摂食障害患者への心療内科病棟での看護師のかかわり  [in Japanese] Support for the Nurses of Eating Disorder Inpatients  [in Japanese]

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Author(s)

    • 須藤 信行 Sudo Nobuyuki
    • 九州大学病院心療内科|九州大学大学院医学研究院心身医学 Department of Psychosomatic Medicine, Kyushu University Hospital|Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University
    • 河合 啓介 Kawai Keisuke
    • 九州大学病院心療内科|国立国際医療研究センター国府台病院心療内科 Department of Psychosomatic Medicine, Kyushu University Hospital|Department of Psychosomatic Medicine, Kohnodai Hospital, National Center for Global Health Medicine

Abstract

<p>摂食障害患者は, その疾患の特徴上, 治療中に治療からの回避や行動化が認められることがある. 具体的にはスタッフの対応への不満の表出, 会話拒否, 操作性のある言動, 離院などである. 当科では摂食障害患者への看護師の効果的なかかわりのため, 以下の研鑽を重ねている. ①患者対応をまとめたマニュアルの作成, ②疾患の理解を深めるため医師のレクチャーに参加, ③病棟で自己学習会を開催. 加えて, ④チーム医療実践のために週に1回摂食障害患者に特化した多職種での合同カンファレンスを実施. この合同カンファレンスでは, 主治医, 看護師, 病棟薬剤師, 管理栄養士が参加して, それぞれの立場から意見交換を行う. 当科では神経性やせ症患者に対して 「行動制限を用いた認知行動療法」 という治療的枠組みを用いているが, その経過中に顕在化してきた心理的・社会的問題を病棟スタッフが共同で取り扱っている. 看護師は細部の入院生活の環境をつくるという点で重要な役割を担っている. 本稿ではこれらの取り組みの実際について症例を交えて報告する.</p>

<p>Patients with eating disorders may engage in avoidance behaviors and act out during therapy due to the character of the disease itself. Typically, these behaviors are expressions of dissatisfaction that result in refusal to communicate with or difficulties in communicating with the nursing staff, speech and behavior that attempt to manipulate the therapists and caregivers, and running away from the ward. Based on our experience, our nurses have developed methods to create an atmosphere of an effective caregiver/patient relationship, as follows : 1) A treatment manual was developed by the nursing staff that presents possible answers to the patient actions, 2) Our nurses participate in lectures, given by doctors, that help them better understand the diseases, and 3) The nursing staff hold study meetings in which they engage in "self-learning". 4) In addition, once a week we have a joint conference for the various types of specialists who deal with our eating disorder patients in order to succeed with a team approach. The chief physician, nurses, pharmacists, and nutritionists share their opinions. Our inpatient treatment program is based on a therapeutic frame called "cognitive-behavioral therapy using behavior limitation". The staff deal with psyco-social problems that emerge during the course of treatment. Observing and structuring the daily life environment are indispensable to the therapeutic framework of this treatment. Our nurses play an important role in creating an environment conducive to effective inpatient treatment. We report these attitudes with a typical case report.</p>

Journal

  • Japanese Journal of Psychosomatic Medicine

    Japanese Journal of Psychosomatic Medicine 57(4), 368-375, 2017

    Japanese Society of Psychosomatic Medicine

Codes

  • NII Article ID (NAID)
    130005530272
  • NII NACSIS-CAT ID (NCID)
    AN00121636
  • Text Lang
    JPN
  • ISSN
    0385-0307
  • NDL Article ID
    028068244
  • NDL Call No.
    Z19-26
  • Data Source
    NDL  J-STAGE 
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