臺灣博碩士論文加值系統

末期腎臟疾病接受血液透析患者疲憊感是最常見的症狀，此影響患者的情緒和生活品質。本研究的目的在檢視穴位指壓按摩對末期腎臟疾病患者改善其疲憊感、生活品質和憂鬱的成效。本研究為實驗型前測和後測研究設計，研究對象為南部一所區域醫院及醫學中心的洗腎室，洗腎時間超過三個月以上的病患；採方便取樣62位洗腎病患，以分層隨機方式（一、三、五；二、四、六）隨機分配至實驗組及控制組各31位。實驗組患者接受每星期三次及每次15分鐘的按摩及穴位指壓，為期四週；控制組則接受一般洗腎照護。四週前、後以結構式問卷：疲憊感量表、生活品質量表（SF-36台灣版）、貝氏憂鬱量表進行會談，收集實驗組與控制組疲憊感、生活品質及憂鬱的得分。所得資料以描述性統計分析、卡方檢定、配對t檢定、獨立樣本t檢定及共變異數分析（ANCOVA）進行資料分析與檢定。結果顯示：研究對象有中等程度的疲憊感受，有63.8﹪的患者有憂鬱情緒及生活品質比一般人低。在介入實驗處置後，實驗組之疲憊感（F=9.05, p=.004）、憂鬱（F=4.20，p=.045）和生活品質之心理健康構面（F=5.65, p=.02）之改善顯著優於控制組，顯示穴位指壓介入措施，能顯著改善患者的疲憊感、憂鬱及生活品質。研究結果建議可將此減輕疲憊感之穴位指壓方案納入洗腎患者的護理照護中，以提高護理末期腎臟疾病接受血液透析患者的照護品質。

Fatigue is the most significant symptom experienced by patients with end-stage renal disease. The purpose of this study is to examine the effectiveness of acupressure in fatigue, quality of life and depression among patients with end-stage renal disease (ESRD) who were receiving hemodialysis treatment.
The study is an experimental pretest and posttest design. Sixty-two hemodialysis patients participated in the study. Data were collected from two hemodialysis clinics of major hospitals in the southern Taiwan. Subjects were randomly assigned to an acupressure group or a control group. Patients in the acupressure group received acupoints massage for 15 minutes per day, 3 days per week, for a consecutive of 4 weeks. Subjects in the control group only received unit routine care. The measures included the Revised Piper Fatigue Scale, the Beck’s Depression Inventory and the MOS SF-36. Descriptive statistics, c2 tests, t-test and analyses of covariance were used for data analysis. The results indicate that hemodialysis patients experienced a moderate level of fatigue. Nearly 65﹪of hemodialysis patients had a depressed mood. Patients rated their quality of life were lower than the normal population. ANCOVA results indicates that fatigue, depression and quality of life of patients in the acupressure group had a significantly greater improvement（p＜0.05）than patients in the control group. Findings of this study provide an interventional model for nurses who are taking care of ESRD patients.

誌 謝 --------------------------------------------------- I
中文摘要 --------------------------------------------------- II
英文摘要 --------------------------------------------------- IV
目 錄 --------------------------------------------------- VI
圖表目次 --------------------------------------------------- IX
第一章 緒論
第一節 研究動機及重要性 ---------------------------------- 1
第二節 研究目的 ------------------------------------------- 2
第二章 文獻查證
第一節 末期腎臟疾病的定義及處置 -------------------------- 3
第二節 疲憊感的定義 -------------------------------------- 3
第三節 有關疲憊感的研究 ---------------------------------- 8
第四節 穴位指壓 ------------------------------------------ 9
第五節 有關穴位指壓的研究 --------------------------------18
第六節 生活品質的定義 ------------------------------------19
第七節 末期腎臟疾病與生活品質的研究 ------------------------22
第八節 憂鬱的定義 ------------------------------------------24
第九節 末期腎臟疾病與憂鬱 ----------------------------------25
第三章 研究架構、假設、名詞界定
第一節 研究架構 ------------------------------------------28
第二節 研究問題與假設 ------------------------------------28
第三節 名詞解釋 ------------------------------------------29
第四章 研究方法
第一節 研究設計 ------------------------------------------31
第二節 研究對象 ------------------------------------------32
第三節 研究工具 ------------------------------------------32
經穴指壓方案 -------------------------------------------32
穴位的選定 --------------------------------------------33
指壓手法的選擇 ----------------------------------------34
介入處置的時間 ----------------------------------------35
經穴指壓之信效度控制 ----------------------------------35
疲憊量表 ----------------------------------------------37
生活品質量表 ------------------------------------------38
貝氏憂鬱量表 ------------------------------------------40
第四節 研究過程 ------------------------------------------41
第五節 資料處理與分析 ------------------------------------43
第五章 研究結果
第一節 研究對象背景資料 ----------------------------------44
第二節 穴位指壓對血液透析患者疲憊感的成效 ----------------51
第三節 穴位指壓對血液透析患者生活品質的成效 ----------------55
第四節 穴位指壓對血液透析患者憂鬱的成效 --------------------60
第五節 研究對象指壓後的主觀感覺 ----------------------------64
第六章 討論
第一節 研究對象基本資料之分佈 ----------------------------65
第二節 血液透析患者之疲憊感、生活品質及憂鬱的狀態 --------66
第三節 穴位指壓對血液透析患者疲憊感、生活品質及憂鬱的成效 68第七章 討論與建議
第一節 結論 ----------------------------------------------71
第二節 研究之限制 ----------------------------------------71
第三節 護理上之應用與建議 --------------------------------72
參考文獻
中文部分 --------------------------------------------------74
英文部分 --------------------------------------------------78
附 錄
附錄一 研究工具使用同意函 ---------------------------------87
附錄二 研究工具使用同意函 ---------------------------------88
附錄三 研究說明書 -----------------------------------------89
附錄四 參與研究同意書 -------------------------------------90
附錄五 穴位點位置圖 ---------------------------------------91
附錄六 實驗組穴位指壓方案 ---------------------------------92
附錄七 實驗組穴位指壓方案之專家評分表 ---------------------93
附錄八 專家效度函 -----------------------------------------94
附錄九 實驗組穴位指壓方案之專家內容檢定 -------------------95
附錄十 穴位指壓方案專家效度名單 ---------------------------96
附錄十一 指壓力量之內在信度測定 -----------------------------97
附錄十二 穴位指壓部位之正確性專家認定表格 -------------------98
附錄十三 問卷 -----------------------------------------------99
圖表目錄
圖3-1 概念性架構 -------------------------------------------28
表3-1 研究模式 ---------------------------------------------31
表5-1 研究對象社會人口學資料 -------------------------------49
表5-2 研究對象疾病相關屬性資料 -----------------------------50
表5-3 兩組研究對象之疲憊感 ---------------------------------53
表5-4 兩組研究對象疲憊感之共變數分析 -----------------------54
表5-5 以成對t檢定兩組研究對象疲憊感、生活品質和憂鬱之前後差 55
表5-6 兩組研究對象之生活品質次量表得分 ---------------------59
表5-7 兩組研究對象生活品質之共變數分析 ---------------------60
表5-8 研究對象之憂鬱程度 -----------------------------------63
表5-9 兩組研究對象憂鬱程度之比較 ---------------------------63
表5-10 兩組研究對象憂鬱之共變數分析 -------------------------63

一、中文部分
方吾八（1994）‧手法刺激強度及演變規律的探索‧按摩與導引，55（2），14-15。
王志萍、張煜、馬志民、李祥煌（2000）‧隔葯灸結合血透治療慢性腎功能衰竭療效觀察‧中國針灸，3，136-138。
中華民國腎臟基金會（2000）‧台灣地區八十九年度透析人數統計圖‧透析通訊，38（12）。
印會河（1997）‧中醫基礎理論‧台北：知音。
江惠英、鍾信心（1995）‧血液透析病人疲倦感與社會支持、憂鬱傾向及血液生化檢驗值相關性探討‧護理研究，5（2），115-126。
李和惠等著（1997）‧當代內外科護理（第四版）‧台北：華杏。
何權峰（1996）‧穴道保健新紀元-傳統穴療的科學詮釋與實用‧台北：宏欣。
吳樺姍、林麗嬋（2000）‧經穴指壓對改善慢性阻塞性肺疾病患者呼吸困難的成效‧未發表之碩士論文，台北：陽明大學。
林秋菊、賴曉蓉、周偉倪（2000）‧運動訓練對血液透析病患生理、心理之效應‧中華衛誌，19（3），161-170。
林季宏、曾冬勝、龍弗衛、郭泰松（2000）‧尿毒症患者合併有憂鬱症之文獻回顧‧當代醫學，27（7），598-603。
林文森‧陳必誠（2001）‧電針血海穴對於血液透析患者尿毒性搔癢症的療效評估‧未發表之碩士論文，台中：中國醫藥學院。
昊曉鳴（1996）‧按摩對人體機能的影響探索‧按摩與導引，71（6），44-45。
周海波（2000）‧足三里在臨床中的運用‧針灸臨床雜誌，16（12），30-31。
卓姬（2000）‧淺談三陰交配伍應用‧針灸臨床雜誌，16（11），33-34。
芹澤勝助（2001）‧穴道指壓‧台北：書泉。
洪振傑（1992）‧腎病末期患者的生活品質‧腎臟與透析，4（2），147-149。
洪麗嬌（2001）‧穴位點指壓對待產婦的影響‧未發表之碩士論文，台北：台北護理學院。
柯慧貞、陸汝斌（1994）‧貝克氏憂鬱量表之心理計量特性：在台十年評估‧中華民國精神醫學會（第三十三屆）論文發表摘要。
姜小英（2001）‧艾灸足三里、關元穴對血液流變性的影響‧四川中醫，19（3），75。
施淑娟（2002）‧比較時間增長型及強度增強型運動訓練計畫對心臟衰竭病患之成效 ‧未發表的碩士論文，台北：台北醫學院。
陳美玲、顧乃平（1996）‧血液透析病患生活品質及其相關因素探討‧未發表的碩士論文，台北：國防醫學院。
馬素華（1997）‧穴位點壓法對於慢性阻塞性肺疾病人的成效‧長庚護理，8（4），13-25。
馬素華（1998）‧穴位點壓法簡介‧長庚護理，9（3），85-89。
馬素華（2000）‧台灣中醫護理研究現況與未來發展‧護理雜誌，47（6），25-31。
張美月（2000）‧按摩對減輕分娩婦女疼痛感受與焦慮之成效‧未發表的碩士論文，高雄：高醫大學。
陳麗麗、王純娟、蔡秀珠（1998）‧穴位按摩法對剖腹產後促進腸蠕動療效之初探‧護理研究，6（6），526-534。
高陽堂譯（2001）‧指壓教本（第二版）‧台南：大孚。
黃秋錦（1995）‧透析治療在台灣-1995年透析評估‧中華民國腎臟醫學誌，9，71-83。
黃世惠、藍忠孚（1991）‧腎病人品質之研究‧未發表的碩士論文，台北：國立陽明大學。
張永賢（2000）‧經穴按摩保健康（第九版）‧台北：元氣齋。
張貴昌（2001）‧實用穴道療法‧台北：正展。
楊甲三（1994）‧針灸學上、下冊‧台北：知音。
董秀閣（1996）‧臨床治療中寮時問題之管見‧按摩與導引，71（6），4-6。
蔡仁貞（1996）‧冠狀動脈病患疲倦感受度、運動耐力與日常活動量之探討‧護理研究，4（4），312-320。
賴永勳、黃尚志、楊五常、暨中華民國腎臟醫學會透析評估委員（1998）‧台灣地區八十七年度透析評估工作報告‧中華民國腎臟醫學會雜誌，12，157-195。
劉世森、高益民（1991）‧圖解實用保健按摩‧台北：渡假。
劉淑樺、陳彰惠（2000）‧運動訓練對血液透析病患運動耐力、血液生化值、疲憊與健康控制歸因之成效‧未發表的碩士論文，高雄：高醫大學。
劉淑樺、周偉倪、王鈺霖、林恆騰、黃文君、沈靜枝（2000）‧運動訓練對尿毒血液透析患者在心費耐力與憂鬱狀態之效果‧中華復健醫誌，28（4），237-243。
劉文良、盧瑞芬、吳淑瓊、詹嘉萍、池惠娟（1996）‧長期照護需求量表的建立SF-36中文版‧行政院衛生署研究發展計畫研究報告。
盧令儀、盧瑞芬、王炳龍（2000）‧某教學醫院冠狀動脈疾病病患施行心臟相關手術後生活品質之探討‧未發表的碩士論文，桃園：長庚大學。
鍾麗娟、高紀惠（1995）‧血液透析患者疲憊定義特徵及相關因素之臨床校度測定‧長庚護理，6（2），13-25。
鍾麗娟、方基存（1998）‧末期腎病患者疲憊之介紹‧腎臟與透析，10（4），205-211。
謝紅桂（2001）‧血液透析病人生活品質及其相關因素探討‧未發表的碩士論文，台南：成功大學。
辭海編輯委員會（1981）‧辭海（中）‧台北：中華。
二、英文部分
Aaronson, L. S., Teel, C. S., Cassmeyer, V., Neuberger, G. B., Pallikkathayil, L., Pierce, J., Press, A. N., Williams, P. D., & Wingate, A. (1999). Defining and measuring fatigue. Image-the Journal of Nursing Scholarship, 31(1), 45-50.
Aaronson, N. (1988). Quality of life : What is it ?How should it be measured. Oncology, 2(5), 69-74.
Aghanwa, H. S., & Morakinyo, O. (1997). Psychiatric complications of hemodialysis at a kidney center in Nigeria. Journal of Psychosomantic Research, 42(5), 445-452.
Anonymous. (1998). News in mental health nursing. Acupuncture shows promise in treating depression. Journal of Psychosocial Nursing & Mental Health Services, 36(11), 7.
Barrett, B. J., Vavasour, H. M., Major, A., & Parfrey, P. S. (1990). Clinical and psychological correlates of somatic symptoms in patient on dialysis. Nephron , 55, 10-15.
Brazier, J. E., Harper, R., Jones, N. M. B., O’Cathain, A., Thomas, K. J., Usherwood, t., & Westlake. (1992). Validating the SF-36 health survey questionnair: new outcome measure for primary care. BMJ, 305(18), 160-164.
Broomhead, C. J. (1995). Reducing the incidence of postoperative nausea and vomiting. British journal of Hospital Medicine, 53(10), 511-512.
Bruckbauer, E. A. (1991). Recognizing poststroke depression. Rehabilitation Nursing, 16(1), 334-339.
Brunier, G. M., & Graydon, J. (1993). The influence of physical activity on fatigue in patients with ESRD on hemodialysis. ANNA Journal, 20(4), 457-461.
Brunier, G. M., & Graydon, J. (1996). A comparison of two methods of measuring fatigue iin patients on chronic hamodialysis : visual analogue vs likert scale. International Journal of Nursing Studies, 33(3), 338-348.
Buckwalter, K. C., & Babich, K. S. (1990). Psychologic and physiologic aspects of depression. Nursing Clinics of North America, 25(4), 945-953.
Cagney, K. A., Mu, A. W., fink, N. E., Jenckes, M. W., Meyer, K. B., Bass,E. B., & Powe, N. R. (2000). Formal literature revivw of Quality-of-Life instrumente used
in End —Stage Renal disease. American Journal of Kidney Disease, 36(2), 327-336.
Cameron, J. I., Whiteside, C., Katz, J., & Devins, G. M. (2000). Differences in quality of life across renal replacement therapies:a meta-analytic comparison. American Journal of Kidney Disease, 35(4), 629-637.
Cardenas, D. D., & Kuter, N. G. (1982). The problem of fatigue in dialysis patients. Nephron, 30, 336-340.
Carpentio, L. J. (1995). Nursing diagnosis: Application to clinical Practice. Philadelphia: J. b. Lippincott.
Chen, M. L., Lin, L. C., Wu, S. C., & Lin, J. G. (1999). The effectiveness of acupressure in improving the quality of sleep of institutionalized residents. Journal of Gerontology, 54A(8), 389-394.
Clancy, D., Mathews, M., & Shlay, J. C. (1996). Jin Shin Jyutsu acupressure to improve quality of life in people with HIV/AIDS. Alternative & Complementary Therapies, 2(3), 173-5.
DeOreo, P. B. (1997). Hemodialysis patient-assessed functional status predicts continued survival, hospitalization, and dialysis-attendance compliance. American Journal of Kidney Diseases, 30(2), 204-212.
Diaz-Buxo, J. A., Lowrie, E. G., Lew, N.L., Zhang, H., & Lazarus, J. M. (2000). Quality of life evaluation using Short Form 36: comparison in hemodialysis and peritoneal dialysis patient. American Journal of Kidney Disease, 35(2), 293-300.
Dunn, C., Sleep, J., & Collett, D. (1995). Sensing an experimental study to elaluate the use of aromatherapy, massage and period of rest in an intensive care unit. Journal of Advanced Nursing, 21, 34-40.
Ferrans, C. E., & Powers, M. J. (1992). Psychometric assement of the quality of life index. Research in Nursing & Health, 15, 29-38.
Freeman, L. W., & Lawlis, G. F. (2001). Mosby’s complementary and alternative therapy: A research-based approach. St. Louis: Mosby.
Gift, A. G. (1989a). Visual analogue scales: measurement of subjective phenomena. Nursing Research, 38(5), 286-288.
Gift, A. G. (1989b). Validation of a vertical visual analogue scale as a measure of clinical dyspnea. Rehabilitation Nursing, 14(6), 323-325.
Gift, A. G., & Pugh, L. C. (1993). Dyspnea and fatigue. Nursing Clinics of North America, 28(2), 373-384.
Hagerty, B. M., & Williams, A. R. (1999). The effects of sense of belonging, social support, conflict, and lonliness on depression. Nursing Research, 48(4), 215-219.
Harbara, B. K. (1999). Clarification and integration of similar quality of life concepts. Image: Journal of Nursing Scholarship, 31(3), 215-220.
Hare, M. L. (1988). Shiatsu acupressure in nursing practice. Holistic Nursing Practice, 2(3), 68-74.
Hart, L. K., Freel, M. L., & Milde, F. K. (1990). Fatigue. Nursing Clinics of North America, 25(4), 967-976.
Hass, B. K. (1999). Clarification and integration of similar quality of life concepts. Image: Journal of Nursing Scholarship, 31(3), 215-220.
Irvine, D. M., Vincent, L., Graydon, J. E., & Bubela, N. (1998). Fatigue in women with breast cancer receiving radiation therapy. Cancer Nursing, 21(2), 127-135.
Kathleen, M., & Jennifer, B. (2000). Fatigue in persons with renal failure who require maintenance haemodialysis. Journal of Advanced Nursing, 32(5), 1132-1142.
Kelly, M. (1996). Chronic renal failure. American Journal Nursing, 96(1), 36-37.
Killingworth, A. (1993). Psychosocial impact of end-stage renal disease. British Journal of Nursing, 2(18), 905-909.
Kimmel, P. L., Peterson, R. A., Weihs, K. L., Simmens S. J., Alleyne, S., Cruz, I., & Veis, J. H. (2000). Multiple measurements of depression predict ortality in a longitudinal study of chronic hemodialysis outpatients. Kidney International, 57(5), 2093-2098.
Lee, K. A., Hicks, G., & Nino-Murcia, G. (1990). Validity and reliability of a scale to assess fatigue. Psychiatry Research, 36, 291-298.
Lok, P. (1996). Stressors , coping mechanisms and quality of life among dialysis patients in Australia. Journal of Advanced Nursing, 23, 873-881.
Lombardo, N., Dresser, m., Malivert, M., McManus, C., Vehvilainen, L., Ooi, W., Rosowsky, e., Drebing, C., Sheridan, P., Lewis, S.., Imada, T., Hohnstein, J., & Perry, K. (2001). Acupuncture as treatment for anxiety and depression in person with dementia: results of a feasibility and effectiveness study. Alzheimer’s Care Quarterly, 2(4), 28-41.
Luria, R. E. (1975). The validity and reliability of the visual analogue mood scale. Journal of Psychiatric Research, 12(1), 51-57.
Malkin, K. (1994). Use of massage in clinical practice. British Journal of Nursing, 3(6), 292-294.
Maxwell, J. (1997). Complementary therapies: the gentle power of acupressure. RN, 60(4), 53-56.
McCaffery, M., & Pasero, C. (1999). Culturally sensitive pain control. American Journal of Nursing, 99(8), 18.
McCann, K. & Boore, J. (2000). Fatigue in persons with renal failure who require maintance haemodialysis. Journal of Advanced Nursing, 32(5), 1132-1142.
McCorkle, R. & Young, K. (1978). Development of a symptom distress scale. Cancer Nursing, 1, 373-378.
McEwen, D. R. (1994). Arteriovenous fistula vascular access for long-term hemodialysis. AORN Journal , 59(1), 225-32.
Meeberg, G. A. (1993).Quality of life: a concept analysis. Journal of Advanced Nursing, 18, 32-38.
Meruks, M, P., Jager, K, J., Dekker, F. W., Boeschoten, E. W., Stevens, P.,Krediet
, R. T. (1999). Physical symptoms and quality of life in patients on chronic dialysis: Results of The Netherands Cooperative Study on Adequacy of Dialysis（NECOSAD）
.Nephrology Dialysis Transplantation, 14, 1163-1170.
Mingardi, G., Cornalba, L., Cortinovis, E., Ruggiata, R., Mosconi, P., & Giovanni Apolone for the DIA-QOL Group. (1999). Health-related quality of life in dialysis patients. A report from an Italian study using the SF-36 Health Survey. Nephrol Dial Transplant, 14, 1503-1510.
O’Donnell, K., & Chung, J. Y. (1997). The diagnosis of major depression in end-stage renal disease. Psychotherapy & Psychosomatics, 66(1), 38-43.
Painter, P., & Zimmerman, S. (1986). Exercise in end-stage renal disease. American Journal of Kidney Diseases, 7, 386-94.
Piper, B. F., Lindesy, A. M., & Dodd, M. J. (1987). Fatigue mechanisms in cancer patients: developing nursing therapy. Oncology Nursing Forum, 14(6), 17-23.
Piper, B. F., Dibble, S. L., Dodd, M. J., Weiss, M. C., Slaughter, R. E., & Paul, S. M. (1998). The revised Piper Fatigue Scale:psychometric evaluation in women with breast cancer. Oncology Nursing Forum, 25(4), 677-684.
Ream, E., & Richardson, A. (1996). Fatigue：a concept analysis. International Journal of Nursing Studies, 33(5), 519-529.
Revill, S. I., Robinson, J. O., Rosen, M., & Hogg, M. J. (1976). The reliability of a linear analogue for evaluating pain. Anesthesia, 31, 1191-1198.
Shidler, N. R., Peterson, R. A., & Kimmel, P. L. (1998). Quality of life and psychosocial relationships in patients with chronic renal insufficiency. American Journal of Kidney Diseases, 32(4), 557-566.
Simmons, R. G., Anderson, C. R., & Kamstra, L. K. (1984). Comparison of quality of life of patients on CAPD, hemodialysis and transplantation. American Journal of Kidney Diseases, 4, 253-255.
Simmons, R. G., & Abress, L. (1990). Quality-of-life issues for end-stage renal disease patients. American Journal of Kidney Diseases, 15(3), 201-208.
Skalla, K. A., & Lacasse, C. (1992). Patient education for fatigue. Oncology Nursing Forum, 19(10), 1537-1541.
Sklar, A. H., Riesenberg, L. A., Silber, A. K., Ahmed, W., & Ali, A. (1996). Postdialysis fatigue. American Journal of Kidney Diseases, 28(5), 732-736.
Sousa, K. H. (1999). Description of a Health-Related quality of life conceptual model. Outcomes Management for Nursing Practice, 3(2), 78-82.
The WHOQOL Group. (1995). The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Social Science and Medicine, 41(10), 1403-1409.
The WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551-558.
Tsay, S. L., & Healstead, M. (2001). Self-care self-efficacy, depression, and quality of life among patients receiving hemodialysis in Taiwan. International Journal of Nursing Studies, 39, 245-251.
Tsay, S. L., & Chen, M. L. (in press). Acupressure and quality of sleep in patients with end-stage renal disease---a randomized controlled trial. International Journal of Nursing Studies.
Tsay, S. L. (in press). The effect of acupressure on fatigue in patients with end-stage renal disease.
Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473-483.
Welch, J. L., & Austin, J. K. (2001). Factors associated with treatment-related stressors in hemodialysis patients. Journal of Advanced Nursing, 33(2), 200-207.
Winningham, M. L., Nail, L. M., Burke, M. B., Brophy, L., Cimprich, B., Jones, L. S., Sandra P-H, Rrhodes, V., Pierre, B. S., Beck, S., Glass, E. Cc., Mock, V. L., Mooney, K. H., & Piper, B. F. (1994). Fatigue and the cancer experience: the state of the kuowledge. Oncology Nursing Forum, 21(1), 23-36.
Zhan, L. (1992). Quality of life: conceptual and measurement issues. Journal of Advanced Nursing, 17,795-800.