Korean J Adult Nurs.  2020 Feb;32(1):67-77. 10.7475/kjan.2020.32.1.67.

Mediating Effects of Self-Care Competence on the Relationship between Uncertainty and Quality of Life in Hemodialysis Patients

• Chae YJ
• Ahn JH
• Kang KP
• Jo E

• KMID: 2471030
• DOI: http://doi.org/10.7475/kjan.2020.32.1.67

Abstract

PURPOSE
This study aimed to explore the mediating effect of self-care competence on the relationships between uncertainty, self-care competence, and quality of life in patients undergoing hemodialysis.
METHODS
This study used a descriptive correlation design. Participants were 169 patients who were receiving hemodialysis treatment. Data were collected from November 01, 2017, to June 30, 2018. Measurements included the Patient Assessment of Mishel Uncertainty in Illness Scale, Self-as-Carer Inventory Scale, and the Medical Outcomes Study Short Form-12 (MOS SF-12). The MOS SF-12 comprises the Physical Component Score (PCS) and Mental Component Score (MCS). Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and a three step regression analysis using Baron and Kenny's method for mediation.
RESULTS
Mean scores were 2.78±0.03 and 3.96±0.07 for uncertainty and self-care competence, respectively. The mean PCS score was 41.90±17.45) and the mean MCS score was 55.23±15.09. Self-care competence had a partial mediating effect (z=−3.50, p<.001) between uncertainty and PCS as well as an explanatory power of 20%. Self-care competence had a partial mediating effect (z=−2.36, p<.001) between uncertainty and MCS as well as an explanatory power of 11%.
CONCLUSION
To improve the quality of life of hemodialysis patients, developing programs suitable for patients with high uncertainty or programs that increase the self-care competence abilities of the patients should be considered.

MeSH Terms

Humans
Mental Competency*
Methods
Negotiating*
Quality of Life*
Renal Dialysis*
Self Care*
Uncertainty*

Reference

1. The Korean Society of Nephrology. Current renal replacement therapy in Korea [Internet]. Seoul: ESRD Registry committee, Korean Society of Nephrology;2019. cited 2018 December 29. Available from: http://www.ksn.or.kr/rang_board/list.html?code=sinchart.

2. Shona SP, Ajay S. Approach to patients with chronic kidney disease, Stage 1-4. In : John TD, Peter GB, Todd SI, editors. Handbook of Dialysis. 5th ed. San Francisco, CA: Jossery-Bass;2014. p. 3–13.

3. Chiou CP, Chung YC. Effectiveness of multimedia interactive patient education on knowledge, uncertainty and decision-making in patients with end-stage renal disease. Journal of Clinical Nursing. 2012; 21(9-10):1223–1231. DOI: 10.1111/j.1365-2702.2011.03793.x.

4. Jang HS, Lee CS, Yang YH. Influence of uncertainty and uncertainty appraisal on self-management in hemodialysis patients. Journal of Korean Academy of Nursing. 2015; 45(2):271–279. DOI: 10.4040/jkan.2015.45.2.271.

5. Cho YM, Yum KS. The relationship between of uncertainty, depression, physiologic index and basic psychological need of hemodialysis patients. Journal of Digital Convergence. 2017; 15(10):281–291. DOI: 10.14400/JDC.2017.15.10.281.

6. Mishel MH. Uncertainty in illness. Journal of Nursing Scholarship. 1998; 20(4):225–232. DOI: 10.1111/j.1547-5069.1988.tb00082.x.

7. Yang NY, Kim MJ. Concept analysis of uncertainty related to illness. Journal of Korean Gerontological Nursing. 2002; 4(2):187–194.

8. Orem DE. Nursing: Concepts of practice. 6th ed. St. Louis: Mosby;2001. p. 20–22.

9. Han KH, Kim MH. A Study on relationships between hope, self-care efficacy in hemodialysis patients. The Korean Journal of Rehabilitation Nursing. 2001; 4(2):137–145.

10. Yun SJ, Lee YH. Factors influencing uncertainty in dialysis patient by duration of dialysis. Korean Journal of Adult Nursing. 2012; 24(6):597–606. DOI: 10.7475/kjan.2012.24.6.0597.

11. Kaba E, Bellou P, Iordanou P, Andrea S, Kyritsi E, Gerogianni G, et al. Problems experienced by hemodialysis patients in Greece. British Journal of Nursing. 2007; 16(14):868–872.

12. Morsch CM, Goncalves LF, Barros E. Health-related quality of life among hemodialysis patients-relationship with clinical indicators, morbidity and mortality. Journal of Clinical Nursing. 2006; 15(4):498–504.

13. Kimmel PL, Patel SS. Quality of life in patients with chronic kidney disease: focus on end-stage renal disease treated with hemodialysis. Seminars in Nephrology. 2006; 26:68–79.

14. Lee MH, Song MS, Yoo KM. Relationship among powerlessness self-efficacy and quality of life in hemodialysis patients. The Korean Journal of Rehabilitation Nursing. 2002; 5(2):166–179.

15. Oh HS. Theory construction in nursing of uncertainty. Korean Journal of Adult Nursing. 2001; 13(2):200–207.

16. Lee MJ. Uncertainty, appraisal of uncertainty and health-related quality of life in recovering clients discharged from hospital after CABG. Ewha Journal of Nursing Science. 2009; 21(1):49–63.

17. Park GY. Study on the hope, resilience, ability to self-care, and quality of life of hemodialysis patients [dissertation]. Seoul: Hanyang University;2016.

18. Heidarzadeh M, Atashpeikar S, Jalilazar T. Relationship between quality of life and self-care ability in patients receiving hemodialysis. Iranian Journal of Nursing and Midwifery Research. 2010; 15(2):71–76.

19. Kwon GS, Lim KH. Mediating effects of depression and social supports between type D personality and quality of life on hemodialysis patients. Korean Journal of Adult Nursing. 2019; 31(4):439–448. DOI: 10.7475/kjan.2019.31.4.439.

20. Chung CW, Kim MJ, Rhee MH, Do HG. Functional status and psychosocial adjustment in gynecologic cancer patients receiving chemotherapy. Korean Journal of Women Health Nursing. 2005; 11(1):58–66. DOI: 10.4069/kjwhn.2005.11.1.58.

21. Geder E, Taylor S. Self-as-carer: a preliminary evaluation. In : in proceedings of the seventh annual nursing research conference, MO: University of Missouri-Columbia School of Nursing; 1988.

22. So HS. Testing construct validity of self-as-carer inventory and its predictors. Korean Journal of Adult Nursing. 1992; 4(2):147–161.

23. Ware JE, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care. 1996; 34(3):220–233.

24. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 1986; 51(6):1173–1182. DOI: 10.1037/0022-3514.51.6.1173.

25. Kang SK. Study on the physical symptoms, uncertainty, resilience, and self-care competency of hemodialysis patients [dissertation]. Busan: Inje University;2018.

26. Kim YJ, Choi HJ. The influence of uncertainty and social support on general well-being among hemodialysis patients. The Korean Journal of Rehabilitation Nursing. 2012; 15(1):20–29. DOI: 10.7587/kjrehn.2012.20.

27. Park GY. Study on the hope, resilience, ability to self-care, and quality of life of hemodialysis patients [dissertation]. Seoul: Hanyang University;2016.

28. Cha JE, Yi MS. Relationships between treatment belief, personal control, depressive mood and health-related quality of life in patients with hemodialysis. Korean Journal of Adult Nursing. 2014; 26(6):693–702. DOI: 10.7475/kjan.2014.26.6.693.

29. Yoon MY. Predicting factors of self-esteem in patients with hemodialysis. Journal of Digital Convergence. 2018; 16(8):253–261. DOI: 10.14400/JDC.2018.16.8.253.

30. Perl J, Karaboyas A, Morgenstern H, Sen A, Rayner HC, Vanholder RC, et al. Association between changes in quality of life and mortality in hemodialysis patients: results from the DOPPS. Nephrol Dial Transplant. 2017; 32(3):521–527. DOI: 10.1093/ndt/gfw233.

31. Park YJ, Lee HJ. The levels of physical activity and its relationships with depression, health-related quality of life, sleep disturbance, and physiological indicators in hemodialysis patients. Korean Journal of Adult Nursing. 2015; 27(6):718–727. DOI: 10.7475/kjan.2015.27.6.718.

32. Kim EY, Kim JS. Predictors of quality of life among hemodialysis patients. Korean Journal of Adult Nursing. 2004; 16(4):597–607.

33. Suck YM, Park JW, Jeon MJ, Kim CY. Effect of periodic video education on knowledge about hemodialysis, patient role behavior and the physiologic index in patients with hemodialysis. Journal of Korean Biological Nursing Science. 2013; 15(3):122–132. DOI: 10.7586/jkbns.2013.15.3.122.