体重増加が著しく,嘔気や嘔吐を繰り返していた透析患者が,看護婦とのかかわりの中で,徐々に体重コントロールが出来るように変化していった。そこで,透析患者に行動変容をもたらした看護援助が何であったのかを明らかにすることを目的として,本事例を振り返り,Banduraの「自己効力理論」と,河口らの,行動変容への「とっかかり言動」の概念に基づいて考察した。その結果,患者に行動変容をもたらした看護援助は以下のようであることがわかった。(1)患者の気持ちや行動を受け止め,共感することで,患者が感情表出しやすい環境を整えた。(2)患者の行動変容に結びつく言動を逃さずキャッチした。(3)「それぐらいならできそう」という,患者にとって身近で実行可能な行動目標を共に考えた。(4)患者が成功体験を積み重ねることが出来るように,患者を支援し,行動を評価して,患者の自己効力を高めた。The purpose of this study is to clarify what a nursing care brought some changes in a hemodialysis patient's behavior. Based on Bandura's self-efficacy theory and on a concept of "speech and action for clue" proposed by Kawaguchi et al, the nursing care was discussed. The results were as follows : (1) Nurses made positive environments in which for the patient to express his emotion frankly through nurse's acceptable and empathic manner. (2) Nurses appropriately caught the patient's speech and action as clue to change in his behavior. (3) Nurses helped the patient consider his behavioral objectives that he can carry out by himself. (4) Nurses supported the patient and evaluated his behavior, and helped him succeed in his task so that he could improve his self-efficacy