血液透析患者の自己決定の構造

Components of Decision-making among Hemodialysis Patients

要旨

　血液透析を受けている患者を対象に，患者が健康を守るために自ら行っている自己決定の構造を明らかにすることを目的に，帰納的研究を行った．データを分析し検討した結果，本研究から以下のような結論に達した．

①患者の自己決定は，〈目標〉〈状況認識〉〈自己認識〉〈選択肢〉〈計画性〉〈決断結果に対する思い〉の6つの構成要素からなる．

②自己決定は，6つの構成要素が互いに影響しあっており，その特徴から，建設的決定型・現実直視決定型・綿密的決定型・独断的決定型・消極的決定型・成り行き任せ的決定型・低抗的決定型の7つのタイプが見られた．

③自己決定の質を支える要因として，現実の認識力・ニード願望のコントロール・柔軟性・決断への自己関与が抽出された．

Abstract

　The purpose of this descritive study was to identify the components of decision-making among the dialysis patients.

　Subjects were a Convenience sample of hemodialysis patients who agreed to participate this study. The data was collected through semi-structured interviews was recorded on the tape and transcribed. Docision-making episodes were picked andinterpreted by researchers. Data was analyzed based on the Grounded Theory Approach.

　Result : Subject were 21 patients from 4 hospitals. The mean age was 51.1 and the mean duration after the hemodialysis was 9.1years. The number of episode of decision-making were 136.

　Six components of decision-making were extracted suchas＜goal＞＜recognition of situation＞＜recognition of self＞＜choice＞＜planning＞＜evaluation＞.

　The subject were making decision by examining and judging the situation and oneself, and then setting the goal. They were selecting situation and themselves. After all, the outcoma of decision- making were evaluating.

　Seven type of decision-making, erection type, realty-oriented type, elaborate type, dogmatic type, passive type, chance type, resistant type were extracted.

　Discussion : The factors which were related to the quality of decision-making were discussed such as the ability to examine the reality and control own wishes and needs, and the commitment for the decision-making. The nursing approach to facilitate the patients to make the decision were mentioned.