未破裂脳動脈瘤により血管内手術を受けた患者の不確かさの体験と看護支援に関する研究  [in Japanese] Experience of Uncertainty in Patients with Unruptured Intracranial Aneurysms Treated with Endovascular Coiling and Their Nursing Care  [in Japanese]

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Abstract

未破裂脳動脈瘤(以下UIAとする)に対する血管内手術を受けた患者19名を対象とし,UIAにより血管内手術を受けた患者の体験を明らかにし,看護支援のあり方を検討した.縦断群:退院前,手術後1カ月,3カ月,横断群:手術後1~1.5年の時期に,半構成的面接を行い,解釈的現象学を参考に分析した.その結果,5つの時期が抽出され,体験した不確かさ,受け止め・対処,意味づけの3側面が抽出された.各時期に異なる不確かさを体験していた.診断期には体験した不確かさの側面にのみテーマが存在しており,治療選択期では受け止め・対処の側面に多くのテーマが出現した.治療期においては,不確かさから一時的に解放された.その後,日常性の取り戻し期・再治療選択期に至ると意味づけの側面のテーマが増していた.UIAにより血管内手術を受けるということは不確かさが常につきまとい,診断・治療も繰り返される可能性があるという現実を受け入れ,患者が自分で意思決定し意味を見出していけるように支援する必要がある.

This study aimed to clarify the experience, and discuss the nursing care of, 19 patients with unruptured intracranial aneurysms(UIA)treated with endovascular coiling. Using semi-structured interviews I collected data about illness-related events and their thoughts at 'before the discharge,' '1 month after the treatment,' '3 months after the treatment'(longitudinal group), and '1~1.5 year after the treatment'(cross group). The data was analyzed inductively. As a result, 5 phases were chosen and classified into 3 aspects as "uncertainty experienced," "perception and coping," and "give meaning." The participants experienced the different levels of uncertainty during different phases. There are themes of "uncertainty experienced" only in the diagnosis phase, and "perception and coping" appeared in the treatment decision-making phase. During the phase, the uncertainty disappeared temporarily. During the recovery phase, getting back to their dairy life and remaking decisions lots of "give meaning" themes appeared. Patients with UIA who chose endovascular coiling were always annoyed by the uncertainty, so it is necessary to help them accept the fact that they may have to have check-ups and follow-up treatment. It is also necessary to support them in making their own decisions and finding meaning through this experience.

Journal

  • Journal of Japan Academy of Critical Care Nursing

    Journal of Japan Academy of Critical Care Nursing 6(3), 16-25, 2010

    Japan Academy of Critical Care Nursing

Codes

  • NII Article ID (NAID)
    130004950129
  • Text Lang
    JPN
  • ISSN
    1880-8913
  • Data Source
    J-STAGE 
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