激しい拒絶を示す患者の看護に関する一考察 CASE STUDY OF A SIVERELY REJECTIVE PATIENT : EFFECTS OF STUDENT NURSES' PRACTICES AND CONTROVERSIES

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精神科治療においては最近さかんに議論されるようになってきたインフォムード・コンセントを徹底させることが困難な事例かおる。ある激しい拒絶的な患者を受け持った看護学生がスタッフの患者への対応を批判したことから、スタッフは看護方針の見直しを図ることになった。次に受け持った看護学生は同じ患者と良い関係を持つことができたが、患者が「どうしてもっと強くやってくれないのか。無理やりやられるのが好き」と語ったことから、一方的に見える患者-看護婦関係の患者側の問題が明らかになった。批判した学生も患者から拒絶され、患者の隠されたニードに気がつかなかったほどショックを受けていたのである。実習の場で学生が現場のやり方を告発することは、臨床の質を高める契機にもなるが、スタッフ側の問題だけでなく、患者の病理、学生の問題を指導者は掴んでおく必要がある。

There have been many controversies over "informed consent" of psychiatric patients. It sometimes becomes inevitable for staff to do something without a patient's consent in order to keep his/her safety. A student nurse criticzed staff for being abusive to a highly rejective and regressive female psychiatric patient. The patient did nothing by herself, so that staff had to urge her, for example, to eat or to take a medication everyday. The student nurse was also bitterly refused by her. The criticism the student nurse made arouse a serious discussion among the nurses. Some staff disagreed with her observation, but they decided to reconsider their approach to the patient. Then another student nurse took charge of the same patient, and could manage to make good relationship with her. One day the patient asked the student nurse why she hadn't pushed her hard enough, and admitted that she liked staff to be tough on herself. As a matter of fact violence was common-place in her family. It seemed that she was trying to realize her own family by the severely regressed behavior against the staff. It also became clear that some nurses were aware of and reacted instinctively to her hidden need for dependence. There remained an educational problem in this case. The student nurse who criticised the staff for the patient abuse could not understand the patient's unspoken emotional need, because she was shocked by a patient's severe rejection, although she made good contribution to making better practice of nurses. It is really a difficult matter for teachers how to do with students' straight criticism. We must deal with the students' emotional problems as well as the controversial issues they made.

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各種コード

  • NII論文ID(NAID)
    110008145271
  • NII書誌ID(NCID)
    AN10478677
  • 本文言語コード
    JPN
  • 資料種別
    雑誌論文
  • ISSN
    09180621
  • データ提供元
    CJP引用  NII-ELS 
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