消化器がん術後患者と家族員の社会復帰を促進する効果的な外来看護

Effective Outpatient Nursing Support to Facilitate Rehabilitation after Gastrointestinal Cancer Surgery for Patients and Their Family Members

要旨

　本研究の目的は，筆者ら（2003）が開発した消化器がん手術後患者と家族員の社会復帰を促進する外来看護援助を実施し，援助内容を精錬することである．対象は，病名を告知され消化器がん術後外来に通院する成人患者とその家族員．研究方法は，開発した看護援助を受持ち看護師として2カ月間実施すると同時に，援助に対する反応を参加観察法および半構成面接法によりデータ収集を行う．研究協力施設の倫理委員会の承諾を得て開始．データ分析は，記述資料から「対象者の変化」と対象者の変化をもたらした「看護援助」の記述を抽出し，質的・帰納的方法で行う．研究に同意した20組の患者と家族員による結果は，以下である．対象者の変化は，14カテゴリが得られ，心がひらかれる，自分の健康は自分で創り出す，など4つの意味の変化に分類された．変化をもたらした看護援助は，9カテゴリが得られ，心の扉の開放，内なる力の引き出し，など3つの意味の援助に分類された．これらの結果から，特徴的看護援助として，消化器がん術後の状況変化に対する了解を促し，病気と共に生きる活力を保持するための自己肯定力を引き出す，など4つ導き出された．

　以上から，消化器がん術後の患者と家族員の社会復帰を促進する効果的な外来看護は，明確にされた4つの看護援助を介入の焦点とし，精錬した援助内容を提示した．援助内容には，生活体験に対する感情と状況を共有し，社会復帰への努力を承認する，などが含まれる．

Abstract

　This study aimed to implement and improve the effectiveness of an outpatient nursing support program developed by the authors(2003)to facilitate postoperative rehabilitation of gastrointestinal cancer patients and their family members. Subjects were adult patients who underwent surgery for gastrointestinal cancer after being informed that they had cancer and who regularly received post.operative outpatient treatment, and their family members. During a two.month period, the previously developed nursing support program was conducted by the first author who is a nurse. Responses regarding the support program were collected as descriptive data through participant observation and semi.structured interviews. The protocol of this research was approved in advance by the ethics committees of the participating facilities. Data were analyzed by qualitative and inductive methods and any description of "changes observed in the subjects" and "nursing support" observed to have elicited such changes were extracted. Data obtained from 20 sets of patients and family members about changes observed in the subjects were sorted into 14 categories of 4 different meaning groups including "balanced self.esteem" and "ability to look after one's own health". The data also indicated that the nursing support could be sorted into 9 categories of 3 different meaning groups including "helping patients to open their minds" and "inducing inner power". Consequently, 4 specific nursing support practices were identified that should be the focus of an effective outpatient nursing support program that facilitates the post.operative rehabilitation of gastrointestinal cancer patients and their family members. These included "facilitating acceptance of changes in physical and psychosocial status following surgery for gastrointestinal cancer and inducing self.affirmation to sustain energy to live with the disease". The improved support practices include "sharing emotions and life experiences and recognizing efforts for rehabilitation".