造血幹細胞移植を受けた造血器腫瘍患者の病みの体験と看護援助

The Illness Course Experienced by Patients with Hematopoietic Malignancy and Hematopoietic Stem Cell Transplantation, and Recommended Nursing Care for these Patients

要旨

　本研究の目的は造血器腫瘍患者がたどる発症から造血幹細胞移植後の生活に至るまでの病みの体験を明らかにし，その体験に即した看護援助への示唆を得ることである．罹病期間5年以内の8名の造血器腫瘍患者を対象に半構成的面接を行い，ライフヒストリー法により分析した．

　対象者によって語られた発症から現在に至るまでの病みの体験として《症状を軽くみる時期》，《重大な病気を疑う時期》，《死ぬ病気にかかり衝撃・混乱ととともに死の不安が生じる時期》，《生きられるという希望が芽生え闘病意欲が生じる時期》，《繰り返される治療に身体的・精神的に弱くなるが生きるために治療を継続する時期》，《造血幹細胞移植に伴う身体的・精神的苦痛によって死の不安が再び強くなる時期》，《再発の不安の中で新たな生活を構築する時期》の7つの局面が導き出された．これにより，今まで部分的に取り上げられることの多かった発症から移植後の生活に至るまでの造血器腫瘍患者の心理過程を統合することができた．

　そして，造血器腫瘍患者が過去にどういう心理過程を経てきたのか，今後どのような心理過程をたどるのかを予測することができ，患者の時期を見据えた関わりが可能になると考える．

Abstract

　The purpose of this study was to identify the illness course experienced by patients with hematopoietic malignancy who have undergone hematopoietic stem cell transplantation, during the period from the onset to the post-transplantation, and to find ideas for recommended nursing care for the patients. We had semi-structured interviews with 8 such patients within 5-year survival, and the data was analyzed using the life history research method.

　The illness courses experienced and narrated by the participants had the following 7 phases:(1)They see their symptoms lightly,(2)They suspect themselves to be seriously ill,(3)They are shocked and confused knowing they have an incurable disease, and fear death,(4)They hope for life and face up to their diseases,(5)They continue to receive treatment to live even though their physical and mental/emotional condition deteriorates through repeated treatment,(6)They start to fear death again because of increasing physical and mental/emotional suffering from hematopoietic stem cell transplantation,(7)They construct new lives fearing the recurrence of the disease and eventual death. Accordingly we were able to integrate the mental/emotional process of the patients from the illness onset up to the post-transplantation, which had been previously been regarded, separately.

　From our result, it is possible to anticipate to some extent the mental/emotional phases which patients with hematopoietic malignancy have gone and will go through, and this enables the practice of appropriate and timely nursing care for them.