口蓋扁桃摘出術およびアデノイド切除術後の疼痛に伴う学童の体験

School-Age Children's Experiences with Postoperative Pain following Tonsillectomy and Adenoidectomy

要旨

　本研究の目的は, 口蓋扁桃摘出術およびアデノイド切除術 (以下アデレクと略す) 後の疼痛に伴う学童がどのような体験をしているのかを明らかにし, アデレクを受けた学童の体験に即した看護師の関わり方への示唆を得ることである. 研究方法は, レイニンガーの民族看護学の研究方法を用いた. アデレクを受けた7～10歳の学童6名を主要情報提供者とし, 17名の小児病棟看護師, 手術室看護師1名, 学童の家族6名の計24名を一般情報提供者とした. 分析の結果, 6つのテーマが抽出され,【大テーマ】学童は自分の咽喉の痛みはなくなっていくのだろうかという思いを表現したり, 痛みに対処したりしながら手探りで回復への実感を探し続けている, が導き出された．

　本研究の結果から, 術前から子どもや家族と術後に痛みの程度や限界を伝える手段を検討しておき, 術直後は疼痛緩和を早期に行い, 学童の理解と看護師との説明との間のずれが生じることのないよう, 術直後看護師が説明した内容を学童がどのように理解したかを確認しながら関わることの重要性が示唆された．

Abstract

　The present study describes the experiences of school-aged children with postoperative pain following tonsillectomy and adenoidectomy. Investigation of nursing care for these illnesses was performed using Leininger's ethnonursing method. Six school-aged children were selected as key informants. Twenty-four general informants were selected, including 17 pediatric ward staff, 1 operating room staff and the mothers of the 6 children.

　One main theme and six sub-themes were determined during this study. The main theme revealed that school-aged children who experience tonsillectomy and adenoidectomy merely want to get better and the uncertainty of whether they will get better or not is very dominant in their minds.

　Results indicate that prior to surgery it is important for nurses to discuss the level of postoperative medical care with the child and mother, as children can not communicate postoperatively due to loss of voice. Following surgery, nurses must ease the pain of school-aged children at an early stage. It is also necessary to check that the child has understood not only the purpose of the discussions with nurses regarding postoperative medical care but also the content of these discussions.