高齢者の看護方法に関する研究 : 自我発達を促進する看護援助の構造

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本研究は,高齢者が自己と人生を受容し,人格の再統合を通して自己実現に向かって自我発達することを目指し,そのための看護援助の構造を明かにすることを目的としている。現実や自己への不満が大きいために無為・無感動であったり,医療職員により自己中心的と捉えられ,避けられがちであった老人病院入院中の4名の高齢者を看護援助の対象とした。分析に用いたデータは,看護援助の実践の中で,高齢者によって個々特有なあり方で言語化された様々な要望,不平や不満,不安,疑問などの思考や感情と表出された行動や状態,これに応じた筆者との対話,ならびに筆者の判断や日常生活全般にわたる看護援助過程の詳細な記録である。分析は,まず各事例ごとに,高齢者の経過について自己概念を手がかりにして,自我発達が読みとれた場面をパターンとして取り出し,その過程で行われていた看護援助を自我発達の観点から援助の性質を検討し,分類・命名した。そして各事例の自我発達の経過とそれに対応した看護援助の過程を検討した。その後,4事例から得られた自我発達の経過と看護援助の過程を比較検討し,自我発達を促進する看護援助の構造を検討した。高齢者の自我発達を促進する看護援助の構造として,『自我を脅威にさらさない援助』が基盤となり,『自己肯定促進への援助』が続くこと。そしてこの『自己肯定促進への援助』は,『自己有能性促進』・『自己理解促進』・『自己決定促進』・『自己満足感の獲得・増大』への援助を可能にさせると同時に,これら4つの援助によって支えられて行われる関係にもあること。また,これら4つの援助は,いずれも互いを可能にさせるとともに支え合う関係で行われる構造をThe purpose of this study was to clarify the structure of nursing care for the aged so that they can accept themselves and life by focusing on ego-development toward self-actualization through reintegration of their personality. Four elderly patients who were shunned by medical staff in the gerontological hospital were selected as subjects of nursing care in this study. They were regarded as being unemotional, idle or self-centered. Analysis of the data was detailed documentation of the nursing care process. The documentation was about their thoughts, feelings, behavior and the states that were expressed through various demands, discontent, dissatisfaction, anxiety and the patients'doubts in personal interaction, along with my thoughts, interpretations, inference and judgement. Every case was analyzed individually. The pattern of ego-develpment with their self-concept was taken out and traced how to accordingly of their state。 After that, it was classified and given character of nursing care from an ego-development point of view. I examined the process of nursing response to the process of their ego-development. Furthermore I examined the structure of nursing care by making a comparative study of the process of ego-development and the process of nursing in all four cases. The structure of nursing care for facilitation of ego-development on elderly was as follows; 1. It was based on "the nursing care to avoid exposing themselves to an ego-threat". 2. The nursing care for facilitation of self-affirmation" was on the heels of nursing care to avoid exposing oneself to an ego-threat. 3. The nursing care for facilitation of their self-affirmation" was made possible "the nursing care for facilitation of their ego-ability", "the nursing care for facilitation of their ego-understanding", "the nursing care for facilitation of their ego-determination", and "the nursing care for acquisition, and increase of their ego-satisfaction".
1997-06-30

高齢者の看護方法に関する研究 : 自我発達を促進する看護援助の構造

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