小児糖尿病患者の療養行動における主体性に関する研究

A Study of Independence of Diabetic Children in DM Self-Care Behaviors

　思春期は，糖尿病患児の療養行動において，親の管理から患児自身による自己管理への移行期であり，患児自身が考え行動していくことが重要である．患児自身が判断，決定するという主体性は，9つの療養行動においてどのように現れ，適切な療養行動とどのように関連しているかを知る目的で調査を行った．対象は，10～15歳の糖尿病患児とその親で任意の承諾が得られた20名である．患児に療養行動に関する半構成的面接と，診察場面における患児と親の言動を観察した．その結果，以下のことが明らかになった．1）患児が決定する療養行動は年齢とともに増加し，患児が決定している場合は，判断・意味づけが多くみられた．2）運動においては，主体性があると行動が適切になっていた．その他の療養行動では，主体性があっても行動が適切とは限らず，判断基準が適切か，曖昧かによって行動の適切さに違いがみられた．3）療養行動における決定と判断・意味づけをもとに，患児を4つのタイプに分類すると，療養行動の多くを患児が決定しており，患児が決定している行動すべてに判断・意味づけがみられたタイプ1の患児では，適切な療養行動が多かった．4）診察場面において，「患児に任せる」「補足的に発言する」といった親のかかわりは，患児の主体性を促すかかわりであった．以上のことから，患児の主体性の現れやタイプの特徴を知り，看護援助を行うことが必要と考えられた．

　The purposes of this study were to investigate how the independence of diabetic children appears in making judgments and decisions for DM self-care behaviors, and to analyze its relationship to the appropriateness of DM self-care behaviors. The subjects were 20 diabetic children aged 10 to 15 who visited the pediatric diabetic clinic. During a semi-structured interview, each child was asked about 9 DM self-care behaviors such as insulin injection, SMBG, diet, exercise, snack, and the reasons why he chose these behaviors. And the relationships between the parents and child have been observed during their visit to clinic. The following results were obtained: 1) The number of independent DM self-care behaviors taken at the discretion of the child increased with age. DM self-care behaviors taken at the discretion of the child were often based on reasoning and assessment of meaning. 2) Exercise was more appropriately conducted than other behaviors when the child took this action independently. Other DM self-care behaviors were not always appropriate, even when they were conducted independently. Whether DM self-care behaviors were conducted appropriately or not was determined by whether there were appropriate criteria for making judgments. 3) When children with various types of independence were analyzed, we found that an independent stance is important for conducting appropriately DM self-care behaviors. 4) The child whose parents persuade him to discuss his health condition with his health professionals, conducted behaviors independently.