[[alternative]]Exploring how hemodialysis patients live with their disease under death anxiety

[[abstract]]本研究旨在探討血液透析患者如何在死亡焦慮下與疾病共存，從中瞭解患者在開始接受血液透析時的調適歷程、在時間的延遞下透析患者的社會支持、生死觀及死亡態度，以及生命目標的轉變過程及內涵。 研究者於民國八十八年二月至十月在北部一家教學醫院的血液透析室，針對九位血液透析患者進行半結構性深度訪談，並以紮根理論為基礎，進行資料的譯碼及分析，歸納出患者在死亡焦慮下與疾病共存的經驗。 結果顯示患者的血液透析調適歷程分為：警覺、拖延逃避、抑鬱、比較、主動將透析融入生活中、找出最適合自己的透析方式等六階段。患者的社會支持所呈現的風貌為：（一）疾病初期─家庭支持系統的鞏固或潰散，（二）支持系統開展的困難，（三 ）支持系統的逐漸凋零。其生死觀及死亡態度則可歸納為：（一）過一天算一天，（二）善待自己，(三）死亡是解脫，（四）無懼死亡。生命目標則分為已組家庭者及單身兩大族群，前一族群的生命目標是對親代的高度關懷，而後一族群則及以自我為導向。 研究者針對結果加以討論，並進一步與死亡焦慮模型和Erikson的心理社會發展階段等理論相比較，發現血液透析患者藉由「生死觀及死亡態度」與「生命目標」對抗死亡威脅所帶來的死亡焦慮，加上「社會支持」，藉此三者得以繼續積極生存下去。在結論中，研究者嘗試提出血液透析患者與死亡焦慮共存的初步理論。最後，針對研究結果提出若干建議，供臨床照護及日後的研究參考。[[abstract]]The purpose of this study is to explore how hemodialysis patients live with their illness given the permeating death anxiety they experience in and out of the hemodialysis treatment process. Based on the literature and the finding of a pilot study, the current study untangles this complex issue by explore the following questions: (1). How do these patients adapt to their illness and the treatment? (2). How does their social support change as time goes by? (3). How do their death attitudes and life goals change over time? Prior related studies are mainly quantitative in nature and deal with measurable variables like stressors and stress levels. The questions raised in this study are broad and exploratory in nature, so qualitative methods are a more suitable tool. Being a certified hemodialysis nurse working in the hemodialysis unit, the researcher has the privilege to approach these patients, build up rapport with them, and invite them to participate in this study. The research interviewed a total of nine patients. In-depth semi-structural interviewing was employed to collect data and grounded theory method was used to analyze data and guide the subsequent data collecting. The findings show that the process of patients’ adapting to the illness can be classified in to six stages, namely, alertness, procrastination and avoidance, depression, making comparisons, acceptance of hemodialysis as a part of one’s own life, and finding out the best personal surviving method. Their social support did undergo changes as the illness prolonged and the treatment continued over time. And the change took different forms. Under the incessant treat of death, these patients’ death attitudes were also undergoing changes. Among these nine participants, they all achieved the stages of accepting their fate and were prepared to face their death without fear. With regard to their life goals, the married patients were devoted to caring for their offspring while the single ones were concerned about their own self-actualization. The finding were compared to the death anxiety model proposed by Tomer & Eliason (1996) and further discussed in terms of Erikson’s psychosocial developdmental theory. It is concluded that the death attitudes and the life goals these patients developed enabled them to fight against death anxiety. Together with social support, the three factors enabled the patients to live on hope. Based on the findings, a provisional theory is proposed. Some suggestions are made for further research and clinical care