The Relationship Between Resilience And Positive Coping Style Of Middle-aged And Aged Maintenance Hemodialysis Patients And Caregivers And Application Of Dyadic Coping Intervention

Objective:1.Establish a "actor-partner interdependence model" of resilience and positive coping style of middle-aged and aged maintenance hemodialysis(MHD)patients and their caregivers,and to analysis subject and object effect of resilience and positive coping style between patients and caregivers,so as to provide a theoretical basis for future nursing field develop "patient-caregivers centered" dyadic intervention research in psychological and coping behavior.2.Under the guidance of Dyadic Disease Management Theory,an intervention program was constructed to carry out dyadic coping intervention on middle-aged and aged MHD patients and their caregivers,and to explore evaluate its effectiveness on the resilience and positive coping style of patients and their caregivers and dialysis adequacy of patients.Methods:This study contains 2 parts:Horizontal research and quasi-experimental study.1.Horizontal research:By convenience sampling sampling method,246 pairs of maintenance hemodialysis patients and their caregivers of two tertiary hospitals in Shanxi Province were selected.The general information questionnaire,the resilience scale(CD-RISC),and the simplified coping style subscale(SCSQ)were used to investigate.Descriptive statistical analysis,univariate analysis and were Pearson analysis performed by SPSS21.0 software,and through Amos24.0 software and by structural equation model to constructe actor-partner interdependence model(APIM).2.Quasi-experimental study:Selecting 96 pairs of middle-aged and aged MHD patients and caregivers in the Blood purification centre of a tertiary hospital in Shanxi Province,and divided research objects into control group and experiment group,48 pairs each.The control group performed conventional nursing,including the implementation of dialysis treatment and dialysis medication,monitoring and nursing during dialysis,maintenance of vascular access,dialysis-related knowledge and health education,etc.The intervention group performed the dyadic coping intervention conducted on the theory of Dyadic Illness Management.Resilience Scale(CD-RISC)and simplified coping style subscale(SCSQ)and IDWG%were used to collect data to evaluate the effect of the dyadic coping intervention program on the resilience and coping style of middle-aged and aged MHD patients and caregivers and dialysis adequacy of patients,before and after intervention.Results:1.Cross-sectional study results:(1)Current status of resilience and positive coping style of middle-aged and aged MHD patients and caregivers:total scores of resilience of middle-aged and aged MHD patients and caregivers were(58.20±13.34)and(62.55±11.01),total positive coping style score was(22.30±6.03)and(23.39±4.94),respectively.(2)Comparison of differential resilience and positive coping style between middle-aged and aged MHD patients and caregivers:the scores of resilience and positive coping style among middle-aged and aged MHD patients were significantly lower than their caregivers(t=-4.421,P<0.001;t=-2.569,P<0.05).(3)The relationship between resilience and positive coping style among middle-aged and aged MHD patients and caregivers:there was positive correlation between among middle-aged and aged MHD patients and caregivers’ resilience and positive coping scores(r=0.284～0.425,P<0.001).(4)Analysis of subject and object effect of resilience and positive coping mode of middle-aged and aged MHD patients and caregivers:In terms of subject effect,the resilience level of middle-aged and aged MHD patients and their caregivers can affect their own positive coping style(β=0.292,β=0.243,all P<0.001);in terms of object effect,only the resilience of patients can affect the positive coping style of caregivers(β=0.082,P<0.001).2.Results of quasi-experimental studies:(1)During the intervention process,among the control group,2 patients have experienced withdrawal and 1 patient has referral.Among the intervention group,2 patients have experienced withdrawal and 3 patients has referral from hospital.There were 43 pairs in the experiment group and 45 pairs in the control group who finally completed the study.(2)Resilience scores:The comparison between groups show that no difference in all dimension and total points of resilience before intervention(Z=-0.779～-0.456;Z=-0.682～-0.157,all P>0.05).After the intervention,in all dimension and total points of resilience in experiment group higher than control group(Z=-3.441～-2.074;Z=-3.460～-2.335,all P<0.05).Comparison within group before and after intervention,it’s no significant difference in resilience total points and each dimension score of patients and caregivers in the control group(Z=-1.716～-1.309;Z=-1.578～-0.007,all P>0.05),while there were respectively significant difference in resilience total points and each dimension of patients and caregivers in the experiment group(Z=-5.508～-2.853;Z=-3.140～-1.971,all P<0.05).(3)Positive coping style:The comparison results between groups,before the intervention was implemented,it’s no respectively significant difference in the points of MHD patients and caregivers(Z=-0.004;Z=-0.188,all P>0.05).After intervention,the points of MHD patients and caregivers in experiment group were higher than control group(Z=-2.875;Z=-3.717,P<0.01).Comparison within groups before and after intervention,there was significant difference in the points of positive coping style of MHD patients of control group(Z=-2.234,P<0.05),it’s no significant difference in caregivers of control group(Z=-1.836,P>0.05),the points of MHD patients and caregivers in experiment group were higher than intervention haven’t implemented(Z=-4.273;Z=-4.965,all P<0.01).(4)IDWG%:The comparison results between groups,it’s no difference in IDWG%before the intervention(t=-0.263,P>0.05).After the intervention,the IDWG%in experiment group were lower than control group(t=2.437,P<0.05).Comparison within groups,before and after intervention,there were statistically difference in the IDWG%of control group and experiment group(t=2.133;t=6.170,P<0.05).Conclusions:1.The resilience and positive coping style of middle-aged and aged MHD patients and caregivers were at medium and low levels,and the resilience and positive coping methods of patients were lower than those of caregivers.2.Middle-aged and old MHD patients and caregivers between resilience is closely related to positive coping style,and there was an interactive influence,which suggests that clinical workers should regard patients and caregivers as a dyadic whole,timely identify and intervene their resilience,actively explore to "patient-caregivers centered"more targeted intervention,establish a positive coping style.3.The dyadic coping intervention based on the Dyadic Disease Management Theory can significantly improve the resilience and positive coping style of middle-aged and aged MHD patients and caregivers,improve patients’ IDWG%.It is a feasible intervention method in MHD patients and caregivers to improve the mental health and coping style.