腎移植後再透析した患者の病気の体験から示唆された看護の方向性

Nursing Method Suggested by the Patients who Underwent Dialysis again after Renal Transplantation

　本研究の目的は腎移植後再透析した患者にそった看護の方向性の示唆を得るために患者の，認知する病気の体験を明らかにすることである。その方法として，腎移植後再透析した40代の男性患者2名に，再透析患者に特有な病気の時期である，①透析前，②透析後から腎移植まで，③賢移植から再透析まで，④再透析から現在まで，⑤現在，の5つの時期における患者の認知する出来事とその心情を自由に語ってもらった。分析の結果，患者は苦悩し葛藤し，多くの透析患者の中で孤独感・孤立感があると考えられたが，患者の力と他者からの支援により，移植の経験を肯定的に受け止め，新しい価値観を形成していた。今後の看護の方向性として，①患者の心理プロセスへのチームでの対応，②患者が自身の悲しみや苦しみを直面化できるための援助，③患者の家族や周囲・透析患者への働きかけ，④自己の存在理由を見出せるための援助，⑤受けたい医療を悔いなく自己決定できるための援助の必要性が示唆された。

　The purposes of this study were to analyze the experiences of patients with renal diseases who underwent redialysis after renal transplantation and to find a nursing method suitable for such patients. We asked two male patients in their 40s who had undergone dialysis again after renal transplantation to describe the incidents and feelings they experienced in the five stages of the disease requiring dialysis. The stages were (1) before the start of dialysis; (2) between the start of dialysis and renal transplantation; (3) between renal transplantation and the re-start of dialysis; (4) between the re-start of dialysis and the present; and (5) at present.

　We considered that these patients were more distressed and troubled with loneliness and helplessness among many other patients undergoing dialysis, but the patients had had positive experiences of renal transplantation and had established new values in their own capacities and helping of other people.

　Five interventions were suggested for better nursing, as follows; (1) counseling patients in team on the psychological process, (2) supporting patients in confronting their grief and distress, (3) communication with patients' family and people in contact with patients, with dialysis, (4) supporting patients in finding a raison d'être, and (5) advising patients on choosing treatment methods so that they will not regrets.