在宅終末期がん療養者が他者との関係性の中で主体性を発揮して納得できる療養生活を見出していく過程 : 訪問看護師の語りから  [in Japanese] PROCESS OF FINDING A CONVINCING MEDICAL TREATMENT LIFE UNDER HOME-BASED NURSING CARE DEMONSTRATING SUBJECTIVITY IN RELATIONSHIP WITH OTHERS IN TERMINAL CANCER PATIENTS : AN INTERVIEW BASED ON VISITING NURSES' PERSPECTIVES  [in Japanese]

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Abstract

[要旨] 目的 : 訪問看護師の視点から,在宅終末期がん療養者が他者との関係性の中で主体性を発揮して納得できる療養生活を見出していく過程を明らかにする。方法 : 第一段階では,訪問看護師の語りから原案を作成した。第二段階では,原案について専門家会議で内容妥当性を検証した。結果 : 過程は,以下の局面1~7がみられた。すなわち,局面1【思い通りに体調や生活を取り戻すことができず,現状との隔たりを知覚し,行先が見通せない気がかりを明かす】,局面2【自分が思い描く生活がかなわないことや,他者との間で気持ちの相容れなさを感じることで,怒りや不満などの感情や態度を表現する】,局面3【治療の選択や余命に関する情報を求めて自分や家族の状況を見通し,「これからどのように過ごすか」についてこれまでの方法を試しながら,今後の手立てを模索する】,局面4【気がかりや願望を共有し,力になってくれる他者の存在に気づき支援を求める】,局面5【他者との対話を通して,「これからどのように過ごすか」について,自分の方向性を表明する】,局面6【自分の選び取った療養生活を送るために,コントロール感覚をもって他者と協力して取り組む】,局面7【自分が選んだ治療や生活に対する納得を表明し,身体的な限界や間近な死を受け止めて,残された時間を「どう過ごすか」を決めて,自らの意思を他者に伝える】であった。考察 : これらの局面は,看護支援において,療養者の主体性発揮の様相をつかみ,個人の状況に合わせた支援の手がかりを得る上でアセスメントの視点になると考える。

[SUMMARY] Purpose : This study aimed to elucidate the process of finding a convincing medical treatment life under home-based nursing care demonstrating subjectivity in relationship with others in terminal cancer patients from the viewpoint of visiting nurses. Method : In the first phase, based on utterances of visiting nurses, a tentative plan on the "process of finding a convincing medical treatment life under home-based nursing care demonstrating subjectivity in relationship with others in patients with terminal cancer" was developed. In the second phase, the validity of the content of the tentative plan was verified in meetings with experts. Results : The process was found to entail the following seven stages : Stage 1 "unable to regain the desired physical condition and lifestyle, perceive the gap with the current situation, and exhibit anxiety about the unforeseeable future" ; Stage 2 "express feelings and attitudes such as anger and dissatisfaction due to perceived unattainability of envisaged lifestyle, and feelings of disharmony in relationship with others" ; Stage 3 "seek information on choice of treatment and life expectancy to foresee the status of self and the family, and explore future options while experimenting with ways about 'how to spend the time hereafter' " ; Stage 4 "share the concerns and desires, recognize the presence of others who can be of help, and seek their support" ; Stage 5 "express own intention about 'how to spend the time hereafter' through communication with others" ; Stage 6 "work with others with a sense of control to lead the personally chosen medical treatment life" ; and Stage 7 "express satisfaction with personally chosen treatment and lifestyle, accept the physical limitations and imminent death, and communicate own volition to others after deciding about 'how to spend' the remaining time." Discussion : In providing nursing support, these stages may provide an assessment viewpoint for understanding patients' subjectivity and obtaining clues on support tailored to their circumstances.

Journal

  • 千葉看護学会会誌

    千葉看護学会会誌 25(1), 19-27, 2019-08

    千葉看護学会

Codes

  • NII Article ID (NAID)
    120006774931
  • NII NACSIS-CAT ID (NCID)
    AA11354292
  • Text Lang
    JPN
  • Article Type
    journal article
  • ISSN
    1344-8846
  • NDL Article ID
    029987075
  • NDL Call No.
    Z19-B794
  • Data Source
    NDL  IR 
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