The Coping Process in Adults with Acute Leukemia Undergoing Hematopoietic Stem Cell Transplantation

接受幹細胞移植的成人白血病患者之適應過程

10.1097/JNR.0b013e318257b5e0

Zahra Farsi；Nahid Dehghan Nayeri；Reza Negarandeh

適應 ； 紮根理論 ； 白血病 ； 長期追蹤質性研究 ； 幹細胞移植 ； coping ； grounded theory ； leukemia ； longitudinal qualitative design ； stem cell transplantation

The Journal of Nursing Research

20卷2期（2012 / 06 / 01）

99 - 109

英文

背景 雖然越來越多的血癌患者接受造血幹細胞移植（Hematopoietic Stem Cell Transplantation，HSCT）而存活，然而他們仍面臨許多挑戰。鮮少文獻探討這群血癌患者的因應歷程，瞭解他們面對此威脅情境的因應歷程，將有助於健康照護人員提供整體性照護。目的 本研究的目的，在於瞭解接受造血幹細胞移植的成人急性血癌患者其因應歷程。方法 本研究為縱貫性的紮根理論質性研究，於2009至2011年進行。從伊朗Shariati hospital in Tehran招募共十位罹患急性血癌並接受HSCT的病人參與本研究。分別於移植前、後，在HSCT的單位進行一系列的訪談，最後一次的訪談時間安排在移植後的2至6個月，於門診單位進行。結果 從訪談資料中可形成五個類目，分別為感受威脅、在恐懼與希望中游移、重生、脈絡因素與因應策略。雖然病人在因應光譜中移動（從反抗到默許），但最終「發現意義」的經驗作為其能夠有效因應的指標。結論／實務應用 罹患血癌並經歷HSCT對病人來說是獨特的經驗。這些威脅生命的情境，嚴重影響病人的覺知，並造成他們生活上短期或永久的改變。護理人員能夠協助病人因應這些情境，從中發現意義與希望，並透過有效的介入措施減少恐懼與壓力。

Background: The increasing numbers of leukemia cancer survivors treated with hematopoietic stem cell transplantation (HSCT) face numerous challenges after their transplant procedure. Little information has been published regarding the coping process of this population. Understanding how they cope with this life-threatening disease can assist healthcare professionals to provide holistic care.Purpose: This study was designed to elicit the coping process of adults experiencing acute leukemia who underwent HSCT therapy.Methods: This longitudinal qualitative study and grounded theory took place during 2009-2011. Ten adults with acute leukemia scheduled for HSCT were recruited from Shariati Hospital in Tehran, Iran. A series of pretransplant and posttransplant interviews were held in the hospital's HSCT units. Final interviews took place 2-6 months posttransplant in the hospital's outpatient clinic.Results: The five categories that emerged from the data included perceived threat, suspension between fear and hope, rebirth, contextual factors, and coping strategies. Although patients vacillated within the coping spectrum (i.e., the ”buffer zone” between fighting and acquiescing), ”finding meaning” was identified as the final outcome of their experience that indicated effective coping.Conclusions/Implication for Practice: Each patient perceives leukemia and HSCT therapy uniquely. This life-threatening disease can significantly affect patient perception and change patient lives both temporarily and permanently. Nurses can apply effective interventions to help patients cope with their unique situation, find meaning and hope, and allay fear and stress.

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