kjan Korean Journal of Adult Nursing Korean J Adult Nurs 1225-4886 2288-338X Korean Society of Adult Nursing 10.7475/kjan.2019.31.1.68 kjan-31-68 Original Article Resilience as a Moderator and Mediator of the Relationship between Symptom Experience and Quality of Life in Hemodialysis Patients Cho Yeon Hee 1 Lee Yun Mi 2 MSN, RN, Department of Nursing, College of Medicine, Inje University, Busan, Korea Professor, Department of Nursing, College of Medicine, Inje University, Institute of Health Science, Busan, Korea Corresponding author: Lee, Yun Mi https://orcid.org/0000-0002-3860-0365 Department of Nursing, College of Medicine, Inje University, 75 Bokji-ro, Kaegum-dong, Pusanjin-gu, Busan 47392, Korea. Tel: +82-51-890-6933, Fax: +82-51-896-9840, E-mail: lym312@inje.ac.kr 22019 2122019 311 6877 12122018 09012019 28012019 Copyright © 2019 Korean Society of Adult Nursing 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

The purpose of this study is to identify the moderating and mediating effects of resilience in the relationship between symptom experience and quality of life.

 Methods

Participants were recruited from one general hospital and one hospital specialized in hemodialysis located in Busan city. The participants included 105 patients diagnosed with chronic renal failure who had been receiving hemodialysis twice a week or more on a regular basis. Data collection was conducted from December 14, 2017, to January 15, 2018. Collected data were analyzed using the SPSS/WIN 24.0 program.

 Results

There were significant correlations between participants'symptom experience and resilience (r=-.36, p<.001), symptom experience and quality of life (r=-.50, p<.001), and resilience and quality of life (r=.67, p<.001), respectively. Resilience had a partial mediating effect (z=-3.48, p<.001) in the relationship between symptom experience and quality of life but did not have moderating effects.

 Conclusion

To improve the quality of life among patients on hemodialysis, it is necessary to develop interventions that enhance resilience in addition to providing symptom relief.

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Symptom Experience, Resilience and Quality of life according to General Characteristics of Patients (N=105

Characteristics Categories n (%) Symptom experience Resilience Quality of life
M± SD t or F (p) M± SD t or F (p) M± SD t or F (p)
Age (year) 50 30 (28.6) 1.10±0.78 1.12 2.24±0.57 0.56 2.97±0.53 0.53
50~59 25 (23.7) 1.24±1.11 (.344) 2.40±0.85 (.646) 3.03±0.58 (.662)
60~69 28 (26.7) 0.87±0.55 2.13±0.76 2.89±0.70
≥70 22 (21.0) 0.91±0.78 2.24±0.78 2.83±0.62
Gender Men 65 (61.9) 0.93±0.79 -1.72 2.19±0.78 -0.88 2.98±0.59 1.02
Women 40 (38.1) 1.21±0.86 (.088) 2.33±0.78 (.384) 2.86±0.63 (.310)
Religion Yes 61 (58.1) 1.07±0.83 0.48 2.30±0.89 1.04 2.97±0.63 0.67
No 44 (41.9) 0.99±0.82 (.631) 2.15±0.60 (.303) 0.89±0.58 (.508)
Marital status Unmarried a 27 (25.7) 1.46±1.04 5.34 2.14±0.75 0.51 2.87±0.64 0.17
Married b 58 (55.2) 0.87±0.60 (.006) 2.31±0.82 (.604) 2.95±0.62 (.844)
Other c 20 (19.1) 0.94±0.90 a＞ b, c† 2.18±0.71 2.96±0.54
Education Uneducated 3 (2.9) 0.65±0.30 0.35 2.08±0.57 1.62 2.77±0.33 2.67
Below middle school 25 (23.8) 0.99±0.80 (.792) 1.99±0.82 (.188) 2.68±0.65 (.051)
High school 46 (43.8) 1.10±0.95 2.26±0.84 2.96±0.63
Above college 31 (29.5) 1.01±0.66 2.44±0.65 3.12±0.48
Occupation Yes 28 (26.7) 1.01±0.71 -0.17 2.46±0.69 1.75 3.06±0.56 1.34
No 77 (73.3) 1.04±0.86 (.864) 2.16±0.80 (.082) 2.89±0.62 (.184)
An average monthly income of households (10,000 won) 100 a 60 (57.1) 1.08±0.92 0.52 2.05±0.81 2.64 2.81±0.66 1.66
100~＜200 b 16 (15.2) 1.00±0.48 (.723) 2.32±0.63 (.038) 3.00±0.48 (.166)
200~＜300 c 9 (8.6) 1.22±0.85 2.69±0.68 a＜ c, e† 3.08±0.48
300~＜400 d 7 (6.7) 1.01±1.02 2.43±0.83 3.16±0.54
≥400 e 13 (12.4) 0.76±0.53 2.61±0.64 3.19±0.54
Duration of hemodialysis (year) 5 a 44 (41.9) 0.85±0.73 3.40 2.22±0.84 0.28 3.07±0.61 1.62
5~＜10 b 22 (21.0) 1.01±0.68 (.021) 2.25±0.72 (.840) 2.89±0.51 (.190)
10~＜15 c 15 (14.3) 1.61±1.16 a, b, d＜ c† 2.12±0.97 2.71±0.67
≥15 d 24 (22.8) 1.03±0.75 2.35±0.60 2.87±0.61
Number of hemodialysis per week 2 6 (5.7) 0.43±0.31 1.99 2.60±0.74 1.10 3.38±0.38 1.99
3 94 (89.5) 1.08±0.84 (.142) 2.20±0.78 (.336) 2.90±0.62 (.141)
4 5 (4.8) 0.83±0.80 2.54±0.85 3.09±0.36
Monthly hospital expenses (10,000 won) 10 49 (46.7) 0.86±0.72 1.26 2.25±0.72 1.82 2.97±0.54 0.54
10~＜20 23 (21.9) 1.25±0.94 (.293) 0.93±0.81 (.130) 2.78±0.72 (.707)
20~＜30 17 (16.2) 1.19±0.97 2.53±0.84 2.93±0.57
30~＜40 10 (9.5) 0.98±0.86 2.49±0.78 3.08±0.52
≥40 6 (5.7) 1.28±0.47 2.15±0.83 2.99±0.90
Comorbidity Yes 83 (79.0) 1.11±0.87 1.84 2.17±0.78 -1.95 2.86±0.61 -2.48
No 22 (21.0) 0.75±0.55 (.068) 2.53±0.75 (.054) 3.21±0.50 (.015)

LSD test.

Level of Symptom Experience, Resilience and Quality of Life of Patients (N=105)

Variables M± SD Range Min Max
Symptom experience 1.03±0.82 0~5 0.03 4.06
 Physical symptoms 1.01±0.79 0~5 0.04 4.00
 Emotional symptoms 1.10±1.08 0~5 0.00 4.22
Resilience 2.24±0.78 0~4 0.08 4.00
Quality of life 2.93±0.61 1~5 1.31 4.35

Correlation among Symptom Experience, Resilience, and Quality of Life of Patients (N=105)

Variables Symptom experience Resilience Quality of life
r (p) r (p) r (p)
Symptom experience 1
Resilience -.36 (＜.001) 1
Quality of life -.50 (＜.001) .67 (＜.001) 1

Moderating Effect of Resilience between the Symptom Experience and Quality of life of Patients (N=145)

Variables Model 1 Model 2 Model 3 Model 4
B SE β t p B SE β t p B SE β t p B SE β t p
Associated disease 9.14 3.70 .24 2.48 .015 5.85 3.30 .15 1.77 .079 3.13 2.69 .08 1.17 .247 3.13 2.70 .08 1.16 .249
Symptom experience -0.29 0.05 -.48 -5.58 ＜ .001 -0.18 0.04 -.29 -3.98 .001 -0.17 0.05 -.29 -3.64 ＜ .001
Resilience 0.44 0.06 .55 7.45 .001 0.44 0.06 .55 7.40 ＜ .001
Symptom experience × Resilience 3.98 0.00 .00 0.02 .985
R2 .06 .28 .53 .53
Adjusted R2 .05 .26 .52 .52
F (p) 6.13 (.015) 19.50 (＜.001) 38.47 (＜.001) 28.56 (＜.001)

Mediating Effect of Resilience between the Symptom Experience and Quality of life of Patients (N=105)

Step Independent variables Dependent variables β t (p) Adjusted R2 F (p)
1 Symptom experience Resilience -.36 -3.93 (＜.001) .122 15.40 (＜.001)
2 Symptom experience Quality of life -.48 -5.58 (＜.001) .262 19.50 (＜.001)
3 Symptom experience Resilience Quality of life -.29.55 -3.98 (＜.001)7.45 (＜.001) .519 38.47 (＜.001)
Sobel test: z=-3.48, p＜.001