探討慢性阻塞性肺病病人之罹病經驗

本研究為探討慢性阻塞性肺病個案進入第二期之後之生活經驗，研究目的在了解慢性阻塞性肺病對個案生活的影響、家庭角色功能、人際關係與健康照護體系的經驗。採質性研究，以立意取樣選取符合收案條件之參與者。收案期間為2013年09月至2014年06月，共有5位參加此研究，並有6次訪談資料進行分析。依質性資料主題分析法將本研究結果彙整並歸納成三個主要主題，分別為忽略、困惑與調整策略。而忽略的次主題為：一、對喘感受不明顯；二、不自覺疾病嚴重；三、自覺到醫院就可以處理「不適」。困惑的次主題為：一、對疾病不了解；二、身體狀況與感覺分離；三、對治療看法不同於他人（家人）。調整策略的次主題為：一、促進舒適；二、嘗試維持身體功能；三、尋求資源；四、努力維持個人的完整性（貢獻力）；五、承認但不談未來（不想太多）。結論：個案對疾病不了解，因而忽略慢性阻塞性肺病疾病進展的警訊，而以一般感冒症狀輕忽之，建議加強基層醫療院所對慢性阻塞性肺病的專業判斷與及早診斷。雖然個案對疾病疑惑，但最後迫於疾病仍需做出抉擇；當此類個案處於疑惑或存在希望不願意談到未來時，醫療專業人員在疾病演進和對參與者疾病歷程不了解時要提供不予施行心肺復甦術（Do not Resuscitate, DNR）的建議與說明，需有更多研究，才有辦法在適當的時機介入更多的努力。

關鍵字

慢性阻塞性肺病；罹病經驗

並列摘要

This research attempted to explore the life experience of patients with stage 2 chronic obstructive pulmonary disease (COPD). The purpose of the research was to understand the impact of the disease on patients, on their roles in the family, and on their interpersonal relationships. The research also sought to understand patients’ experience with the health care system. Five participants were chosen using purposeful sampling, and six interviews were conducted between September 2013 and June 2014. With qualitative research thematic analysis, research data was reviewed, and three themes emerged: ignoring, confusion, and adaptation strategies. The sub-themes for ignoring were: (1) ignoring difficulty of breathing; (2) ignoring a potential disease; (3) seeking medical help only for the relief of symptoms. The sub-themes of confusion included: (1) inadequate knowledge of the disease; (2) inadequate knowledge of the symptoms; (3) having different opinions from others (families) as to the treatment of the disease. The sub-themes for adaptation strategies included: (1) seeking relief of symptoms; (2) trying to maintain physical function; (3) seeking resources; (4) trying to maintain social function; (5) accepting the reality but not thinking about the future. The research found that patients tended to ignore the progression of COPD due to lack of understanding of the disease. The research suggested that medical facilities achieve early diagnosis and intervention of COPD. Because of confusion, patients may be forced into medical decisions. Medical professionals, as a result, have to achieve better communication with patients, providing explanation and advice concerning the disease and the use of Do Not Resuscitate (DNR).

並列關鍵字

Chronic Obstructive Pulmonary Disease ； Illness Experiences

參考文獻

汪昇達、王勝廣、高東煒、方文輝、張耀文、高森永等（2011）．高齡患者長期住院醫療利用影響因子之探討．台灣老年醫學暨老年學雜誌，6（2），86－104。

邱啟潤、陳武宗、陳宜品（2005）．慢性病病患家庭照顧者支持系統之研究．長期照護雜誌，9（3），245－262。

邱啟潤、許淑敏、吳淑如（2003）．居家照護個案之主要家庭照顧者綜合性需求調查．醫護科技學刊，5（1），12－25。

邱艷芬、唐修平、曾詩雯（2003）．改良式腹式呼吸法促進慢性阻塞性肺疾病病患肺功能與活動能力之效果．台灣醫學，7（4），492－501。

林金定、嚴嘉楓、陳美花（2005）．質性研究方法：訪談模式與實施步驟分析．身心障礙研究，3（2），122－136。

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探討慢性阻塞性肺病病人之罹病經驗

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