がんの再発・転移を告知され，永久的ストーマを造設した患者と看護師で行うナラティヴ・アプローチの効果

The Effect of Narrative Approach in a Relation of Nurse-Patient with Permanent Stoma Informed of Cancer Recurrence/Metastasis

要旨

　本研究は，がんの再発・転移を告知され，永久的ストーマを造設し，不安や悩みをもつ7名の患者とWOC看護認定看護師との間でナラティヴ・アプローチを試み，双方の新たな思考形成にどのように役立つかを明らかにすることを目的とした．研究デザインは，患者のナラティヴとそれを聴いた看護師の自己内省ジャーナルに基づいた質的研究であり，研究と看護実践を結びつけた実践的看護研究である．

　患者の看護師への語り（ナラティヴ）は，がんを告知された時の衝撃から始まり，やがてストーマを造設したことに意味を与え，自分の人生の新しい側面からがん体験の中に意味を見いだした．また，これを実践した看護師は，患者にとってのストーマがもつ意味の理解が拡がるとともに新たな側面を発見し，がん体験を通して成長・発展していく人間の可能性が納得できた．ナラティヴ・アプローチは，患者と看護師の相互作用の中で双方の成長と発展を助ける看護介入として，実践への導入が可能であることの示唆を得た．

Abstract

　In the present study, a narrative approach was made between a WOC - certified nurse and 7 patients with recurrent, metastatic cancer and permanent stoma, and how this approach was useful in helping the patients form a new way of thinking was evaluated. Following learning they have cancer, the patients were anxious and distressed. The study was designed as a qualitative study based on patients' narrative and a self - reflection diary kept by the nurse in response to patients' narratives. It is a practical nursing study that links research and practical nursing activities.

　Patients started their narratives with the nurse with the impact they received upon being informed of their illness. Thereafter, they found a meaning for the creation of stoma and ended by discovering a meaning in their cancer experience in new aspects of their life. Through the narrative approach, the nurse was able to discover new aspects in each patient, and her understanding of the meaning of stoma for patients expanded. She was able to understand the possibility of human beings who grow and develop themselves through cancer experience. Findings obtained in the present study suggested that the narrative approach can be introduced into practice as a nursing intervention that promotes the growth and development of both patients and nurses through their interactions.