血液透析病人靈性健康狀態與相關因素探討

The Relationships Between Spiritual Health and Related Factors Among Hemodialysis Patients

背景：長期血液透析治療影響病人身心靈狀態以及生活品質，靈性是許多人面對重大事件重要的支持資源，台灣血液透析疾病的發生率及盛行率都位居世界前茅，但血液透析病人靈性健康相關探討較為罕見，可能會限制醫療照護團隊提供病人適當的靈性照護。目的：探討血液透析病人靈性健康狀態及其相關因素。方法：橫斷式相關性研究設計，方便取樣邀請北部某血液透析機構病人參與研究。研究工具包含短版靈性健康量表、宗教信仰量表、宗教活動量表、宗教信念量表及人口學變項，以獨立樣本t test、單因子變異數分析及皮爾森相關法分析變項間的相關，以迴歸分析影響靈性健康之重要因子。結果：共137位血液透析病人參與研究(回收率為82%)，靈性健康總分78.12(SD=11.21)屬中等程度、靈性健康次量表得分由高到低依序為「與人締結」、「超越逆境」、「明己心性」、「宗教寄託」、「活出意義」。靈性健康與性別(t=-2.096，p<.05)、年齡(r=-.313，p<.01)、教育程度(F=8.102，p<.001)、工作狀況(t=-2.335，p<.05)、自己是主要照顧者(t=2.560，p<.05)、宗教信仰(F=28.245，p<.001)、宗教活動(r=.440，p<.001)、宗教正向信念(r=.567，p<.001)、宗教負向信念(r= -.527，p<.001)達顯著相關。經由迴歸分析顯示男性、教育程度較低者、需仰賴他人照顧、無神論與負向宗教信念者，靈性健康得分較低，正向宗教信念者則靈性健康得分較高，整體解釋力達顯著(R2=57.6，F=17.783，p<.001)。
結論：血液透析病人靈性狀態屬中等程度，但生命意義感得分較低，建議將靈性列為血液透析常規評估與照護項目，特別是具有靈性健康得分較低的基本屬性者，如男性、年長者、低教育程度、無法自我照顧、無神論、宗教信念較負向者，應多關注其靈性的需求，提供適當的靈性照護。

Background : Long-term hemodialysis treatment affects patients’body–mind–spiritual status and quality of life. Spirituality is an important supportive resource for people experiencing critical events. In Taiwan, the rates of incidence and prevalence of hemodialysis are among the highest in the world, yet few studies have explored the spiritual health of hemodialysis patients. This may limit healthcare teams in providing appropriate spiritual care for hemodialysis patients. Purpose: To explore the status of spirituality in hemodialysis patients and the association between spirituality and related factors. Methods: Convenience sampling was used to recruit hemodialysis patients from a hemodialysis institute in northern Taiwan. The cross-sectional, relational study identified demographic characteristics, religious affiliation, and religious activities and used the religious belief scale and the spiritual health scale short form as instruments. Results: The study included 137 patients, and the response rate was 82%. The total score for spiritual health was 78.12 (SD = 11.21), which was moderate. The spiritual health subscale scores, from high to low, were connection to others, transcendence, self-understanding, religious attachment, and meaning derived from living. Spiritual health was associated with gender (t = -2.096, p < .05), age (r = -.313, p < .01), educational level (F = 8.102, p < .001), work status (t = -2.335, p < .05), primary caregiver (t = 2.560, p < .05), religious affiliation (F = 28.245, p < .001), religious activities (r = .440, p < .001), positive religious beliefs (r = .567, p < .001), and negative religious beliefs (r = -.527, p < .001). The regression analysis showed that participants had lower score of spiritual health when they were male, lower education level, relied on others to care, atheism, and negative religious beliefs. Participants with positive religious beliefs had higher score of spiritual health. These predictors explained 57.6% of the total variance (F = 17.783, p < .001). Conclusions: Hemodialysis patients had moderate levels of spirituality; however, their scores for the meaning derived from living were lower. Therefore, it is recommended that spirituality be routinely assessed and used as a nursing care item for hemodialysis patients. Particularly for those with low spiritual health scores for male, aging, low educational level, unable to self-care, atheism, and more negative religious belief, more attention should be paid to spiritual needs and the provision of appropriate spiritual care.