精神科看護師の身体をとおした統合失調症者の理解と看護実践

Psychiatric Nurses' Embodied Understanding of Patients with Schizophrenia and How to Care for Tem

要旨

　目的：精神科看護師が自身の身体をとおして，どのように統合失調症者を理解して看護を実践しているのかを明らかにする．

　研究方法：Merleau-pontyの現象学的身体論に基づいた質的帰納的研究デザインを用い，統合失調症の看護経験が3年以上の看護師15名に半構成的インタビューを行った．

　結果：1．精神科看護師の身体をとおした統合失調症者の理解と看護実践には，身体性の次元と言語の次元がみられた．2．統合失調症者の生き辛さは，《自分の身体に馴染めない》，《他者の身体に脅かされる》，《自分らしく生きることに困難を抱える》であった．3．精神科看護師は，【共鳴する】ことと【応じる】ことを通して【関係性によって癒す】という実践をしていた．

　考察：精神科看護師は，統合失調症者の「自己性の形成不全」という生き辛さを，間身体性による付き合い方の身体知によって築いた関係性によって癒すことが示唆された．

　Purpose: The purpose of this study was to describe psychiatric nurses' understanding and practice with regard to the care of patients with schizophrenia by examining the nurses' embodied experience of providing that care.

　Methods: Semi-structured interviews regarding episodes of providing care for patients with schizophrenia were conducted with 15 nurses who had three or more years of experience working with such patients. Data were analyzed using a phenomenological approach based on Merleau-Ponty's ideas on embodiment.

　Results: 1. The nurses' embodied understanding of patients with schizophrenia and how to care for them was found to have two dimensions: corporeal and linguistic.

　2. According to the nurses, living was found to be difficult for patients with schizophrenia for three reasons. Two related to corporeality: “They can't adapt to their bodies” and “They feel threatened by the bodies of others.” The other related to expressing themselves through language: “They have difficulty living their lives in a way that they can be themselves.”

　3. In the nurses' care practices related to each of these difficulties, they tried to “Treat the patient's illness by relating to them,” “Resonating,” and “Being responsive.”

　Discussion: The results suggested that through the phenomenon of intercorporeality, the psychiatric nurses were able to treat the difficulties that patients with schizophrenia had in life—which stemmed from their “malformed sense of self”—by relating to them using embodied knowledge about how to interact with them.