白血病維持療法中の学童・思春期の患者が疾患をもちながら生活する姿勢

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本研究の目的は,白血病維持療法中の学童・思春期の患者が疾患をもちながら生活する姿勢と影響要因を明らかにすることである。維持療法中の6組の学童・思春期の患者と親を対象に半構成面接を行い,質的に分析した。その結果,患者が疾患をもちながら生活する姿勢は,抗腫瘍薬の内服,感染予防行動,外来受診において特徴がみられた。1)患者は必ずしも抗腫瘍薬の内服の必要性を理解していなかったが,全てのケースが内服を継続していた。必要性を理解していない患者は,親への思いや親のサポートがあった。また,抗腫瘍薬の副作用に伴う嘔気・嘔吐に対応する姿勢は,入院中の経験の影響を受けていた。2 )思春期の患者では,維持療法直後には感染予防行動を自分から行っていたが,学校生活に慣れ,入院前の自分や友人と比較し「普通」という思いを抱くことで,一部の感染予防行動のみ行う傾向があった。3)患者は外来受診を必要と認識し,嫌という思いがあっても毎回欠かさずに来ており,診察時には白血球数を気にかけ,身体症状や学校のことは自分で医療者に伝えていた。このような患者の姿勢には,患者の成長発達段階や患者が身体症状等に対応する能力を見極めた上での親のかかわりが影響していた。治療の副作用による日常生活への支障を最小限にし,親からの適切なサポートを受けながら,患者が疾患を自分のこととして捉え,徐々に自立に向かうように促す看護援助の方向性が示唆された。Children (8-13years) and their parents were recruited from pediatric Hematology/Oncology outpatient department in a general hospital in Japan. Data were collected using semi-structured interviews about their perception of self-care related to maintenance chemotherapy. In addition, participant observations during medical appointments were conducted. The data was analyzed using descriptive methods. The attitudes of six children were characterized by the three behaviors types. 1) Two of six children understood the necessity of taking their chemotherapy. Of the children who didn't understand the necessity, they took their medication. Because they thought “I don't want to trouble my parents" or their parents supported them to take their medicine. 2) At the beginning of maintenance chemotherapy, adolescents perceived they needed to prevent infections and washed their hands and/or gargled. However, as they returned to school, felt better, and spent more time with friends, the frequency of their washing hands and/or gargling decreased. 3) Even if all children didn't want to visit the hospital, they went for check-ups, because they perceived they needed to receive the medical check. While seeing the physician, three of six children were concerned with their number of white blood cell and all children talked to physicians about their physical symptoms and school life. All the children were able to describe their feelings, even if parents spoke for them during hospitalization. 4) Children's attitudes were influenced by whether parent's promoted the children's developmental level and encouraged self-care. The attitudes of children during maintenance chemotherapy were characterized by the three behaviors types including the importance of taking medication, normalizing activities, and continued knowledge of their disease. Children's attitudes were influenced by parent's encouragement. Therefore, it is important to assess children's self-care related to maintenance chemotherapy as well as their percept･･･
2008-06-30

白血病維持療法中の学童・思春期の患者が疾患をもちながら生活する姿勢

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