生命末期老年血液透析患者对濒死状态的感知和体验的质性研究

The perception and experience of dying among elderly hemodialysis patients near the end of life:a qualitative research

目的探讨处于生命末期的老年血液透析患者对濒死状态的感知和体验。方法采用质性研究中的现象学研究方法,于2014年10月至2015年2月对厦门市7例老年血液透析患者进行半结构式访谈,根据Colaizzi 7步分析法对原始资料进行整理分析。结果生命末期老年血液透析患者对濒死状态的感知可划分为从血液透析治疗本质的认识中感知死亡的临近、通过愈发加重的病情感知死亡临近和从病友的离世中预估自己的死因3个主题,对濒死状态的体验可归纳为自己无法接受死亡来临、感知死亡的压力较大、希望死亡快点到来、意图采取措施加速死亡的来临、期待与外界加强交流和渴望知道疾病进展以及终止透析的时间6个主题。结论生命末期的老年血液透析患者在对待生命存在和进行死亡思考时,多种体验并存。根据患者的心理认知状态和需求,探索并提供完善的姑息照护,是今后改善老年血液透析患者生存质量的途径之一。

Objective To investigate inner thoughts and feelings and experience relating to death and dying of elderly hemodialysis patients near the end of life. Methods A total of 7 elderly patients undergoing maintenance hemodialysis in one tertiary hospital in Xiamen were interviewed.The interviews were analyzed using phenomenological methodology. Results The perception of near-death state among elderly hemodialysis patients could be classified into 3 themes：the assumption of coming of death and forecasted by knowing the nature of hemodialysis treatment, by the aggravating illness and by peers＇ death. The experience of dying state could be extracted as 6 themes：unable to accept approaching death,having great pressure of the death,hoping for a quick death,intentionally taking measures to accelerate the coming of death,looking forward to strengthening exchanges with the outside,and expecting infor- mation of disease progression and withdrawal time of hemodialysis. Conclusion The elderly patients undergoing maintenance hemodialysis near the end of life have positive and negative emotional experience and coping styles. According to patients＇ psychological status and needs, exploring and providing thorough palliative care is one of the ways to improve elderly hemodialysis patients＇ quality of life.