血液透析導入に至った成人期の慢性糸球体腎炎患者の経験─保存期の療養生活についての「語り」に焦点を当てて

The Experiences of Adulthood Patients with Chronic Glomerulonephritis undergoing Hemodialysis: Focused on the “Narrative” of the Life under Medical Treatment in the Conservative Phase

　血液透析導入に至った成人期の慢性糸球体腎炎患者が，保存期にどのような療養生活を体験したのかを明らかにすることを目的とし，6名の研究対象者に対し半構造的インタビューを行った結果，その体験は【体の不調が受診行動に繋がらない】，【透析の可能性を知った衝撃】，【治療への積極的な取り組み】，【食生活を変え，継続することの困難さ】，【心配し気遣ってくれる家族の存在】，【腎臓が悪いと言われても生活を変えられない】，【透析時期を宣告されてからの療養開始】，【透析導入直前の極限のつらさ】，【療養を始めるタイミングを逃していた】など，11のカテゴリーに分類された．

　特に「症状があった際に受診をするか」，「診断がついてから療養をするか」という2つの選択の局面が，患者のその後の経過に大きくかかわっていることが明らかになり，患者の受診行動を促すためのかかわりや，患者が自身の生活のなかで実行可能な療養のプランをともにつくりあげていくかかわりが必要であることが示唆された．

　また，看護師が患者の語りを聴くことによって，患者は自分の考えや行動について意識的に語ることができた．受診行動や療養生活についての選択には，患者それぞれの事情や生活の背景が大きく影響しているため，患者の病いの進行を遅延し，その人らしい生き方を守るためにも，看護師は患者と語り合いながら，保存期の療養生活を充実させていく必要があることが示唆された．

　The purpose of this study is clarification of the experiences of the life under medical treatment in the conservative phase of the chronic glomerulonephritis patient undergoing hemodialysis in adulthood. As a result of having performed a semi-structural interview to six patients, the experiences were classified in 11 categories. Those were as follows:［the disorder of the body does not lead to a consultation action］,［the shock that was informed of possibility of the dialysis］,［active action to treatment］,［difficulty of changing the eating habits, and continuing it］,［existence of a family worrying about］,［even if kidney is bad, life is not changed］,［started medical treatment after the sentence of dialysis］,［extreme tightness just before the dialysis introduction］［missed a timing to begin medical treatment］ and others.

　Particularly, it was revealed that two choices greatly affected in the next progress of the patient. Those were “have a medical examination or not, when there was a symptom” and “undergo medical treatment or not after given a diagnosis”. And it was suggested that the medical person's relation were necessary about two of the next. Those were the relation to promotion consultation action of the patient, and to making up a plan together of executable medical treatment in the life of the patient.

　In addition, the patient was able to narrate one's thought and action consciously by a medical person's listening to the narrative of the patient.

　The background of circumstances and the life of the each patient greatly influence choice about treatment and the medical treatment life. Thus, it was suggested that it was necessary for the medical person to expand the medical treatment life of the patient that is in the conservative phase by the method of talking with a patient to delay the progress of illness of the patient and protect the way of life true to oneself.