低位前方切除術を受けた初発直腸がん患者の社会生活におけるResilience

Phases of Resilience in the Social Life of Primar y Rectal Cancer Patients after Low Anterior Resection

要旨

　本研究の目的は，低位前方切除術を受けた初発直腸がん患者の社会生活におけるResilienceの要素を明らかにすることである．低位前方切除術を受けた外来通院中の初発直腸がん患者12名を対象に半構造化面接を行い，質的記述的に分析した．その結果，低位前方切除術を受けた初発直腸がん患者のResilienceを構成する要素として，4コアカテゴリーと18カテゴリーが抽出された．

　社会生活において自分らしさの回復をもたらすプロセスとしてのResilienceは，術後排便機能障害とがんを患うことから【低位前方切除術後に変わってしまった受け入れがたい現実を注視する】という自己喪失の直面化を起点に，これが問題の熟考や他者の援助を引き出すものとなり【前向きな意味へと自らに備わった力を発動する】ことで自己の再統合が促進され，【変化した自分と調和のとれた健やかな暮らしが拡がる】結果が得 られ，このプロセスを通して【新しく獲得された自己成長を認める】と新たな自己の獲得を含んだ心理的な動的プロセスを呈していた．

　これらから，看護者による患者の退院早期の面談を通して，患者が知覚する問題を共有する支持的な治療関係を築き，消耗する心身機能の抵抗性を高めるための日常生活支援の必要性や，Resilienceの力は他者との関係性のなかで拡がるため，患者の内省・客観的自己理解による自己の力の気づきや他者からの知識・スキルを得て新たな力を生み出す，Resilienceを理解する看護者による心理的介入の重要性が示唆された．

　The purpose of this study was to identify resilience phases and elements in the social life of patients with primary rectal cancer after low anterior resection as well as how they went through the process. The participants were 12 outpatients who had undergone low anterior resection without stoma formation less than three years before. A semi-structured interview was performed, and the data was analyzed qualitatively and descriptively. The following four elements of resilience were extracted from the data. The first phase began with “persistent recognition of unacceptably changed reality after low anterior resection,” and this element linked to the second phase, “activating self-healing power to make a positive meaning.” Then, these elements led to the third phase indicating a progression of recovery “leading oneself to a healthier life in harmony with a reintegrated self.” Through these processes, the final element, “being able to have self-awareness of newly-acquired internal growth,” was provided as the fourth phase associated with growth. Early post-operative nursing care becomes a reliable form of support for patients to enhance resilience, by sharing negative feelings and focusing on issues recognized by those patients. Thereby, nurses provide support in increasing patients' mental and physical stability and resistance. In addition, it is important that resilient nurses who are knowledgeable about resilience be involved as a partner in the process of strengthening or discovering potential for resilience in patients.