高齢慢性心不全患者の日常生活における身体変化の自覚

Awareness of Physical Change in Their Daily Lives among Elderly Patients with Chronic Heart Failure

抄録

　本研究は，高齢慢性心不全患者が日常生活において心不全に伴う身体変化をどのように自覚しているのかを明らかにすることを目的とした．対象は，慢性心不全と診断され入院または外来通院している高齢者11人として半構成的面接を行いデータ収集し，質的記述的に分析した．高齢患者は，【変化速度の緩急】【体の制御感の喪失】【自己調整できる苦しさ】【自分のありたい姿との調和】【忘れられない極限の体験からの予見】【独特な身体感覚】【客観視された情報による気づき】によって自己の身体変化を自覚していた．患者は，自分の身体を知ろうと模索し感じとった身体変化を特有な表現で他者に伝えることや，自己調整できる苦しさであるという自覚によって対処が遅れる可能性を抱えていた．患者の感じている身体変化を看護師が理解するためには，患者が感じたままに表現できる場を設け，患者の身体に対する期待や理想，日常生活のなかで感じる不都合さ，忘れられない極限の体験を手がかりとして思いを聞くことが有効である．

　The purpose of this study was to clarify awareness of physical change in their daily lives among elderly patients with chronic heart failure (CHF). The subjects were 11 elderly patients diagnosed with CHF and who are receiving inpatient or outpatient treatment. The data were collected through semi-structured interviews and then analyzed through qualitative descriptive analysis. As a result of the analysis, the following seven categories were identified with regard to how elderly CHF patients become aware of changes in their physical symptoms: [sudden or gradual occurrence of changes], [a sense of losing control over their body], [bearable or manageable pain], [harmony with their current state], [foreknowledge from critical conditions experienced in the past], [peculiar physical sensations], and [becoming aware through objective observation and information]. This study found that patients groped for words and used peculiar expressions to tell other of the physical changes that they experienced. It was also found that there was a possibility of a delay in treatment due to patients' self-judgment that the pain was bearable and manageable. In order for nurses to understand the changes that patients feel in their bodies, it is effective to create a place where patients can express themselves freely, and to listen to patients' thoughts and feelings, based on a thorough understanding of their desired state of health, inconveniences experienced in daily life, and critical conditions experienced in the past.