| 特集名 | 開かれたCKD看護の模索―意思決定を支援する | |
|---|---|---|
| 題名 | ［実践報告］高齢透析患者に対する意思決定支援の実際―死の不安を抱く高齢担がん透析患者の「尊厳ある生の終焉」を目標とした看護 | |
| 発刊年月 | 2017年 10月 | |
| 著者 | 大賀 由花 | 赤磐医師会病院・認定看護師（糖尿病看護） |
| 【 要旨 】 | 死の不安を抱く高齢担がん透析患者に対して「尊厳ある生の終焉」を目標として看護を行い，病みの軌跡理論の病期を基に分析した．クライシス期では「傍らで関心を示し続ける支援」，不安定期では「重荷を下ろす支援」が重要であり，介入は「治療選択の意思決定支援」「積極的傾聴」「家族の予期的悲嘆の促進」などであった． 不安定期では，揺れる患者のニーズに合わせて柔軟に業務調整ができるチームワークが大切であり，安定期の患者は「残された時間のコントロール感を維持する」ことができた．下降期の看護として，透析医療が侵襲的な治療となったときに，透析時間の短縮などの緩和的な医療について相談を行った．患者と信頼関係を築くことがもっとも重要であると考える． |
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| Theme | Seeking for nursing which responds to the individual needs of the patients -- from the perspective of decision-making support | |
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| Title | Provision of nursing care with the goal of dignified life closure to a elderly dialysis patient with death anxiety | |
| Author | Yuka Ohga | Department of Nursing, Akaiwa Medical Association Hospital |
| [ Summary ] | Nursing care with the goal of "dignified life closure" was provided to a dialysis patient with death anxiety. Caregiving was analyzed based on the stages of the illness trajectory theory. The types of support provided were "support by continuing to show interest in the patient" in the crisis stage and "support in relieving the patient of a burden" in the unstable stage. Some of the interventions were "support in decision making regarding choice of treatment," "active listening," and "promotion of anticipatory grief of the patient's family." In the unstable stage, teamwork that allowed for work adjustments wherever necessary was crucial to meet the vacillating needs of the patient. In the stable stage, the patient was able to maintain a sense of control on the time left. During the downward stage, when dialysis became an invasive treatment, palliative treatment, such as shortening the dialysis time, was considered. Overall, it was found to be important to build a trust-based relationship with patients. |
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