臨床看護師による保存期慢性腎臓病入院患者の行動変容を促す療養援助のプロセス

Recuperation Support Processes by Clinical Nurses to Promote Behavior Change in Hospitalized Patients With Predialysis Chronic Kidney Disease

要旨

　目的：臨床看護師が実践している入院中の保存期慢性腎臓病患者の行動変容を促す療養援助のプロセスを明らかにすること．

　方法：腎臓病指導を行う臨床看護師10名に半構造的面接を実施し，修正版グラウンデッド・セオリー・アプローチ（M-GTA）を用いて分析した．

　結果：臨床看護師が保存期慢性腎臓病患者とともに患者自身が取り組もうと思える療養行動を見出すプロセスは，【患者の療養体験と希望を知覚する】ことを起点とし，【患者に承認してもらう】関係性を築けると【立ち止まって確認したり説明する】【患者とこころを合わせ療養行動を見出す】援助につながり，行動変容を促進できる．話をきかせてもらっても【及び腰になる】【一方的に指導する】という行動変容を促すことができないプロセスも見られるが，【チームで支援する】ことで行動変容を促す療養援助を継続できる．

　結論：患者の関心事について【患者の療養体験と希望を知覚する】ことを通して顔なじみとなり【患者に承認してもらう】関係性を築くことが，行動変容を促す療養援助において重要であることが示唆された．

　Purpose: This study aims to clarify the process of how clinical nurses' recuperation support promotes behavior change in hospitalized patients with predialysis chronic kidney disease.

　Methods: Semi-structured interviews were conducted with ten clinical nurses who provided kidney disease guidance to hospitalized patients, and the results were analyzed using the Modified Grounded Theory Approach (M-GTA).

　Results: In recuperation support, the clinical nurse works with the patient to find recuperation behaviors in which the patient is willing to engage. In this process, the nurse begins by "perceiving the patient's recuperation experiences and wishes." This leads to the nurse "getting approved by the patient," "taking time to confirm the patient's words (thoughts) and explain things to the patient," and "building rapport and working with the patient to find suitable recuperation behaviors for the patient," which promote the patient's behavior change. When the nurse listens to the patient's story, actions that may suppress behavior change, such as the nurse "being hesitant" and "giving one-sided guidance," are still observed. However, continuous recuperation support that promotes behavior change can be accomplished by "supporting the patient as a team."

　Conclusion: This study suggests that "getting approved by the patient" by "perceiving the patient's recuperation experiences and wishes" is important in helping the nurse provide recuperation support that promotes behavior change in hospitalized patients with chronic kidney disease.