外来通院する造血細胞移植後早期の患者のライフコントロール

Life Control of Patients Who Visit a Hospital as an Outpatient in the Early Stage after Undergoing Hematopoietic Stem Cell Transplantation

要旨

　研究目的は，外来通院する造血細胞移植後早期の患者のライフコントロールはどのようなものなのかを明らかにし，移植後に外来通院をする患者のライフコントロールを支える看護の示唆を得ることである．

　研究デザインは，現象学を基盤とする質的記述的研究であり，データ収集は18名の参加者に半構成的面接法を用いて行った．分析はGiorgiの記述的現象学的方法を参考に行った．

　分析の結果，3の大テーマ，7の中テーマ，20のテーマを見出した．外来通院する移植後早期の患者のライフコントロールは，「患者が不確実な状況の中で生存するために強い危機感をもち，【これからの生活に目安をつけ（る）】て生活する．そして，周囲の人の支援なしで生きることが困難である中，今の生活を営むために【他者との隔たりの中で生活する】．さらに，再発や厳しい予後を意識しないように【生活していくために気持ちの均衡を保つ】ことである」と理解できた．

　ライフコントロールは，移植片対宿主病（GVHD），再発などによる不確かな状況を理解したうえで，これからの生活がどうなるのかを患者が予測し，自らを律していたことが特徴的であった．看護師は患者の行為をライフコントロールの視点で捉え関わることで，患者に具体的な行為のイメージと，これからの生活の目安を促すことができると考える．また，患者が自らを律することで無理が生じていないか確認し，患者を支援する必要性が示唆された．

　The present study aimed to obtain an insight into nursing practices supporting the life control of outpatients who have undergone transplantation, by clarifying the state of such control among patients who visit a hospital as an outpatient in the early stage after undergoing hematopoietic stem cell transplantation (HSCT). The study was conducted based on phenomenology in a qualitative and descriptive manner. Semi-structured interviews were held with 18 participants, and the obtained data was analyzed using the descriptive and phenomenological approach of Giorgi. As a result, patients' life control was divided into three major themes comprised of seven themes and 20 subthemes. In addition, we revealed the following concerning the life control of patients who visit a hospital as an outpatient in the early stage after undergoing HSCT: 1）They are deeply concerned about their uncertain circumstances and “re-orienting their lives,” 2）they “lead their lives while maintaining a certain distance from others” and face challenges due to the absence of support for them, and 3）they “balance their own feelings and continue their lives” while trying not to think about their unfavorable prognoses or the possibility of recurrence. The life control of patients was characterized by them predicting their lives, and restraining themselves, while understanding their uncertain circumstances due to various factors, such as graft versus host disease (GVHD) and the possibility of recurrence.

　The results of our study suggest that nurses can help patients to realize concrete action, and nurses can help outpatients re-orient their lives by viewing their actions through life control. Nurses should also understand that patients have difficulty due to their strict restraints, and support them accordingly.