乳幼児期の先天性心疾患児を育てる母親の自律的育児に向かうプロセス

Process of Acquiring an Autonomous Child-Raising Method in Mothers of Infants With Congenital Heart Disease

要旨

　目的：中等症から重等症の先天性心疾患児の母親が自律的育児を見出すためのプロセスを明らかにする．

　方法：訪問看護利用経験のある先天性心疾患児の母親7名に対し振り返り法によるインタビューを実施，複線経路等至性モデル，経験学習理論を用いて分析した．

　結果：母親は，【自ら育てると決心する】【症状の安定に一定の自信を獲得する】【成長に喜びを見出す】【時に育児を社会にゆだねる】という分岐点を経て，等至点：母親が落ち着いて家で子どもと共に暮らしている状態に至っていた．

　結論：在宅療養中の先天性心疾患児の母親が自律的な育児を習得するためには，母親が置かれている状況に応じて促進要因や阻害要因を考慮した具体的な支援方法を検討することで，母親の実態に対応したケアの提供が期待できることが示唆された．

　Purpose: The purpose of this study was to clarify mental stages of mothers of children with moderate to severe congenital heart disease (CHD) experience in developing an autonomous parenting method, and to describe how these mothers establish stable home care for their CHD children after discharge from a hospital.

　Methods: Seven mothers of children (age range: 0 to 8 years) with CHD who used home care nursing services were interviewed using the retrospective method from December 2021 to June 2022, with informed consent obtained to participate in our study. A qualitative and descriptive investigation was conducted and the results were analyzed using the Trajectory Equifinality Mode (TEM) and the Kolb's experiential learning theory.

　Results: Before reaching a state of "living calmly with a CHD child", the mothers experienced 4 bifurcation points: "deciding to raise the child by her own will," "prioritizing stabilization of the child's symptoms, " "valuing the child's growth as the most important, " and "choosing to occasionally access to the government's social resources and local childcare resources".

　Conclusion: To facilitate autonomous child-rearing methods for mothers of children with CHD receiving home care, it is essential to prepare optimized care suited to each mother's specific circumstances. This requires consideration of specifically tailored support methods that account for both promoting factors and inhibiting factors within their environments.