Analysis For Uncertainty In Illness Of Rheumatoid Arthritis Patients

BackgroundUncertainty in illness is a new topic in the field of nursing, is when a person to a thing cannot give appropriate classification or generated by a cognitive organization. The American psychological nursing experts Mishel is defined uncertainty in illnessas a lack of ability to decide things related to the disease. After decades, sense of uncertainty in illness caused global attention of nursing, there are quite a few nursing experts studied and discussed.Present, the theory of uncertainty in illness has been widely used in the study of cancer disease and various kinds of chronic disease population. Research object by patients also extended to the family and children’s parents. Cancer patients including breast cancer, lymphatic cancer, colon cancer, prostate cancer, cervical cancer and other people; In a variety of chronic diseases patients, has studied groups include:various types of cardiac patients, endometriosis, multiple sclerosis, human immunodeficiency virus (HIV) infection and premature pregnant women, asthma, chronic obstructive pulmonary disease, low back pain, lupus erythematosus, kidney failure, diabetes, and all kinds of organ transplant patients.Rheumatoid arthritis (RA) is a kind of unknown etiology, chronic, symmetrical polyarthritis as the main clinical manifestations of autoimmune diseases. Its pathology is the chronic inflammation of synovial joints hyperplasia pannus formation, infringement of articular cartilage and lower cartilage, ligaments and tendons, etc., cartilage, bone and joint capsule damage, eventually leading to joint deformity and loss of function, and can also damage the heart, lung, kidney, nerve and other internal organs. Uncertainty in RA patients mainly comes from four aspects:the symptoms of the disease uncertainty; Complex treatment and care; The lack of related to disease diagnosis and severity information; Unpredictable process and prognosis. Effect of patients with RA treatment cycle is long, slow, once becomes a lifelong sex disease. Because of the problem such as economy, human, personal needs, no long-term hospitalization. Based on our country present stage community care is not developed, RA nurse requires high characteristic, RA in clinic nursing of all research and intervention.ObjectivesThe purpose of this study was to investigate the level of uncertainty in RA patients.Analysis the influence factors of uncertainty in illness. Correlation with coping styles and social support. Discusses how to help RA patients to cope with or manage the uncertainty, in order to improve the quality of survival.Subjects and Methods1. SubjectsThe200RA patients all were recruited from Peking university Shenzhen hospital between May,2012and August,2012. The patients were enrolled if they were (1) are in line with the American rheumatism association (American College of Rheumatology, ACR) the2009revision of the diagnostic classification standard [1].(2) patients volunteered to participate in this study;(3) is not associated with other serious organic disease;(4) cognitive accessibility.2. Methods2.1Establishing outpatient medical record informationOutpatient medical record information content questionnaire including general condition and clinical data. 2.2Measure the level of clinics RA patients’s uncertaintyThe uncertainty in illness scale (MUIS)[2] to investigate clinic RA patient’s disease uncertainty levels. The higher the score of respondents disease, the higher the degree of uncertainty.2.3Medcial Coping Modes Questionnaire (MCMQ)The questionnaire designed to measure patients’ coping styles.2.4Social support rating scale.The scale is mainly used to understand the individual levels of social support.2.5collecting dataBy the researcher himself as investigators, obtaining permission from the respondents, the investigators explain to all the respondents said the purpose of this study and methods, fill out the request, independently complete the questionnaire by the respondents to the because of the low degree of culture cannot be independent, a phased by investigators to read it to the patient, a detailed to choose its independence. A total of200questionnaires,200taken back, the recovery rate of100%.2.6Statistical Analysis.SPSS13.0software was adopted to construct the database and descriptive analysis of data of the input, gender, marital status, educational level, work status, personal income level score comparison by using two independent sample t-test, age, illness, disease severity and consciously medical expense payment score compared using analysis of variance. With multiple linear stepwise regression finally have an impact on uncertainty in illness scores of the independent variable for multiple factors analysis. Application of Spearman correlation analysis research disease uncertainty and the correlation between coping style and social support.Results1. RA patients disease uncertainty situation The study found that patients with RA disease uncertainty score in the medium level.2. RA patients disease uncertainty of single factor analysisRA patients from gender, age, marital status, educational level, work status, personal income level, sick time, severity of disease, medical treatment charge of payment and disease uncertainty score on the single factor analysis of the results of different gender, age, marital status, educational level, personal income level, perceived severity of disease in patients with disease uncertainty level differences statistically significant (P<0.05).3.The uncertainty in RA patients with disease multiple linear stepwise regression analysisThe degree of culture, personal income, disease severity was elected to the regression equation (Y=125.684-5.057X4-5.041X5-12.514X6,R2=0.836), with statistical significance, shows that cultural degree, personal income level, perceived severity of the disease is RA patients disease are the main factors causing the sense of uncertainty.4. RA patients disease uncertainty and coping styles of correlation analysisRA patients compared to patients with the usage of coping styles and the general,"face" and "avoidance" coping style score and there are no significant difference compared with women, but "yield" score is significantly higher than the general patients. The Pearson correlation analysis showed that patients with RA disease uncertainty and yield were positively correlated (P<0.05), but negatively correlated with the face or withdrawal (P<0.05).5. RA patients disease uncertainty and social support of correlation analysisRA patients social support score (41.03±4.42), the total score and the scores in the general population (34.56) for one sample t test, the result was statistically significant, according to the RA patients social support score is lower than the average people. The Pearson correlation analysis showed that RA patients was found to be inversely associated with the disease uncertainty and social support (P<0.05). Conclusion1. The patient’s disease uncertainty score were (86.72+13.92) points, in the medium level, the ambiguity scored the highest, followed by complexity and unpredictability scored lowest.2. The RA patients in gender, age, marital status, educational level, income level, disease severity disease uncertainty of total score differences statistically significant (P<0.05).3. By the multiple linear stepwise regression analysis, regression equation into the disease uncertainty of culture degree, income level, the severity of disease. Is main influence factors of uncertainty in RA patients with disease.4. RA patients disease uncertainty and yield were positively correlated (P<0.05), and negatively correlated with the face (P<0.05).5. RA patients was found to be inversely associated with the disease uncertainty and social support (P<0.05).