造血幹細胞移植を受けて困難な状況で長期外来通院を続ける成人前期男性患者への看護支援と病気体験の変化

Nursing Support for Early Adult Male Outpatients after Bone Marrow Transplantation : with a Focus on Changes in Their Experience of Illness as They Continue to Visit Hospital in a Suffering Situation

要旨

　研究目的は，マーガレット・ニューマンの「健康の理論」のもと，造血幹細胞移植後，困難な状況で長期外来通院中の成人前期男性患者と看護師がパートナーとなって，患者が自己の軌跡をなぞり自分全体のあり様を認識する看護支援を行い，それによって患者の病気体験にどのような変化が生まれるかを探究することであった．研究デザインは実践的看護研究のもとで，ニューマンが提唱する解釈学的・弁証法的方法を採用した．研究参加者は30歳代男性患者4名であった．データは面談の内容と研究者のジャーナルであった．参加者らの病気体験は，「自分の人生の表面的な振り返りと直視できない病気体験の開示」，「自分の本音の気持ちを模索して表出」，「現在の困難な状況にある自分の承認」，「新しい気づきと自己成長」という4つの局面を経て変化し，ニューマンが主張する‘いまの自分自身のあり様を認識することから得る洞察による人間の成長'の様を示した．本支援は，移植後長期間困難な状況にあり，発達課題の達成に苦悩している成人前期男性患者に役立つという示唆を得た．

Abstract

　The purpose of this study was to identify what changes occur in the experience of illness, when a nurse and a client who has undergone bone marrow transplantation(BMT)and continues to visit hospital for a long time follow his pattern recognition process together. The theoretical framework is Newman's theory of health. Newman's hermeneutic, dialectic approach was chosen for praxis research design. The participants were 4 male outpatients in their 30's. The data consisted of the content of dialogues in the participant.researcher partnership and of the researcher's journals. The participants showed four transformational phases. These were: "Superficial reflection on one's own life and expressions of the experiences of illness that one had not been able to confront", "Groping for one's true feelings and showing them", "Recognition that one is in a hard situation at present", "New awareness and self.revolution". Their insights suggested an expanding human consciousness and supported Newman's theory. The findings suggest that this nursing support helps long term male outpatients in early adulthood who are suffering from not being able to achieve their life tasks after BMT.