透析を受ける病者の「生活の編みなおし」の検討―糖尿病性腎症による向老期透析導入患者を焦点に

Assessment of “Life Restructuring” of Patients on Dialysis: Focus on Over-middle-aged Patients with Diabetic Nephropathy Who are Going to Initiate Dialysis

要旨

　本研究は，糖尿病とともに生活してきて，向老期に至るまでの生活史が形作られている透析導入患者の，生活史の編みなおしに影響する心理的様相について検討することを目的とした．5名の対象に対して，半構成的面接法を用いた．その結果，次のような3つの相反する様相が見出せた．①「透析生活は楽しみややりがいを縮小させる・新たな楽しみを見出す」，②「透析生活は，発達する自己の停滞感を抱かせた・新たな役割によって透析を受け入れた」，③「無力感，罪責感による諦め・現実を受け入れ自己一貫性の維持」であった．患者が生活史の編みなおしをするには，過去の体験と現在おかれている状況を患者自身がどのように意味づけ，将来を見通しているかという，自己の気持ちに気づくことが重要となる．したがって，生活の編みなおしの視点には，対象のこれまでの生活史での体験の様相と，これからの見通しへの心理的特性を見極めた看護が求められ，その必要性が示唆された．

Abstract

　The purpose of this study is to examine psychological complexities that affect restructuring of the life history of patients who are going to initiate dialysis and have a given life history leading up to the over-middle-aged that includes living with diabetes mellitus. Five patients were studied using a semi-structured interview, and the following three conflicting complexities were found.

　（1）“Life with dialysis reduces fun and challenge” vs. “Need for the discovery of new pleasures,” （2）“Life with dialysis brought about a sense of stagnation of self-development” vs. “Acceptance of dialysis as a result of new roles” and（3）“Resignation as a result of sense of helplessness and guilt” vs. “Accepting reality and preserving self-consistency.” It is important for patients restructuring their life history to discover their own feeling toward how they represent their past experiences and their current status and how they focus on their future. Therefore, from the viewpoint of life restructuring, care that identifies the complexities of the patient's experiences during their past life history and psychological features targeting the patient's future outlook is required. The need for such care was suggested.