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J Korean Acad Adult Nurs. 1997 Aug;9(2):239-250. Korean. Original Article.
Lee HJ , Kwon HJ , Kim KH .
Abstract

Nowadays administration of bone marrow transplantation is increasing state by developing society and high leukemia incidence. Decrease of relapse and infection rate result from chemo therapy drug development of treatment and strength. So we look for continuos development of treatment. But through before and after BMT, it takes several months by planing and HLA typing matching possibility of BMT. Also, it takes one or two month by duration of BMT and discharge. During BMT, patients experience emotional change-suggering, anxiety, depression and so on-due to changed body image and strictly isolation in special facility. After BMT, the patients also experience stress such as conditions self-care, support from family, concern of relapse risk and so far enlarge mental, economic and physical change surrounding them due to high cost. Accordingly nurses are required high quality of nursing attentive assesment, understanding of patient's environment and consideration, and teaching in administrative work. The study is attempted to establish nursing theory patients' experience in BMT treatment. Research method followed grounded theory methodology by strauss & Corbin. Subjects were 1 adolescent including highschool patient and 6 adults. This study continued from February 1996 through August 1996. All of these subjects were interviewed by this author. Interview were done by long interview technique and observation. Each interview took 1 hour to 2 hours Content of interview was recorded and transcribed later. The data thus collected were analyzed immediately after interviews and fed into the next round of interviews until the data collection reaches the saturation point. In the process of data analysis, "Terribleness" or "Miserableness" was found to be the core phenomenon. Results were composed to 103 concepts. These concepts were grouped into twenty four categories, and then to eleven categories. Categories include "physical burden", "economic burden", "mental distressing", "heartbreaking", "being gloomy", "horror", "being crushed", "feel oppressed", "being exhausted", "family dependent", "support", "previous data for procedure", "inclination", "exploding", "sharing", "mitigation", "bracing oneself", "becoming attached", "dependence", "thanks", "anxiety", and "abandonment". Patients with bone marrow transplantation were revealed to face "terribleness". Terribleness is found to be progressed through the cycle production-coping-solution. Fourteen hypotheses were derived from the integration of categories as follows ; (1) The stronger the term of suffering as perceived by the subjects, the stronger the "terribleness" will be. (2) The more excessive the degree of suffering as perceived by the subjects, the more excessive the "terribleness" will be. (3) If subjects have family dependent "terribleness" is expressed with abusement. (4) If subjects have no family dependent, "terribleness" will be expressed with exposure and suppressing. (5) The more abundant the sufficient support, "terribleness" will be expressed with exposure and suppressing. (6) The less abundant the sufficient support, "terribleness" will be expressed with abusement. (7) The more abundant the previous data, "terribleness" will be expressed with exposure and suppressing. (8) The less abundant the pervious data, "terribleness" will be expressed with abusement. (9) The more introvert the subject's inclination, "terribleness" will be expressed with exposure and suppressing. (10) The more extrovert the subject's inclination, "terribleness" will be expressed with abusement. (11) The more excessive the degree of "terribleness" will be expressed with abusement. (12) The less excessive the degree of "terribleness" it will be expressed with exposure and suppressing. (13) The more expressive the abusment, "terribleness" will be solved despair. (14) The more expressive the exposure and suppressing, "terribleness" will be solved with expectation. On the basis of the patterns that have the four these below were confirmed. 1. If patients felt large amount of terribleness because of severe suffering, they had family dependent. insufficient support, no previous data and their inclination was extrovert, "terribleness" is solved despair with abusement. 2. If patients felt large amount of terrible because of severe suffering family dependent, sufficient support, pervious data, and their inclination was introvert, "terribleness" is solved expectation with suppressing and exposure. 3. If patients felt small amount of terribleness because of little suffering, no family dependent, insufficient support, no previous data, and their inclination was extrovert, "terribleness" is solved despair with abusement. 4. If patients felt small amount of terribleness because of little suffering, no family dependent, sufficient support, previous data, and their inclination was introvert, "terribleness" is solved expectation with exposure and suppressing. On the basis of the above result, in orer to help nurses take good care of their patient, and understands patient's inclination and background, nursing assessment and intervention on life readjustment, and getting support should be required. It is expected that theoretical framework provided by this study, which shows how "terribleness" products, changes, increases and decrease. Therefore public relations, education, counseling emotional support, understanding inclination and exchange of information will have to be accomplished.

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