腰痛のある双胎妊婦への訪問援助の分析―Roy適応看護モデルの適用

The Analysis of Nursing Applying the Roy Adaptation Model to Twin Pregnant Women Experiencing Low Back Pain

要旨

　本研究はRoy適応看護モデルをもとに腰痛のある双胎妊婦への看護介入を計画し，介入の効果を分析するために，実験群と対照群に分けて不適応行動である“腰痛の訴え”の変化を適応様式の四側面から査定することを目的とした。対象は妊娠中期から後期の双胎妊婦で，各群6例ずつ得られた。調査期間は1例に対して三週間以上四週間以内とし，実験群への介入は研究者自身が二回の家庭訪問と随時不安・疑問への対応を行った。訴えの査定は面接法および質問紙法を用いて両群とも調査初日と最終日の二時点で行った。

　研究の結果，次の点が明らかになった。実験群の訴えの改善例数が対照群よりも多かった。介入の効果が認められたのは，生理的ニード適応様式では『対処法の数・種類を増やすこと』，自己概念では『腰痛に伴い変化した自己概念を好転すること』，相互依存では『腰痛に伴い生じた医療者への依存ニードを充足すること』以上においてである。また，訴えが増悪した事例が実験群には認められず，一方対照群には認められた。よって介入は訴えを改善するのに効果が有ると判断した。さらに研究の結果，当モデルの特性として，①適応様式間で介入の効果が波及すること，②残存刺激が関連刺激として捉え直されることで介入の焦点が明らかになること，以上の点が示唆された。

Abstract

　This research focuses on the planning and practice of nursing interventions among twin pregnant women experiencing low back pain. The research was based on the Roy Adaptation Model. The research compares adaptation abilities between those in an experimental group with those in a control group and analyses nursing interventions used to assist women in increasing their adaptation abilities. The complication of low back pain was considered to be a maladaptive reaction and was assessed from the four adaptive modes.

　Six subjects were selected for the experimental group and six subjects for the control group. The age of gestation for each subject was calculated to be within 20-36 weeks. Data collection on each subject was designated to be over a period of 3 weeks and within 4 weeks. The researcher accomplished two homevisits per subject in the experimental group. The subjects in the control group were not visited.

　An increase in adaptation ability was noted more frequently among those subjects in the experimental group and no cases were noted where the ability to adapt decreased in this group. In the control group, however, it was noted that some subjects experienced a decrease in adaptation ability. Therefore the outcome of the designated nursing intervention was considered to be effective.

　In addition, the following characteristics of the Roy Model were suggested: 1. Due to an overlap between the four adaptive modes, the effect of an intervention on one mode extended to yet another mode.

2. As residual stimuli were understood as contextual stimuli, the focus of the intervention became clear.