青年期男性透析患者の自立を促す看護に関する研究

Analysis of Nursing Interaction with The Hemodialysis Adolescent Patient

要旨

　透析治療の開始は，患者のそれまでの生活や自己概念を否応なしに変えてしまう．特に青年期はアイデンティティの確立過程であることや，種々の問題に対処していく能力も十分には育っていない時期であるため，透析への適応が困難であると思われる．本研究は，青年期透析患者の自立を促す看護を明らかにする目的で行った．

　自己管理面・社会復帰面の問題が容易に解決されない青年期の男性患者1名に対し，相談・面接の方法を用いた援助を行い，患者の持つ問題の特性と援助方法，ならびにその意義を検討した．

　その結果，患者―看護婦間の相互変容過程を経て，患者の自立が促された．また，青年期男性透析患者にとって，透析前の身体的活動能力へのこだわりが，透析患者としての自己概念の形成を妨げている大きな要因になっていることがわかった．その身体的活動能力へのこだわりを解決するためには，患者が活発に活動していた過去の自分に対する気持ちを自由に語ることができ，患者の自尊心が尊重される場を提供する援助が有効であった．

Abstract

　The introduction of hemodialysis treatment forces patients to make drastic change in their life styles and self-image. This is especially true for adolescents who are still in the process of growing up and have defficulty of adapting to those drastic changes.

　The purpose of this study was to clarify the role of nursing for the patients to establish their independence and adapt to dialysis therapy. One adolescent patient on dialysis treatment experiencing difficulties in self-care and social rehabilitation was selected and interviewed in a manner of supporting his emotional expressions by a nurse interviewer.

　Interactions occured in the interviews were analyzed, which resulted the adolescent patient to establish his independence while the patient-nurse relationship was maintained, and to discuss his problems frankly with the nurse interviewer. It was found that the patient's adherence to the memory of the past himself with physical abilities had caused his self-image affected. It was clear that creating an atmosphere in which the patient could talk freely about his own problems such as his physical difficulties was particularly important in order for him to restore his self-respect and dignity and establish his independence.