遅発性パラフレニーが疑われる独居高齢者の支援－訪問看護師の立場から－

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  • Support of Elderly People Living Alone with The Late Paraphrenia Condition －From The Position of The Visiting Nurse－
  • チハツセイ パラフレニー ガ ウタガワレル ドッキョ コウレイシャ ノ シエン ホウモン カンゴシ ノ タチバ カラ

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背景：遅発性パラフレニーの先行研究は､医師の研究等は見られるが看護職による報告は見当たらない｡今後の遅発性パラフレニーの看護の一助となると考える｡ 目的：遅発性パラフレニーが疑われる独居高齢者との関わりで貴重な体験を分析･検討し幾つかの示唆を得たので報告する｡ 研究デザイン：事例研究 対象：Ｔ 81歳 女性 独居｡ 支援期間：1999年1月～2000年２月｡ 方法：1) 訪問看護記録等を看護職者数人で支援経過を中心に分析･検討した｡ 2) 介護保険制度の介護認定調査の問題行動の項目(７群) での評価｡ 倫理的配慮：Ｔの娘に説明し同意を得､事例紹介にあたっては一部修正を加えた｡ 結果：第1期：筆者は幻覚妄想状態の訴えを傾聴し続けた｡約２ヶ月後外来受診となる｡ 第2期：Ｔの幻覚妄想状態は継続しながらも筆者に相談を始めた｡関わって６ヶ月､Ｔが室内に上がるように勧めた｡ 第3期：Ｔの幻覚妄想状態の訴えが多くなった｡Ｔは心臓発作を起こし後､受け入れは良好で通帳の名義変更の相談も受けた｡ 第4期：Ｔの幻覚妄想状態は変化なく､風邪症状と高血糖があり受診介助と訪問回数を増やし対応｡しかし､Ｔは急変し永眠した｡ １. 結論：本対象において以下のことが確認できた｡ 1)遅発性パラフレニー(疑) の対象は周りとのトラブルを起こしやすくラポールの確立が難しい｡ 2)忍耐強い傾聴と共感的対応がより良い結果をもたらした｡ 3)遅発性パラフレニー(疑) の支援は､社会的孤独の予防､薬物療法と可能なら難聴や視力障害の改善に向けた環境調整が有効である｡ 4)支援者の対応が継続できた背景に､利用者との契約による有料サービス､開所間もない訪問看護ステーションで様々な要求があった｡|Background : Previous research on late paraphrenia by doctors can be found but reports relevant to nursing work can not be found. This report is considered from the viewpoint of nursing aid for future late paraphrenia. Objective : To report on an analysis of an examination of a precious experience by the relations with elderly people living alone with late paraphrenia and to make some suggestions based on this case. Design: Case study. Subject: 81 years old, female, elderly person living alone. Period of providing home care services: From Jan. 1999 to Feb. 2000. Method：1) The materials used for the analysis are the visit nursing records and the minutes. 2) Evaluation of the items (seven groups) of problem action of care authorization and investigation of public nursing care insurance. Ethical Considerations：We showed and explained Mrs. T the research purpose fully, and got her agreement. As there was no hindrance in the main point, we added modification by the case introduction for privacy protection. Results: First period: The author kept listening to the situation of the hallucination delusion condition. The patient went to outpatient department with visiting nurse for about two months rest. Second period: Her hallucination delusion condition persisted. Mrs. T began consultation with us. It continued for six months, and it was suggested that Mrs. T come out from her room. Third period: Mrs. T hallucination paranoia condition worsened. Mrs. T had a heart attack. After that, reception was good, and the consultation of the transfer of ownership of the bankbook was taken, as well. Fourth period: She had hallucination delusion condition and cold symptoms, hyperglycemia and went to outpatient department with visiting nurse. Visiting nurse increased the duration and frequency of visiting times. However, T changed suddenly and died. Conclusion: In this case. 1)The person suspected of late paraphernalia has difficulfy of establishing good relations with others, and tends to cause trouble with the surroundings that leads to lack of rapport. 2)It was patience and listening and sympathy-correspondence that brought about the better result. 3)Support of the suspected late paraphrenia patient should come in the from of social isolation prevention, medication, and effective environmental adjustment towards the improvement of hardness of hearing and eyesight obstacles, if possible. 4)The background which led to continued correspondence of support reguired the fee for service contract with the user, and various demands at the home nursing station soon after opening.

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