筋萎縮性側索硬化症患者の看護問題とそれに関する看護者の認識について―Taxonomy I上の診断に分類された看護問題の分析

Nursing Problems of the Amyotrophic Lateral Sclerosis Patients and Clinical Nurses' Recognition in Japan

　Taxonomy Iを枠組みとして看護者の記録を分析し，文献との比較をもとにALS患者の看護問題について看護者の認識を考察した結果，以下の知見を得た．（1）『交換』，『伝達』，『運動』パターンなど病態生理やADLにかかわる領域は，文献に挙げられている以上に現場の看護者によって看護問題として認識され，個別にアセスメントされている．（2）『関係』パターン領域では，海外文献の内容と比較して，「ケア提供者の役割緊張」が多く，逆に「社会的孤立」が少なかった．ここには，「家族」に大きく依存する我が国の医療と福祉のあり方と，社会とは隔絶した日本独特の病人役割の形態が反映されている．（3）自己概念に関する『知覚』領域は，文献では強調されていたが，実際は看護問題としての明確なレベルには達しておらず，断片的な情報にとどまっていた．今後この領域に対する十分な理解とより詳細なアセスメントが必要とされる．

　This research analyzed 1558 clinical nursing problems using 170 ALS patients' nursing documentations by NANDA's Taxonomy I, and compared the Japanese clinical nurses' concern and recognition as patients' nursing problem with the review of the nursing literature. The results are as follows: (1) The Japanese clinical nurses were concerned about the problem in 3 "human response patterns" namely; 'Exchanging' pattern, 'Communicating' pattern, and 'Moving' pattern. The information in these aspects were taken sufficiently and were recognized exactly as nursing problems, and were assessed sufficiently for each of patient. All these problems are related with ALS patients' pathophysiological state or ADL level which affect nurses' daily work. (2) In 'Relating' pattern, comparing with the American literature, the Japanese nurses paid more attention to the problems classified as "caregiver's role strain", and less attention to the problems classified in "social isolation". This result showed that Japanese medical system tended to expect more care responsiblity from each patient's family, and that Japanese sick-role was constructed only in the familial context without social relationship. (3) 'Perceiving' pattern is related with self-concept, so it is known as the important and original territory of the nursing. But only a few Japanese documents mentioned nursing diagnoses of that area. In proportion to ALS patients who lose their self control, they are forced to change their body-image and personal identity. As the result, they have low self-esteem, feel powerless, hopeless and so on. The recommendation is more focus-assessment and must be done in the field of that diagnoses.