| Summary: | 碩士 === 長庚科技大學 === 護理研究所在職專班 === 103 === Background：The medical expenses of dialysis in renal disease have reached around NTD$ 38.7 billion in 2013, taking 7% of total health expenditure. In order to save the gigantic medical expenses and promote people's health, the urgent priority is to perform the optimal intervention as soon as possible. According to the systematic literature review, low-protein diet may defer the course of chronic kidney diseases; currently clinical medical health care also treats low-protein diet as one of the key medical health educational guidance. Nevertheless, many studies focused on quantitative research design, few explored the barriers of patients’ adopting low-protein diet. From my experiences of a case manager, patients always feel blurred about their cooperated diet and implementation; besides, many nurses even neither to probe what the actual problems are!
Purposes：Therefore, this study conducted a qualitative research design to explore the lived experiences regarding how those patients with chronic kidney disease adopt low-protein diets as well as what difficulties encountered in their daily life.
Methods：The research design takes phenomenology as the theoretical basis with purposive sampling. Based upon the phenomenological analysis step proposed by Colaizzi in 1978, we proceeded on the in-depth interviews with patients one-to-one by means of semi-structured interview guide. Patients were asked to elaborate their distinctive experiences and predicaments regarding how to adopt low-protein diet in daily life. In considering of the trustworthy credibility of research results, the peer scrutiny and member checking were carried out after data analysis. For the purpose of reliably accurate, integrated and credible data analysis, all the interviews were recorded and those transcripts were further translated into precise text with cautious reading to determine its validity. In addition, we also utilized the audit cross-way to request the vocational assistance from an expert with qualitative research experiences. The expert detected the consistency of both data analysis by extracting transcripts to double verify the credibility.
Results：There were fifteen interviews with chronic kidney disease to be classified into eventual four categories：Psychological stun at initial disease confirmation, diet struggles in daily life. Turning points of life and a fresh look at life, just bravely face it.
I.Psychological stun at initial disease confirmation, inclusive of two subjects：
(1)Astonished shock at patients’ initial aware of kidney disease facts; sub-theme as anxious concern about unable to be recovered from kidney disease.
(2)Individual feelings and cognition regarding kidney disease; sub-theme as considering negligible without uncomfortableness and fear of dialysis.
II.Diet struggles in daily life, inclusive of three subjects：
(1)Getting along with people; sub-theme as the differences in controlling diet disorders, the patience of diets and the dietary intake difficulty for fastfood junkies.
(2)Easier said than done of diet; sub-theme as：take care of daily life, too many excessive restrictions to be executed and things go contrary to our wishes.
(3)Hunger breeds discontentment; sub-theme as the competitive difficulty of diet implementation, the cognition of protein diet servings and the predicament of staple food substitution.
III.Turning points of life, inclusive of two subjects：
(1)Feel life-threatening; sub-theme as：the cataclysm of body health, only powerless control without any alternative solution due to complications.
(2)Love of family; sub-theme as wishing him/her healthy grown-up.
IV.A fresh look at life, just bravely face it, inclusive of two subjects：
(1)Self-control approaches self-treatment; sub-theme as coexist with the kidney disease to accept it, self-care of health indicators.
(2)Comfortably face with fate without any complaints; sub-theme self-adjustment, perseverant implementation leads to diet changes.
Conclusion/Implication： Though there are no obvious symptoms for chronic kidney disease patients, the possible deterioration is still needed to be cautiously worried about. The study result suggests：care for chronic kidney disease patients, the related caregivers should diligently realize their physical life dilemma, such as the frequency and difficulty of fastfood die, the relevant factors of being unable to heed the dietary advices from educators or dietitians, the impacts of the surrounding environments etc., and then further to discuss the appropriate solutions with patients accordingly. In the event, the outcome also anticipates to assist the clinical staff could formulate the relevant health promotion education programs in the near future; so that to ensure the practical implementation of patients diet control and thus could positively defer the time course of dialysis.
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