保存期慢性腎臓病患者へのコンコーダンス概念を活用した療養援助—アクションリサーチによる取り組み

Recuperation Support Utilizing the Concept of Concordance for Pre-dialysis Patients with Chronic Kidney Disease Using Action Research

要旨

　目的：2017年に実施した入退院を繰り返す保存期慢性腎臓病患者11名の療養体験に関するインタビュー結果報告会とコンコーダンス概念の勉強会を通して，看護師の療養指導時の認識や実践にどのような変化がおこるのかを記述し，そのプロセスを考察することである．

　方法：2018年5月〜2020年3月にアクションリサーチにより腎臓内科病棟看護師に報告会および勉強会を3回実施後，看護師4名に2回面談を行い，質的記述的に分析した．

　結果：報告会および勉強会で現状の療養指導の問題点が明確化され，病棟看護師は療養指導の視点を自ら再考することができた．その後の療養指導時【一方的な指導が問題だと思う】ことから【患者の言葉で語ってもらうことを意識した】等の認識により，【先入観をもたずに患者自身の状況を意識して話をきいた】ことで【患者の生活に合わせた代替案を話し合った】等の実践の変化がみられた．

　結論：患者の療養体験を知りコンコーダンス概念を意識することで，患者の療養における行動変容に効果的な療養援助への示唆を得た．

　Purpose: The purpose of this study was to describe and consider the process of changes that occurred in nurses' perceptions and practice of patient education through two sessions: a debriefing session on the recovery experience of patients with chronic kidney disease and a study session on the concept of concordance.

　Methods: This study was conducted based on action research between May 2018 and March 2020. After conducting a debriefing session and a study session for the ward nurses, we interviewed four nurses two times. The contents of the interviews were analyzed qualitatively.

　Results: The nurses said that the debriefing and study sessions clarified the current problems in patient education, and they were able to reconsider the perspectives of patient education. The nurses “realized that unilateral patient education was a problem,” so they “tried to have the patients speak in their own words.” Because nurses “tried to listen to the patients without preconceptions and with awareness of the patients' own situations,” changes in practice such as “discussing alternatives that fit the patients' life” were observed.

　Conclusion: Our study suggested that learning about the patient's recuperation experience and being aware of the concordance concept are effective in conducting recuperation assistance for behavior change in patients.