手術を受けるがん患者に付き添う家族の体験と看護支援の検討

The Experience of Families with Cancer Patients having on Operation and Nursing for Them

要旨

　本研究の目的は手術を受けるがん患者に付き添う家族の体験を家族の視点から明らかにし，術前・術後を通してがん患者に付き添うことが家族の成長の一助となる看護支援を検討することである．

　研究参加に同意を得た9名の家族を対象に，付き添うことに関した内容の半構成的面接と術前から患者と共に過ごしている場面の参加観察にてデータ収集を行い，質的帰納的に分析した．

　その結果，手術を受けるがん患者に付き添う家族は《手術までの家族の反応と準備の時期》《患者の状態に翻弄されながら立ち向かう時期》《付き添うことによりもたらされた成果が現れる時期》の3つの時期を経験していること，また，家族の経験には〈家族が混沌とした状況から抜け出せないパターン〉〈揺るぎない家族関係を示すパターン〉〈手術が好機となり家族間のつながりが強まるパターン〉の3つの類似パターンがあることが明らかになった．さらに，明らかになった3つの時期，3つの類似パターンを統合することによって手術を受けるがん患者に付き添う家族の体験の構造図を明らかにすることができた．

　そして，手術を受けるがん患者に付き添うことは満足感やゆとりをもたらし，成長の一端となる反面，家族の混乱や潜在する問題が露呈する危険性が示唆された．がん患者に付き添うことが家族の成長の一助となるためには術前の精神的つらさに着目し，術後は付き添う中での経験を肯定的に積み重ねる看護支援が必要である．

Abstract

　The purpose of this research is to make evident the experience of the family accompanying a cancer patient undergoing surgery from the viewpoint of the family. I will examine how nursing support can supplement the growth of family's accompanying cancer patients throughout the surgery including pre and post surgery.

　I found nine target families, and having received their consent, I conducted semistructured interviews that were about accompanying a cancer patient, and I observed the families as they spent time with the patient. In those ways, I collected date that I then analyzed qualitatively and inductively.

　The results I found were that families accompanying cancer patients go through three stages. They are: a stage of reaction and preparation prior to the surgery, a stage of being at the mercy of the patient's condition and having to face that reality, and a stage of the appearance of beneficial results from sticking together as a family. I also found that each family's experience can be categorized into three patterns: being unable to escape a chaotic situation, the emergence of unshakable family bonds, and the surgery being a good opportunity to strengthen family bonds. Moreover, by combining these three stages and patterns, I was able to construct a diagram describing the experience of a family accompanying a cancer patient undergoing surgery.

　Lastly, standing by a family member about to undergo surgery often brings about a sense of satisfaction and ease, and is one part of the growth as a family. However, there were also indications that there is a danger of latent problems and uncertainty within the family being brought to the surface. This is why nursing support which focuses on preoperative mental stress and helping the family to view their experiences in a positive light is necessary so that accompanying a family member with a cancer can contribute to the family's growth.