维持性血液透析患者疾病感知与自我管理行为的链式中介效应

The chain mediating effect between illness perception and self-management behavior in maintenance hemodialysis patients

目的探讨维持性血液透析患者疾病感知、认知融合、反刍思维和自我管理行为间的关系,以期为患者的临床护理干预提供一定的参考和依据。方法采用方便抽样法选取2020年4-10月在浙江省某三级甲等医院血液透析中心行血液透析的312例患者作为研究对象。使用一般资料调查问卷、简版疾病感知问卷、中文版Nolen-Hoeksema反刍思维量表、中文版认知融合量表和血液透析患者自我管理行为问卷进行调查。使用Amos 17.0软件构建结构方程模型图,并进行中介效应检验。结果维持性血液透析患者疾病感知、反刍思维和认知融合得分分别为(50.12±13.78)分、(63.15±14.58)分和(47.63±10.30)分。自我管理行为得分为(66.73±13.18)分,总体处于较低水平。反刍思维、认知融合在疾病感知和自我管理行为间的特定中介效应和链式中介效应均成立,反刍思维的特定中介效应占30.7%,认知融合的特定中介效应占19.2%,链式中介效应占7.7%。结论医务人员在对维持性血液透析患者的护理干预中,应注意应帮助患者客观面对疾病和治疗,降低患者反刍思维,疏导其负性情绪,阻断患者的认知融合和心理僵化,提高其自我管理行为水平和生活质量。

Objective To explore the relationship amongst illness perception,cognitive fusion,rumination,and self-management behaviour in patients with maintenance haemodialysis and to provide some reference and basis for clinical nursing intervention.Methods A total of 312 patients who underwent haemodialysis were selected from the haemodialysis centre of a tertiary hospital in Zhejiang Province between April and October 2020 through convenience-sampling method.The basic data questionnaire,Brief Illness Perception Questionnaire,Chinese version of Nolen-Hoeksema Ruminative Responses Scale,cognitive fusion questionnaire,and haemodialysis patients'self-management behaviour questionnaire were used in the investigation.Amos17.0 software was used to construct the structural equation-model diagram and perform the intermediary effect test.Results The scores of illness perception,cognitive fusion,and rumination were(50.12±13.78)points,(63.15±14.58)points,and(47.63±10.30)points,respectively.The score of self-management behaviour was(66.73±13.18)points at a lower level overall.The specific mediating effect and chain-mediating effect of rumination and cognitive fusion between illness perception and self-management behaviour were all established.The specific mediating effect of rumination accounted for 30.7%of the total indirect effect,and that of cognitive fusion accounted for 19.2%of the total indirect effect.The chain-mediating effect accounted for 7.7%of the total indirect effect.Conclusion In the nursing intervention of maintenance hemodialysis patients,medical personnel should pay attention to help them objectively face the disease and treatment,reduce their rumination thinking,ease their negative emotions,block their cognitive integration and psychological rigidity,improve their self-management behavior and quality of life.