腹部の手術を受ける患者のコーピングに関する実態調査: 手術前後のコーピング方略の構造的把握を目指して A SURVEY OF PATIENTS' ABILITY TO COPE BEFORE AND AFTER ABDOMINAL SURGERY

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Abstract

本研究は, 腹部の手術を受ける患者の手術前後のコーピングの実態と構造を包括的に明らかにすることを目的とした.調査対象は, 腹部の手術をした患者113人中, 回収ができた103人である.手術前後において対応する各58項目を調査内容に設定して数量的に分析を行った.その結果, 手術前は手術後と比較してより多くの種類のコーピング方略を用い, また活用度も高い (<I>p</I>=038) 58のコーピング方略を研究者間で考慮して16領域に分類後, 多次元尺度法により布置図を作成した結果, 距離関係から4群に分類ができ, 「援助希求行動」と「積極的覚悟と行動」, また「緊張緩和行動」と「回避」がそれぞれ近い距離にあることを示した.LazarusとFolkmanを参考にして前者を問題焦点型コーピング, 後者を情動焦点型コーピングと位置づけた.この4群の中で手術前後にもっとも活用されたのが「積極的覚悟と行動」であり, 手術への覚悟と不安というストレスフルな課題に対する問題解決的援助の必要性が示唆された.一方, 「緊張緩和行動」は, 手術後に有意に増加しており (<I>p</I><001) , 情動焦点型コーピングへの看護援助も相対的に重要になることがうかがわれた.悪性腫瘍群と非悪性腫瘍群の間では, 悪性腫瘍群は手術前「情緒的回避 (<I>p</I>=002) 」「成長期待 (<I>p</I>=002) 」.手術後「計画立案 (<I>p</I>=030) 」が, 非悪性腫瘍群より有意に高く, 苦痛緩和に対して回避のコーピング方略が有効である可能性が示唆された.手術前の患者の問題解決型コーピングの援助, 特に情報提供を十分に行うことが, 看護の重要課題の一つであることが明らかになった.また, 手術前だけでなく, 手術後のコーピングに対する援助も看護的援助の課題であることを問題提起した.

The purpose of present study is to demonstrate the structure of patients' coping before and after abdominal surgery including digestive system disease. The research subjects consist of 103 people (66 males and 37 females) among 113 patients who underwent surgeries at a hospital in Tokyo. The average age was 59.6 years (±12.7), The period of data collection was between July 1, 2003 and May 31, 2004. The investigators handed the survey sheets to the subjects at the time of hospital admission the survey sheets were and the subjects filled them out 2-3 days before and after the surgery; directly collected by the investigators. Fifty-eight coping strategy items for pre-surgery and post-surgery were analyzed. Overall use of coping was more frequent with more variety in the pre-surgery period than in the post-surgery period (<I>p</I>=.038) . The 58 coping items were classified into the 16 areas. As a result of multidimensional scaling mapping in reference to the cluster analysis (Ward method) based on similarities among the 16 areas of coping before and after surgery and their structure, the items were successfully categorized into four strategies: help-seeking behavior, positive preparation and behavior, relaxation of tension, and avoidance. Help-seeking behavior and positive preparation- behavior were called problem-focused coping, and relaxation of tension and avoidance were named as emotion-focused coping in relation to the coping theory of Lazarus and Folkman (1984) . Among the four strategies, positive preparation- behavior strategies were used mostly in the pre-operation period based on the psychological stress from anxiety toward the forthcoming surgery. Relaxation of tension strategy was utilized significantly more in the post-operational period (<I>p</I><.001) . We suggest relaxation of tension and avoidance strategies can contribute to pain relief. The malignancy group used more coping strategies of “affective avoidance” (<I>p</I>=.002), and “growth expectation” (<I>p</I>=.002) in the preoperational period, and more “future planning” (<I>p</I>=.03) in the posttest period than the non-malignancy group. The results suggest the importance of the nurses' role in helping patients use appropriate coping strategies based on their needs before and after surgery.

Journal

  • Journal of The Showa Medical Association

    Journal of The Showa Medical Association 68(6), 334-344, 2008

    The Showa University Society

Codes

  • NII Article ID (NAID)
    130001820573
  • NII NACSIS-CAT ID (NCID)
    AN00117027
  • Text Lang
    UNK
  • Journal Type
    大学紀要
  • ISSN
    0037-4342
  • NDL Article ID
    10343503
  • NDL Source Classification
    ZS7(科学技術--医学)
  • NDL Call No.
    Z19-373
  • Data Source
    NDL  J-STAGE 
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