Exploring Adjustment Process in Cirrhotic Patients: Developing a Caring Model

Abstract

Abstract: Introduction: Liver cirrhosis patients suffer from several physical, psychological, and social problems caused by the disease and its treatments. The presence of such problems makes it a major challenge for the patients and the researchers to adjust with the disease and its treatments. Thus, designing a treatment pattern will help the patients and the caregivers to work properly to make adjustment with the disease. Since designing a caring model to make adjustment in cirrhosis patients requires a complete understanding of the adjustment process in patients, doing a research seems necessary to identify the experiences of liver cirrhosis patients. The present research has been carried out regarding two main goals of: identifying the adjustment process of liver cirrhosis patients, and presenting a caring model. Method: To achieve the research's first goal, the qualitative grounded theory study was done on patients’ adjustment process based on experiences and interactions among the patients and others. The data were gathered through unstructured and semi-structured interviews and field notes. Sampling was started by the purposeful selection of liver cirrhosis patients and gradually it was continued by a theoretical sampling based on codes and classes until the theory was completely implemented. In this study and to reach theory adjustment stage, 32 participants (including 20 patients, 8 persons from among family members of the patients, 2 doctors, and 2 nurses) were interviewed. Data analysis was performed concurrently with data gathering and by using Straus and Corbin (1998) approach. After the recognition of fundamental concepts of adjustment process, the adjustment promotion model for liver cirrhosis patients was designed using Walker and Avant theory construction strategy. Findings: The findings have been represented in the first step that was open coding stage and include of 2850 initial codes were grouped in 82 categories, and during axial coding were categorized in 8 categories including: “Understanding the disease threat”, “Despair of treatment”, “disease's stigma”, “Abeyance between death and life”, “Dealing with the disease”, “Turbulence life”, “Resources and obstacles to adjustment with disease”, and “Life retrieving”. The comparative and constant analysis of the data showed that the main problem of the participants was "Disease threat". “Efforts to maintain the existential integrity” was considered as the central variable that has had the major role in adjustment process. At second stage and after recognizing the main concept of adjustment process, the caring model focusing on the concept of “Promoting maintain of the existential integrity in cirrhotic patients” was designed using grounded theory study results and related theories Conclusion: The present research showed that adjustment with liver cirrhosis disease is a multidimensional and context specific (the disease, treatment, and environment) and has had a positive developmental trend concept in order to preserve efforts to maintain the existential integrity through which the patients try to enhance their perception of the disease and its treatment and overcome the restrictions resulted from the disease by using adjustment strategies and accept the disease as a part of their lives.