發展一個理論指導末期腎臟疾病患者適應腹膜透析

台灣在末期腎臟疾病發生率及透析治療流行率為全球居冠。「2017年腎病年報」中指出台灣使用腹膜透析比率從2007年13.1%增加至2015年71.3%。在末期腎臟疾病患者在面臨需要長期透析治療時，將面臨其身心衝擊與抉擇衝突。因此，本研究的目的為發展出一個理論去指導末期腎臟疾病患者適應腹膜透析，採用質性研究的紮根理論研究法，從南部某醫學中心收案，共訪談25位已適應腹膜透析之病患後達到資料飽和，資料收集時間從2018年01月至2018年9月。資料分析使用開放編碼、主軸編碼、選擇編碼，並採用NVivo 11電腦軟體協助整理。本研究結果發展出一個理論指導末期腎臟疾病患者適應腹膜。『面對腹膜透析生活，與透析共存』為最重要的核心類別。其它重要類別和次類別連接著核心類別是：一、自我內在調節：自我克服、自我轉念、轉移注意力；二、日常生活的調適：日常生活透析注意要點、預防日常生活透析的感染；三、適應透析方法過程：善用輔助工具、變通透析方法。此研究結果可幫助醫療人員瞭解末期腎臟疾病患者適應腹膜透析的過程，進而幫助患者能盡早適應腹膜透析生活，以提升患者生活品質和醫療照護品質。

關鍵字

末期腎臟疾病；腹膜透析；適應；紮根理論

並列摘要

Taiwan ranks first worldwide in end-stage renal disease(ESRD) incidence and dialysis prevalence. The「2017 Taiwan Nephrology Annual Report」indicates that the proportion of patients with ESRD who undergo peritoneal dialysis(PD) increased from 13.1% in 2007 to 71.3% in 2015. When ESRD patients face the requirement of long-term dialysis, they also confront physical and mental distress and conflict of choice. Thus, this study aimed to develop a theory to guide patients with ESRD to adapt to PD using qualitative grounded theory. After interviewing 25 patients who had adapted to PD at a medical center in Southern Taiwan from January 2018 to September 2018, data saturation was achieved. Data analysis was conducted with open coding, axial coding, and selective coding using NVivo 11 software to assist in data organization. From the results of this study have developed a theory that guide patients with ESRD to adapt to PD. The most important core category in this theory was, “confronting peritoneal dialysis to live and co-exist with dialysis”. Other important categories and sub-categories, which connect to the core category, included:1.Self-inherent regulation: overcoming oneself, self-transformation to positive thinking, and divert attention to adjust; 2. Regulation of daily life: points to note on dialysis in daily life, prevention of dialysis-related infection in daily life; 3.The process of acclimating to dialysis method: making the best use of assisting tools and being flexible towards dialysis methods. The results could help medical personnel to better understand the process of ESRD patients’ acclimation to PD, thereby facilitating the adaption of ESRD patients to undergo dialysis in their daily life, enhancing their quality of life, and improving the quality of medical care.