第六章 結論與建議
第三節 研究限制
ㄧ、在研究取樣方面，本研究採橫斷式的研究，為立意取樣方式，對象僅 探討中部地區某地區醫院的慢性腎臟病患者，正式納入收案數僅113 位，因此本研究在因果推論上，僅能推論至與樣本性質相近之群體，
無法推論至不同研究人口學背景和不同醫院屬性的族群，未來應增加 樣本數，以增加研究結果之可信度。
二、在研究設計上，本研究本應針對不同慢性腎臟病期別的患者進行比較 性分析，但所收集之研究個案出現集中於第五期的現象，故無法做更 進一步的分析與比較。未來將針對不同慢性腎臟病期數的患者之重點 執行不同分期別之比較性或介入性措施之研究。
三、本研究因人力和經費的考量，研究樣本無法做更進一步推論，建議未 來可擴大收案，比較不同地區的個案其壓力感受與生活品質差異性分 析。
參考資料 一、中文資料
方華章、鍾孝民（2001）．腎臟疾病的神經系統併發症．腎臟與透析，
13
（3），125-129。
王梅美、林美良（2003）‧讓她洗得更舒適-照護一位腹膜透析患者之護 理經驗‧新臺北護理期刊，
5（2），103-114。
王舒民、楊雅斐、黃秋錦（2007）‧慢性腎臟病與高血壓‧腎臟與透析，
19
（2），64-70。行政院衛生署（2009）．死因統計．2009 年6月17日取自http://www.doh.
gov.tw/DM/DM2_P01.aspx
台灣腎臟醫學會（2006）‧台灣腎臟醫學會
2003
透析年度報告‧台北：台 灣腎臟醫學會。台灣腎臟醫學會（2008）‧97年度腎臟病健康促進機構推展成效‧2009 年 6月17日取自http://www.tsn.org.tw//UI/H/H002.aspx
李月卿（2002）‧認知行為團體治療對末期腎疾病患者之成效探討‧未發 表的碩士論文，台北：國立台北護理學院護理系研究所。
李麗珠、郭碧照、孫閫範、陳芳真（2003）‧中部某醫學中心血液透析患 者皮膚搔癢及處置之探討‧中山醫學雜誌，
14（4），523-531。
李瑜弘、王瑞霞（2001）‧長期血液透析病患之無助、社會支持與自我照 顧行為之相關探討‧護理研究，
9（2），147-155。
林秋菊、李瑜弘、洪娟娟、李碧娥（2006）‧血液透析病患疲憊量表之發 展‧台灣醫學，
10（4），422-428。
林愛眞（2002）‧因應訓練對末期腎疾病患者之成效探討‧未發表的碩士 論文，台北：國立台北護理學院護理系研究所。
林美玲（1995）‧血液透析患者之疾病反應、社會支持及其相關因素之探 討‧未發表的碩士論文，台北：國防醫學大學護理系研究所。
林佳靜、梁靜祝；黃芬蘭、賴裕和（2004）‧血液透析患者之希望與社會 支持的相關性探討‧臺灣腎臟護理學會雜誌，
3（1），17-31。
周學智、葉淑娟、黃月妍（2004）‧長期血液透析患者壓力源之探討‧榮 總護理，
21（1），67-76。
周學智、葉淑娟、黃月妍、朱文洋（2005）‧長期血液透析病患調適方法 之探討‧臺灣腎臟護理學會雜誌，
4（2），42-54。
洪永祥（2002，12月20日）‧長期洗腎問題面面觀‧透析通訊，44，取自 http://www.kidney.org.tw/issue-0.html
洪永祥（2003，4月20日）‧更高活力的洗腎生活
-
洗腎最新三合一療法‧ 透析通訊，48，2009年1月19取自http://www.kidney.org.tw/issue-0.html 胡海國編著 (1991)。精神醫學診斷手冊(第二版)。台北：國立台灣大學醫學院出版委員會。
柯豐城、李碧娥、施惠慈（2007）‧長期洗腎病患的主觀生活品質－ 質 性研究觀點‧護理雜誌，
54(1)，53-61。
姚開屏(2002a)‧健康相關生活品質概念與測量原理之簡介‧
台灣醫學，
6
（2
），183-191。財團法人中華民國腎臟基金會(2007)．九十六年度台灣地區透析總人數統 計圖．2008年9月4日取自http://www.kidney.org.tw/a96.gif
財團法人中華民國腎臟基金會(2006)．九十五年度台灣地區透析總人數統 計圖．2008年9月4日取自http://www.kidney.org.tw/a95.gif
馬麗卿、謝湘俐（2008）‧照護一位末期腎疾病患者面對血液透析治療之 護理經驗‧臺灣腎臟護理學會雜誌，
7（1），60-73。
孫宜孜、徐邦治、楊福麟、廖晉興、林崇舜、李茹萍（2005）‧血液透析 患者之憂鬱狀態及影響因素探討‧慈濟護理雜誌，
4（3），47-55。
張春興（1989）‧張氏心理學辭典（初版）‧台北：東華。
張甄芳（2006 年5 月8 日）‧腎臟病患透析治療、感受深；提升醫療品 質、有目共睹‧2008年6 月20 日取自
http://www.nhi.gov.tw/epaper2/ItemDetail.asp?DataID=122&IsWebData
=0&ItemTypeID=7&PapersID=32&PicID=
張慈惠、黃秀梨（2000）‧生活品質評量之臨床應用‧台灣醫學，
4（1），
86-89。
郭英調(2001)，臨床研究手冊‧台北：合慶。
陳美玲、顧乃平（1998）‧血液透析病患生活品質及相關因素之探討‧護 理研究，
6（5），393-403。
陳一心（2006，8月25日）‧透析病人常見的併發症與處理方法‧透析通 訊， 2008年6 月20 日取自取自http://www.kidney.org.tw/issue-0.html 陳佩英、郭素青、張惠甄、劉亞君、徐子英（2007）‧血液透析病患其控
握信念、心理困擾與健康促進行為之初探‧臺灣腎臟護理學會雜誌，
6（2），27-41。
曾立源、洪崇尹、彭聖曾、馮祥華、楊垂勳（2004）‧腹膜透析病患疝氣 之探討‧Acta Nephrologica，
12(6)， 57-61。
黃秀明（2002）‧血液透析患者及家屬之壓力與需求之探討
-
以嘉義某區 域教學醫院‧未發表的碩士論文‧嘉義‧華南大學管理研究所。鈕淑芬（2004）‧透析病患生活品質及其相關因素探討‧台灣腎臟護理學 會雜誌，
3
（2），88-104。雷玉華、丘周萍（2000）‧生活品質概念分析‧國防醫學，
31(2)，163-167。
楊乃菁（2007）‧慢性腎臟病危險因子的探討‧北市醫學雜誌，
4（9），
880 -889。
楊樹昌、王榮德、吳麥斯、郭佩雯、蘇喜（2007）‧長期血液透析病患的 生活品質‧台灣醫學，
11（2），140-152。
楊樹昌、吳麥斯、蘇喜、王榮德、鍾國彪（2006）‧血液透析病患以存活 調整之健康輪廓及預期終生存活期損失‧血液淨化雜誌，
11（1），
1-16。
廖秋萍、蔣偉姣、陳淑娟（2006）‧腹膜透析病患生活品質及其相關因素 探討‧臺灣腎臟護理學會雜誌，
5（1），22-39。
劉莉香，黃淑瑛（2002）‧血液透析病患失眠問題之原因與護理‧腎臟與 透析，
14（2），111-113。
二、英文資料
Aspinwall, L. G. (1997). Where planning meets coping: Proactive coping and
the detection and management of potential stressors. In S. L. Friedman &
E. K. Scholnick (1st ed.). The developmental psychology of planning:
Why, how, and when do we plan? (pp. 285-320). Mahwah, NJ: Erlbaum.
Aspinwall, L. G., & Taylor, S. E. (1997). A stitch in time: Self-regulation and proactive coping. Psychological Bulletin, 121(3), 417-436.
Baldwin, D. R., Chambliss, L. N., & Towler, K. (2003). Optimism and stress:
an African-American college student perspective. Retrieved January 19, 2009, from http://www.findarticles.com/cf_dls/m0FCR/2_37/103563751/
print.jhtml
Benz, R. L., Pressmen, M. R., Hovick, E. T., & Peterson, D. D.( 2000).
Potential novel predictors of mortality in end-stage renal disease patients with sleep disorders. American Journal of Kidney Disease, 35(6), 1052-1060.
Bisschop, M. I., Kriegsman, D. M. W., Beekman, A. T. F., & Deeg, D. J. H.
(2004). Chronic disease and depression ： The modifying role of psychosocial resources. Social Science & Medicine, 59(4), 721-733.
Borawski, E.A., Kinney, J. M., & Kahana, E. (1996). The meaning of older adults' health appraisals: Congruence with health status and determinant of mortality. Journal of Gerontology: Series B: Psychological Science
and Social Science, 51(3), S157-S170.
Carvajal, S. C., Garner, R. L., & Evans, R. I. (1998). Dispositional optimism as a protective factor in resisting HIV exposure in sexually active inner-city minority adolescents. Journal of Applied Social Psychology,
28(23), 2196-2211.
Carver, C.S., Blaney, P. H., & Scheier, M. F. (1979). Focus of attention, chronic expectancy, and response to a feared stimulus. Journal of
Personality and Social Psychology, 37(7), 1186-1195.
Cimete, G. (2002). Stress factors and coping strategies of parents with children treated by hemodialysis ： A qualitative study. Journal of
Pediatric Nursing, 17(4), 297-306.
Cohen, S., & Syme, S. L. (1985). Social support and health. Issues in the study
and application of social (1st ed.). Orlando: Academic.
Connor, K. M., Davidson, J. R., & Lee, L. C. (2003). Spirituality, resilience,
and anger in survivors of violent trauma: A community survey. Journal
of Traumatic Stress, 16(5), 487–494.
Coresh, J., Astor, B. C., Greene, T., Eknoyan, G., & Levey, A. S. (2003).
Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. American Journal Kidney Disease, 41(1), 1–12.
Cossette, S., Frasure-Smith, N., & Lesperance, F. (2002). Nursing approaches to reducing psychological distress in men and women recovering from myocardial infarction. International Journal of Nursing Studies, 39 (5), 479-494.
Danesh, F., & Ho, L. T. (2001). Dialysis-related amyloidosis：History and clinical manifestations. Seminars in Dialysis, 14（2）, 80-85.
Haroun, M. K., Jaar, B. G., Hoffman, S. C., Comstock, G. W., Klag, M. J., &
Coresh, J. (2003). Risk factors for chronic kidney disease: A prospective study of 23,534 men and women in Washington County, Maryland.
Journal American Socience Nephrol, 14(11), 2934-41.
Hagren, B., Peppersen, I-M., Severinsson, E., Lutzen, K., & Clyne, N. (2005).
Maintenance haemodialysis: patients’ experiences of their life situation.
Journal of Clinical Nursing, 14(2), 294–300
Heiwe, S., Clyne, N., & Dahlgren, M. A. (2003). Living with chronic renal
failure: Patients’ experiences of their physical and functional capacity.
Physiotherapy Research International, 8(4), 167–177.
House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540–545.
Hsu, Chih-Cheng, Hwang, Shang-Jyh, Wen, Chi-Pang, Chang, Hsing-Yi, Chen, Ted, Shiu, Ruei-Shiang Horng, Shiow-Shiun, Chang, Yu-Kang &
Yang, Wu-Chang. High Prevalence and Low Awareness of CKD in Taiwan: A Study on the Relationship Between Serum Creatinine and Awareness from a Nationally Representative Survey. American Journal
of Kidney Diseases, 48(5), 727-738.
Humphreys, J. (2003). Resilience in sheltered battered women. Issues in
Mental Health Nursing, 24(2), 137–152.
Iliescu, E. A., Coo, H., McMurray, M. H., Meers, C. L., Quinn, M. M., Singer, M. A., & Hopman, W. M. (2003). Quality of sleep and health-related quality of life in hemodialysis patients. Nephrology Dialysis Transplant,
18(1), 126-132.
Iliescu, E. A., Yeates, K. E., & Holland, D. C. (2004). Quality of sleep in patients with chronic kidney disease. Nephrol Dialysis Transplant, 19(1), 95–99.
Jassal, S. V., Trpeski, L., Zhu, N., Fenton. S., Hemmelgarn, B. (2007).
Changes in survival among elderly patients initiating dialysis from 1990 to 1999. Canadian Medical Association Journa , 177(9), 1033-1038.
Kalender, B., Ozdemir, A. C., Dervisoglu, E., & Ozdemir, O. (2006). Quality of life in chronic kidney disease: Effects of treatment modality, depression, malnutrition and inflammation. Clinical Practic, 61(4), 569–576.
Kutner, N. G., Zhang, R., McClellan, W. M., & Cole, S.A. (2002).
Psychosocial predictors of non-compliance in hemodialysis and peritoneal dialysis patients. Nephrol Dialysis Transplantation. 17(1), 93–99.
Kalantar-Zadeh, K., Kopple, J. D., Block, G., & Humphreys, M. H. (2001).
Association among SF36 quality of life measures and nutrition, hospitalization and mortality in hemodialysis. Journal American Social
Nephrology, 12( 12), 2797–2806.
K/DOQI NKF (2002). Clinical practice guidelines for chronic kidney disease:
Evaluation, classification and stratification. American Journal of Kidney
Disease, 39(supple 1), S1-S266.
Kiberd, B. A., & Clase, C. M. (2002). Cumulative risk for developing end-stage renal disease in the US population. Journal American Social
Nephrology 13(6), 1635–1644.
Krishnasamy, M. (1996). Social supportand the patient with cancer: A consideration of the literature. Journal of Advanced Nursing, 23(1), 747-756.
Kurella, M., Covinsky, K. E., Collins, A. J., Chertow, G. M., (2007).
Octogenarians and nonagenarians starting dialysis in the United States.
Ann Intern Medicine, 146(3),177-183.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York：Springer.
Lederer, E., Ouseph, R. (2007). Chronic kidney disease. American Journal of
Kidney Diseases, 49(1) , 162-171.
Levin A. (2006). KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. American
Journal Kidney Disease, 47(5), 11–15.
Levy, J., Morgan, J., & Brown, E. (2004). Oxford handbook of dialysis (2nd ed.). NY: Oxford.
Lillberg, K., Verkasalo, P. K., Kaprio, J., Teppo, L., Helenius, H., &
Koskenvuo, M. (2003). Stressful life events and risk of breast cancer in 10,808 women：A cohort study. American Journal of Epidemiology,
157(5), 415-423.
Liu, H. E. (2006). Fatigue and associated factors in hemodialysis patients in
Taiwan. Research in Nursing & Health, 29(1), 40–50.
Lysaght, M. J. (2002). Maintenance dialysis population dynamics: Current trends and long-termimplications. Journal of American Socience Nephrol,
13(Supp l 1), 37-40.
Mau, Lih-Wen, Chiu, Herng-Chia, Chang, Pi-Yu, Hwang, Su-Chen, Hwang, Shang-Jyh (2008). Health-related Quality of Life in Taiwanese Dialysis Patients: Effects of Dialysis Modality. The Kaohsiung Journal of Medical
Sciences, 24(9), 453-460.
McClellan, W., Aronoff ,S. L., Bolton, W. K., et al. (2004). The prevalence of anemia in patients with chronic kidney disease. Current Medicine
Research Opinion, 20(9), 1501–1510.
McKinney, A. A., & Melby, V. (2002). Relocation stress in critical care：A review of the literature. Journal of Clinical Nursing, 11(2), 149-157.
Meeberg, G.A. (1993). Quality of life: A concept analysis. Journal of
Advanced Nursing, 18(1), 32-37.
Mok, E., & Tam, B. (2001). Stressors and coping methods among chronic hemodialysis patients in Hong Kong. Journal of Clinical Nursing, 10(4), 503-511.
Myin-Germeys, I., Krabbendam, L., Delespaul, P., & Os, J. V. (2004). Sex differences in emotional reactivity to daily life stress in psychosis.
Journal of clinical, 65(6), 805-809.
Polaschek, N. (2003). Living on dialysis：Concerns of clients in a renal setting.
Journal of Advanced Nursing, 41(1), 44-52.
Ross, C. A., & Keamey, K. (2000). Dialysis disequilibrium syndrome.
American Journal of Nursing, 100(2), 53-54.
Sabbatini, M., Minale, B., Crispo, A., Pisani, A., Ragosta, A., Esposito, R., Cesaro, A., Cianciaruso, B., & Andreucci, V. E. (2002). Insomnia in maintenance hemodialysis patients. Nephrology Dialysis Transplant, 17 (5), 852-856.
Scheier, M. F. & Carver, C. S. (1987). Dispositional optimism and physical well-being: The influence of generalized outcome expectancies on health.
Journal of Personality, 55(2), 169-210.
Sesso, R., Rodrigues-Neto, J. F., & Ferraz, M. B. (2003). Impact of socioeconomic status on the quality of life of ESRD patients. American
Journal Kidney Disease, 41(1), 186–95.
Shayamsunder, A. K., Patel, S. S., Jain, V., Peterson, R. A., & Kimmel, P. L.
(2005). Sleepiness, sleeplessness, and pain in end-stage renal disease:
distressing symptoms for patients. Seminars in Dialysis, 18(2), 109–118.
Stausbøl-Grøn, B., & Overgarrd, J.（1999）Relationship between tumour cell in vitro radiosensitivity and clinical outcome after curative radiotherapy for squamous cell carcinoma of the head and neck. Radiotherapy and
Oncology, 50(1), 47-55.
Stojanovic, M., & Stefanovic, V. (2007). Assessment of Health-related Quality of Life in Patients TreatedWith Hemodialysis in Serbia:
Influence of Comorbidity, Age, and Income. International Center for
Artificial Organs and Transplantation, 31(1), 53–60.
Strandberg, G., Ström, G., & Norberg, A. (2002). Struggling to be/show oneself valuable and worthy to get care. Scandinavian Journal of Caring
Sciences 16(1), 43–51.
Szromba, C., Thies, M. A., & Ossman, S. S. (2002). Advancing chronic kidney disease care: New imperatives for recognition and intervention.
Nephrology Nursing Journal, 29(6), 547-559.
Taylor, S. E., & Brown, J. D. (1988). Illusion and well-being: A social psychological perspective on mental health. Psychological Bulletin,
103(2), 193-210.
Thomas, R., Kanso, A., Sedor, J., R. (2008). Chronic Kidney Disease and Its Complications. Primary Care Clincal Office Practice, 35 (2), 329–344.
Tislér, A., Logan, A., G., Akócsi, K., Tornóci, L., Kiss, I. (2007). Circadian Variation of Death in Hemodialysis Patients. Americam Journal Kidney
Disease, 51(1), 53-61.
Tong, E., M., & Nissenson, A. R. (2002). Dialysis in Nursing Homes.
Seminars in Diaiysis, 15( 2) , 103-106.
Tossani, E., Cassano, P., & Fava M. (2005). Depression and Renal Disease.
Seminarsin Dialysis, 18(2), 73–81.
Tyrrell, J., Paturel, L., Cadec, B., Capezzali, E., & Poussin, G. (2005). Older patients undergoing dialysis treatment: Cognitive functioning. Aging &
Mental Health, 9(4), 374-379.
Turner, R. J., & Noh, S. (1988). Physical disability and depression：A longitudinal analysis. Journal of Health and Social Behavior, 29(1), 23-37.
Unruh, M. L., Newman, A. B., Larive, Dew, M. A., Miskulin, D. C., Greene, T., Beddhu, S., Rocco, M. V., Kusek, J. W., Meyer, K. B., & the Hemodialysis Study Group (2008). The influence of age on changes in health-related quality of life over three years in a cohort undergoing hemodialysis. The American Geriatrics Society, 56(9), 1608-1617.
US Renal Data System. USRDS Annual Data Report (2004). The National Institutes of Health, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, USA.
Wang, P. L., & Watnick, S. G. (2004). Depression ： A common but underrecognized condition associated with end-stage renal disease.
Seminars in Dialysis, 17(3), 237-241.
Welch, J. L., & Austin, J. K. (2001). Stressors, coping and depression in hemodialysis patients. Journal of Advanced Nursing, 33 (2), 200-207.
Williams, S. w.; Tell, G. S., Zheny, B., Shumaker, S., Rocco, M. V., & Sevick, M. A. (2000).Correlates of sleep behavior among hemodialysis patients- the kidney outcomes prediction and evaluation (KOPE) study. American
Journal of Nephrology, 22(1), 18-28.
Wuerth, D., Finkelstein, S. H., Kliger A.S., & Finkelstein, F. O. (2003):
Chronic peritoneal dialysis patients diagnosed with clinical depression:
Results of pharmacological therapy. Seminal Dialysis, 16(4), 424–427.
Yi, J.P., Vitaliano, P.P., Smith, R. E., Yi, J.C., & Weinger, K. (2008). The role of resilience on psychological adjustment and physical health in patients with diabetes. British Journal of Health Psychology, 13(2), 311–325.
Yeoh, H., Tiquia, H. S. Abcar1, A. C., Rasgon1, S. A., Idroos, M. L., &
Daneshvari, S. F. (2003). Impact of pedialysis cre on cinical outcomes.
Hemodial Intensive, 7(4), 338–341.
Zoccali, C., Mallamaci, F., Tripepi, G. (2002). Nocturnal hypoxemia predicts incident cardiovascular complications in dialysis patients. Journal
American Social Nephrology, 13(10), 729-733.
附錄一
受訪者同意書
計畫名稱：慢性腎臟病患者身體症狀困擾、壓力源、壓力調適方法與生活品質問卷 計畫主持人：陳光慧 職稱：中國醫藥大學護理研究所研究生
聯絡電話： 0932952169；0972530167；037-366858 轉 511 一、計畫簡述
經醫師診斷為國際疾病分類碼(ICD-9-CM)為 585.1~585.5 之慢性腎臟病患至少罹 患此病達6 個月以上，目前正接受治療且同意受測者的選樣標準。
附錄二
IRB 通過書
附錄三
慢性腎臟病患者之身體症狀困擾、壓力源、壓力調適方法 與生活品質問卷
個人基本屬性資料表
個人基本屬性資料表