人生の歩みに基づく対象理解に着目した家庭訪問援助に関する研究
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概要
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本研究の目的は,家庭訪問援助において,人生の歩みに基づいて対象の状態を理解すること(以下,人生の歩みに基づく対象理解)により,どのように対象理解が深まり,対象に即した援助へ発展するかを明らかにすることである。筆者自身が保健師の立場で家庭訪問援助を行った3事例を分析対象とし,それらの援助過程における,対象理解の内容,援助方針についての思考内容,援助行為を調査した。各事例の援助課題ごとに,事実,気持ち・考えから査定した対象理解に,人生の歩みの情報を加えて理解することによって,対象理解の内容,援助方針決定・変更へ向けた思考内容,援助行為に,何が付加されたかを検討した。その結果,健康状態や生活状況の成因,生活を営む力が養われた経験,健康状態や生活状況への気持ち・考えの成因へ対象理解を深めることができた。そのことによって,生活の肯定的な面を強化して対象の力を活かす,築いてきた生活と気持ち・考えを尊重することへ援助が発展した。対象は,健康管理が生活の一部となり,家族や身近な人々と支えあう力が高まり,本人と家族の健康状態・生活状況が改善した。The purpose of this study was to assess the ability of PHNs to appreciate and understand patient needs based upon patients' previous experience with home health nursing. The subjects of this study were sourced from three families and data was collected from the researcher's own nursing experience as a PHN. The various processes involved in understanding patients by the PHN, as well as the means by which a PHN settled upon the most appropriate treatment for a given situation, were analyzed Other aspects of the study were to determine how PHNs acquired a thorough understanding of patients', and how they developed their own skills and attitude regarding nursing. The results of the study revealed the following: 1. PHNs were observed to be capable of understanding, a) the status of patients health conditions relative to their previous lifestyle, and the patients' views about them, b) the extent to which patients have been able, or have been prepared to, develop the skills necessary to take care of themselves, c) how well care givers have developed their skills and ability, and, d) the extent to which the patient perceives the treatment to have been effective. 2. PHNs can provide treatment that is most appropriate given a patients' previous experience Specifically, a PHN should be able to a) reinforce any positive developments that the patient has made, and b) respect their patients' lifestyles, appreciate their views, and understand how these views developed. The study thus demonstrated that PHNs have the ability to encourage their patients positively with respect their lifestyles and possible changes they may need to make to maintain their health, and are able to assess the extent to which patients have implemented those recommendations in their daily lives.
- 2004-12-30
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