Study on the intervention effect of magnetic bead auricular point pressing on sleep disorders and comfort status in maintenance hemodialysis patients

OBJECTIVE: 1. To understand the comfort status of maintenance hemodialysis patients and analyze the factors related to their comfort status. 2. To explore the effect of magnetic bead auricular point pressing in improving sleep disorders and promoting comfort in maintenance hemodialysis patients. METHODS: End-stage renal disease patients receiving maintenance hemodialysis in the Department of Blood Purification of Fuzhou General Hospital of Nanjing Military Command were selected as study subjects. The study was divided into three stages. In the first stage, expert consultation and other methods were used to revise the General Comfort Questionnaire (GCQ) developed by the American comfort care expert Kolcaba, forming a "Comfort Scale for Maintenance Hemodialysis Patients" suitable for maintenance hemodialysis patients in China, and its reliability and validity were tested. In the second stage, the "Comfort Scale for Maintenance Hemodialysis Patients" and a self-designed "Questionnaire on Factors Influencing the Comfort Status of Maintenance Hemodialysis Patients" were used to investigate and analyze the comfort status of maintenance hemodialysis patients and the related influencing factors. In the third stage, with magnetic bead auricular point pressing as the intervention, and the "Comfort Scale for Maintenance Hemodialysis Patients", the Pittsburgh Sleep Quality Index (PSQI) and the efficacy criteria for insomnia as evaluation tools, 60 maintenance hemodialysis patients meeting the diagnostic criteria for insomnia and the TCM syndrome differentiation criteria for insomnia were selected and randomly divided into a magnetic bead auricular point pressing group (experimental group) and an estazolam group (control group), with 30 cases in each group. The intervention lasted 8 weeks, with 4 weeks as one course, for a total of 2 courses. Through self-controlled comparison before and after the intervention and comparison between groups, the effect of magnetic bead auricular point pressing in improving sleep disorders and promoting comfort in maintenance hemodialysis patients was explored. Descriptive statistics, t test, rank-sum test, chi-square test, analysis of variance and multiple stepwise regression analysis were used to analyze the data. RESULTS: 1. The homogeneity reliability Cronbach's α coefficient of the "Comfort Scale for Maintenance Hemodialysis Patients" was 0.935, with α coefficients of each dimension between 0.879 and 0.930. The test-retest correlation coefficient of the overall comfort score was 0.944, and those of each dimension were between 0.817 and 0.924. Factor analysis extracted 4 common factors, with a cumulative variance contribution rate of 68.758%, and the items included in each common factor were consistent with the theoretical assumptions of the original scale. 2. Results of the comfort status survey of maintenance hemodialysis patients: the overall comfort score was 72.91±7.60. The mean item scores were: overall comfort 2.60±0.27, physical domain 2.27±0.46, psychological domain 2.51±0.35, social domain 2.77±0.44, and environmental domain 3.20±0.37. 3. Comfort status differed significantly among maintenance hemodialysis patients of different age groups, monthly household income per capita, medical payment methods, dialysis frequency, dialysis duration and serum creatinine levels (P<0.05), whereas there was no significant difference in comfort status among patients of different sex, occupation, educational level, marital status and religious belief (P>0.05). 4. Factors such as worry about treatment efficacy, poor sleep, fatigue and weakness, worry about economic status, lack of disease-related knowledge, prolonged bed rest, and dry mouth and thirst were related to the comfort status of maintenance hemodialysis patients. 5. After 2 courses of intervention, the incidence of sleep disorders in the magnetic bead auricular point pressing group was significantly lower than in the control group; there was a significant difference in PSQI between the two groups (P<0.01) and a significant difference in the total effective rate between the two groups (P<0.05). Magnetic bead auricular point pressing had a marked effect on the heart-spleen deficiency type (markedly effective rate 90.91%, total effective rate 100.00%), followed by the heart deficiency with timidity type and the yin deficiency with effulgent fire type; estazolam had a marked effect on the heart deficiency with timidity type (markedly effective rate 66.67%, total effective rate 100.00%), followed by the heart-spleen deficiency type and the liver depression transforming into fire type. The magnetic bead auricular point pressing group scored higher than the estazolam group in overall comfort and in physical and psychological domain comfort, with a significant difference in comfort status between the two groups (P<0.01). CONCLUSION: 1. The "Comfort Scale for Maintenance Hemodialysis Patients" is concise, clear and convenient to use, and easily accepted by nurses and maintenance hemodialysis patients in China. Testing showed that the scale has good reliability and validity; it is recommended for assessing the comfort status of maintenance hemodialysis patients and evaluating the effect of comfort care interventions. 2. The comfort status survey of maintenance hemodialysis patients showed that comfort in the physical domain was the poorest, followed by the psychological and social domains, while comfort in the environmental domain was relatively good, suggesting that in nursing care physical discomfort should be improved, psychological care emphasized and social support strengthened. 3. Age, household economic level, medical payment method, dialysis frequency, dialysis duration and serum creatinine level can affect the comfort status of maintenance hemodialysis patients, suggesting that in clinical nursing more attention should be paid to patients who are younger, have a poorer household economic situation, pay out of pocket, have less frequent dialysis, a shorter dialysis duration and poorer renal function. 4. Targeted psychological care should be provided for psychological problems caused by worry about treatment efficacy, economic status and other reasons. Corresponding measures should be taken promptly to intervene on the related factors affecting the comfort status of maintenance hemodialysis patients, such as poor sleep, fatigue and weakness, lack of disease-related knowledge, prolonged bed rest, and dry mouth and thirst. 5. Magnetic bead auricular point pressing has a significant effect in improving sleep disorders in maintenance hemodialysis patients; the method is simple and easy to learn, convenient to use and low in cost, with few adverse reactions; it produces positive economic benefits for patients, is easily accepted by patients with high treatment adherence, has a certain promoting effect on improving patient comfort, and is worth promoting and applying in clinical nursing practice.