精神障害者へのハンドケアリング前後の変化—自律神経活動および不安，対人距離の心理的指標から

A Study on Changes of Hand Caring on Individuals with Mental Disorder Using Autonomic Activity and Psychological Indexes about Anxiety and Interpersonal Distance

要旨

　本研究は，独自に開発したソフトタッチの皮膚接触をベースとするハンドケアリングを精神障害者に実施し，その効果を，心拍変動，アミラーゼなどの自律神経活動指標と，不安，リラックス度，疲労度，会話欲求度，親近感の心理的指標を用いて明らかにした．対象は地域で生活する精神障害者10名（平均年齢56.7±14.9歳）であり，内田クレペリンテストによる負荷後，座位対面式にて15分間のハンドケアリングを実施した．各指標を実施前後で比較分析した結果，心拍数は有意に低下し，pNN50は有意に増加した．STAI得点は，特性不安と状態不安ともに実施後に有意に低下し，VASを用いた主観的評価では疲労度のみが有意に低下した．施術者との会話欲求度と親近感は，実施後50％以上増加した．唾液αアミラーゼは，安静時と実施前後で有意差を認めなかった．ハンドケアリングは，副交感神経活動の亢進および，不安や主観的疲労感の軽減とともに，施術者との心理的距離に良好な影響を与えており，患者−看護師関係の形成に向けた活用の可能性が示された．

　In this study, we performed hand massage on individuals with mental disorder, based on a soft-touch skin contact method developed by us. In addition, we elucidated the changes before and after the intervention using autonomic activity indices, such as heart rate variability and amylase, and psychological indices, such as anxiety, the degree of relaxation, the level of fatigue, desire for conversation and the sense of intimacy. The subjects were 10 individuals with mental disorder living in a community (mean age 56.7±14.9 years) who underwent 15 min of face-to-face hand massage in a sitting position following loading with the Uchida-Kraepelin test. A comparative analysis conducted for each index before and after the intervention revealed a significant decrease in the heart rate and a significant increase in pNN50 after the intervention. The State-Trait Anxiety Inventory (STAI) score showed significant decreases in both state and trait anxieties after the intervention, and a subjective evaluation using the Visual Analog Scale (VAS) showed a significant reduction in the level of fatigue alone. Desire to converse with and the sense of intimacy toward the practitioner was increased by ≥50% following the intervention. No significant difference in salivary α-amylase was observed between the state at rest and before and after the intervention. In addition to enhancing the parasympathetic activity and causing a reduction in anxiety and subjective fatigue, our study indicates that hand massage has a favourable effect on psychological distance from the practitioner and has nurse-patient relationships forming of possible applications.