喉頭全摘出術を受け退院を控えた患者の自己概念の様相

The Self-Concept of Laryngectomee before Discharge from Hospital

要旨

　本研究は, 喉頭全摘出術を受け退院を控えた患者の自己概念の様相を把握することを目的とした. データは入院中の患者5名を対象に, 手術前後にわたる参加観察と半構成的面接により収集した. カテゴリー化し関連を分析した結果,【閉ざされた意思と相互理解の途切れ】, 【作り変えられた身体】,【自己を方向づける根拠】, 【自己を維持するための取り組み】, 【元の居場所に帰った時の予想】に分類された.【閉ざされた意思と相互理解の途切れ】, 【作り変えられた身体】の内容は, 失声などの特徴的な変化の認識を超えて, その人全体に複雑かつ多面的な変化を呈するものであった. しかし, 自己概念は元来の自己像などの【自己を方向づける根拠】に支えられ, そのことが新たな身体での社会適応に向けた【自己を維持するための取り組み】の動機となり, 【元の居場所に帰った時の予想】の根拠となっていた. 元来の自己への信頼感を維持できる看護の必要性が示唆された．

Abstract

　This study aims to clarify the self-concept of patients who have undergone total laryngectomy in order to improve the nursing provided to such patients. Data were collected from 5 hospitalized patients through participant-observer study and semi-structured interviews before and after operations. As a result of categorization and analysis, the self-concept of patients was classified into five categories: “negative volition and interruption of mutual understanding”; “alteration of body”; “basis for self-orientation”; “approaches to self-sustainment”; and “expectations for a return to normality”.

　“Negative volition and interruption of mutual understanding” and “alteration of body” indicate complicated and multifaceted changes in patients after the recognition of aphonia and other changes. Self-concept of the patient is supported by “basis for self-orientation” including original self-images. Such support gives motivation to the patient to initiate “approaches to self-sustainment” as a means of adapting to society with an altered body and provides a foundation for “expectations for a return to normality”. The findings suggest a need for nursing that sustains the patients' confidence in themselves.