前立腺全摘除術を受けた既婚男性の治療に伴う気持ちの変化

Changes in Feelings Associated with Treatment in Married Men Who Undergo Radical Prostatectomy

要旨

　研究の目的は，前立腺全摘除術を受けた既婚男性の治療に伴う気持ちの変化を明らかにすることである．Modified Grounded Theory Approach（M-GTA）に沿い，研究対象者8名よりデータ収集し分析した．

　結果，彼らは診断より【どうすればいいか分からない】と衝撃を受けるが，病気の特徴を知ることなどにより，【自分の病気はたいしたことない】安堵の気持ちに至り，【じっくり治療法を選びたい】【前立腺全摘除術を受けたい】へ変化した．治療選択では，【男ゆえに尿漏れは避けたい】と【性機能は諦めたくない】の気持ちが影響し【他の治療法を考えたい】に至った．【性機能は諦めたくない】は【性機能障害は仕方がない】へ変化し，【自分だけじゃない】気持ちとともに，【前立腺全摘除術を受けたい】へ気持ちが変化する際に影響を与えた．

　そして，術前の【男ゆえに尿漏れは避けたい】は，術後には【尿漏れをなんとかしたい】から，【尿漏れは苦にならない】へ変化し，妻に援助を求める気持ちも含まれていた．対照的に，妻と話し合うことを避けたいとする【性機能障害はあえて触れない】気持ちは持続した．また，術前に【性機能は諦めたくない】【性機能障害は仕方がない】【性機能障害はこだわらない】の気持ちをもち，術前の【性機能は諦めたくない】と【性機能障害は仕方がない】は術後【失った性機能は惜しい】へ変化した．

　明らかになった気持ちの変化より，彼らへの病気の特徴の理解を促進する援助と尿漏れを理解し対策がたてられる援助が，看護への示唆となった．

　The purpose of this study was to clarify the changes in feeling associated with treatment in married men who undergo radical prostatectomy. Data from eight subjects were analyzed in line with a modified grounded theory approach.

　It was found that their initial reaction to the diagnosis was shock, thinking I don't know what to do. Upon learning the characteristics of the disease and other factors, however, their feeling changed to one of relief: This disease is not such a big thing, followed by I'd like to carefully select the treatment or I'd like to have a radical prostatectomy. Selection of treatment was affected by feelings of As a man, I'd like to avoid urinary incontinence and I do not want to give up my sexual function, later arriving at I would like to consider other treatments. I do not want to give up my sexual function changed to Sexual dysfunction may be unavoidable, which had an effect in a change of feeling to I am not the only one together with I'd like to have a radical prostatectomy.

　The preoperative feeling of As a man, I'd like to avoid urinary incontinence changed postoperatively from I want to do something about urinary incontinence to Urinary incontinence is not that troubling. This also included feelings of seeking help from one's wife. In contrast, the subjects continued to have feelings of I won't purposely bring up the topic of sexual dysfunction, indicating a desire to avoid talking about it with one's wife. Preoperatively, there were feelings of I do not want to give up my sexual function, Sexual dysfunction may be unavoidable, and I will not be so preoccupied by sexual dysfunction. The preoperative feeling of I do not want to give up my sexual function and Sexual dysfunction may be unavoidable changed postoperatively to I am sorry to have lost my sexual function.

　The changes in feelings shown here suggest that nurses should provide support that promotes understanding of characteristics of this disease in patients and that helps them to understand urinary incontinence and take measures to deal with it.