Illness Representations and Coping Processes of Taiwanese Patients with Early-Stage Chronic Kidney Disease

早期慢性腎臟疾病病患之疾病詮釋與因應過程

林秋菊(Chiu-Chu Lin) ； 陳玫君(Mei-Chun Chen) ； 謝秀芳(Hsiu-Fang Hsieh) ； 張淑真(Shu-Chen Chang)

《The Journal of Nursing Research》 21卷2期 (2013/06) Pp. 120-128

https://doi.org/10.1097/JNR.0b013e3182921fb8

摘要

背景：慢性腎臟疾病（chronic kidney disease, CKD）之盛行率及發生率不斷增加，醫療花費亦高，已是普遍存有的公共衛生議題。個人對於疾病的詮釋會影響其健康相關的行為，然早期慢性腎臟疾病病患對其疾病的感受表現卻鮮少受到關注。目的：本質性研究旨在描述台灣的早期CKD病患疾病詮釋與因應過程之經驗。方法：本研究以立意取樣，從台灣兩家醫學中心腎臟科門診中，招募15位確診為早期CKD之病患為研究對象。採半結構、開放式之一對一、面對面訪談，訪談結果以質性內容分析方法進行分析，並以Lincoln與Guba所提的嚴謹度之四個準則進行評核。結果：從質性分析中得出以下六大主題：經歷到早期症狀、自我解釋其罹患CKD之原因、體認CKD是一種長期性疾病、相信遵從醫囑就可以控制CKD、預料罹患CKD的後果、以及採取因應策略來延緩CKD之病程。結論／臨床應用：本研究發現，健康照護專業人員對於患有腎臟疾病此族群病患，對其疾病的解讀與因應有更進一步的瞭解。相較於過去所發表之研究結果顯示，個人的疾病詮釋可以透過教育改變，繼而改善個人的因應行為。此發現使健康專業人員更體認到，進行衛生教育前，必須先評估個案對其疾病的解讀為何，如此方能提供具文化敏感性的介入措施。

關鍵字

慢性腎臟疾病 ； 因應過程 ； 疾病詮釋 ； 質性研究

並列摘要

Background: Chronic kidney disease (CKD) is a public health problem worldwide with an increasing incidence and prevalence and high cost. The role of illness perceptions in understanding health-related behavior has received little attention in patients with early-stage CKD. Purpose: This qualitative study aimed to describe the illness representation and coping process experience of patients with early-stage CKD in Taiwan. Methods: A qualitative content analysis approach was used to analyze semistructured, open-ended, one-on-one interviews with 15 patients with early-stage CKD. Purposive sampling was used to recruit patients diagnosed with early-stage CKD from the nephrology departments of two medical centers in Taiwan. Trustworthiness of the study was evaluated using four criteria suggested by Lincoln and Guba. Results: Six themes emerged from the analysis: experiencing early symptoms, self-interpreting the causes of having CKD, realizing CKD as a long-term disease, believing CKD could be controlled by following doctors' orders, anticipating the consequences of having CKD, and adopting coping strategies to delay the progress of CKD. Conclusions/Implications for Practice: Findings from this study compared with previous studies reveal that education can effectively change patient illness representations as an approach to improve coping behavior. This finding offers healthcare professionals insight into the health education necessary to assess patient illness representation to provide culturally sensitive interventions.

並列關鍵字

chronic kidney disease ； coping ； illness representation ； qualitative study

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