冠動脈バイパス術を受けた病者の術直後のサバイバルプロセス

Postoperative Survival Process of Patients who Underwent Coronary Artery Bypass Grafting

要旨

　本研究の目的は，集中治療下で病者が自らの生命の脅威にどのように挑み乗り越えていくのかを明らかにすることである．冠動脈バイパス術を受けた男性7名女性1名に対し，参加観察法と半構成的面接法を用いてデータを収集し，平行して継続的比較分析を行った．結果，冠動脈バイパス術を受けた病者のサバイバルプロセスは，《生を自分であやつることができる》に至るまでの，術直後から4日ないし7日までのプロセスであることが見いだされた．さらにこのプロセスは，〈暗やみ〉，〈生の芽ばえ〉，〈ちぐはぐな生〉，〈自分から生をつかむ〉，そして〈生をあやつる〉の5段階から成り立っていることが判明した．これらの段階を構成する次元は，〈動きの度合い〉，〈生命維持機能を自分で管理する度合い〉，そして〈精気の度合い〉であった．見いだされたサバイバルプロセスは，生の回復をめざして，病者自身が主体的に努力していることを示していた．これを受けて，クリテイカルケア領域における看護は，病者の自立を促すアプローチが重要であることが示唆された．

Abstract

　The purpose of this study was to observe the postoperative survival process of the eight patients -seven males and one female- who underwent coronary artery bypass grafting (CABG). After CABG, most of the patients went through life-threatening experiences. Qualitative inductive design was utilized in explaining and describing postoperative survival process. For collecting data, participant observation and semi-structured interview were used. For data analyses, constant comparative method based on Grounded Theory Approach was adopted.

　It turned out that survival process was observed between the 4th day and the 7th after the operation, after which period the patients were able to “manage their own life”. It also turned out that postoperative survival process consisted of five consecutive phases,- a) “being-in-the-dark condition”, b) “beginning to feel alive”, c) “feeling his or her life not to be under complete control”, d) “gradually getting out of the previous c-phase and trying his or her own ability” and e) “having his or her life under control”. These five phases arose in accordance with the enhancement of a) “the degree of physical movement”, b) “the degree of controlling his or her life-supporting functions”, and c) “the degree of arousal of vitality”. In proportion to the recovery of the three “dimensions” mentioned above, we could observe the five phases consecutively surfacing. This study shows that postoperative survival process owes much to the patients' willingness to recover. Consequently it seems to be of utmost importance to encourage the patients to be self-reliant and self-subsistent.