看護ケアにナラティブ・アプローチを導入した老年患者の語りの変化の研究

Study of Changes of Narratives by Old Patients under Nursing Wherein Narrative Approach is Introduced

要旨

　本研究では，老年患者の語る物語の変化からナラティブ・アプローチを看護に導入する有用性を考察する．67歳から80歳の5名の老年患者にテーマを設定した3回のナラティブ・アプローチを行い，語られた物語の変化を分析した．結果は..物語にはネガティブな反応が揺れ動く変動として常に表出されている．転院や手術日の決定といった療養生活の転機，抜糸といった回復を実感する出来事によって，物語はより具体的な生活の方法や生きることへの意欲というポジティブな物語へ変化していた」というものであった．

　そして，老年者は繰り返し語ることで病や老いへの顕在的・潜在的な反応を揺れ動く気持ちとして表出し老化による認知・表現能力の低下を補う，老年患者へのナラティブ・アプローチは生き方を語る機会を作り解決の手がかりを見つける支援になる，テーマに特徴をもたせ何度か語る機会を設けたナラティブ・アプローチは老年患者が問題解決の具体的方法に気付き心理的変化への障害を取り除く働きをする看護ケアである，と考察した．

Abstract

　The purpose of this study is to evaluate the effect of narrative approach introduced into nursing based on the changes of narratives by old patients. Narrative approach was made three times to five patients of ages of 67 to 80 with given themes and the development of their narratives was qualitatively analyzed. Results their negative reactions were always expressed as wavering variation in their narratives. Such turning points in their lives as moving from a hospital another and decision on the date of operation and such events entailing actual feelings of recovery as the removal of stitches caused their narratives to change into positive ones about concrete ways of living, the will to live, and so on. The old patients expressed their apparent and latent reactions to illness and aging as wavering variation by narrating repeatedly. Such variation always took place and their listeners picked up leads on how to support them. Narrative approach with characteristic themes and several chances to narrate proved effective in helping old patients to find concrete methods of solving problems and remove obstacles to psychological changes.