成人期に血液透析を受けている者の家族の生活の諸相—主支援者である家族員の視点から

The life aspects of families with adults under hemodialytic treatment: The perspective of a family member, who plays a central role in supporting its in the family

　本研究は，成人期透析者の家族において，透析の導入および継続により起こっている生活の諸相を，家族のなかで主になって支援をしている家族員の視点から記述し，家族看護を考える一助とすることを目的にした質的記述的研究である．研究参加者は，透析導入後1年以上経過した40〜64歳の透析者の家族員3名で，いずれも透析者の妻であった．

　家族にとって，透析者の食事づくりは，生死を左右する食事をつくるという料理をする以上の意味があった．家族は，食生活を守ることで透析者の命を守ろうとし，家族として不可避なケア役割を担う重責を負っていた．また，透析の衝撃から家族を守るために，人間関係を断ち切り，家族員が主導となって家族体制を再編していた．家族は，透析導入により，一度は未来を失ったと感じるが，透析と歩む人生を引き受け，日常の営みに新たな価値を見出し，ともに過ごす時間を感じることによって，喪失した未来を取り戻していた．家族員は，葛藤，苦悩，喪失を伴いながら，家族自身がセルフケアを行い，変化し，価値観を変えて透析とともにある生活を継続していた．

　看護者がみる現在の家族の生活の諸相は，家族の歴史の積み重ねと複合して透析の影響が生活に現れるものである．透析者を含めた家族援助に求められていることは，家族としての苦悩に耳を傾け，家族がとらえた意味を肯定し，変化を促し，支えることである．

　We present a qualitative descriptive study to help family nursing care by describing various aspects of life for families with a person on dialysis from the viewpoint of the family's main care provider, especially associated with the introduction and continuation of dialysis. The study participants were three wives of men aged 40 to 64 years who had been on dialysis for 1 year or longer.

　To family members, preparing meals for family members on dialysis means preparing meals influencing their life and death; they sought to protect the life of the person on dialysis by protecting their dietary life, assuming the heavy responsibility of providing necessary care for the family member. Furthermore, families provided care by severing their own relationship with others, leading to the realignment of the family system to protect its members. Although families felt at one point that they had lost their future because of the introduction of dialysis, they regained the lost future by accepting life with dialysis, identifying new values in daily activities, and spending time together. Family members provided care to the person on dialysis while they struggle and feel distressed and lost and continued to lead a life with dialysis by changing themselves and their values.

　The various aspects of current family life observed by caregivers reflect the effect of dialysis overlapped with their accumulated family history. The assistance families with a family member on dialysis need are attentive listening to their distress as the family of a person on dialysis, affirmation of what this means to families, promotion of changes within families, and support.