脊髄損傷者の受傷による苦悩から立ち直りに向け意識が変化する要因

Factors Influencing Mental Recovery from Distress in Patients with Spinal Injury

　本研究の目的は，初期段階の脊髄損傷者への援助を検討するために，受傷による苦悩から立ち直りに向け意識が変化するきっかけとなった体験内容を明らかにすることである。

　方法は，受傷後1年以内で障害告知を受け訓練の段階にある脊損者30名を対象に，障害告知後の感情とその後前向きに感じたり考えられるようになったと思われるきっかけについて面接調査を行なった。

　分析の結果，全対象者は若悩を体験し，そのなかから立ち直りに向け気持ちを変化させていた。変化のきっかけとなった内容は，「身のまわりの生活が整えられる」「生活機能が拡大をする」「気持ちが満たされる」「自己の存在が大事にされる」「今後の生活の見通しが描ける」「自己をみつめ直すことができる」の6つの要因であった。脊損者はまわりの援助を受け止めながら精神の安定や新たな価値の見いだしへと自らの力を発揮していた。

　次いでこれらの要因となった体験内容を，身体回復の時間的変化の過程として不安定な時期，障害を見極める時期，生活機能の拡大を目覚する時期の3時期別に重ね，各時期に必要な看護のポイントを導いた。

　The purpose of this study was to clarify the contents of experiences that led patients with spinal injury to recover mentally from distressful conditions in the early phase after the injury. An interview survey was made with thirty spinal injury patients under rehabilitation about the emotional responses to the notification conducted within one year from the occurrence of spinal injury, and the experience by which a patient become able to have a positive attitude toward life. The survey revealed that most of the patients experienced the distress and recovered the positive feelings. The data showed that the most influencing factors to recover from such distressful conditions were as follows: 1) settlement of affairs in daily life, 2) functional improvement of livings, 3) a feeling of being satisfied, 4) a feeling of being respected by others, 5) ability to image own prospect for the future, 6) ability to recollect own previous healthy days. Moreover, it was indicated that the patients took the forward step to reach an emotionally stable life and found a reason for living, while they received various supports by surrounding peoples.

　Furthermore, various contents of experiences to induce these six factors were divided to three stages, the early unstable stage, the middle stage recognizing their handicaps and the final recovery stage by improving their functional livings, and the nursing instructions in these three stages were made.