臺灣博碩士論文加值系統

Background: A great deal of self-management behaviors are necessary for patients undergoing hemodialysis. Self-management behaviors can increase patients’ active participation in managing their disease and has been shown to improve fluid adherence, which remains a major problem with patients undergoing hemodialysis.
Despite the fact that hemodialysis is the most frequently used treatment for chronic kidney disease in Indonesia, and the reported level of poor fluid adherence is still quite high, the concept of self-management remains little known. More understanding of what influences self-management behaviors and an exploration of factors which affect the clinical outcomes due to self-management behaviors is thus required before effective self-management programs can be implemented.
Purpose: The purpose of this study was to understand the influence demographic and psychological factors have on self-management behaviors and Inter Dialysis Weight Gain (IDWG) as a fluid adherence marker among patients undergoing hemodialysis in Indonesia.

Method: A cross-sectional study was conducted. A convenience sample of 145 patients undergoing hemodialysis was recruited from the dialysis units in two hospitals in Jakarta from September to December 2015. Questionnaires were used to examine the following variables: self-management behaviour indices, and the Depression, Anxiety and Stress Scale-Short Form (DASS-SF). Data analysis involved descriptive statistics, Pearson correlations, and hierarchical multiple linear regression was used for identifying the predictors of Self-Management Behaviour and Inter-dialytic weight gain.

Results: The overall score of the self-management behavior indices was 74.11 ± 10.72 (median = 75; range= 48-104), and the average of IDWG was 4% (mean= 3.97; SD= 2.17). The average item score for each of the five dimension of self-management behaviors were 3.4 in partnership, 2.34 for self-care, 2.09 for communication, 2.06 for partnership in care, and 1.39 for self-advocacy. Hierarchical linear regression analyses were used to model the relationship between each dimension of self-management behavior and the psychological factors. This analysis indicated that anxiety was the only one of the psychological factors which had positive and significant associations with the self-advocacy dimension. The final model of hierarchical linear regression analyses for each dimension of self-management behavior explained 18% of the variance in IDWG and indicated that the partnership in care dimension was a predictor of IDWG.

Conclusion: With regard to the dimensions of self-management behavior, the medication adherence dimension is the most performed by patients undergoing hemodialysis, followed by self-care, communication, partnership in care and self-advocacy. Self-management behaviors, especially the partnership in care dimension, are potential predictors that can be modified by nephrology nurses in order to enhance clinical outcomes, with the specific outcome being IDWG in this context.

TABLE OF CONTENTS
ABSTRACT I
TABLE OF CONTENTS III
LIST OF TABLES VI
CHAPTER I INTRODUCTION 1
Section 1- Background 1
Section 2- Purpose 5
CHAPTER II LITERATURE REVIEW 6
Section 1- Chronic Kidney Disease 6
1.1 Chronic Kidney Disease 6
1.2 Hemodialysis 7
1.3 ESRD in Indonesia 9
Section 2: Self-Management 10
2.1 Self-Management of Chronic Disease 10
2.2 Self-Management as a Paradigm Shift 11
2.3 Self-Management as a Concept 12
2.4 Self-Management Behaviors of Chronic Kidney Disease 15
CHAPTER III RESEARCH DESIGN AND METHOD 31
Section 1: Design and Sample 31
Section 2: Research Framework 32
Section 3: Instrument 35
Demographic, disease related factors and clinical details 35
Self-Management Behavior Indices 35
Depression Anxiety, Stress Scales 37
Section 4: Ethical Considerations 38
Section 5: Data Collection Procedures 39
Section 6: Data Analysis 40
CHAPTER IV RESEARCH RESULTS 41
Section 1- Characteristics of Participants 41
Section 2- Self-Management Behaviors 43
Section 3- Correlations between Demographic, Psychological Factors and Self-Management Behaviors 43
Section 4- Regressing Psychological Variables on the Self-Management Behavior Dimensions 45
Section 5 – Self-Management Behaviors and Inter-dialysis Weight Gain 50
Section 6- Regression of the Relevant Demographics, Psychological Factors, and Dimensions of Self-Management Behavior on IDWG 53
CHAPTER V DISCUSSION 56
REFERENCES 71
APPENDIX 85
Appendix 1: Demographic ＆ disease related factors questionnaire 85
Appendix 2: Record of IDWG 86
Appendix 3: Self-Management Behavior Indices 87
Appendix 4: Self-Management behavior indices questionnaire permission 89
Appendix 5: Self-Management Behavior Indices: Items 91
Appendix 6: Self-Management Behavior (Forward Translation) 92
Appendix 7: Depression Anxiety Scale (DASS) 95
Appendix 8: DASS Indonesian Version 96
Appendix 9: Scoring DASS 98
Appendix 10: Informed Consent 100
Appendix 11: Ethical Clearance Document 102
Appendix 12: Research Permission Approval Document 103

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