臺灣博碩士論文加值系統

研究背景：血液透析是生命歷程的重大壓力事件，也為患者的人生帶來巨大轉變，患者被告知需透析到接受血液透析治療的過程中，需經歷一段艱辛且不穩定的過渡歷程，血液透析對患者身、心、靈、社會層面造成沈重的負荷。末期腎臟疾病患者在一開始面對血液透析事件所面臨的挑戰、自身如何調整，以及與他人的互動歷程值得進一步探究。
目的：探討末期腎臟疾病患者被宣告須接受透析治療後到開始接受血液透析治療過渡期間之歷程與因應。
方法：本研究採紮根理論研究法，研究期間自2022年10月至2023年10月，採立意取樣，以半結構訪談指引進行深度訪談，在資料浮現出範疇後進行理論抽樣，直到資料飽和後停止收案。資料分析從第一筆資料開始，程序包含開放譯碼、主軸譯碼以及選擇譯碼，並使用譯碼典範統整此現象之結構歷程，資料以Nvivo 14質性分析軟體協助管理。
結果：本研究共收案十六位末期腎臟疾病接受血液透析之患者。研究之核心範疇浮現【內外夾擊的處境】，包含兩個範疇。範疇一「內心的紛擾」，其次範疇為(1)驚恐的情緒；(2)自我的瓦解；(3)求死的意念。範疇二「存活的窘境」其次範疇為(1)身體的負擔；(2)經濟的負擔；(3)他人的負擔。其結構歷程之因果條件：忽視病況的進展、未察覺的威脅。脈絡條件：禁錮的時間、受縛的身體。患者的策略行動包括嘗試偏方、祈求神明、遵循醫囑。介入條件有醫病溝通的模式、家庭與社會支持的程度。後果為心的跨越、認命。
結論：本研究清楚呈現患者從獲知需要進行血液透析消息到接受透析過渡期間的整體樣貌，患者面臨內在與外在夾擊的窘境，他們的內心遭受巨大壓力與衝擊，醫療人員應識別患者驚恐的情緒與擔憂，以及患者可能因此去尋求偏方延緩治療時機。當患者開接受治療後也需評估身體接受透析後承受的痛苦，協助患者處理透析引起身體不適的感受。另外，透析治療後工作中斷與家庭的負擔都是不利於過渡的風險因素，而適切的醫病溝通、社會資源訊息的提供，以及家人提供適當支持與鼓勵，則有利於患者減輕血液透析的過渡期的困境。

Research Background：Hemodialysis is a major stressful event and elicits considerable changes in patients’ lives. Such patients undergo a complex and unstable transition from being told they need dialysis to receiving hemodialysis treatment. Hemodialysis causes a heavy burden on patients physically, mentally, spiritually, and socially. The challenges patients with end-stage renal disease face during hemodialysis events at the beginning of the process, how they adjust themselves, and their interactions with others require further investigation.
Purpose：This study investigated the process and responses of patients with end-stage renal disease during the transition period from being informed of the necessity of dialysis treatment to starting hemodialysis.
Method：This study used a grounded theory research method and performed and performed purposive sampling from October 2022 to October 2023. We conducted in-depth interviews using a semi-structured interview guide. After the categories of the research data emerged, we performed theoretical sampling and terminated enrollment once data saturation was reached. Data analysis started with the first piece of data. The procedures included open coding, axial coding, and selective coding, and coding paradigms were used to unify the structural process of this phenomenon. We performed data management using NVivo 14 qualitative analysis software.
Results：This study enrolled 16 patients with end-stage renal disease receiving hemodialysis. The core category of the study were [the situations of internal and external attacks], which included two categories. Category 1, “inner turmoil,” comprised the following sub-categories: (1) panic emotion, (2) self-disintegration, and (3) thoughts of death. Category 2, “survival dilemma,” comprised the following sub-categories: (1) physical burden, (2) economic burden, and (3) burden on others. The causal conditions of the structural processes were negligence of the disease progression and failure to recognize the threat. The context conditions were imprisoned time and bound body. The action strategies of patients included trying folk remedies, praying to gods, and following medical advice. Intervening conditions included the mode of doctor-patient communication and the level of family and social support. The consequences were the detachment of mind and acceptance of fate.
Conclusions：This study presented the overall picture of a patient’s transition from being informed of the necessity to undergo hemodialysis to receiving dialysis. When patients face the dilemma of internal and external attacks, they suffer tremendous stress that impacts their body and mind. Healthcare personnel should recognize patients’ panic and worry, which may lead to patients seeking folk remedies to delay treatment. When patients start treatment, it is necessary to assess the physical pain they experience after undergoing dialysis and help them address the physical discomfort caused by dialysis. Moreover, work interruption and family burden after dialysis treatment were found to be risk factors for this transition. Adequate doctor-patient communication, provision of social resource information, and support and encouragement from family members can help mitigate the challenges caused by hemodialysis for patients in the transition period.

致謝 I
中文摘要 III
英文摘要 V
目錄 VI
第壹章　緒論 1
第一節　研究背景 1
第二節　研究動機及重要性 4
第三節　研究目的、研究問題 6
第四節　名詞界定 7
第貳章　文獻查證 9
第一節　末期腎臟疾病與血液透析治療之介紹 9
第二節　血液透析治療對患者之影響 15
第三節　過渡理論之概述 20
第參章　研究方法 24
第一節　紮根理論的起源與發展 25
第二節　紮根理論方法論之概述 28
第三節　研究設計 33
第四節　嚴謹度 38
第五節　倫理考量 41
第肆章 研究結果 43
第一節　參與者之基本資料介紹 45
第二節　內外夾擊的處境 47
第三節　內心的紛擾 49
第四節　存活的窘境 52
第五節　血液透析治療過渡期之結構歷程 55
第伍章 討論 65
第一節　內外夾擊的處境與因應 65
第二節　內心的紛擾 69
第三節　存活的窘境 72
第陸章 結論 76
第一節　研究之總結 76
第二節　研究限制 78
第三節　研究建議 79
參考資料 81
附錄一：訪談指引（第一次） 103
附錄二：增修後訪談指引（第二次） 104
附錄三：增修後訪談指引（第三次） 105
附錄四：人體試驗委員會試驗說明書 106
附錄五：開放譯碼資料分析之概念化過程 107
附錄六：主軸譯碼（譯碼典範）分析步驟 108
附錄七：本研究資料分析之歷程 109

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