造血幹細胞移植病患住院期間主觀治療經驗

Patients’ Experiences of Hematopoietic Stem Cell Transplantation in Hospitalization: A Qualitative Research

梁天麗(Tienli Liang) ； 廖怡珍(I-Chen Liao) ； 李美麗(Mei-Li Lee) ； 林冠品(Kuan-Pin Lin)

《弘光學報》 74期 (2014/12) Pp. 82-101

https://doi.org/10.6615/HAR.201412.74.06

摘要

造血幹細胞移植是血液腫瘤病患寄望治癒的醫療方式，然而在整個移植過程中病患承受相當程度的痛苦，治療副作用產生的症狀不僅在生理上造成影響，在心理、社會與家庭功能等層面也都遭受衝擊，其中又以移植後住院期間急性期的影響最顯著。本研究是探討接受周邊造血幹細胞移植病患住院期間對於治療的主觀經驗感受，採質性研究方法，以半結構式深度訪談萃取其治療經驗，收案方式是在中部某醫學中心血液腫瘤科病房進行，採立意取樣、年滿20歲並接受自體或異體周邊造血幹細胞移植之成人病患，共訪談八位患者，所得資料以內容分析法進行分析，結果歸納出四大主題和十四個類屬：在『生理困擾』的部分，由於移植前接受高劑量化學治療引起許多明顯的副作用，使得病患感受到明顯的生理症狀困擾例如：「噁心嘔吐」、「口腔黏膜破損」、「味覺改變」、「睡眠品質不佳」、「疲憊」、「環孢靈服用困擾」等。第二個主題是『擔憂』，病患對於移植的過程與結果開始產生不確定感，焦慮擔憂常常困擾著他們，包含的類屬有：「擔心生育問題」、「擔心移植失敗與復發」、「擔心感染」。第三個主題是「困難重重」，住院期間由於需龐大的醫藥費用、家人的辛苦照料與必須採取保護隔離，在家庭社會層面也出現困境，讓病患覺得艱鉅的任務困難重重，包含的類屬有：「人際互動模式的改變」、「對家庭的衝擊」、「經濟困難」。最後，病患在層層困難之下產生因應的方式，其中『堅持的信念』是支撐他們繼續下去的動力，包含的類屬有：「拼下去」、「宗教信仰的認定」。本研究主要的發現是雖然病患在移植期間承受著極大的身心痛苦，然而他們也從受苦過程以心中信念堅持下去，此外，研究也發現家庭與宗教信仰對於病患是重要的信念來源，建議醫護人員應更積極地傾聽、給予關注並運用同理心，使得在此移植的過程更能夠提供適切的護理照顧。

關鍵字

造血幹細胞移植 ； 主觀經驗

並列摘要

Hematopoietic stem cell transplantation(HSCT) is a successful therapy of malignant disorders, but during the HSCT process many patients experience high levels of physical and psychosocial distress related to the unpredictability of their progress. The purpose of this study was to explore the subjective experiences of cancer patients who had received hematopoietic stem cell transplantation (HSCT) in hospitalization in Taiwan. The participants for this study consist of 8 adult (＞20 years) patients with cancer for HSCT recruited through purposive sampling. The qualitative research involved analyzing verbatim transcriptions of tape-recorded interviews with patients. The interviews were held before discharge from the hospital in the Oncology unit. Four major themes emerged regarding participants´ experiences: (a) physical distress, (b) worry, (c) difficulties (d) adhere to the belief. The participants expressed their physical distress and anxiety often was related to the transplant process and worry about failure or cancer recurrence. They could re-consider meaning in their lives even after confronting very suffering situations. In addition, the findings of this study indicate that having religious beliefs and practicing one´s religion were important for participants. There is an ongoing need for nurses to listen sensitively, attentively and empathically in order to provide appropriate support through therapeutic nursing care.

並列關鍵字

hematopoietic stem cell transplantation ； subjective experiences

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