食事療法の難しさを伝える糖尿病者における食事経験の現象学的記述

Phenomenological description of the dietary experiences of persons living with diabetes who relate their difficulties with diet therapy

【目的】食事療法の難しさを語る糖尿病者にとっての食事経験を現象学的に記述することである．

【方法】現象学的看護研究である．糖尿病治療で入院していた4名の定期受診の場面を中心に，入院から約1年間（2015〜2016年），参加観察と非構造化面接を実施した．食事に関して何気なく繰り返された表現等からその人の見方を分析し，病者自身はっきり自覚していない次元まで遡り，そこから意味が現われる「地」と「図」の関係とともに，象徴する1名の食事経験を記述した．

【結果】研究参加者は，1）切実に入院中の食事療法を再現する，2）病院と家における食べ物のありようの違い，3）状況によって食べ方が変わるという食事経験をしていた．

【考察】糖尿病者はその食事経験の中で，意識的な管理とは別に，身のまわりのさまざまな食べ物に出会い“あれば食べてしまう”世界を生きていた．これまでの治療を通じて学んだ知識は現在において塗り替えられ，多角的に変わりゆく食事療法を経験していた．

[Purpose] The purpose of this study is to describe, in a phenomenological manner, the dietary experience of diabetic persons who relate the difficulties they have with diet therapy.

[Methods] This is a phenomenological nursing study. I conducted participant observations and unstructured interviews with four participants who had been hospitalized for treatment of diabetes, mainly at regular follow-up examinations, for about a year (2015-2016) starting immediately after their hospitalization. Analysis of their utterances identified each participant's perspective, as represented in repeatedly-used casual verbal expressions about diet, of which one participant's dietary experience was described together with the relationship between “ground” and “figure,” where an implication emerges from a dimension that was not clearly self-recognized.

[Results] The participant's dietary experience included: 1) She keenly attempted to copy the meals that she had been provided during her hospitalization. 2) The way she ate in hospital was different from that at home. 3) She reflected on how her ways of eating varied according to her situation.

[Discussion] Even with the intention of conscious management of diet, subconscious actions are inevitable. It was observed that persons with diabetes live in a world where they tend to “eat unthinkingly if food is in front of them,” since various types of food are available all around them. Persons with diabetes reconsidered from many different perspectives the knowledge they had acquired during their clinical treatment and made sense out of the diet that evolved in diverse ways.