乳がん患者の自己概念の変化に即した看護援助

Nursing Intervention Focused on Change in Self Concept of Breast Cancer Patients

要約

　本研究の目的は，乳がん患者の癌罹患の経験を通して変化する自己概念と自己概念の変化に即した看護援助を明らかにすることである．対象は，乳癌の告知を受け手術予定の者であった．面接と参加観察により対象の入院から退院後3ヶ月までの自己概念に関するデータを収集し，エスノナーシングの分析ガイドに基づき作成した手順に従い分析を行った．

　その結果，乳がん患者の癌罹患の経験を通して変化する自己概念として，［納得していても心が揺らぐことがある］［同病者を他人と思えない］［がん患者である自分を守りたい］［これからは自分のためにも生きていきたい］［今までの自分でやっていける］が得られた．

　乳がん患者の自己概念の変化の持つ意味は，患者が自己否定に陥りながらも，自己価値を維持し新しい価値観を明確にしようとする点にあると考える．従って，乳がん患者の自己概念の変化に即した看護援助として，意志決定への援助，自己価値の維持への援助，対人関係への援助，自己受容への援助が重要である．

Abstract

　The purpose of this study was to elucidate the change in self concept of patients with breast cancer, and nursing intervention focused on this change. The interview method and participant observation were used to assess the self concept and its change in 8 patients during hospitalization and 3 months after discharge. The data were analyzed by an original method based on qualitative data analysis of ethno-nursing.

　The results indicated the change in self concept of participants meant they were shaken by their experience; they felt they and other patients with breast cancer influence each other; they wanted to defend themselves against others; they not only wanted to live for other people but for themselves as well as from now on; and they thought they could live by themselves as they were. These results suggest that the patients with breast cancer may struggle to regain their self respect and form a new sense of values while they are in a condition of low self-esteem. Key strategies used by the nurse to support patients include: facilitating decision-making by patients, their self respect, personal relationships, and acceptance of reality.