慢性腎不全をもつ思春期患者の親のかかわりの様相
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概要
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本研究の目的は,慢性腎不全をもつ思春期患者の親のかかわりの様相および影響要因を明らかにし,慢性腎不全をもつ思春期患者とその親への看護援助について考察することである。幼少期に慢性腎疾患を発症もしくは診断され,慢性腎臓病の重症度分類stage 3 以上にある10～18歳の思春期患者をもつ母親7名を対象に半構成面接と質問紙調査を行い,質的に分析した。以下の結果と慢性腎不全をもつ思春期患者の親に対する看護援助の示唆を得た。1 .慢性腎不全をもつ思春期患者の親のかかわりは『子どものつらさを軽減するための努力』を行いながらも,『子どもを尊重し,応えるかかわり』や『セルフケアを期待し,思春期患者のセルフケアを促すためのサポート』と『病状が悪化しないように子どもを守り,適切に管理しようとするかかわり』との間を揺れ動きながら関わっていた。親のかかわりには,「疾患や治療に対する親の受け止め」,「疾患や治療に対する子どもの反応の認識と子どもに対する感情」,「子どもの体調変動に関する親の認識」と「子どもの病状や治療,腎移植の時期の見通し」が影響していた。2 .親のかかわりの様相は,思春期患者の病状や病期,発達段階に影響され,思春期患者の病状や病期の進行により≪病状悪化の不安による統制的かかわり≫や『サポートできない・混乱するかかわり』が認められた。 以上の結果から,慢性腎不全をもつ思春期患者とその親への看護援助として,慢性腎不全をもつ思春期患者の親のかかわりの揺れ動きをアセスメントし,揺れを支える看護援助の必要性が示唆された。The objective of this study was to describe aspects of the parental relationship and related factors in adolescents with chronic renal failure. Subjects were seven mothers of adolescents with chronic renal failure (predialysis or peritoneal dialysis). Data were collected using semi-structured interviews and a questionnaire regarding the parental relationship with the adolescent and were qualitatively analyzed. The following aspects of parental relationships were identified: 1. The parental relationship to adolescents with chronic renal failure vacillated between "relationships thatvalue and are responsive to the adolescent's self-care", "expectation and encouragement of adolescent self-care" and "tendency to ignore the adolescent's self-care to protect the adolescent's health and prevent loss of renal function", as the parents made respond to "efforts to alleviate the adolescent's emotional pain resulting from the diagnosis of chronic renal failure". Parental relationships were influenced by "acceptance of the adolescent's illness and treatment", "recognition of the adolescent's reaction to illness and treatment and their emotional reactions to these factors", "recognition of loss of renal function" and "prediction of the adolescent's condition, treatment, and chance of kidney transplantation in the future. 2. Aspects of parental relationships were also influenced by "the adolescent's condition and chronic kidney disease stage" and "developmental stage". In addition, as the adolescent's condition and disease stage deteriorated, "a controlling relationship caused by anxiety about the deterioration in the adolescent's condition" and "inability to support the adolescent or failure to respond to questions causing a confused relationship with the adolescent" developed. These findings suggest the need to assess and support the various and dynamic parental relationships with adolescents with chronic renal failure.
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