小児がんの子どもが腰椎穿刺時に対処行動を高めるための看護介入

Nursing Intervention to Foster Pain-Coping-Behavior of Children with Cancer during Lumbar Puncture

はじめに

　入院している小児がん患児は，化学療法や放射線療法などのさまざまな治療を受けている。治療の過程で，小児がんの子どもが体験する多くの苦痛の軽減を図ることは非常に重要なことである。現在，痛みの軽減を目的とした介入は，薬物による鎮静（以下，セデーションとする）によるものがほとんどであるが，看護婦の関わりにより苦痛が軽減すると思われるものも多い。

　先行研究では，検査についての事前の説明，音楽療法や催眠療法などの気晴らし，リラクセーション等の子どもの認識に働きかける看護介入により，子どもの認識する痛みが減少していた。Broomeら（1994）は，小児がんの子どもを対象に，痛みを伴う処置の時に気晴らしとイメージを用いた看護介入を行ない，子どもの痛みと不安行動の減少を報告している。

[Objects] To guide the nursing intervention to foster pain-coping-behavior of children with cancer during L.P. (Lumbar Puncture).

[Subjects] Subjects in this study consisted of six boys and four girls, who were 5-15 years old and hospitalized for cancer chemotherapy.

[Methods] For the first, L.P., the researcher observed children's coping behavior and recorded process records. Until the second L.P., the researcher provided nursing interventions for children to foster their pain-coping-behaviors. In the second L.P., the researcher adjusted their surroundings as the children want.

[Findings] Nursing behavior provided were classified into ten categories. And, the interventions used often and effective were ‘put children at ease’, ‘accept the children's feeling and what they were saying’, ‘distract children's feeling from L.P.’, ‘make children to express their feelings’, and ‘make children to act positively during L.P.’. The nursing intervention promoting pre-school children to make up their concrete image is more effective, and to distract by their favorite music and toys is effective. On the other hand, for the school age, it is effective that nurses promote and draw their self-coping ability. It is important that nurses intervene the children before the L.P. for them to do what they want. Nurses and the children should discuss about their hoping coping-behaviors and present other coping-behaviors. So, nurses promote the children do more subjective.