慢性腎不全をもつ思春期患者のセルフケアと親のかかわり : 思春期患者が認識する親のかかわりとセルフケアとの関連に注目して
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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が認識する親のかかわりとセルフケアとの関連を明らかにし,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。慢性腎臓病の重症度分類stage3以上にある10～18歳の思春期患者7名を対象に半構造化面接と質問紙調査を行い,質的に分析し,以下の結果を得た。・慢性腎不全をもつ思春期患者のレディネスは,思春期患者なりに疾患や治療,セルフケア行動を理解し,セルフケア行動実施への意欲や関心があるケースと,適切な知識がありながらも,セルフケア行動実施への意欲や関心がないケースが認められたが,レディネスに関わらず主体的・問題解決のセルフケア行動と,受け身・逃避・否認のセルフケア行動の両者が認められた。・慢性腎不全をもつ思春期患者のセルフケアは,思春期患者が親のかかわりをサポートとして認識していること,セルフケア行動を実施していくことに対する親の期待を認識することと関連していた。・思春期患者の病状や病期に関わらず,疾患や治療による日常生活や身体への否定的な影響を捉える一方で,学校の仲間や教諭との関係を肯定的に捉えていた。以上の結果から考察した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,慢性腎不全をもつ子どもが疾患や治療を自覚し,成長発達に沿ったセルフケア能力を高める支援の必要性と,腎代替療法やセルフケアに対する思春期患者の思いや葛藤を支える支援の必要性が示唆された。The purpose of this study was to describe how adolescents with chronic renal failure perceive their relationship with their parents and how their perception affects their self-care behaviors. Subjects were seven adolescents with chronic renal failure (pre-dialysis or peritoneal dialysis) in Japan. Date were collected using semi-structured interviews and a questionnaire regarding adolescents' self-care and were analyzed qualitatively. The following results were obtained. Adolescents' readiness to deal with chronic renal failure had two patterns: 1) Some adolescents understood the disease, medical treatments, and self-care behaviors needed and were motivated and interested in performing self-care behaviors; 2) other adolescents had no motivation and were indifferent to performing self-care behaviors, although they had appropriate knowledge to understand what was needed. Regardless of their readiness, self-care behavior represented both a pattern of "autonomy and problem-solving" and "passive, escape, and denial" in all adolescents. Adolescents' self-care was different when they recognized parental relationship as providing support and considered their parent's expectations regarding self-care. Regardless of their condition and the degree of renal failure, adolescents recognized the negative impact of chronic renal failure and treatment on daily life and body image. Adolescents indicated that they received support from friends and teachers. These finding suggests the needs to help children's and adolescents with chronic renal failure be conscious of their disease, treatment, and self-care behavior and to support their needs and address conflicts regarding renal replacement therapy and self-care.
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