臨牀透析 Vol.34 No.3(3-1)


特集名 キュアとケアをつなぐナーシングスキル
題名 実践報告(1)慢性腎臓病患者に対するキュアとケア―慢性腎臓病とともに生きることを支えるための看護支援
発刊年月 2018年 03月
著者 井上 智恵 大阪医科大学附属病院看護部・慢性疾患看護専門看護師
【 要旨 】 慢性腎臓病(CKD)患者が病いとともに生きていくためには,腎機能が低下していることを受け止めることが重要になる.しかし,ケアの視点が腎機能の維持や合併症予防の療養支援に向けられるため,患者が病気を受け止めることは難しい.今回,主治医から血液透析(HD)導入と伝えられ,頑なにHDをしたくないと話した患者が,病気を受け止めていく過程を支援した.患者のこれまでの療養行動で判断するのではなく,HD導入をしたくない気持ちを受け止め,本人が望む治療が受けられるように主治医と交渉することで,自分の病気の管理の責任は自分で負うという自覚を促した.これまでの病気体験を話すことで,患者はCKDとともに生きていくことを受け止められるようになった.
Theme Nursing skill -- integrating cure and care
Title Nursing approach to support for living with chronic kidney disease
Author Tomoe Inoue Department of Nursing, Osaka Medical College Hospital / Certified Nurse Specialist in Chronic Care Nursing
[ Summary ] In order to live with chronic kidney disease, it is important to accept that renal function has deteriorated. However, it is difficult for a patient to do so because medical care is usually targeted to maintain renal function and prevent complications. We supported the process through which a patient refused initiation of hemodialysis and came to accept his disease. We did not condemn his past behavior, but negotiated with his doctor to let him receive his choice of treatment and respect his refusal of hemodialysis, while making him aware that he must be responsible for his illness. He accepted living with his chronic kidney disease by talking about his experience with the illness.
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