تبيين فرايند حمايت اجتماعي درك شده در بيماران دچار نارسايي مزمن كليه تحت همودياليز: يك مطالعه كيفي

A QUALITATIVE STUDY OF HEMODIALYSIS PATIENTS’ EXPERIENCE OF PERCEIVED PERSONAL SOCIAL SUPPORT

پيش زمينه و هدف: يكي از پيش بيني كننده هاي سلامت روان، حمايت اجتماعي درك شده است كه مفهوم آن به ارزيابي شناختي فرد از محيطش و سطح اطمينان فرد به اينكه در صورت لزوم كمك و حمايت در دسترس خواهد بود متمركز و مفهومي مهم در بيماري هاي مزمني چون نارسايي مزمن كليوي منجر به همودياليز است، با توجه به اينكه مطالعات چنداني در زمينه اين مفهوم در افراد همودياليزي در ايران انجام نشده است؛ بنابراين ادراك اين مسئله بر اساس تجارب كساني كه مدتي تحت درمان با همودياليز قرار داشته اند، مي تواند به متصديان بهداشت و درمان ازجمله پرستاران در تمامي سطوح بهداشتي، درماني و بازتواني در ارائه خدمات هدفمند و با كيفيت بهتر ياري نمايد. هدف از اين مطالعه تبيين فرايند حمايت اجتماعي درك شده در بيماران همودياليزي است. مواد و روش ها: اين مطالعه يك پژوهش كيفي از نوع نظريه پايه است كه 32 نفر از مشاركت كنندگان بر اساس نمونه گيري هدفمند از بين افراد مبتلا به نارسايي مزمن كليوي تحت درمان با همودياليز، اعضاي خانواده و پزشكان، پرستاران و مسئوليني كه در انجام حمايت اجتماعي براي بيماران نقش داشتند، مورد مطالعه قرار گرفتند. مصاحبه هاي فردي به مدت زمان 65-20 دقيقه و در دفعات 31 بار براي جمع آوري داده ها استفاده شده است. مكالمات مشاركت كنندگان ضبط و كلمه به كلمه بر روي كاغذ پياده شده و تجزيه وتحليل داده ها به روش تحليل محتواي كيفي انجام گرفته است. يافته ها: پنج طبقه مربوط به حمايت اجتماعي درك شده در بيماران همودياليزي از مفاهيم استخراج شد: 1 تهديدات درك شده ناشي از مشكلات ناشي از همودياليز 2 جستجو براي حمايت اجتماعي 3 حمايت اجتماعي در دسترس 4اعتقادات و ارزش ها 5 دستيابي به حمايت درك شده بر مبناي پذيرش واقعيات موجود. بحث و نتيجه گيري: شناسايي عوامل مؤثر بر حمايت اجتماعي و روند دستيابي به آن مي تواند به اصلاح باورهاي غلط و كمك هاي مؤثر و دادن اطلاعات و آموزش هاي مناسب به مددجويان و خانواده آنان منجر و باعث توانمندسازي بيماران و همراهان و مشاركت مؤثرترشان در كاهش مشكلات ناشي از ماهيت بيماري و عوارض ناشي از آن شود. اين كار، نيازمند همراهي مددجويان و تمامي افرادي است كه به نحوي در رابطه اجتماعي و درماني با آنان قرار مي گيرند.

A QUALITATIVE STUDY OF HEMODIALYSIS PATIENTSrsquo EXPERIENCE OF PERCEIVED PERSONAL SOCIAL SUPPORT Aghakhani N[1], Sharif F [2]*, Molazem Z[3], Habibzadeh H[4] Received: 14 May , 2014 Accepted:16 Jul , 2014 Abstract Background Aims: Chronic renal failure disease is considered as one of the highest causes for mortality rate in Iran that affects on physical, psychological and social health aspects of patients. Various treatments like hemodialysis prolong the life of these patients, but they must tolerate many complications in many aspects. Due to the interactional and cultural nature, social support sounds to be vital and necessary to be investigated in patients. The aim of this study was to highlight perceived personal social support in hemodialysis wards as experienced by patients with chronic renal failure. Materials Methods: A grounded theory approach was used in this qualitative research. Key informants were 22 patients who were treated by hemodialysis. Three nurses, 4 general practitioners, a specialist and two family members participated in the study, and they were interviewed from April to September 2012. Interviews were guided to unveil the perception of the drastic changes in their existence, needs for social support for the disease complications, and hemodialysis as a treatment process. Purposive sling was done up to data saturation. Data analysis was done based on Strauss and Corbin method. Constant comparison analysis was done until data saturation. Results: The research results appeared in 3 steps. In the first step, five main themes from 993 first codes were explored based on the meaning of general themes including ldquo threats caused by disease and hemodialysis quot , ldquo searching for a social supportquot , ldquo attained social supportrdquo , ldquo subjective values and beliefsrdquo , and quot acquired social supportquot . Conclusion: The qualitative research completed our knowledge about patientsrsquo needs and problems for social support. This issue reveals many problems for supporting the patients that are experienced by health team members, family members and social organizations. The findings reveals that individual experiences must be considered if social support should be done, and if health providers and policy makers consider these items in health facilities. Key words: hemodialysis, experiences, perceived, personal, social support, qualitative study, Iran. Address: Community Based Psychiatric Care Research Center, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. PO Box: 713451359. Tel: (+98)7116474250 Email: fsharif@gmail.com [1] Ph.D, Assistant Professor, Department of Nursing Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. [2] Professor, Community Based Psychiatric Care Research Center, Department of Mental Health Nursing, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. [3] Assistant Professor, Department of Nursing Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. [4] Assistant Professor, Department of Nursing Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.