The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong.
The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong.
Int J Nurs Stud. 2014 Jun;51(6):908-16. doi: 10.1016/j.ijnurstu.2013.10.012. Epub 2013 Oct 22.
The nature of end-stage renal disease and the need for continuous ambulatory peritoneal dialysis require patients to manage various aspects of the disease, its symptoms and treatment. After attending a training programme, patients are expected to adhere to the renal therapeutic regimen and manage their disease with the knowledge and skills learned. While patients are the stakeholders of their health and related behaviour, their perceptions of adherence and how they adhere to their renal therapeutic regimen remains unexplored.
To understand adherence from patients' perspectives and to describe changes in adherence to a therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis.
This study used a mixed methods design with two phases - a survey in phase I and semi-structured interviews in phase II. This paper presents phase II of the study.
The study was conducted at a renal unit of an acute hospital in Hong Kong.
Based on the phase I survey results, maximum variation sampling was employed to purposively recruit 36 participants of different genders (18 males, 18 females), ages (35-76 years), and lengths of dialysis experience (11-103 months) for the phase II interviews.
Data were collected by tape-recorded semi-structured interviews. Content analysis was employed to analyse the transcribed data. Data collection and analysis were conducted simultaneously.
Adherence was a dynamic process with three stages. At the stage of initial adherence, participants attempted to follow instructions but found that strict persistent adherence was impossible. After the first 2-6 months of dialysis, participants entered the stage of subsequent adherence, when they adopted selective adherence through experimenting, monitoring and making continuous adjustments. The stage of long-term adherence commenced after 3-5 years of dialysis, when participants were able to assimilate the modified therapeutic regimen into everyday life.
The process of adherence was dynamic as there were fluctuations at each stage of the participants' adherence. With reference to each stage identified, nursing interventions can be developed to help patients achieve smooth transition throughout all the stages.
终末期肾病的性质和持续流动腹膜透析的需求要求患者管理疾病的各个方面，包括症状和治疗。在参加培训计划后，患者预计将坚持肾脏治疗方案，并运用所学的知识和技能来管理疾病。虽然患者是自身健康和相关行为的利益相关者，但他们对坚持治疗的看法以及他们如何坚持肾脏治疗方案的情况仍未得到探索。
从患者的角度了解坚持治疗的情况，并描述接受持续流动腹膜透析的患者对治疗方案的坚持情况的变化。
本研究采用混合方法设计，分为两个阶段 - 第一阶段为调查，第二阶段为半结构式访谈。本文介绍了研究的第二阶段。
该研究在香港一家急症医院的肾脏科进行。
根据第一阶段的调查结果，采用最大差异抽样法，有目的地招募了 36 名不同性别（18 名男性，18 名女性）、年龄（35-76 岁）和透析经验长短（11-103 个月）的患者进行第二阶段的访谈。
通过录音的半结构式访谈收集数据。采用内容分析法对转录数据进行分析。数据收集和分析同时进行。
坚持治疗是一个动态过程，分为三个阶段。在初始坚持阶段，患者试图按照指示进行治疗，但发现严格坚持治疗是不可能的。在透析开始后的 2-6 个月后，患者进入后续坚持阶段，通过尝试、监测和不断调整来采取选择性坚持治疗。在透析开始 3-5 年后，患者进入长期坚持阶段，此时他们能够将修改后的治疗方案融入日常生活中。
坚持治疗的过程是动态的，因为患者在坚持治疗的各个阶段都有波动。根据确定的每个阶段，可制定护理干预措施，帮助患者顺利过渡到所有阶段。
