Purpose The purpose of this study was to examine the mediating effects of uncertainty appraisal and self-care behavior on uncertainty and the physiological indexes of hemodialysis patients.
Methods This study used a descriptive correlation design. The participants were 140 patients receiving hemodialysis treatment. Data were collected from July 16 to August 20, 2020. Measurements included Mishel’s uncertainty in illness scale, the uncertainty appraisal scale, and the self-care behavior scale. Data were analyzed using descriptive statistics. The mediating effects were verified by the bootstrapping method using the PROCESS macro for SPSS.
Results The mean scores for uncertainty, uncertainty danger appraisal, uncertainty opportunity appraisal, and self-care behavior, respectively, 2.67±0.42 (range 1~5), 1.34±1.02, 2.17±1.12 (range 0~5), 3.58±0.45 (range 1~5). Uncertainty did not have a direct effect on physiological indexes. However, uncertainty opportunity appraisal and self-care behavior had serial mediating effects on the relationship between uncertainty and physiological indexes of serum phosphate and interdialytic weight gain.
Conclusion To the control physiological indexes of hemodialysis patients, it is necessary to develop a nursing intervention program that can lower the this uncertainty and increase self-care behavior by considering uncertainty to be an opportunity.
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Hemodialysis(HD)-associated hypotension is a frequent complication, but it is difficult to manage. Until now, several maneuvers have been tried to prevent the HD-associated hypotension. Of these, the sodium content of dialysate was regarded as an important factor for maintaining blood pressure during HD. In this study, we evaluated the effect of hypertonic dialysate on blood pressure, interdialytic weight gain and the incidence of thirst. The study was done for 6 weeks successively with 3 different groups. Each patient was dialysed with 3 different dialysates for 2 weeks: Group I(Conventional HD: sodium concentration: 137 mEq/L), Group II(Hypertonic HD: 147 mEq/L) and Group III (Sequential HD: from 147 to 140 mEq/L). Hemodynamic parameters(blood pressure, pulse rate and ultrafiltration rate), biochemical parameters(hematocrits, blood urea nitrogen, creatinine, osmolality, sodium, potassium, chloride, fasting blood sugar) and complications (interdialytic weight gain &thirsty sensation) were compared among 3 groups. The results were as follows: 1. Decline of systolic blood pressure and diastolic blood pressure at the time of a 3 hour check during hemodialysis was lower in the Group II than Group I and III (p=0.002; p=0.012). and decline of diastolic blood pressure at the time of a 4 hour check during hemodialysis was lower in the Group II and III than Group I(p=0.04). 2. ncidence of hypotensive episodes during dialysis was significantly lower in Group II than group I (p=0.0287). 3. The ultrafiltration in Group III at the time of 1 hour, 2 hour and 3 hour check during hemodialysis was higher than that in Group I and II at the time of 1 hour, 2 hour and 3 hour check during emodialysis respectively (p=0.0001; p=0.0001; p=0.0004). 4. Interdialytic weight gain was higher in Group II(3.1+/-0.8) than GroupI(2.8+/-0.8) and III (2.9+/-0.9) (p=0.0422). 5. Hematologic and biochemical results were not significantly different among 3 Groups. 6. Frequency of thirst was different in Group I, II and III, 0.05+/-0.12, 0.41+/-0.24 and 0.22+/-0.29 respectively (p=0.0259). The results suggest that hypertonic HD was effective in preventing HD-associated hypotension but interdialytic weight gain and thirst sensations were increased as compared with a conventional method. In this situation, sequential HD seems to be an alternative method to minimizes the side effect of hypertonic HD.
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