軽症脳卒中患者の発症後の体験—脳卒中患者のACPを促進する看護の検討

Post-onset Experiences of Patients with Minor Stroke: A Nursing Care Investigation to Encourage Advance Care Planning (ACP) for Patients With Stroke

要旨

　目的：軽症脳卒中患者が発症後に病気や今後についてどのようなことを思考したり感じたり行動したりしたかを明らかにし，脳卒中患者のACPに対する看護への示唆を得る．

　方法：発症後1年程度までの外来通院中の軽症脳卒中患者20名を対象に半構造化面接を実施し，質的帰納的に分析した．

　結果：〔脳卒中の後遺症や再発への恐怖と共に人生を生きることの不可避〕〔脳卒中と共に生きる自分を支えてくれる他者と他者を支えることができる自分の再認識〕〔脳卒中再発時の重症化を想定した身辺整理と心構え〕等の7カテゴリが得られた．

　結論：再発時の重症化リスクに対する的確な認識や自己の社会的存在意義の実感が，後遺症・再発リスクと共に人生を生きることや再発時を想定した準備を後押ししていると推察された．脳卒中患者のACPに対する看護として，脳卒中の再発リスク・再発時の重症化リスクに対する患者の認識を強化すること等が重要と考えられた．

　Aim: To elucidate the thoughts, feelings, and actions of minor stroke patients regarding their condition and future following the onset of stroke symptoms, in order to gain insights that may inform nursing care related to advance care planning (ACP) for this patient group.

　Methods: Semi-structured interviews were conducted on 20 minor stroke patients receiving outpatient care who had experienced onset of symptoms during the previous year. Qualitative inductive analysis was conducted to evaluate results.

　Results: Seven categories were derived, including the following: "the inevitability of living with the fear of stroke sequelae and recurrence," "the re-recognition of support provided by themselves and their care takers," and "getting one's affairs in order and conducting mental preparation in case stroke recurrence with increased severity of symptoms occurs."

　Conclusion: An accurate assessment of the risk of increased severity of symptoms with stroke recurrence and realizations pertaining to the patient's own societal significance had a facilitative effect on preparations made towards living with the aftereffects and recurrence risks of strokes. Furthermore, this also helped with the preparations made in case stroke recurrence occurs. Increasing patient awareness regarding the risk of stroke recurrence and increased severity of symptoms is crucial towards the provision of nursing care related to ACP for stroke patients.