血液透析患者復原力之探究

A Study on Resilience of Hemodialysis Patient

楊敏婕(Min-Jie Yang)

指導教授 ： 蔡佩真

國立暨南國際大學/人文學院/社會政策與社會工作學系/碩士(2016年)

摘要

慢性病為持續或長期的疾病，現已十分普遍，患者罹病後如何運用復原力讓其能適應疾病為十分重要的課題。血液透析(洗腎)為典型的慢性疾病，其有著病程穩定，不會立即有生命危險的特性。因此本研究以血液透析患者為主，並採用紮根理論，試圖建立血液透析患者復原力發展模式。發展出本研究的研究目的:一為建立血液透析患者復原力發展模式，二為了解血液透析患者復原力發展的現況。
本研究訪談了9位血液透析患者，透析年資不限，分布地區為台南彰化與南投地區研究發現，復原力發展模式包含保護因子、因應策略與四個歷程變化，在每個歷程中，包含了個人、醫療與家庭保護因子與個體不同的因應策略，且每個歷程的階段中，患者的階段所展現的保護因子與因應策略影響程度各會不同；血液透析復原力發展為一個歷程，歷程有著變動性與持續發展性，且根據歷程不同，在身體、心境與未來規劃與想法也有所不同，開始透析後，身體狀況逐漸恢復，此時的患者心境也會逐漸平穩，對未來也充滿希望與想法，隨著併發症出現後，身心狀況逐漸起伏不定，對未來也從充滿期望變成不敢期待。所以身體狀況為影響復原力發展的關鍵，血液透析患者的復原力會因身體狀況逐漸衰弱而使得復原力無法穩定再提升。
本研究最後則根據研究結果針對醫療團隊、血液透析患者與家庭分別提出建議，以提供專業人員與未來研究之參考。

關鍵字

血液透析 ； 慢性病 ； 復原力 ； 復原力模式 ； 透析

並列摘要

Chronic illnesses, diseases that are persistent or long-lasting, have been commonly seen in the modern society. How patients use resilience for subsequent adaption is a vital issue. Hemodialysis, a typical chronic illness, features a stable course of disease and does not impose immediate danger to sufferers. The current study, therefore, focused on hemodialysis patients and adopted the grounded theory to build the resilience model for such patients. Specific purposes of the study included: (1) to build the resilience model for hemodialysis patients, and (2) to probe into the status quo of resilience development among hemodialysis patients.
A total of nine hemodialysis patients from Tainan, Changhua, and Nantou were interviewed, regardless of the length of their hemodialysis treatment. The resilience model included protective factors, corresponding strategies, and four stages. Each stage included different protective factors (individual, medical, and family) as well as individual-specific corresponding strategies. In each stage, patients demonstrated different protective factors and corresponding strategies. Hemodialysis resilience development is a progress that features variation and persistent development. Different progresses demonstrate different physical conditions, mindset, and future planning. Upon dialysis, the patients gradually recovered and their mindset gradually became stable, enabling them to be hopeful of the future. With the appearance of complications, the patient’s psychological and physical conditions turned unstable, making them not to expectant of the future. Therefore, physical condition is the key to resilience development. Resilience among hemodialysis patients gradually weakens and fails to improve due to weakening physical conditions.
The current study concludes with suggests for medical teams, hemodialysis patients, their families, and future researchers.

並列關鍵字

Hemodialysis Patients ； Chronic illness ； Resilience ； Resilience model ； dialysis

參考文獻

中文部分:

中央健康保險局(2012)。101年門診透析總額專業醫療服務品質報告。

王文玲(1992)。與慢性病共存－慢性病患家庭的需要。護理雜誌，39(3),25－30。

白倩如（2010）。機構安置少女復原力培育之行動研究。臺大社工學刊，25， 103-155。

白倩如、林仰慈、曾華源 (2014)。復原力任務中心社會工作：理論與技術。台北:洪葉。