医療依存度が高い者の特徴分析と高度ケースマネジメントモデルの試行

内容の要旨, 審査の要旨広島大学(Hiroshima University)博士(看護学)Doctor of Philosophy in Nursingdoctora

The process of forming a cooperative structure for dietary therapy by families of predialysis patients with chronic kidney disease

保存期慢性腎臓病患者の食事療法における家族員の協力体制形成過程を明らかにするため，計8人に対しフォーカスグループインタビューを行った結果，4のカテゴリーと15のサブカテゴリーが抽出された．協力体制は，第1段階【家族（患者）が腎臓病と生きることと向き合う】第2段階【食事療法の協力者として動機づけられる】第3段階【協力者という役割を獲得し始める】第4段階【協力者としての役割を継続する】の過程を経て形成されていた．保存期腎臓病患者の家族員らは，まず，患者の病気の診断や予後の説明に対し，衝撃を受け，悲嘆のプロセスを踏んでいた．その後，協力者としての信念・使命感によって動機づけられ，どの程度協力できるか模索していた．また，患者のノンコンプライアンスと格闘しながらも，食事療法実施によるポジティブな変化の気づきや，患者の感謝による再動機づけによって，協力を継続していた．結論として，協力体制形成の促進要因では，自己効力感，維持要因では，協力者としての信念・使命感，協力成果の確認，限界感やストレスへの対処，患者からの感謝の言葉，協力者となったことによるポジティブな変化が抽出された．To understand the process of forming a collaborative union among family members regarding dietary therapy for patients with predialysis chronic kidney disease, we conducted a focus group interview and abstracted 4 Categories 【】 and 15 Subcategories 《 》 from the results. The collaborative situations were formed through the following process: 1st stage 【Facing the fact that the family (patient) must live with kidney disease】, 2nd stage 【Being motivated to become collaborators in dietary therapy】 , 3rd stage 【Starting to perform a role as collaborators in dietary therapy】, and 4th stage 【Maintaining a role as collaborators in dietary therapy】. First, subjects were shocked by diagnosis of kidney disease and description of the prognosis, and stepped on the process of crisis. Then, they were motivated by a belief in their role and a sense of mission and sought how they could collaborate. Finally, they maintained their collaboration by gaining motivation from the patient's gratitude and positive changes in his/her condition. Consequently, it was shown that psychological support, education, encouragement, and peer support are very important for the family members of patients with predialysis chronic kidney disease

Reconstruction of Virtual Neural Circuits in an Insect Brain

The reconstruction of large-scale nervous systems represents a major scientific and engineering challenge in current neuroscience research that needs to be resolved in order to understand the emergent properties of such systems. We focus on insect nervous systems because they represent a good compromise between architectural simplicity and the ability to generate a rich behavioral repertoire. In insects, several sensory maps have been reconstructed so far. We provide an overview over this work including our reconstruction of population activity in the primary olfactory network, the antennal lobe. Our reconstruction approach, that also provides functional connectivity data, will be refined and extended to allow the building of larger scale neural circuits up to entire insect brains, from sensory input to motor output

Factors That Facilitate Discussion and Documentation of End-of-Life Care among Community-Dwelling Older Adults: A Cross-Sectional Study

We aimed to clarify the regional cultural characteristics in areas with different death rates at home, and to identify factors that influence the discussion and documentation of end-of-life care (EOLC) among community-dwelling older adults. This study was a cross-sectional study using a self-administered questionnaire survey, and participants were Japanese older adults. A chi-square test and multiple regression analysis were conducted. Among the 227 respondents, 143 were analyzed. There were no statistical differences by area. Participants who had intentions to discuss EOLC tended to discuss EOLC with their families and family doctors and tended to create documents to show their wills on EOLC (p < 0.05). The following factors that influence the intentions to discuss EOLC were extracted: experience in providing EOLC; information on EOLC; having religious and spiritual beliefs, and not avoiding the subject of death as part of beliefs related to life and death. These results indicate that beliefs and intentions regarding EOLC may be similar across Japan. Moreover, our findings suggest that to increase the interest of older adults on EOLC, it is important to provide opportunities for older adults to share and discuss information about EOLC with healthcare professionals and others who have experience providing EOLC