臨牀透析 Vol.22 No.10(2-2)


特集名 移植腎機能喪失後の透析再導入とケア
題名 [各論]透析再開を要する患者心理とメンタルケア
発刊年月 2006年 09月
著者 窪田 基予子 東京医科大学八王子医療センター移植検査センター・移植コーディネーター
著者 松野 直徒 東京医科大学八王子医療センター外科学第五講座
【 要旨 】 腎移植後の透析再開の原因はさまざまだが,患者は皆,術前から透析再開を意識づける説明を段階的に受けており,透析再開が訪れることを理解している.しかし,透析再開は患者にとって最大の恐怖であり,いざ透析再開を明確に宣告された際には必ずしも受容がスムーズにいくとはかぎらない.透析再開を受容するまでには,いくつもの心理的プロセスとそれに伴う時間が必要とされるが,患者の健康観やコーピングスキルなどの心理的特性によって,個々の心理状態や受容に要する時間は異なる.患者の「語り」を通して,心理的背景を理解し,個々の患者に応じた現実の受容と精神的立ち直りをはかる支援を惜しまないメンタルケアが求められる.
Theme Dialysis Re-initiation and Related Cares after Functional Loss of Transplanted Kidney
Title Psychological status of and mental care for patients requiring resumption of dialysis
Author Kiyoko Kubota Transplant Inspection Center, Hachioji Medical Center, Tokyo Medical University
Author Naoto Matsuno The Fifth Surgical Department, Hachioji Medical Center, Tokyo Medical University
[ Summary ] The need for resumption of dialysis following kidney transplantation arises due to a variety of causes. In general, patients receive explanations regarding dialysis resumption prior to the operation, and thus gain a full understanding of the possible need for dialysis resumption. However, dialysis resumption remains patients' greatest fear ; therefore, it may be difficult for them to accept dialysis resumption when they are informed that it is necessary. Numerous psychological processes, as well as the time required for implimentation of such processes, is thought to be crucial in achieving acceptance in patients. However, an individual's psychological status and the amount of time required to accept dialysis resumption vary depending on the patient's perspective on their health, psychological characteristics, and coping skills. Given these circumstances, it is necessary to gain an understanding of patients' psychological backgrounds through their “narratives”, in order to provide mental care that meets individual patients' needs and also assists patients in accepting reality and achieving psychological recovery.
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