健康促進教育團體改善透析病人憂鬱程度、希望感及生活品質的研究

背景：臺灣目前透析病人的發生率及盛行率高居世界第一位，文獻說明透析治療開始時的憂鬱嚴重程度是存活率的獨立預測因子，憂鬱使慢性腎臟病人病情顯著惡化，其不良後果包括增加死亡率和住院率，以及較差的遵從性和生活品質。有鑑於問題的重要性，提供安全和有效的訊息，對透析病人實施良好的護理活動措施是迫切需要的。目的：本研究目的是探討健康促進教育團體對透析病人的憂鬱程度、希望感及生活品質的改善成效。方法：本研究透過實驗研究設計採隨機分配將符合收案條件並同意參與健康促進教育團體的透析病人分為實驗組及對照組各20人。對照組則維持例行性透析治療及護理照顧，實驗組成員除了維持例行性透析治療及護理照顧外，並加上每週2次、每次90分鐘，總共8次的健康促進教育團體活動介入。研究者以對照組與實驗組成員的量性資料及實驗組成員於團體進行中的質性資料分析驗證健康促進教育團體的介入成效。結果：研究結果發現健康促進教育團體介入對透析病人的憂鬱程度、希望感及生活品質有顯著改善成效，透析病人主觀感受健康促進教育團體可以幫助他們學習適應身體狀況、轉念，把快樂作為人生的目的、面對困境時保有希望及增加相互扶持的力量。結論／實務應用：本研究實證護理人員提供跨領域整合照護之健康促進教育團體能顯著改善透析病人的憂鬱程度、希望感及生活品質，肯定透析單位的個案管理護理師為透析病人安排的健康促進教育團體可以促進透析病人的心理健康及生活品質，因此建議繼續教育課程強化透析單位的個案管理護理師跨領域整合照護之健康促進教育團體的知能並推廣應用在透析病人的全人照護中。 Background: Taiwan has the highest incidence and prevalence of dialysis in the world. The literature suggests that severity of depression at the beginning of dialysis treatment is an independent predictor of survival. Depression significantly worsens the condition of chronic renal disease patients, with the adverse consequences of depression including increased mortality and hospitalization rates as well as poor compliance and quality of life. Given the importance of this problem, providing safe and effective information and good nursing care to dialysis patients is urgently needed. Purpose: The purpose of this study was to explore the effects of implementing health promotion education groups on self-perceived depression, hope, and quality of life in dialysis patients. Methods: Dialysis patients who met the study criteria and had provided consent to participate in the health promotion education group were randomly assigned to either the treatment group (20 persons) or the control group (20 persons). In the control group, routine dialysis treatment and nursing care were maintained. In addition to receiving routine dialysis treatment and nursing care, the experimental group participated in health promotion education group activities for 90 minutes, twice a week for a total of 8 sessions. The quantitative data from both groups and the qualitative data analysis of the experimental group were used to assess the effects of the intervention. Results: The results showed that the intervention had significantly improved self-perceived depression, hope, and quality of life in the experimental group. The participants indicated that the health promotion education group had helped them learn to adapt to their physical conditions, change their mindset, learn to regard happiness as the purpose of life, and maintain hope and increase mutual support in the face of difficulties. Conclusion/Implications for Practice: This study demonstrated that the cross-disciplinary integrated care provided through health promotion education groups is able to significantly improve depression, hope, and quality of life in dialysis patients. Thus, health promotion education groups arranged by the case management nurses for dialysis patients have the potential to promote mental health and quality of life in these patients. Therefore, continuing education is recommended to strengthen the awareness and knowledge of dialysis case management nurses with regard to applying integrated cross-disciplinary care in health promotion education groups and to promoting the implementation of these groups in the holistic care of dialysis patients.