非妊時の糖尿病自己管理が良好ではなかった1型糖尿病をもつ女性の産褥期における経験と思い

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一般に糖尿病合併症を併発している糖尿病をもつ女性では，産褥期には血糖コントロールが悪化するといわれている．今回，1型糖尿病をもつ女性の妊娠前から産褥期における糖尿病自己管理に関する経験と思いを明らかにすることを目的とした研究を実施した．このうち本稿では非妊時の糖尿病自己管理が良好ではなかった1型糖尿病をもつ女性の産褥期における経験と思いについて報告する．本研究は，修正版グラウンデッド・セオリー・アプローチを用いた質的帰納的研究である．データは3名の研究参加者から半構成的面接法により得た．カテゴリーは【　】，概念は〈　〉で示す． 　分娩後，女性は，困難を乗り越えて生児を得ることができたという達成感を感じ，〈あきらめずに子どもを産んでよかった〉と思う．しかし，自身の〈持続する糖尿病合併症〉と〈子どもが検査・治療を受けなければならない原因は自分〉であると思うことは【糖尿病をもっているがゆえにハイリスク妊産婦である】ことを自覚させる．この自覚は〈子どものために良好な糖尿病自己管理を継続しなければならない〉という気持ちを生じさせることとなる．妊娠・出産は厳格な糖尿病自己管理が必要なため辛く大変であったが，元気な子どもを得ることができただけでなく，自分を変化させることもできたため〈妊娠・出産はよい体験だった〉と振り返る． 　退院後は〈育児と糖尿病自己管理との両立の大変さ〉を感じるが，今の大変さより〈妊娠中に生じた身体的変化による苦痛は大変だった〉と思い起こす．妊娠中と同じようには糖尿病自己管理を続けられない状況ではあるが，妊娠中に知り得た〈同じ1型糖尿病をもつ女性の存在〉により頑張らなければいけないという気持ちを保っている．

It is generally said that blood glucose control of women with type 1 diabetes mellitus who have diabetic complications is deteriorated in the puerperal period. In this study, we conducted research for the purpose of clarifying the experiences and emotion in the puerperal period of women with type 1 diabetes mellitus in terms of self-controlling of diabetes. Semi-structured interviews were conducted with three women with type 1 diabetes mellitus. The data obtained from the interviews were analyzed qualitatively and inductively based on the Modified Grounded Theory Approach. Category is shown with【　】and concept is shown with〈　〉. After delivery, the participants had an accomplished feeling that they could give birth to a child despite difficulties they had faced, and also thought that 〈they had made the right decision to have the child〉. However,〈continuous diabetic complications〉and〈to blame themselves for their child's having to undergo medical examination and treatment〉made them recognize that they were【high-risk pregnant and parturient women due to diabetes】. And then came to feel that〈they would have to maintain good self-control of their illness, especially for their child〉. They realized that their attitudes towards diabetes had changed, and remembered how their pregnancy and delivery were hard. They thought〈pregnancy and delivery were good experiences〉because of their babies they obtained after the hard time. After being discharged from the hospital, they noticed〈difficulties balancing child-rearing and self-controlling of diabetes〉. At the same time, they remembered that〈the pain caused by their physical change which had happened during pregnancy was far worse〉than the difficulties they were then experiencing. In the situation, they could not maintain the same level of treatment for diabetes as that they had during pregnancy. However, they did keep feeling that they had to have a positive attitude towards continuous diabetic complications, considering〈the existence of other women with type 1 diabetes mellitus〉whom they came to know while they were pregnant.

収録刊行物

  • 三重看護学誌

    三重看護学誌 15 (1), 19-25, 2013-03-15

    三重大学医学部看護学科

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