<論文>看護における患者への教育方法に関する研究 : ナラティブ・アプローチの視点から
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概要
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Due to an increase of chronic disease and advances in cancer treatment, patients are going to live with disease in their home or work. Their daily life will have a deep relationship with medicine. Patient education by medical practitioners is going to be more important than now. More specifically, it will require to patient education in nursing, not only to inform about biological knowledge and technology but also to promote experiential learning through the patient's illness. The purpose of this study is to describe interpretatively the experiences of cancer patients with surgical treatment from the viewpoint of a narrative approach and to examine the methods of patient education from these descriptions. The narrative approach used in this study has the following characteristics: 1) use of self-reflection as an analytic tool, 2) two thought modes(narrative mode and paradigmatic mode, 3) plot has meaning, and story has tense such as "beginning", "development", "end", 4) existence of story-teller and listener, 5) listener's attitude based on the pure curiosity. From the viewpoint of this approach three postoperative cancer patients(Case A: Gastric cancer, Case B: Esophageal cancer, Case C: Lung cancer) were interviewed, and some episodes were extracted from the interview content. In addition, the experience of the illness in each case was summarized as follows through interpretable descriptions. Case A had determined to live for herself after her husband's death by gastric cancer. Case B has come to understand deeply her child's refusal to go school, overlapping with the experience of her disease. Case C has examined his own mortality after information of his life expectancy and being in postoperative bad physical condition. In conclusion, the method of patient education was examined as follows: 1) it is important to take as positive patients who are not passive, who wrestle with recollecting their own experience, 2) nurses' role is not only information giver, distributor of knowledge and skills, but listener to patients' narrative, 3) education of cancer patients with recurrence problem and transitions is not often carried out. It was suggested that the externalization of the problem on therapeutic side of the narrative would be useful for the education of such cancer patients.
- 2002-03-27