Literature review on the adult kidney transplantation - based on nursing perspective-

慢性腎不全の治療法の一つに腎移植がある。この文献検討の目的は、医学、精神医学、心理学、社会学ならびに看護学における腎移植に関する諸外国を含めた最近の研究論文を吟味し、今後の腎移植看護の実践や研究に必要な課題を明らかにすることである。文献検討は、看護学の立場から重要と思われる腎移植を受けた成人を対象にした研究論文を集めて、それを基に行った。その結果、腎移植は人工透析やCAPDよりもQOLを高める治療法であり、慢性腎不全患者にとっては期待が大きく関心の高い治療法であることが明確になった。また移植後に新たな身体的、心理的、精神的及び社会的な問題が生じることによって、レシピエントはストレスフルな状況にさらされやすいこと、レシピエントの効果的な対処の仕方がQOLを高めることなどがわかった。これらの知見から、腎移植看護の発展のためには、腎移植者の生活体験の意味を明らかにしたり、効果的な看護介入・教育の開発をめざした研究や、移植前から移植後を通じての継続的な看護の取り組みが今後の課題として考えられた。Kidney transplantation is a preferable choice of therapy in the end-stage renal disease. The purpose of this review is to clarify the problems surrounding it and discuss the directions for future clinical nursing through the survey of the recent studies on the kidney transplantation. Worldwide literature concerning the nursing for the adult recipients undergoing kidney transplantation was studied. The majorty of studies were involved comparison of quality of life between transplants and dialysis populations. The results were follows.(1)) Successful transplantation recipients had the highest quality of life.(2)) The recipients however were often exposed to stressful situation due to the physical, mental, and psychosocial difficulties after transplantation.(3)) The effective coping way had to with the quality of life after transplantation. These results suggested that understanding the virtual life experiences of the recipients and researching the methods of the nursing intervention or education toward the recipients would be important for developing the high quality of life in recipients following kidney transplants

Coping for the better quality of life(QOL) after adult kidney transplantation and factors affecting on the coping

腎移植は、免疫抑制剤の進歩に伴う高い生存率や生着率はもちろんのこと、今日では特に移植後のQOLに焦点が当てられている。移植後のQOLを向上させていくためには、レシピエントが移植後の様々な出来事にいかに対処していくかが重要である。本研究は、腎移植後のレシピエントの対処に焦点を当て、移植後のQOLに関係する対処および対処に影響を及ぼす要因を明らかにすることを目的とした。対象者は、関東の2施設で腎移植を受けて入院および外来通院をしている20才以上の10名のレシピエントで、研究参加の同意を得た後、腎移植後どのように対処しているかや、何が対処に影響を与えているかについて面接並びに観察による調査を行った。分析の結果、腎移植後の対処は＜問題と取り組む＞＜情報の交換＞＜問題状況の再認知＞である対処様式が主に用いられており、医師に任せるという＜お任せ＞は全員に見られなかった。また、腎移植後の対処に影響を及ぼす要因として、＜身体の状態＞＜自己概念＞＜不確かさ＞＜ソーシャルサポート＞が見いだされた。Concerning kidney transplantation today, posttransplantation quality of life(QOL) is intensively focused on as well as the patients survival or the graft survival. For improving QOL of the recipients, how effectively the recipients can cope with the postoperative events is important. The purpose of this study is to know the coping ways of recipients after kidney transplantation for better QOL and clarify the factors affecting on them. The 10 patients aged 20 or more undergoing kidney transplantation in two hospitals in Kanto area were subjected for this study. They were interviewed and observed. The analyzing results showed that there were three main types of coping way ; tackling the problem, seeking the information and a new recognition of the situation. There was not the way of leaving everything to doctor. The factors affecting on their coping way were physical state, self concept, uncertainty, and social support

Assessment of the brain function by evoked potentials: analysis of the late components of visual evoked potentials recorded from the vertex

Visual evoked potentials recorded from the vertex were studied in seventy four individuals with mental retardation，ranging from l old to 50 years old. They were classified into 4 groups according to the level of IQ/DQ，and the relation between the late components and the intellectual level was exarnined. In 9 of 74 cases(12.2%)，la tency of the N130 component was prolonged and in 7 of 74 cases (9.6%)，the P190 component was prolonged. There was，however，no correlation between the number of the cases with prolonged N130 or P190 latency and the level of IQ/DQ. Cases with prolongation in N130 and/or Pl90 were almost exclusively found among those with such complications as cerebral palsy and/or epilepsy，while few cases without complications showed prolongation. From these results，it is suggested that the prolongation in the late components developes reflecting the presence of the organic lesions that have a common causative potent producing cerebral palsy and/or epilepsy

The roles and the position of nurses in the renal transplant nursing

本論文の目的は,腎移植医療のなかで看護婦が果たすべき役割とその位置づけを明確にすることである。まず最初に,腎移植看護のフィロソフィーとチーム医療としての移植医療について述べた｡次に調査結果と文献的考察を基に,腎移植看護に携わる看護婦の役割とその位置づけを概説した。ここでは, 看護の対象がレシピエントとその家族,生体腎ドナーであり,看護婦の役割は,移植を待機している時期,移植術前の時期,移植術直後の時期,退院前の時期,退院後のフォローアップの時期に区分して示した｡その役割は予期的指導,術前術後の管理,セルフケア教育,相談指導,心理的支援,危機介入などであり,継続看護の必要性を強調している｡The purpose of this study is to clarify the roles and the position of nurses in the renal transplant nursing. First of all, the author describes philosophy of transplant nursing and medical care of recipients undergoing transplantation as a team. Then, the author outlines the roles and the position of nurses in relation to renal transplantation. Objects of nursing in this situation are the recipients, their families, and the living donors. The roles of nurses are shown in a separate manner at the period of waiting for transplantation, immediately before and after transplantation, before discharge from hospital, and follow-up period after discharge. The roles of nurses are anticipatory guidance, pre-and postoperartive management, self-care education, consultation, emotional support, and crisis intervention and so forth and the author stresses the necessity of continued nursing care

The relationships between the components in QOL causal model of kidney posttransplant recipients and recipient characteristics.

本研究の目的は,概念枠組みを基盤にして作成した腎移植後レシピエントQOL因果モデルの構成要素とレシピエント特性との関係を明らかにすることである｡対象者は,関東と名古屋の4施設において外来通院をしている腎移植者で,研究参加に同意を得た210名である。データ収集は,自己記入式質問紙 法,面接法ならびに診療記録より収集した。その内容は,身体の状態,自己概念,不確かさ,ソーシャルサポート,対処,QOLについてである｡またレシピエント特性として,年齢,婚姻状況,学歴,移植後年数などを取り上げた｡データ分析は,ピアソンの積率相関係数, t検定,一元配置分散分析(対比較)を用いた｡分析の結果,年齢,婚姻状況,学歴,就労状況,移植後年数,入院を要するほどの合併症および入院回数がモデルの構成要素のいずれかに関係していた｡ したがって,それらは腎移植後のケアを行う時に考慮されるべき重要なレシピエント特性であることが明らかになった｡The purpose of this study is to analyze the relationships between the components in QOL causal model of kidney posttransplant recipients and recipients characteristics. Based on the conceptual framework for study, the QOL causal model was constructed. The subjects are 210 recipients after kidney transplant aged 20 or more from four hospitals in Kanto area and Nagoya city, who agreed to participating in this study. The data were collected by means of an interview and a questionnaire, and from medical records. The questionnaire consists of physical state, self-concept, uncertainty, social support, coping, QOL, and medical and demographic characteristics such as age, marital status, education, time since transplant. Pearson's correlation coefficient, t-test, and one-way ANOVA were used for analysis. Age, job, marital status, education, time since transplant, frequency of hospitalization, and complications were related to any of the components of the causal model. From this evidence, it follows that they are important characteristics for the care of the recipients after kidney transplant

An analysis of quitting behavior and desire to quit of nurses.

本研究の目的は,臨床看護婦の離職の実態と離職願望およびその背景因子との関連性について実証分析を行うことである｡2箇所の地方都市の公立病院で働く看護婦582名を対象として,離職と転職の意志と理由ならびに個人要因と職場要因についての調査を実施した｡その結果,次のような知見を得た｡ 1) 地方都市の大規模公立病院で働く看護婦の8割が卒業後ずっと同じ病院で勤務していた｡ 2) 実際の離･転職者は調査対象者の約15%であり,その7割を20代が占めた｡ 3) 20歳代の離職には2つの理由が見られた｡一つは結婚･出産および家族の世話による離職であった｡職業と家庭の両立は困難と考えていた。もう一つは未婚の看護婦による他の看護職への転職であった。 4) 約6割が離職願望をもっていた｡離職願望の背景として,仕事要因と個人要因および年齢的な特徴が見られた｡すなわち,20代では自分の適性や能力への不安｡30歳代では子育てと労働条件の負担｡40歳代以降では健康上の理由であった｡しかし給料との関連は低かった｡ 5) しかし地方都市の公立病院においては離職者は減少傾向にあり,就労形態は｢若年短期未婚型｣より｢中高年継続就労型｣へと以降しているものと考えられた｡The purporse of this study is finding existing situation and those reasons of nurses who would resign or desired to resign from their jobs. A survey was conducted to 582 nurses in two public hospitals located in the province. The following results were obtained. 1. 15% of all the target nurses would segign soon. 70% of which was in age of twenties. 2. There were two main reasons of resignation among nurses in age of twenties. One was getting married, having child or family care ; they felt it is difficult to continue both their working life and family one. The other was they were planning to be qualified for another nursing professional. 3. 60% of all the target nurses desired to resign from their jobs. 4. The reason was different by age group. Each had own reason ; Anxieties for their aptitude and ability as nurses in the twentie, responsibility for their children and family menbers in the thirties, and anxieties for health in the forties and fifties. But amont of salaries did not affect their disire

Japanese government policy to innovative R&D in pharmaceutical industry

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Civil and Environmental Engineering, 1994.Includes bibliographical references (leaves 95-97).by Yuko Hayashi.M.S