臨牀透析 Vol.35 No.3(3-4)


特集名 慢性腎臓病の看護実践をリフレクションする
題名 実践報告 (4) 血液透析患者の看護:導入期看護―個人の持てる力と価値観の共有に基づく療養継続への支援
発刊年月 2019年 03月
著者 榊 みのり 筑波大学附属病院看護部・慢性疾患看護専門看護師
【 要旨 】 CKDステージG4~5は,急激な病態進展の危険性が高く,療養継続の支援が重要である.また,壮年期患者は仕事や家庭での役割と療養を両立するうえで,生活の場でさまざまな困難に直面することが予測される.今回,壮年期の患者の1事例への支援の振り返りから,働ける体力の喪失,社会的役割の変化,病状や治療を家族に理解されない辛さ,医療費の重圧,などの困難が明らかになった.外来において,患者が自身と個々の生活に合う療養の方略を行使して自己効力を知覚すること,生活者である患者の苦悩や価値観を傾聴しながら役割遂行による自尊感情を高めること,医療費負担を緩和することへの看護支援が,療養継続やより良い生活に向けた行動変容に繫がったと考える.
Theme "Reflection" of nursing practice to chronic kidney disease patients
Title Practice report: Nursing for hemodialysis patients -- Initiation of dialysis
Author Minori Sakaki Nursing Unit, University of Tsukuba Hospital / Certified Nurse Specialist in Chronic Care Nursing
[ Summary ] Patients with chronic kidney disease in stages 4 to 5 have a high risk of sudden pathological progress, sustaining these patients' care activities is important. Additionally, middle-aged patients are expected to face various difficulties in balancing work, home role, and medical treatment. Review of support for such patients revealed difficulties such as fatigue and low energy limiting ability to work, inability to continue working due to change in social role, difficulty of understanding the disease condition and treatment by family members, and increased medical costs. In an outpatient setting, nurses listen to patients' suffering and values, support successful experiences by exercising medical strategies matching their own lives, and utilize the medical subsidy system to ease medical expenses. Patients continue medical treatment, leading to behavioral changes necessary for a better life.
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