統合失調症をもつ利用者に対する効果的な訪問看護の目的と技術に関する研究

Effective Home Visit Nursing for Clients with Schizophrenia：Its Purposes and Skills

要旨

　本研究は，統合失調症をもつ者への効果的な訪問看護を，その目的と技術に着目して明らかにした．対象は，統合失調症をもつ利用者を2年以上継続して看護し，その間利用者に入院のなかった経験をもつ7名の訪問看護師，およびこの7名の訪問看護を受けた9名の利用者である．訪問看護師へのインタビューと訪問場面の参加観察を，質的に分析した．効果的な訪問看護では，利用者の地域生活に対する意志を看護師が了解する前後で目的が変化していた．意志を了解する前の段階では，「利用者の意志表出に道を付ける」が目的となり，「利用者の状況を五感でみる」「精神障害者として生きてきた体験の把握」「その人らしい特性の把握」「意図的に日常（ふだん着）の自分を使う」等の看護技術を用いていた．利用者の意志を了解した後は，「利用者に必要な生活能力を育成する」が目的となり，一部上記の技術を継続しながら「生活上の対処能力の把握」「意図的な日常の自分と専門家としての自分を使い分ける」等の技術を用いていた．

Abstract

　This study is aimed at exploring the nursing purposes and skills in effective home visit nursing for clients with schizophrenia. Subjects were seven home visit nurses and their nine clients, the latter having no experience of hospitalization for two years or more while they were assisted by the nurse. The interviews with the nurses and the field notes on the observation of their practice were analyzed qualitatively.

　In effective home visit nursing, the nursing purpose changed from that before establishing the stage of having a common understanding between the client and the nurse regarding how the client wanted to live to new nursing purpose afterwards. Before establishing this ‘common understanding’ stage, the purpose of nursing was ‘letting out the client's oppressed will.’ The nurses used the skills such as ‘observing the client's situation using all of the nurse's perceptive powers,’ ‘understanding the client's experiences living with mental disorder,’ ‘understanding the client's individuality,’ and ‘intentionally utilizing one's non-professional self.’ After establishing the stage of having the common understanding between the client and the nurse, the purpose changed to ‘cultivating the client's living ability.’ Although most nursing skills were changed based on the change in the purpose, the use of some skills were seen both before and after establishing the stage of having the common understanding between the client and the nurse. Following the ‘common understanding’ stage, the nurses used the skills such as ‘knowing the client's ability of daily living,’ and ‘using both professional and non-professional self.’