筋萎縮性側索硬化症患者における病いを意味づけるプロセスの発見

Discovery of a Process of Search for the Meaning of the Illness in Patients with Amyotrophic Lateral Sclerosis

要旨

　本研究の目的は，筋萎縮性側索硬化症患者の病いを意味づけるプロセスを明らかにすることである．Franklの提唱する理論を基盤に，ALS患者の病いの意味づけを，意味への意志という視点から捉える．質的帰納的手法としてグラウンデッド・セオリー法を用いた．対象者は，在宅療養中のALS患者6名であった．データの収集は，参加観察と半構成的面接を用い，継続的比較分析を行った．

　分析の結果，ALS患者の病いを意味づけるプロセスには，＜戦略的補完行為＞＜鏡像行為＞＜新しい生への超越行為＞の3つの位相カテゴリーが見出された．それぞれの位相は4つのサブカテゴリーを含んでいた．各位相間には，一定の時間的順次性が認められ，病いを意味づけるプロセスは発展的変化を示した．最初患者は，病いの状況が補われれば病気前と変わらず完全であることを自他に示そうとするが，やがて病いを自己の現実として直視するようになり，そして，病いに積極的な意味を与え，新しい生き方を切り拓くようになる．つまりALS患者は，生きる意味に向かって3位相の価値転換をしていた．

　以上より，ALS患者にとって極限状況とも思える進行体験は，主体的努力によって乗り越えられることが明確になった．看護ケアの提供において，ALS患者の病いを意味づける能力を高めることの重要性が示唆された．

Abstract

　The purpose of this study was to identify a process of“Search for the Meaning of the Illness”in patients with Amyotrophic Lateral Sclerosis.

　Based on Frankl's theory, the will to meaning was attention to the search for meaning in one's life. A Grounded Theory approach was chosen for this research design and analysis. Six patients who had lived with ALS at home were the subjects for this study. The study was performed using participant observation and semi-structured interviews.

　The results indicated that patients searched for meaning in their lives in the face of a life-threatening illness. Three phases were discovered in the process of“Search for the meaning of the Illness”.

　These three phases were named“strategic supplement (phase 1)”,“ mirror-imaging (phase 2)”, and“transcendence to the new life (phase 3). Four subcategories were found in each phase. In phase 1, ALS patients tried to show themselves and others that they could maintain a normal life if this situation was supplemented. In phase 2, they tried to recognize reality. And in phase 3, they tried to reinterpret their situation and find new meaning in their life. Also this prosess includes searching for a higher order in one's life, changing one's values.

　The result shows patients not only accept their illness but try to establish a positive attitude toward life. Thus, it is assumed that nurses need to enhance the patient's ability to search for the meaning of a chronic illness such as ALS.