1．思春期の慢性腎疾患患児の自己決定に関する研究

A Retrospective Study of Adolescent Self-Decision Making Among Clients with Chronic Renal Disease

　本研究の目的は，思春期にある慢性腎疾患の子どもの自己決定に関する病気体験を明らかにし，看護の方向性について考察することである．成人期の血液透析患者5名に思春期時代の病気体験を半構成面接によりデータ収集し，内容を質的に分析した．その結果，思春期の慢性腎疾患患児は〈病気や治療の不十分な理解〉のまま〈不安・葛藤を自己表現できないもどかしさ〉をかかえながら生活しており，自分の生き方に関して〈自己決定への願望〉をもっていたことが明らかとなった．また，自らが納得した人生を送るために，自己決定を尊重されることが重要であることが明らかとなった．看護への示唆として，インフォームド・コンセントの重要性，家族が真の支援者になるためのケアの重要性，思春期特性をふまえたうえでのかかわりの重要性，日常生活のなかに子どもの自己決定を尊重する環境を保障していくことの重要性が見出された．

　The purpose of the present study was to examine decision-making among adolescent chronic renal disease (CRD) patients in order to improve nursing care among this population. A retrospective design was employed. Five adults with CRD were recruited from a renal dialysis center. After receiving informed consent, subjects were interviewed by the principal investigator using a semi-structured interview format and asked to describe their treatment-related feelings during the period they were adolescents with CRD. Qualitative content analysis of the interview data revealed that in retrospect, adult clients now felt that as adolescents they had: 1. lacked the ability to fully comprehend their disease and treatment, 2. lacked the ability to express their anxiety and psychological distress, and yet 3. felt a strong urge to make autonomous decisions about their life. Subjects reported that feeling in control of their life and being respected were very important to them at that time. The findings suggest that nursing care of adolescents with CRD should include the following: enabling adolescents to make informed decisions regarding their treatment options, teaching the family members how to support the autonomy and independence of the client, awareness of normal adolescent developmental stages, and creating an atmosphere which fosters client independence in decision-making in every day life.