外来血液透析患者の外食における苦悩と工夫—質的研究手法を用いて

Qualitative study of hemodialysis outpatients' eating-out related distress and struggle

　本研究は外来血液透析患者の外食における苦悩と工夫を明らかにし，外食における看護の示唆を得ることを目的とした．外来血液透析患者で，研究の同意が得られた者に対し，外食に関する苦悩および工夫について半構造化面接によるインタビューを行い，内容分析法にて質的に分析を行った．

　対象者は11名であり，男性9名，女性2名であった．平均年齢64.4歳であり，平均透析年数は9.6年であった．血液透析患者の外食における苦悩は68コードから5カテゴリーに集約され，その中でも，［食事制限による周囲への気苦労］と［外食における選択肢の乏しさに対する不満］が外食における苦悩の特性として抽出された．また，外食における工夫においては，110コードから6カテゴリーに集約され，［気を遣わせないための声かけ］と［食事管理における家族や飲食店の協力］が外食時の工夫の特性として抽出された．

　血液透析患者は，外食をするときに店員や同席者に対し気苦労を感じており，メニューや調理法などにおいても外食しやすい環境とはいえない現状が明らかとなった．よって，透析患者の食事指導の中に，外食時に気を遣わせないための声かけの工夫や，安全で利用しやすい飲食店についての情報提供が必要である．また，透析患者の外食における苦悩を軽減するためにも，家族や店員に協力が得られるよう患者のセルフアドボカシーを高める支援が重要であることが示唆された．

　This study aimed to clarify distress and struggle about eating out for hemodialysis outpatients, and obtain suggestions for nursing care assistance while dining out. Qualitative analysis was done on the data obtained from semi-structured interviews with consenting hemodialysis outpatients, who discussed their distress and struggle about eating out.

　The 11 participants comprised 9 male and 2 female patients, with an average age of 64.4 years and mean number of years on dialysis of 9.6 years. The distress of hemodialysis patients about eating out were collated into 5 categories from 68 codes, and the extracted notable concerns included “worrying about the effect of your dietary restrictions on others” and “dissatisfaction with not being able to choose many kinds of food when eating out”

　The struggle of hemodialysis patients about eating out were collated into 6 categories from 110 codes, and the extracted notable ideas included “saying something so that you don't need worry about bothering others” and “choosing restaurants with better menu choices, and seeking assistance from family members.”

　The study revealed that hemodialysis patients worried about how their condition affects the other people they are dining with and the restaurant staff when eating out. It also highlighted how the current dining out environment is not really user-friendly for dialysis patients in terms of the menu, cooking methods and other factors.

　Therefore, regarding dietary guidance for hemodialysis patients when eating out, there needs to be ideas for saying something so the patient doesn't need to worry about bothering others, and sharing information on safe and user-friendly restaurants. The study also suggested that it is important to support self-advocacy of hemodialysis patients so that they can cooperate with their family members and restaurant staffs in order to reduce the distress of eating out.