自然災害で死別を経験した家族の特徴と看護介入に関する文献検討

Characteristics of Bereaved Families in Natural Disasters and Related Nursing Intervention: A Review of the Literature

抄録

【目　的】

　日本国外の文献から自然災害で死別を経験した家族の特徴および家族への看護介入について明らかにし、災害看護における家族ケアへの示唆を得る。

【方　法】

　「Academic Search premier」「CINAHL Complete」「MEDLINE Complete」を用いて「Disaster」「Bereaved」「Family」「Nurse」「Grief」で検索した結果、遺族の特徴として14文献、看護介入として8文献が対象とし、質的帰納的分析の手法を用いて分析を行った。

【結　果】

　遺族の特徴として【ストレスと対処行動】【家族機能】【災害時要配慮者となりうる家族員への災害の影響】【災害による精神的な問題とケア】【信仰心や価値観】が抽出された。また、遺族への看護介入には、【個人に焦点を当てた介入】、【家族の精神面や認知に焦点を当てた介入】、【地域に焦点を当て地域を通して家族をサポートした介入】、【災害サイクルを意識した介入】が抽出された。

【考察・結論】

　遺族の特徴として、多くの家族は複雑性悲嘆や長期的な悲嘆反応を有しており、個々の家族員が抱くストレスの原因や対処行動は異なっていた。また、看護介入としては、「個人」「家族」「地域」「災害サイクル」を意識した介入が重要であり、家族らしさや個人の特性を理解し家族のレジリエンスを活かしながら、震災直後から継続的に長期的な視野で支援していくことが求められる。

　This study was aimed to identify the characteristics of families who had experienced bereavement due to natural disasters as well as the nursing interventions provided to these families by reviewing literature from outside of Japan, to suggest recommendations to provide care to such families through disaster nursing. We searched the databases of “Academic Search Premier,” “CINAHL Complete,” and “MEDLINE Complete,” for the words, “Disaster,” “Bereaved,” “Family,” “Nurse,” and “Grief.” We applied a qualitative inductive analysis method and studied fourteen documents to identify the characteristics of bereaved families, and eight documents to identify the nursing interventions. The following characteristics of bereaved families were identified: stress and coping behavior, family function, impact on family members who may require assistance during a disaster, psychological issues and care, and faith and values. In addition, the following were identified as commonly provided nursing interventions for bereaved families: interventions focusing on the individual, those focusing on psychological aspects and recognition of the family, those supporting the family through the local community by focusing on that community, and those that are conscious of the disaster cycle. Many bereaved families typically experienced complex feelings of grief over an extended period of time, and the rationale underlying coping behavior for stress in family members showed individual variations. It is also important for nursing interventions to consider the requirements of the individual, family, local community, and the disaster cycle. Nursing interventions should take the family identity and individual characteristics into consideration and utilize the resilience of families to provide continuous support with a long-term perspective. The interventions should also begin immediately after the natural disasters occurred.