腹膜透析治療を開始した患者の家族の透析治療への協力体制形成過程 <原著論文>

腹膜透析治療を開始する患者の家族が治療協力者となる過程とその影響要因を明らかにすることを目的に,腹膜透析治療中の患者と共に暮らし,食事や透析の協力を主に行う家族員11名に半構成的面接を行った.結果,家族員が協力者となる過程は「協力者となるための役割移行への取り組み」「療養手技を習得しようとする取り組み」「生活の変化に順応し,継続するための取り組み」の順に3段階にカテゴリー化することができた.家族員が協力者として役割を獲得していく過程には,役割葛藤の有無,療養実施の主体が患者か家族かで違いが生じた.第1段階では知識を得るための環境が,第2段階は看護師の指導や助言者の存在が影響要因として重要であった.第3段階は,家族内の役割分担や勢力,生活・患者の状態の安定が役割葛藤の消失に影響し,生活の変化への順応を促していた.不安との共存や療養生活とうまく付き合うための対処が継続要因として観察された.

The purposes of the study were to clarify the process of family collaborations in the therapy of a family member starting peritoneal dialysis treatment and to examine what factors influenced this process. A semi-structured interview was conducted with eleven family members who collaborated with the patients in terms of food preparation and the dialysis treatment. As a result, it was found that the process of becoming a collaborator comprised three stages: 1) undergoing a role transition to become a collaborator, 2) acquiring therapeutic techniques, and 3) adjusting to life changes and maintaining a continuous collaboration. The process of role-transformation was influenced by the presence of role conflicts and by whether the patient or the family was in charge of the treatment. Important influential factors were the environment, which facilitates knowledge-acquisition in family members during the first stage, and the guidance of nurses and the presence of advisors in the second stage. In the third stage, role sharing and power balance among the family members, and the stability of the patient's life and condition contributed to the resolution of role conflicts and facilitated adjustment to changes in their lives. Coping with anxiety and acquiring effective stress-buffering strategies to manage life with a peritoneal dialysis treatment were observed to be the factors that enabled the continuance of the collaboration.