慢性腎臟疾病病人的因應－－個案管理模式運用初探

Coping in Patients with Chronic Kidney Disease: A Preliminary Study on the Implications of the Case Management Model

本研究旨在探討個案管理模式對慢性腎臟病病人面臨身、心、社會、靈性等層面的困擾，透過「個案管理」的介入措施內容是否提昇自我照顧與問題解決的能力，和協助因應疾病。研究對象為中部某醫學中心採立意取樣診斷為慢性腎臟病的九位個案，運用半結構訪談指引進行「焦點團體」，資料以內容分析法作分析。結果歸納出四個主題與八個次主題:（1）接納生理退化：身體功能衰退，意識健康遠離；擷集多元方法，擬定治療計畫。（2）因應身心變化：惶恐喪失安穩，須調適緩解；積極發掘優勢，找尋停損點。（3）保留社會觸角：需獲外界協助來疏解壓力；與時俱進，重構生活模式。（4）再造靈性活力：面對治療抉擇，勇敢跨越困境；賦予疾病意義，提昇生命價值。個案管理模式運用於照護慢性腎臟病，由各類醫療人員參與照顧，嘉惠面臨疾病衝擊的病人，增加正向因應能力。本研究結果可提供醫療人員在建立個別性、連續性、即時性及適切性等措施時的參考，以協助病人減少損害和採取合宜的因應行為。

The aim of this study was to explore what physical, psychological, social and spiritual difficulties were encountered by patients with chronic kidney disease and whether or not management-based intervention can help these patients take care of themselves, deal with their own problems and thus assist them in coping with the impact of the disease. Purposive sampling was used with nine patients selected for the study and undergoing a semi-structured interview. Data were analyzed using the content analysis method and categorized. The results were grouped into four main categories, with each category consisting of two sub-categories: (1) acceptance of physical degradation: (a) physical decline of bodily function and consciousness of this fact; (b) arranging a care plan including multiple methods for total treatment; (2) coping with bio- psychological changes: (a) fearing the loss of stability and thus trying to improve emotional state; (b) actively looking for things about which to be optimistic and finding a stop-loss point; (3) keeping contact with society: (a) getting external help to relieve distress; (b) re-building a new life within society; (4) rebuilding spiritual vitality: (a) boldly working to solve problems when faced with treatment options; (b) finding meaning behind the illness to enhance the value of life. The application of the case management model was used in caring for CKD patients with participation by medical-care professionals at different levels. The study benefited patients facing CKD by giving them positive impetus to cope. The result of this study can serve as a reference for health care providers when establishing individualized, continuous, timely and appropriate measures for the care of CKD patients. In summary, the case management model can reduce the degree of loss in CKD patients and help them use appropriate coping methods.