美和科技大學健康照護研究所。
41. 劉月敏(2009)。台北，台北護理健康大學長期照顧研究所。
42. 劉月敏,謝湘俐,駱敏淑,馬麗卿,張宏哲(2010)。血液透析患者的復原力與社會支持。臺灣腎臟護理學會雜誌，9(1)，33-43。
43. 劉萱,邱啟潤(2012)。長照機構之老年住民復原力及其相關因素探討。護理暨健康照護研究，8(3)，179-190。
44. 劉麗君,黃美玲,洪麗珍(2008)。血液透析病患因應行為與因應結果之探討。臺灣腎臟護理學會雜誌，7(2)，34-49。
45. 衛生福利部中央健保署（2015）．104 年全民健保統計摘要．取自 http://www.nhi.gov.tw/Content_List.aspx?n=036E78FF20D91CFA&topn=CDA985A80C0DE710&upn=FCD4FED5B24D2441
46. 衛生福利部中央健保署（2017）．全民健康保險末期腎臟病前期（Pre-ESRD）之病人照護與衛教計畫．取自 https://www.nhi.gov.tw/Resource/bulletin/6796_1050016044-2.pdf

1. 陳燁,陳珍緯(2023)。運用復原力於一位末期腎臟疾病病童之照護經驗。臺灣腎臟護理學會雜誌，22(1)，15-27。