地域で生活をする精神分裂病者の自己決定に基づくセルフケア行動の実態

Self-care Behaviors Based on Self-determination among Schizophrenia who were Living in the Community

はじめに

　1993年の精神保健法の改正や社会保険診療報酬の改訂は，精神障害者の社会復帰を積極的に促進することとなった。この社会復帰を促進するために，精神分裂病者の「日常生活」に関する研究が進められ，分裂病者の日常生活上の実態や障害が明らかにされてきた。しかし，これらは「生活の主体者」としての精神分裂病者自身が，日常生活においてどのような決定をしながら生活を送っているのかという点については明らかではなかった。そこで本研究は，地域で生活をする精神分裂病者の「自己決定に基づくセルフケア行動」の実態を明らかにすることを目的とした。

　The purpose of this study was to describe the self-core behaviors hased on self-determination and related factors among schizophrenic patients who were living in the community. Factors considered in this study, were characteristics, illness, care system, and social network. The conceptual framework of this study was the Orem-Underwood model partially modified using Deci's theory of self-determination.

　Participants in the study included 71 schizophrenics who lived in the community and went to the daycare programs of the community mental health welfare center, private psychiatric hospital, and prefectural psychiatric hospital in Kyushu. The data were collected through interviews using a semi structured questionnaire. The interviews took place from December, 1995, to September, 1996. The data were analyzed by context analysis and descriptive statistics.

　The results were as follows:

1) Among schizophrenic patients who were living in the community, there were 3 kinds of self-care behaviors that were based on self-determination- “concrete device” behaviors, “independent” behaviors, and “frequent” behaviors.

2) The self-care behaviors based on self-determination were divided, accord ing to the extent of awareness, into “self-care behaviors hosed on aware self-determination” and “self-care behaviors based on unaware self-determination.” These results showed that self-care behaviors based on self-determination among schizophrenic patients who were living in the community should be thought through “symptoms”, “quality of life”, “quality of being”, and “energy for living”.