難病患者の看護ケアとプロセスの明確化

Cralifying the Nursing Care and Its Process for Patients with Intractable Illness

要約

　現在わが国の保健医療施設において看護婦が難病患者に対して行っている看護ケアとそのプロセスを明らかにすることを目的に，グラウンデッド・セオリー・アプローチを用いた質的帰納的研究を行った．

　分析の結果，難病患者の看護ケアは「患者の感情を受けとめる」，「患者の存在を大切にする」，「患者の可能性を実現する」及び「患者の自律を支援する」の4つのカテゴリーに分類され，これら4つの看護ケアを積み重ねられながら実施されるプロセスであることが明らかになった．

　またこれらの4つの看護ケアが，難病患者が病気の慢性的不可逆的進行にともない体験している心理的な葛藤や社会的な疎外感を軽減すること，及び患者が難病と付き合いながらの生活を再構築していけるよう働きかけることを目的として行われていることが明らかになった．

Abstract

　The objective of this study was to clarify the nursing care and its process for patients with intaractable illness. An inductive qualitative study was conducted by using a grounded theory approach.

　Subjects were seven nurses who cared patients with intractable illness at two hospitals in Japan. The qualitative data was collected by participant observations and interviews to the subjects, and analyzed by the constant comparative analysis.

　Results revealed four categiries of nursing care and its process for patient with intractable illness. Four categories were named as “to accepthis/her emotion”, “to respect his/her exsistence”, “to develop his/her potentiality”,and “to support his/her autonomy”.

　Category 1:“To accept his/her emotion” is a nursing care to make the patient express his/her emotion freely, to understand him/her, and to communicate that everyone could feel so if situated as him/her.

　Category 2:“To respect exsistense” is a nursing care to communucate the patient that the existense of him/her is respectable regardless with his/her ability or evaluation.

　Category 3:“To develop potentiality” is a nursing care to develop the patient's potentiality for his/her life with safety and high-quality through changing or creating the way of life.

　Category 4:“To support autonomy” is a nursing care to support and expand the patient's life activities through the ways of life acquired by him/her.

　This study also revealed some definite actions of nurses who cared for patients with intractable illness.