維持血液透析患者・家族の終末期医療に対する意向を尊重した透析看護師の看護実践

Nursing practice of dialysis nurses who respect the intentions of hemodialysis patients and their families for the end-of-life care

【目的】血液透析患者とその家族の終末期医療に対する意向を尊重することに焦点を当てた透析看護師の看護実践を明らかにすることを目的とした．

【方法】8名の研究対象者に半構造的インタビューを行い，質的記述的に分析した．

【結果】【患者・家族を気づかい信頼関係を築く】【患者の生きてきた軌跡を知って望みをつなぐ】【終末期の意向をきくタイミングを捉える】【終末期の意思決定にゆらぐ患者を支える】【適切な情報に基づき患者にとって最善の意思決定を支える】【終末期においても患者がこれまで築いてきた生活を支える】【チームで協働し最期まで患者の生を支える】という7つのカテゴリが得られた．

【結論】患者の生き方を理解し患者・家族と信頼関係をつくり，意思決定のゆらぎも受けとめながら日々のケアの中で患者を尊重しようとする経験豊富な透析看護師の姿勢や態度は，透析患者の終末期医療に対する意向を引き出し支える看護実践の基盤となっていた．透析看護の特性である多職種や多部門との連携やコーディネートにより，患者が望む生き方を最期まで全うできるように支えることが透析看護師に期待される役割であることが示唆された．

【Objectives】This study aimed to clarify the nursing practice, especially focused on respecting hopes and orders for end-of-life care for hemodialysis patients and their families.

【Method】Semi-structured interviews were conducted for eight cases and the data were analyzed qualitatively and descriptively.

【Results】The study identified seven categories of the dialysis nursing practice which included “awareness of the patients and their families and building a relationship of trust,” “knowing the patients' life trajectories and connecting their hopes,” “grasping the timing of the end-stage intentions,” “supporting patients who were indecisive in decision-making during the terminal-stage,” “supporting the best decision-making for the patient based on the available information,” “respecting the value and belief built by the patient even at the end of life,” “and collaborating with the team and supporting the patients' life until the end.”

【Conclusion】Experienced dialysis nurses intendedly implemented daily care with respecting for the patients. It is an underlying core practice that dialysis nurses understand the way of life of the patient, develop a reliable relationship with them, accept the sluggish resolution, and understand what the patient wants. It was suggested that the role of expected dialysis nurse is to corporate and collaborate with the multiple professions and departments of the medical team and complete the patient's life with great satisfaction.