血液透析患者が守りたい生活と透析による制限のある生活との折り合いをつけるための透析看護認定看護師の看護実践

Nursing Practices of Certified Nurses in Dialysis Nursing to help hemodialysis patients come to terms with the lifestyle that patients wish to preserve and the lifestyle restrictions imposed by dialysis

【目的】血液透析患者が守りたい生活と透析による制限のある生活との折り合いをつけるために，透析看護認定看護師はどのような看護実践をしているのかを明らかにする．

【方法】透析看護認定看護師資格取得後5年以上の透析看護実践経験を有する看護師を対象に，半構造的面接を行い，得られたデータを質的記述的に分析した．

【結果】透析看護認定看護師が行っていた看護実践は，《患者と看護師の関係性の構築に向けた関わり》《腎不全と透析の合併症から患者を守る支援》《透析を受け入れがたい患者への支持的な関わり》《透析に縛られる生活から守りたい生活への移行支援》《より良い自己管理行動に向けての関わり》という5つの大カテゴリーに分類された．

【考察・結論】患者の状況のアセスメントや，状況に合わせた透析看護認定看護師の多様な看護実践は，患者の療養上の安全を確保しながら，生活の拡大，精神状態の安定，透析受容の促進，自己効力感の向上に繋がる重要な援助である．

【Objective】To identify the nursing practices used by Certified Nurses in Dialysis Nursing to help hemodialysis patients come to terms with the lifestyle that patients wish to preserve and the lifestyle restrictions imposed by dialysis.

【Methods】Semi-structured interviews were conducted with nurses who had five years or more of dialysis practice experience after obtaining their Certified Nurse in Dialysis Nursing certification. The collected data were then analyzed using qualitative descriptive analysis.

【Results】The nursing practices used by the Certified Nurses in Dialysis Nursing were categorized into five major categories: “Involvement towards building a relationship between patients and nurses”, “Support to protect patients from renal failure and complications of dialysis”, “Supportive involvement with patients who have difficulties accepting dialysis”, “Assistance in shifting from a life constrained by dialysis to a life that patients wanted to preserve”, and “Involvement towards better self-management behavior”.

【Discussion / Conclusion】The assessment of patient status and the various situation-specific nursing practices of Certified Nurses in Dialysis Nursing provided important support for broadening the scope of patients' lives, stabilizing their mental state, promoting acceptance of dialysis, and improving self-efficacy, while ensuring the safety of patients during their treatment.