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

Exploring the Association of Resources Loss, Resilience, and Disease Coping of Hemodialysis Survivors under Various Time Durations

研究目的：接受血液透析的患者，終其一生皆需要接受治療，研究發現在血液透析初期或隨治療期間增長，患者可能會經歷不同的身心衝擊與資源流失。本研究的目的欲探討在疾病調適期間：（1）不同血液透析期間之患者，他們在「資源流失」種類、「復原力」及使用「因應策略」間的差異情形。（2）探討不同血液透析期間，分組患者的復原力是否能調節不同資源流失下因應的使用。研究方法：研究採橫斷式設計，立意取樣北區八間醫療院所進行血液透析治療的患者，於2012年5月至10月收案，共收有效樣本263位，男性155位，女性108位。依文獻整理，研究以患者血液透析期間達三年以下者為初期組，共84人；三年至十年者為中期組，共95人；十年以上之者為長期組，共84人，三組平均年齡分別為：60.13（SD=13.55）歲、57.23（SD=11.51）歲、59.34（SD=11.66）歲。他們皆完成三份研究問卷，包括：資源保留量表、中文版復原力量表及血液透析因應量表。研究結果：（1）三組血液透析患者其資源流失類型、復原力特性上有部分達顯著差異，但在因應策略上無顯著差異；（2）「復原力」與各「資源流失」種類有顯著負相關，與「接受挑戰」有正相關，與「消極面對」因應有負相關。（3）復原力的調節作用顯現在三至十年血液透析中期組，其復原力能對不同「資源類型」之流失，負向調節「接受挑戰」或「消極面對」因應之使用。研究結論：復原力的調節作用在中期組最具保護作用，初期組並不明顯，在長期組則具有直接影響因應的作用，因此研究顯示要考慮血液透析期間長短資源流失的類別，以及復原力在經歷不同血液透析期間個案上的作用。此外，根據結果，本研究亦提出進一步的建議。

Purpose: Patients who accept hemodialysis (HD) treatment need it for the rest of their lives. Research has found that different durations of HD correspond to different psychological and physiological impacts and resource loss. The present study has two goals: (1) to test the difference in resource loss, resilience, and disease coping among patients of different HD treatment durations; and (2) to examine whether resilience has a different moderating effect between resource loss and disease coping among the various HD treatment durations. Methods: The present study used a cross-sectional design and purposive sampling from 8 hospitals. A total of 155 men and 108 women (263) in 3 HD duration groups participated: under 3 years (84 persons, mean age 60.13), 3 to 10 years (95 persons, mean age 57.23), and over 10 years (84 persons, mean age 59.34). All participants completed 3 instruments: Conservation of Resources Evaluation, Resilience Scale, and Hemodialysis Coping Scale. Data analyzed using one-way analysis of variance, Pearson product-term correlation, and hierarchical regression analysis. Results: (1) Group differences in resource loss and resilience were evident, but no differences in coping were identified. (2) Resilience had a negative relation with different kinds of resource loss, a positive relation with challenge coping, and a negative relation with passive emotional coping. (3) The resilience of the middle group of patients under resource loss had a moderating effect on challenge coping and on passive emotional coping. Conclusions: Researchers need to consider the different groups carefully in terms of resource loss. As the moderating effect of resilience is more salient for the middle group of patients than the other two groups, the protective role of resilience needs to be further explored.