がん手術後の患者と家族員の社会復帰への看護援助に対する参加意識
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概要
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本研究の目的は,がん手術後の社会復帰への看護援助における看護師とがん患者と家族員(以上3者)の参加意識と関係を明らかにし,効果的外来看護援助のあり方を検討することである。看護援助に参加するがん患者と家族員と看護師の協働関係は,両方向の矢印で示すトライアングル型とする。研究の同意が得られ,都市部の中核病院外来で円滑な社会復帰への看護援助を実施した20組の消化器がん術後成人患者と家族員を対象に,援助期間中の患者と家族員の社会復帰への取り組み等について,参加観察法及び半構成的面接法を実施した。患者と家族員を1組としたケース分析の結果,3者の参加意識関係は,トライアングル型の「協働維持」「自律へ移行」,個別の継続希望(患者が希望,患者と家族員が別々に希望)」へと分かれて推移した。援助開始時から終了時(,) に至る過程で看護師に求めた主な事柄として,「協働維持」では,専門的助言を,そして,「自律へ移行」は,自分達のやり方への承認,「個別(患者と家族員別々に)の継続希望へ移行」では,患者と家族員は別々の問題解決と心の支え,「個別(患者)の継続希望へ移行」では,コーチ的役割が認められた。以上の結果から,看護援助は,常にトライアングル型援助意識を持って協働する実施であったが,社会復帰するがん患者と家族員の参加意識は時間的に変化を示す推移が明らかとなった。この変化には,術後がん患者の心身の障害・回復の程度,家族関係のあり様などが影響すると考えられた。The purpose of this study was to clarify the sense of participation and relationships among cancer patients, their family members, and nurses and to examine effective outpatient nursing support for rehabilitation following cancer surgery. Data were collected through participant observation and semi-structured interviews of post-operative gastrointestinal cancer patients and their family members. Cooperation among cancer patients, their family members, and nurses participating in nursing support was assumed to take on a triangular relationship, indicated by bidirectional arrows. Subjects were 20 pairs of cancer patients and their family members who received nursing support for promoting the rehabilitation at an outpatient clinic of a major urban hospital. Regarding effort toward the rehabilitation of subjects during nursing support, case analysis revealed that relationships regarding the sense of participation transitioned from triangular cooperation toward “maintenance of triangular cooperation" “independence" “individual desire to continue (desired by patients or separately by patients and their family members) ". The main roles sought from nurses during nursing support included specialized advice during “maintenance of cooperation", approval of individual approaches during “the transition toward independence", resolution of individual problems and emotional support for patients and their family members during “the transition toward individual desire to continue (desired separately by patients and their family members)", and a coach-like role during “the transition toward individual desire to continue (desired by patients)". These findings indicate that although nurses constantly provided support for promoting cooperation based on a sense of triangular support, cancer patients and their family members had a change in their sense of participation during the rehabilitation into society that were thought to be affected by family relationships, the extent of recovery, and the psychological and･･･
- 2008-06-30
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