自己導尿を行なう患者における導入時からの心理的変化およびそれに影響を及ぼす背景について

The Process of Psychological Acceptance of Clean Intermittent Self-catheterization after Its Induction and the Factors Influence the Process

はじめに

　自己導尿とは，患者自身がカテーテルを使って自分の尿を排出する方法であるが，一般的に清潔間欠自己導尿（clean intermittent catheterization；以下，CICとする）を指している。CICは，1972年米国ミシガン大学のLapides教授^14）が長年の臨床経験から考案し，その導尿手技は厳密な滅菌操作を必要とせずに清潔操作で十分であるとしたものである。それは，膀胱に過伸展を起こさない間隔で尿を排出すれば，たとえ導尿操作に伴って細菌が進入しても感染の危険性は少ないと考えられたことが根拠になっている。それだけではなく，膀胱尿管逆流現象，尿失禁の改善，腎機能の保持にも有効であるといわれ，現在では特に神経因性膀胱の排尿管理に重要な位置を占めるようになっている。

　CICの導入に際しては，視力や手指の運動能力などの身体的能力，CICの意義や清潔操作の必要性に対する理解力といった知的能力，さらに家族をはじめとした周囲の人の理解も必要である^{15），1），11）}。最近では，高齢者においても尿道留置カテーテルを使わない排尿管理方法としてその使用は広がり，注目されつつある^{25），16），26）}。

　Objectives : To investigate transition process of psychological acceptance of clean intermittent catheterization (CIC) and also to explore the factors that influence the process.

　Methods : In the qualitative descriptive study,an information of the patient's feeling toward CIC procedure was collected retrospectively through semi-structured interview with 26 patients undergoing CIC. Each patient's feeling toward CIC and associated events during process after induction of CIC were analyzed and grouped into codes and further categorized.

　Results : The following 6 categories were identified : 1. feelings just before the induction of CIC ; 2. factors of feelings which positively influence psychological acceptance of CIC after induction ; 3. factors of feelings which negatively influence psychological acceptance of CIC ; 4. perceived feelings toward CIC at each time point ; 5. current feelings showing acceptable CIC ; 6. current feelings showings unacceptable CIC. In addition, each patient was classified into 4 patterns of different transition processes ; A. patients have accepted CIC from the beginning ; B. patient's feelings changed from resistance against CIC to its acceptance ; C. patients continued CIC with feelings of resignation ; D. patients have been reluctant to perform CIC ;

　Discussion : It was thought that to accept CIC psychologically was that patients become perceived their urination including their CIC procedure as positive image. The reasons for changing patients' feelings toward acceptance CIC were perceived improvement of urination and the improved technique of procedure.