著者

金城 忍 Kinjo Shinobu キンジョウ シノブ

出版者

千葉看護学会

雑誌

千葉看護学会会誌 (ISSN:13448846)

巻号頁・発行日

vol.4, no.1, pp.23-30, 1998-06-30

被引用文献数

1

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本研究は,透析患者のセルフケアにおける認識の構造を明らかにし,看護の実践的指針を得ることを目的としている。透析中の患者8事例と筆者との看護過程から,患者のセルフケアが表現された場面を選定し,その表現から認識を浮き彫りにし,各事例のセルフケアにおける認識の特徴を取り出した。全事例から取り出された認識の特徴の比較検討により,以下に<>で示した透析患者のセルフケアにおける認識の構造を取り出し,セルフケア能力を高めるという観点から看護の実践的指針が得られた。(1)<客観的データを参考に,自己の生活の修正をしていく>が抽出され,その時体の中の状態が正しく認識に反映されているとは限らないことが明らかとなった。実践的指針:人間の身体にとっての食を細胞のつくりかえに必要な『栄養素』のレベルでとらえていけるような刺激を送る。(2)<体の中の変化や見通しについて,根拠をもって生活調整をする>が抽出され,その時腎の細胞外液の処理機能,腎の細胞のつくりかえの関連性の理解の困難性から,医療への不信・依存や自己流の対処が起こることが考えられた。実践的指針:病気の本質的理解を促し,受容した上で調和の方向を見いだせるような刺激を送る。(3)<治療方針の変更や生活の仕方の改善に対し,その長短を吟味した上で取り入れる>が抽出され,その時,実体や社会関係や認識に相反する条件が生じると,選択ができず葛藤が起こることが考えられた。実践的指針:患者の思いを言語化するのを助け,対象が自己の姿を客観的に見られるような刺激を送ることで客観視を促す。The purpose of this study was to clarify the structure of recognition for self-care in hemodialysis patient and set up guideline of nursing. The study was based on the nursing processes for 8 patients, seen by the author when working as a nurse. First the author selected that the patient-self-care have been stated by in the nursing processes. Recognition of the need for self-care was determined from these statement on self-care and particularity patient recognition of self-care was assessed. Each patient recognition was compared. As a result, recognition for self-care in the patient was clarified and nursing guidelines were established. (1) "Patient is modifying his life by referring objective data." But some patients weren't necessarily adequately aware of what they should do. The nurse needs to see that the patient understands how the patient get ingestion to circulate on work in the body and are metaboliged into a "nutrient" and the processes of cell metabolism. (2) "Patient is coodinating life by own treatment and knows his body." Doctors on other to deal with their disease. But some patients for untrained patients to electrolyte balance and Kidney function. The nurse needs to tell patients the essentials of their disease and find a workable treatment. (3) "Patient is accepting treatment changes and is improving after checking merits and demerits of various processes." But some patients had no ability to choose options and had conflicts or confusion making decisions on treatment about their body and social relations. The nurse needs to let the patient understand his own condition objectively while the nurse is speaking to the patient.