身体が織りなす看護の営み—急性期にある糖尿病足病変入院患者と看護師の関係の現象学的研究

A Way of Nursing through The Physical Involvement with Patients: A Phenomenological Study of The Interactions between Inpatients with Acute Diabetes Foot Lesions and Nurses

要旨

　目的：糖尿病足病変入院患者と看護師との関係で何が起こっているのかを，足病変患者の様々な状況にその都度応じる看護師の日常から記述する．

　方法：Merleau-Pontyの身体論を参考にした現象学的研究方法を用い，看護師が足病変患者を看護する場面の参与観察及び個別面接のデータから，記述した．

　結果：参加者Cさんは，検温時のやり取りから患者の「ぽやっと」した感じを捉えた．それは，糖尿病療養の緩くマイペースな態度であり，それに促され患者のこれまでの生活情報を得るのであった．参加者Eさんは，足病変の処置をしている患者の息遣いに，表情を歪めて痛みを捉えると手を患者の腕に当てた．このEさんの痛みの分有を契機に，患者は毎日の処置時の恐怖を表出したのであった．

　結論：看護師は，患者の症状や苦痛の表現に看護の重要な点を知覚し関与していく．看護師の知覚は，患者と身体の交流から生起するために主観ではないのであり，関係を展開する鍵になっている．

　Purpose: This study describes the experiences of nurses in interactions with inpatients with diabetic foot lesions, focusing on daily occurring situations where ward nurses respond in situations involving patients with foot lesions.

　Methods: Using a phenomenological approach based on the body-theory of Merleau-Ponty, and data collected through field observations and interviews with individual nurses, we describe situations where nurses provided care for patients with foot lesions.

　Results: Participant nurse C perceived an “absent-minded” feeling of a patient during the interaction when checking physical conditions of the patient. It was manifested in a slow and selfpaced attitude unique to patients in diabetes treatment from which nurses gain information about the life of the patient before hospitalization. When participant nurse E perceived that the patient felt pain from the way of breathing and distorted facial expression during the foot lesion care, she put her hand on the arm of the patient. Reacting to this attitude of the nurse showing awareness of the pain, the patient developed fears during the daily care.

　Conclusion: Nurses perceive important points for the nursing from the symptoms and distress expressed by patients. The perceptions of nurses are not subjective because they arise from the interactions with patients through the physical involvement, but are a key element to develop the relationship with patients.