透析療法期にある糖尿病患者の病の受け止めと援助の方向性

Perceptions of Diabetic Patients Receiving Dialysis about Their Disease and Support Direction

　本研究の目的は，透析療法期にある糖尿病性腎症患者の病の受け止めを明らかにし，透析看護における援助の示唆を得ることである．その方法として，血液透析を受ける糖尿病性腎症患者8名（男性6名，女性2名）に，病気の経過と血液透析導入期・現在・これから先について，血液透析の体験を通して，どのように考え，感じているか自由に語ってもらった．分析の結果，患者の語る病の受け止めは，「病への取り組み：病は自分には該当しない，病は自分のしてきたことの報い」，「医療者へおまかせ」，「生への欲求：あるがままに受け入れ生き続ける，しかたない」，「他者と比較する」，「透析を受け入れるきっかけ」，「自分なりのできることを見つける」，「楽しみや行動が狭められる」，「透析継続のつらさ」，「食への欲求」などの9項目に大きく分類された．透析治療期にある糖尿病性腎症患者の援助の方向性として，1）患者が今後の自己像や生活の仕方を見出し，病へ取り組めるための援助，2）患者が自己価値を取り戻し，自己肯定できるための援助，3）身体的自己に自信がもて，自己拡張へ向ける援助，4）実践的知識の拡大への援助の必要性が示唆された．

　The purpose of this study was to clarify the perceptions of diabetic patients receiving dialysis about their disease, and obtain suggestions for improving dialysis nursing support. Eight patients with diabetic nephropathy undergoing hemodialysis (6 males and 2 females) were asked to freely talk about their hemodialysis experience, the course of their disease, initiation of hemodialysis, present status, and outlook toward the future. As a result of analysis, their perceptions were classified into 9 items: “Coping with the disease: I do not deserve the disease; The disease is punishment for what I have done”, “I leave the disease up to the medical staff”, “Desire to live: I accept the disease as it is and continue to live; It can not be helped”, “I compare myself with others”, “What made me accept hemodialysis”, “I find what I can do”, “My pleasures and actions are limited”, “Distress of the continuation of hemodialysis”, “Desire to eat”. Our study suggested the following direction of support for patients with diabetic nephropathy receiving dialysis: 1) support to encourage patients to find their future self-image and the way of living and cope with the disease, 2) support to allow patients to regain their own value and become self-affirmative, 3) support to allow patients to be confident of their physical condition and expand their abilities, 4) support for an increase in practical knowledge.