预立医疗照护计划在血液透析患者中的应用研究

doi:10.3761/j.issn.0254-1769.2022.06.001

摘要/Abstract

摘要：

目的探讨预立医疗照护计划在血液透析患者中的应用效果。方法采用便利抽样法,选取2020年10月—2021年6月在郑州市某三级甲等医院就诊的80例血液透析患者作为研究对象,使用随机数字表法分为试验组和对照组各40例。试验组实施4周预立医疗照护计划干预,对照组实施常规护理。干预前后分别采用死亡态度描绘量表、生命意义感量表中文版和患者尊严量表比较两组死亡态度、生命意义感和尊严感差异。结果干预前两组死亡态度描绘量表、生命意义感量表中文版和患者尊严量表得分差异无统计学意义（P>0.05）;干预后试验组患者死亡态度转为正向态度,生命意义感量表中文版得分高于对照组,患者尊严量表得分低于对照组,差异具有统计学意义（P<0.05）。结论实施预立医疗照护计划干预能够帮助血液透析患者转变为正向死亡态度,增加生命意义感,维护患者尊严。

关键词: 预立医疗照护计划, 慢性肾脏病, 血液透析, 死亡态度, 生命意义感, 干预性研究, 护理

Abstract:

Objective To explore the application effect of advance care planning in hemodialysis patients.Methods A total of 80 hemodialysis patients who were treated in a tertiary hospital in Zhengzhou from October 2020 to June 2021 were selected as the research subjects. According to the random number table method,they were divided into a control group and an intervention group with 40 cases each. The intervention group was implemented with a 4-week advance care planning,and the control group received the routine care. The death attitude profile-revised scale,the Chinese version of the meaning in life questionnaire and the patient dignity inventory scale were used to compare the differences in death attitude,meaning of life and dignity between the 2 groups of patients.Results After the intervention,the patients in the intervention group changed their attitude toward death;the score of meaning of life was higher than that of the control group;the score of dignity was lower than that of the control group;the differences were statistically significant（P<0.05）.Conclusion Advance care planning can help hemodialysis patients change into a positive attitude toward death,increase the sense of meaning in life,and maintain the dignity of patients.

Key words: Advance Care Planning, Chronic Kidney Disease, Hemodialysis, Attitude to Death, Meaning in Life, Intervention Studies, Nursing Care

李豪, 景孟娟, 徐榆林, 李秀梅, 曲瑞杰, 武园园, 郭金铭, 郑燕. 预立医疗照护计划在血液透析患者中的应用研究[J]. 中华护理杂志, 2022, 57(6): 645-650.

LI Hao, JING Mengjuan, XU Yulin, LI Xiumei, QU Ruijie, WU Yuanyuan, GUO Jinming, ZHENG Yan. The application effect of advance care planning in hemodialysis patients[J]. Chinese Journal of Nursing, 2022, 57(6): 645-650.

图/表 4

表1 两组一般资料比较[例（百分比,%）]

Table 1 Comparison of general data between the two groups[case（percentage,%）]

表2 两组干预前后死亡态度描绘量表得分比较（分,$\bar{x}$±s）

Table 2 Comparison of Death Attitude Profile-Revised Scale scores between the two groups（score,$\bar{x}$±s）

表3 两组干预前后生命意义感量表中文版得分比较（分,$\bar{x}$±s）

Table 3 Comparison of Chinese version of the Meaning in Life Questionnaire Scale scores between the two groups（score,$\bar{x}$±s）

表4 两组干预前后尊严量表得分比较（分,$\bar{x}$±s）

Table 4 Comparison of Patient Dignity Inventory Scale scores between the two groups（score,$\bar{x}$±s）

参考文献 20

[1]	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China:a cross-sectional survey[J]. Lancet, 2012, 379(9818):815-822. DOI URL
[2]	Niang A, Iyengar A, Luyckx VA. Hemodialysis versus peritoneal dialysis in resource-limited settings[J]. Curr Opin Nephrol Hypertens, 2018, 27(6):463-471. DOI URL
[3]	李菊, 李建兰, 高爱民. 中国终末期肾病患者行维持性血液透析的流行病学现况[J]. 实用临床医药杂志, 2018, 22(21):160-162.
	Li J, Li JL, Gao AM. Epidemiology of maintenance hemodialysis in patients with end stage renal disease in China[J]. J Clin Med Pract, 2018, 22(21):160-162.
[4]	Wachterman MW, Lipsitz SR, Lorenz KA, et al. End-of-life experience of older adults dying of end-stage renal disease:a comparison with cancer[J]. J Pain Symptom Mana, 2017, 54(6):789-797.
[5]	王心茹, 绳宇. 生前预嘱、预立医疗指示和预立医疗照护计划的概念关系辨析[J]. 医学与哲学, 2020, 41(24):1-4,14.
	Wang XR, Sheng Y. Analysis of conceptual relationships among living will,advance directives and advance care planning[J]. Med Philos, 2020, 41(24):1-4,14.
[6]	Moss AH, Ganjoo J, Sharma S, et al. Utility of the “surprise” question to identify dialysis patients with high mortality[J]. Clin J Am Soc Nephrol, 2008, 3(5):1379-1384. DOI URL
[7]	Haydar SA, Almeder L, Michalakes L, et al. Using the surprise question to identify those with unmet palliative care needs in emergency and inpatient settings:what do clinicians think?[J]. J Palliat Med, 2017, 20(7):729-735. DOI PMID
[8]	Coalition for supportive care of kideney patients. Planning today for tomorrow’s healthcare:a guide for people with chronic kidney disease[EB/OL]. (2017-03-20)[2019-10-06]. https://www.kidneysupportivecare.org.
[9]	罗点点. 我的五个愿望[EB/OL]. (2009-05-20)[2019-10-02]. http://www.lwpa.org.cn/Index.shtml.
	Luo DD. My five wishes[EB/OL]. (2009-05-20)[2019-10-02]. http://www.lwpa.org.cn/Index.shtml.
[10]	Wong PTP, Reker GT, Gesser G. The death attitude profile-revise:a multidimensional measure of attitude toward death[M]//Death anxiety handbook:research,instrumentation and application. Washington DC:Taylor and Francis, 1994:121-148.
[11]	唐鲁, 张玲, 李玉香, 等. 中文版死亡态度描绘量表用于护士群体的信效度分析[J]. 护理学杂志, 2014, 29(14):64-66.
	Tang L, Zhang L, Li YX, et al. Validation and reliability of a Chinese version of Death Attitude Profile-Revised(DAP-R) for nurses[J]. J Nurs Sci, 2014, 29(14):64-66.
[12]	Steger MF, Frazier P, Oishi S, et al. The meaning in life questionnaire:assessing the presence of and search for meaning in life[J]. J Couns Psychol, 2006, 53(1):80-93. DOI URL
[13]	刘思斯, 甘怡群. 生命意义感量表中文版在大学生群体中的信效度[J]. 中国心理卫生杂志, 2010, 24(6):478-482.
	Liu SS, Gan YQ. Reliability and validity of the Chinese version of the Meaning in Life Questionnaire[J]. Chin Ment Heal J, 2010, 24(6):478-482.
[14]	Chochinov HM, Hassard T, McClement S, et al. The patient dignity inventory:a novel way of measuring dignity-related distress in palliative care[J]. J Pain Symptom Manag, 2008, 36(6):559-571. DOI PMID
[15]	葛国靖, 曹艳梅, 刘捷, 等. 中文版患者尊严量表初步修订及信、效度评价[J]. 中国公共卫生, 2016, 32(8):1088-1091.
	Ge GJ, Cao YM, Liu J, et al. Preliminary revision of Chinese version PDI and its reliability and validity test[J]. Chin J Public Heal, 2016, 32(8):1088-1091.
[16]	原小岚, 刘春兰. 慢性心力衰竭患者预立医疗照护计划准备度水平及其影响因素分析[J]. 中国护理管理, 2020, 20(7):990-995.
	Yuan XL, Liu CL. The readiness for advance care planning and its influencing factors among patients with Chronic Heart Failure[J]. Chin Nurs Manag, 2020, 20(7):990-995.
[17]	邓志坚, 陈相应, 杨柳, 等. 癌症患者及家属参与预立医疗照护计划体验质性研究的Meta整合[J]. 中华护理杂志, 2020, 55(12):1864-1870.
	Deng ZJ, Chen XY, Yang L, et al. The experience of cancer patients and their relatives in advance care planning:a meta-synjournal of qualitative research[J]. Chin J Nurs, 2020, 55(12):1864-1870.
[18]	夏浩志, 岳红, 史宝欣. 乳腺癌患者生命意义的概念构建及对护理工作的意义[J]. 中华护理杂志, 2015, 50(8):1004-1009.
	Xia HZ, Yue H, Shi BX. The conceptual model of meaning in life among Chinese breast cancer patients and implication in nursing[J]. Chin J Nurs, 2015, 50(8):1004-1009.
[19]	徐良雄, 石聿树, 熊昌娥, 等. 生命意义感对抑郁障碍患者生活质量的影响[J]. 中国健康心理学杂志, 2020, 28(2):173-176.
	Xu LX, Shi YS, Xiong CE, et al. Effect of sense of life on quality of life in patients with depressive disorder[J]. China J Heal Psychol, 2020, 28(2):173-176.
[20]	肖兴米, 马燕, 石英, 等. 以家庭为中心的预立医疗照护计划在肿瘤终末期患者中的应用研究[J]. 中国护理管理, 2020, 20(2):185-189.
	Xiao XM, Ma Y, Shi Y, et al. Application of family-centered advance care planning in patients with terminal cancer[J]. Chin Nurs Manag, 2020, 20(2):185-189.