意思表出が重度に困難な人にとっての“作業”を見出すために，家族や友人との関わりを通して探索した質的研究

Qualitative study on “occupation” in patients lacking personal expression in family interactions

要旨：本研究は意思表出が重度に困難な人（以下，対象者）にとっての“作業”を，ドキュメンタリー書籍の家族や友人（以下，周囲の人）と対象者との関わりから探索し，概念化した質的研究である．その結果，対象者が“作業”を行っていると見なすことはほぼできない一方，感情・欲求・それ以外の何らかと捉えられるノンバーバルコミュニケーション活動，または存在による活動という4概念の“作業”の特性を持った活動を行っていると見なすことができた．また，周囲の人との“作業”につながる可能性のある相互循環関係が成り立つ特徴があった．“作業”を通して介入するためには，対象者と周囲の人の相互循環関係を考慮することが重要であると考える．

　This qualitative study investigated occupations or activities that include occupational characteristics in patients who have difficulty expressing themselves through the involvement between patients and their family and friends (“surrounding people”)．We conceptualized their occupations or activities. Method : The study included eight documentary books written about patients who could not express themselves due to severe cognitive impairment. Descriptions of patients' responses, and interpretations by the surrounding people were extracted and qualitatively analyzed. Results : Almost no activities could be regarded as an “occupation”, while there were activities that could be regarded as activities including occupational characteristics. The activities have the following characteristics of circulatory interaction between the patients and the surrounding people : non-verbal communication about emotion, demands, excluding emotion and demands, and role activities involving existence. In addition, these circulatory interactions could help promoting the patients' “occupation”. Conclusion : We suggest that patients can be treated through “occupation” by considering the circulatory interaction with their surrounding people.