乳がん患者リハビリテーション看護の概念特性と看護実践内容の明確化—診断を受けてから退院して家庭生活を始める過程に焦点をあてて

Rehabilitation Nursing with Women Diagnosed with Breast Cancer : Focusing on the Time Between Diagnosis and the Return to their Homes

要旨

　本研究の目的は，がんと診断されてから生ある限りがんとともに生きるというサバイバーシップの観点に立った乳がん患者リハビリテーション看護の概念を明らかにすることである．Walker ＆ Avantによるconcept analysisの手法を参考に看護実践的な側面を明確にするような研究デザインを選んだ．乳がん体験者とがん看護に携わる看護者を対象に，参加観察および面接によりデータを収集し分析した．乳がん患者リハビリテーション看護の概念特性として1．直面することをサポートする，2．参画することをサポートする，3．再構築することをサポートする，4．意味を見いだすことをサポートする，の4つが見いだされた．「意味を見いだすことをサポートする」という概念特性は，他の3つの概念特性の核となることが示唆された．また，乳がん患者の体験は，それまでの自分のライフスタイルや生き方を捨て，新しくそれらを創りあげていく移行（transition）の過程であるということができる．

　これらを踏まえて乳がん患者リハビリテーション看護の概念を記述すると，患者ががんの体験に直面し，参画し，再構築し，その中に意味を見いだす過程をサポートすることを通して患者の移行（transition）体験の質を高め，がんの体験を得て新しい局面に患者が成長していくことを援助することであるといえる．その看護実践の内容を4つの概念特性を踏まえ具体的に表現した．

Abstract

　The objective of this research is to clarify the concept of rehabilitation nursing of women with breast cancer from the standpoint of such women's determination to survive from the time they are diagnosed as having cancer. This research was designed so as to clarify aspects of nursing practices, taking into consideration the Walker and Avant method of concept analysis.

　The data was collected through interviews with and observations of women with breast cancer and nurses who are engaged in the nursing of them. As a result, the following conclusions were reached regarding the concept attributes in terms of rehabilitation nursing of women with breast cancer: 1. Nurses assist women in facing the challenges arising as a result of their illness. 2. Nurses assist women in taking active part in new lifestyles. 3. Nurses assist women in reconstructing their lives. 4. Nurses assist women in finding meaning in their new lives. It could also be inferred that the fourth concept listed above was a central part of the other three. It could also be said that such women's experience with breast cancer is a transition : leaving behind their old lifestyle sas lived up to the time of the diagnosis, and creating new lifestyles.

　In listing the concepts of rehabilitation nursing of women with breast cancer based on these points, it could be said that nurses ameliorate the quality of women's experiences with breast cancer by helping them deal with their experiences, participate in new lifestyles, reconstruct their lives(transition), and find some kind of meanings within such new lives, as well as helping women grow throught their experience with cancer.

　Such nursing practices are described in detail, based on the aforementioned four conceptual attributes.