再発悪性脳腫瘍患者をケアする家族の体験

Experiences of Family Caregivers in Taking Care of a Family Member with Recurrent Malignant Brain Tumor

要旨

　本研究の目的は，再発悪性脳腫瘍患者をケアする家族の体験を明らかにし，家族に必要な看護援助について検討することである．入院中の再発悪性脳腫瘍患者をケアする家族10名を対象に，自由回答法による半構成的面接調査法によりデータを収集し，質的帰納的分析を行った．

　その結果，再発悪性脳腫瘍患者をケアする家族の体験は，【死を意識する】【ケアに専念する】【神経症状出現を恐れる】【今後のことを思案する】【疲弊しつつも開き直る】【情報を求める】【医療者を信頼する】【自分の存在意義を信じる】【希望を持ち続ける】の9の大表題に集約された．考察の結果，看護実践への示唆として①相反する複雑な感情が混在することの自然さを強調し，それを支持し，認めていく，②神経症状出現に対する恐怖や驚きの表出を促し，症状出現の理由をわかりやすく説明し，症状出現を家族が受け止められるようにする，③家族の労をねぎらい，家族の今後の生活への気がかりを解決できる情報やアドバイスおよびサポートを提供する，④家族がやりがい感を持ち続けられるように肯定的フィードバックを続け，希望を共有し，希望維持のため達成可能な目標をともに考え実現への援助を行う，が得られた．

Abstract

　The purpose of this study was to elucidate the experiences of family caregivers in taking careof a family member with recurrent malignant brain tumor, and to identify nursing support necessaryfor the family. Semi-structured interviews using open-ended questions were held with 10participants taking care of hospitalized family members, with recurrent malignant brain tumor. Their answers were analyzed qualitatively.

　As a result, the following nine typical experiences were identified: "awareness of death", "dedication to care", "fear of the development of neurological symptoms", "consideration of the future", "find a positive attitude even when exhausted", "search for information", "trust in medical professionals", "belief in the reason for self-existence", and "retention of hope".

　Through discussions, suggestions for nursing practice were extracted, including: 1)normalize the coexistence of ambivalent, complicated feelings, and provide support and approval; 2) encourage the family to express their fear of or surprise at the development of neurological symptoms, and clearly explain the causes to aid their acceptance; 3)acknowledge the family's efforts, and provide them with information as well as advice and support that will help them resolve their concerns about the future; and 4)continue positive feedback to the family so that they can maintain a sense of challenge, share hope with the family, set mutually derived achievable goals to retain hope, and give support for such achievements.