Abstract
Purpose：Nursing intervention using the“Guidelines for Decision—making Support in Daily and Social
Life of People with Dementia”was performed on a heart failure patient with frailty who refuses dialysis.
Permission was obtained from my institution for reporting.
Case：Patient A is a dementia—free woman in her 70s with recurrent heart failure. Her pleural effusion
did not improve with treatment, and dialysis therapy was proposed, which she refused. Upon readmission,
decision—making support was provided regarding the introduction of dialysis.
Results：In the intention forming support, past illness experiences, family relationships, and thoughts
about dialysis were listened to, and understanding of the disease condition was promoted. In the intention
expressing support, we encouraged the patients to express their hopes for their future life, because
we believed that disease management would lead to psychological health and motivation. In the intention
realizing support, she understood that prevention of hospitalization and discharge would lead to
maintenance and improvement of physical function, based on her experience of losing her own role due
to repeated hospitalization and discharge. As a result, A expressed her desire to learn more about dialysis
therapy.
Conclusion：Decision—making support with awareness of the process, regardless of the presence or
absence of dementia, promoted A’s physical and psychological awareness and helped her understand
the necessity of dialysis therapy.
