血液透析患者の自己管理行動と動機づけおよび自己効力感との関連

Relationship between self-management behavior and motivation and self-efficacy in hemodialysis patients

【目的】血液透析患者における包括的な自己管理行動の関連要因を動機づけと自己効力感に焦点を当てて明らかにし，患者が適切な自己管理行動を獲得・維持するための看護ケアについて検討する．

【方法】2020年2月〜5月に医療機関12施設の血液透析患者409名を対象にした無記名自記式質問紙調査を実施した．調査項目は，個人属性，血液透析自己管理行動尺度，慢性疾患患者の健康行動に対するセルフエフィカシー尺度，療養行動の動機づけ尺度である．分析では，自己管理行動と個人属性，自己効力感，動機づけを単変量解析で確認したのち，自己管理行動への関係モデルを構築し，共分散構造分析を実施した．

【結果】血液透析患者の自己管理行動【食事制限と水分制限の遵守】【治療法の管理と合併症の予防】【身体と心理社会生活の調整】のすべてにおいて，自律的動機づけから自己効力感を介した間接効果が確認された．【食事制限と水分制限の遵守】は，自律的動機づけの直接効果も確認された．就業は【治療法の管理と合併症の予防】【身体と心理社会生活の調整】に関係し，血中リン値は【食事制限と水分制限の遵守】と関係していた．

【考察】自己管理行動を獲得・維持するための看護ケアには，血液透析患者が自らの意思で行動をおこすために，医療者による支配的な言動を避け，自律的動機づけを保つように関わることの重要性が示唆された．さらには，血液透析患者が主体的に治療参加できるよう個別性を重視し，自己効力感を高めることが重要となる．

【Objective】To establish nursing care that enables hemodialysis patients to acquire and maintain self-management behavior, we will clarify the related factors of comprehensive self-management behavior in hemodialysis patients by focusing on motivation and self-efficacy, and study nursing care for patients to earn and maintain appropriate self-management behavior.

【Methods】We conducted a survey by sending self-administered questionnaires to 409 hemodialysis patients. The survey items included personal attributes, the hemodialysis self-management behavior scale, the self-efficacy scale for health behavior of patients with chronic diseases, and the motivation scale for medical treatment behavior. First, we examined the relationship between self- the motivation scale for medical treatment behavior, management behavior, individual attributes, physical findings and test data, self-efficacy, and motivation, using univariate analysis. Next, we constructed a relational model of self-management behavior and self-efficacy, and motivation, based on the conceptual framework and the results of the univariate analysis, and conducted covariance structure analysis.

【Results】In all of the self-management behavior of hemodialysis patients had indirect effects through autonomous motivation on compliance with dietary restrictions and water restrictions, regarding the management of therapy and prevention of complications, regarding the adjustment of physical and psychosocial living. Employment was related to regarding the management of therapy and prevention of complications, regarding the adjustment of physical and psychosocial living, and phosphorus was related to compliance with dietary restrictions and water restrictions.

【Discussion】In nursing care for acquisition and maintenance of self-management behavior, it was indicated that it is important to avoid dominant behavior by medical persons and to maintain autonomous motivation in order for hemodialysis patients to act on their own will. Moreover, it is important to emphasize individuality so that hemodialysis patients can participate in treatment independently, and to enhance self-efficacy.