病童歷經骨髓移植治療過程之同化與調整行為

Abstract

本研究目的為探討病童在經歷骨髓移植治療過程之個人經驗及同化與調整行為，為描述性的質性研究。 藉由骨髓移植經驗圖，透過半結構性的訪談指引，和11位接受骨髓移植後的病童進行深度訪談，每位受訪者訪談的時間為60至90分鐘，將訪談的錄音資料撰寫成敘述文字，再以內容分析法歸納骨髓移植病童的個人經驗及同化與調整行為，並予以歸類及命名。 計算質性資料量化分析的結果，共得849個經驗單元，其個人經驗歸納為三方面：身體經驗佔38%、治療經驗佔41%、人際互動經驗佔21%。來自於身體經驗包括身體感覺、身體功能及身體結構；來自於治療經驗包含對醫療過程及醫療環境的經驗；來自於人際互動經驗則包含醫護人員、同學及師長、家屬與個人獨處等。病童因應個人的行為反應包括同化與調整行為，經訪談分析結果，同化行為佔58%，調整行為佔42%。同化行為含認定、比較、期待、評價行為；調整行為分為準備自己、採取措施、轉化期望及情緒發洩行為。研究對象的年齡及移植訪談的時間會影響個人經驗及同化與調整行為的內容。本研究可提供臨床照護之參考，協助護理人員對骨髓移植病童主觀感受的了解，以提供整體性照護，使其順利地渡過人生主要的發展階段。

The purpose of the study was to explore the experience, assimilative and accommodative behaviors of children undergoing bone marrow transplantation, in the framework of a descriptive qualitative study. Based on the diagram of bone marrow transplantation experiences and the semi-structural interview guide, in-depth interviews were conducted on 11 children who received bone marrow transplantation. Each interview lasted 60-90 minutes and was recorded and later composed into descriptive contexts. Content analysis was further applied to identify and categorize the children’s personal experiences, assimilative and accommodative behaviors. From the results of quantifying the qualitative data, a total of 849 experience units were coded. Personal experiences can be categorized in to 3 major aspects, physical experience, therapy experience, and interpersonal experience; and the proportions of each aspect are 38%, 41%, and 21% respectively. The physical experiences include physical perception, physical function, and physical structure. The therapy experiences include the process of medical treatment and the environment of medical treatment. And the interpersonal experiences include interactions with medical staffs, peers, teachers, family members, or being alone. The children’s behavioral reactions include assimilative behaviors and accommodative behaviors. The analysis of the interviews shows that assimilative behaviors are in a proportion of 58% and accommodative behaviors 42%. Assimilative behaviors encompass behaviors of identification, comparison, expectation, and evaluation, while accommodative ones contain behaviors of self-preparation, approaching, changing expectations, and expressing emotions. The age of the research subjects and the time between transplantation and interview will affect personal experiences, assimilative and accommodative behaviors. This study provides a reference of clinical nursing care to assist nursing staffs in understanding the subjective perception of children undergoing bone marrow transplantation so that they can provide comprehensive care to make children go through the main development stages in life easily.