慢性腎臟疾病之中年男性患者的生活經驗探討

Exploring the Lived Experiences of Middle-Aged Males Diagnosed With Chronic Kidney Disease

背景：目前國內外許多關於末期腎病患者之相關研究資料，以量性研究為主，對於早期腎病患者生活體驗的研究咸少，因腎病前期的患者多無明顯症狀，容易遭受忽略。目的：探討中年男性患者在獲知診斷後的生活經驗，著重於工作、人際關係與飲食。方法：本研究以敘事研究法，採立意取樣，訪談10位罹患慢性腎疾病之中年男性患者，為增加研究結果可信度，於資料分析後進行受訪者檢核（member checks）、同儕評論（peer review）與專家角色稽核（debriefing）。結果：歸納四大主題為：（1）保持正常生活步調面對生病，但擔憂病況惡化；（2）雖罹患腎臟病，但未影響工作，如過往維持著肩負家計與父親的角色；（3）即使生病，但面對家人及朋友仍期待自己能付出與貢獻；（4）健康飲食知易行難。結論／實務應用：中年男性早期腎病患者在生活上雖與未罹病前類似，但仍處於病況可能惡化的恐懼中。本研究結果建議相關照護人員於照護早期無症狀之中年男性患者時，宜（1）依患者個別性提供病情告知之資訊。（2）提供適用於不同工作型態與職務之個別性腎臟保健教育。（3）瞭解實際生活之困境，如：外食的難處、無法長期維持營養師建議之飲食等，並與患者討論解決策略。研究結果可以增加臨床護理人員對早期慢性腎臟疾病之中年男性患者生活經驗的了解，做為提供衛教與介入疾病控制之依據。

Background: The majority of studies addressing chronic kidney disease (CKD) have been quantitative. The lived experiences of patients with early stage CKD have not been explored in the literature. Due to the lack of symptoms during the early stages of CKD, the progress of this disease is often ignored.Purpose: This study explores the lived experiences of middle-aged males diagnosed with CKD. Research focuses on the work experiences, interpersonal relationships, and dietary habits of this group.Methods: This qualitative study used a narrative research method with purposive sampling. Ten middle-aged male patients were interviewed. We employed the 3 strategies of member checks, peer review, and debriefing in order to enhance the trustworthiness of the data analysis.Results: Four major themes were identified: (1) keeping the same life pace as usual with concerns of deterioration; (2) continuing to support their family and play the role of father; (3) hoping to participate in family and friend relationships despite the illness; and (4) being challenged to maintain a healthy diet.Conclusions / Implications for Practice: Although the physical status of participants was similar to the general middle-aged adult population, participants were concerned regarding disease deterioration. The results of this study suggest that health professionals: (1) provide appropriate information based on patients' personality, particularly at the first onset or apparent deterioration of the disease; (2) offer specialized healthcare information to patients relevant to their career choices; and (3) understand CKD-patient difficulties in daily life such as eating out habits and challenges faced in maintaining a healthy diet. Results may provide important information to healthcare providers in education planning and implementation and support programs for patients and families.