糖尿病看護認定看護師が捉える糖尿病患者への自己客観視の援助

Nursing care for patients with diabetes to support their objective self-awareness by certified nurses in diabetes.

　　【目的】本研究は，糖尿病看護認定看護師が捉える糖尿病患者への自己客観視の援助を明らかにする．

　　【方法】糖尿病看護認定看護師（CN10名の半構造化インタビューの逐語録を質的統合法（KJ法）で分析した．

　　【結果】CNは【捉えることが難しい自己客観視】と考え【患者が捉える苦労や一生懸命さの理解】をし【患者に近づきすぎないように考えながらの距離感の調整】を行い【患者が一歩引いて自分を見るために安心でき承認される状況の提供】と【今までと違う視点で見ることができるような問い直しと考える時間の見極め】を援助し【過去と現在と未来を見すえて変わっていく患者の自己決定の変化の理解】や【患者が自己決定した目標を腹をくくり受け容れる】援助に繋げていた．

　　【結論】CNは自己客観視は捉えることが難しいと感じつつ，患者が安心・承認される状況の提供と考える時間の見極めを行いつつ，対話による問い直しで援助し，その援助は患者の自己決定に繋がっていた．

　［Purpose］

　Self-care for patients with diabetes（PWD）includes monitoring, such as blood glucose self-monitoring. Understanding the meaning of blood glucose level as an objective value is important. However, monitoring poses a psychological burden；thus, nursing care is essential. This study aimed to clarify objective self-awareness of PWD and its nursing care perceived by certified nurses in diabetes（CN）.

　［Methods］

　This study used the qualitative synthesis method, KJ method, to analyze transcript data from semi-structured interviews with 10 CN.

　［Results］

　CN had a perceived“ Difficulty in understanding objective self-awareness of PWD.”The attitude of CN was based on“Trying to understand the difficulties and struggles that the patients experience.”And CN provided advocacy and created“Nonintrusive supportive relationship” with PWD. Then, CN provide “Approval for PWD to calm down and understand themselves” and“Reflect to recognize PDW's positive qualities themselves and to ensure that they have time to think about themselves.”Finaly, nursing care shared an“Understanding of the PWD's changing self-determination throughout the past, present, and future”and“PWD's established personal goals.”

　［Conclusion］

　CN perceived difficulty in understanding objective self-awareness of PWD. The objective self-awareness of PWD is supported by providing an environment in which the patients feel safe and approved and ensuring that they have time for self-reflection and to engage themselves in interactive communication with CN to deepen self-understanding. This care is considered to respect and acceptance of the changes in the patient’s decision making.