終末期維持血液透析患者にかかわる看護師の実践知

　本研究の目的は，透析室における看護師の終末期維持血液透析患者に対する経験についての語りから得られた実践知を明らかにし，看護師がかかわる際の示唆を得ることであった．対象は，透析室に勤務する透析看護経験年数5年以上の看護師18名であった．各グループ2時間のフォーカス・グループ・インタビューを施行し，分析はヴォーンらが提唱する方法に準じ行った．その結果，【透析は慢性的に長い経過での死であり，日常生活のなかで終末期という時期の見極めの難しさがある】，【患者の状態の変化を察していくなかで死に近いかどうか予期し，家族も含めて準備ができるようかかわる】，【それまでの経験から予後についてや透析中止後死までの期間の予測をもち，患者の思いを汲んだうえでよりよい方法を提示する】など，45の主題が明らかになった．以上のことより，透析看護師は透析生活で築いた関係性により患者・家族にとって信頼がもてる存在となっており，長年の患者・家族との相互作用や，生活のなかでの変化を見出す視点という透析看護の特性を生かした終末期看護があった．また，死を迎える過程において，透析導入時から適宜タイミングを見極めながら病みの軌跡を患者・家族・医療者がともに描き，透析患者の透析を受けながら生きる過程を尊重していくかかわりの必要性が示唆された．

　The purpose of this study was to clarify the practice knowledge obtained from the talk about the experience for the maintenance hemodialysis patient for end-of-life of the nurse in the dialysis room and obtaining a suggestion when a nurse was associated practice in the dialysis room. The subject was 18 nurses more than dialysis nursing years of experience five years to work in dialysis room. We performed focus group interview of each group two hours and we followed the method that Vaughn, et al. proposed and performed the analysis. As a result,【The dialysis is death by the course of long duration chronically, and is there the difficulty of the making certain in the time called the end period in everyday life】, 【We are associated we die while we understand the change that is in a state of the patient and expect it whether it is near and can include the family, and to be ready】, 【We showed a better method after we had the prediction for the period to death after unpleasant dialysis cancellation about a prognosis, and having drawn the thought of the patient】, and the subject of equal 45 became clear from experience of then. The present results indicate that dialysis nurse comes to be able to have trust for a patient/a family by the relationship, and there was nursing for the end-of-life that kept the characteristic of the dialysis nursing called the observing point to find a change in interaction with the longtime patient/family and the life alive. In addition, In the process when a patient invites death to, carefully observe a timing accordingly from dialysis adoption time, and health worker draws an illness trajectory a patient/a family together, necessity the suggestion respects a dialysis patient about the process takes dialysis, and life.