Disruption And Continuity:Research On Illness Experience Of Menopausal Female Dialysis Patients And Social Work Intervention Strategy

Chronic kidney disease(CKD)is a global public health problem that has attracted widespread attention from researchers.The existing research has focused more on treating CKD from a biomedical perspective,while the patient’s illness experience in the world of life has not been adequately explored,especially a little research is known about menopausal female dialysis patients.Women in menopause are at unique risk for developing CKD,liking a high incidence of disease,and difficulty in treatment due to physiological factors.Menopausal female dialysis patients faced greater pain and suffering and urgently called for widespread attention from society.Based on these,the paper takes the patient’s biography as a perspective to explore:what menopausal female dialysis patients have experienced in their daily life?What are the real problems they face?What are the possible intervention strategies of medical social workers for solving their problems?Through using in-depth interviews and participant observation methods,we investigated 15 menopausal female dialysis patients from QL Hospital in Jinan.Finally,the findings of this paper were as follows:The study found that patients’ trajectory of illness experience was divided into two major phases,"biographical disruption" and " biographical continuity." First,patients’ bodies were alienated in the biographical disruption,which mainly manifested in the social stigmatization of their bodies,exclusion from the workplace as a sick body,and the suffering of physical pain;they also experienced the"symptoms" of losing themselves,which are rooted in the psychological disorder after the disease,incongruence of social role and individual fatalism of sick;The crisis of "disruption" in social relationships is also important feedback under the context of the patient’s illness experience,including the deterioration of family relationships,the alienation of patriarchal clan relationships,and the potential for doctor-patient conflict.Second,biographical continuity is another stage in the trajectory of the patient’s illness experience.From the "disruption" to the " continuity " of the life course after the disease,it essentially indicates that the patient’s illness experience is a constantly constructed and changing process.During this process,patients create a return to a"normalized" life through"re-engagement in daily household chores" and "pick up and drop off children from school." Through daily dietary interventions,monitoring of body vital signs,and continuous dialysis treatment,they have developed a set of"body management techniques" for the disease.In terms of ideology,patients create a concept of living with the disease,as well as reconstructing and examining the value of the individual’s life after the disease by creating the meaning of daily life and reconceptualization of life.Throughout the trajectory of the illness experience,patients face a wide range of realistic dilemmas,including insurmountable psychological barriers,delicate doctor-patient relationships,the cumbersome process of seeing a doctor,the emotional crisis of the couple,re-employment dilemmas,and confusion about caregiving after returning home.In this paper,based on these real-life dilemmas patients face,we propose four medical social work interventions,including casework strategy,patient mutual help group cultivation strategy,resource utilization strategy,and individual health management skills training strategy.We hope to introduce the intervention of medical social workers that may provide possible support and humanistic care for menopausal female dialysis patients and improve their quality of life.