自律神経障害を有する糖尿病患者が自分らしく生きるプロセスを支える外来看護援助ガイドの開発

Development of nursing care guide for enhancing self-care in diabetic outpatients with autonomic neuropathy

　本研究は，実践能力の高い看護師が援助を効果的に行うための，自律神経障害を有する糖尿病患者が自分らしく生きるプロセスを支える外来看護援助ガイド（以下，ガイド）の作成を目的とした．自律神経障害のある糖尿病患者への看護援助と結果が詳細に記された先行研究を分析し，ガイド案を作成した．3名の対象患者に適用し，修正したガイドを専門家会議にかけ，有用性と修正意見を求め精錬した．

　ガイドは，ガイドの説明と適用方法，援助指針〔症状マネジメントを支援する〕〔安全安楽な生活調整を支援する〕〔ゆとりある生を支援する〕を柱とする援助計画（看護目標・援助指針・患者到達目標・援助方法）で構成した．ガイドを適用した結果，辛い症状の軽減，安全な生活の確保と豊かな自己形成に繋がる効果を認めた．

　ガイドは，身体・生活・心理社会的側面を包括的かつ関連性を捉えながら，多様なニーズを持つ対象の状況に合う援助を導くことが示唆された．

　The purpose of this study was to “develop a nursing care guide for enhancing self-care in diabetic outpatients with autonomic neuropathy” (“the guide”) for proficient nurse. First, we made a tentative guide by analyzing a previous study of patients with diabetic autonomic neuropathy in which the nursing care and its results were described in details. Next, we applied this guide to design the care provided to three model patients, tested its effectiveness and, finally, consulted expert nurses and researchers for improvement.

　The guide was composed of a general introduction, explanation about using the guide and the nursing care plan which includes the nursing goal, the aspects of nursing care, the patient's goal and methods to reach those goal. Aspects of care can be categorized as: supporting the symptom management, supporting the arrangement of a safe living, and supporting comfortable daily life. As a result of using the guide during nursing care intervention, we noticed a better management of symptoms, an increase in feelings of safety and comfort, and an increased self-confidence in patients.

　This study suggests, that a holistic, relevant and flexible approach to care using the guide we developed can meet the multiple and diverse needs of patients with diabetic autonomic neuropathy.