超長期血液透析患者が経験した痛みと透析生活を支えたレジリエンス

The pain experienced by ultra-long-term hemodialysis patients and the resilience that supported the dialysis life

　超長期透析患者が経験した血液透析に伴う痛みとその透析生活を支えたレジリエンスを明らかにすることを目的とし，3名の研究対象者に対し半構造的インタビューを行った．

　その結果，血液透析に伴う痛みは，【穿刺時の苦痛】【合併症による症状】の身体的な痛み，【透析導入時の精神的苦痛】【結婚や出産に対する不安】【透析を最優先せざるを得ない苦痛】の精神的な痛み，【時間的拘束】【家族への負担】【社会的なプレッシャー】【患者の人間関係】の社会的な痛み，【生きる希望の喪失】【死に対する意識】のスピリチュアルな痛みを経験していることが明らかとなった．

　このような苦痛や困難を乗り越えるためのレジリエンスは，【乗り越えた経験の積み重ねが自信や強さにつながる】【自分の性格や価値観を肯定的にとらえる】【家族や透析仲間，医療者が支えになる】【患者としての役割を獲得する】【仕事に意義や価値を見出す】【運命に従い受け入れる】【みんなと笑いあう】【今という時間を大切にする】であることが明らかになった．患者は，このような前向きに生きていこうとするレジリエンスに支えられ，適応していくプロセスを経験していると考える．

　看護者は患者の生活体験やレジリエンスを理解し，それぞれの適応のプロセスを支援することが求められる．個人の中にあるレジリエンスを信じ，患者が抱える痛みや苦悩を全人的にとらえ，寄り添い支援していく姿勢が重要である．

　We conducted semi-structural interviews with three study participants to understand the pain associated with hemodialysis experienced by ultra-long-term dialysis patients and the resilience that supported their dialysis life.

　We found multiple kinds of pain associated with hemodialysis. These include physical pain: [puncture pain][symptoms due to complications], mental pain: [mental distress when introducing dialysis][anxiety about marriage and childbirth][the pain of having to give top priority to dialysis], social pain: [being tied to a bed, limited time][social pressure][a burden on the family][patient relationships], and spiritual pain: [loss of hope to live][awareness of death].

　The findings show that resilience helped overcome such pain and difficulties. Some examples of resilience were [I can be confident and strong by accumulating the experience I have overcome] and [I take my personality and values positively]. Additionally [the support of family members, dialysis colleagues, and medical staff][acquire a role as a patient][finding meaning and value in work][accepting fate][laugh with everyone] and [valuing the present] are also significant factors.

　Based on these results, we believe that ultra-long-term dialysis patients can experience recovery supported by resilience and live positively. Hence, it is important for nurses to understand the life experience and resilience of patients living with dialysis and to support their recovery process. While believing in the resilience of an individual, it is important to take a holistic view of the pain and suffering that the person is facing and to support them closely.