著者

小坂 美智代 眞嶋 朋子

出版者

千葉看護学会

雑誌

千葉看護学会会誌 (ISSN:13448846)

巻号頁・発行日

vol.16, no.2, pp.67-74, 2011-01

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本研究の目的は,外来化学療法を受けている胃がん術後患者の柔軟な対処の構造を明らかにし,柔軟な対処を支える看護援助を検討することである。研究対象者は胃切除術後に外来化学療法を受けている胃がん患者11名で,半構成的面接,参加観察,記録調査からデータを収集し,質的帰納的に分析した。外来化学療法を受けている胃がん術後患者の柔軟な対処とは,《手術による変化や化学療法が必要な現状と向き合う》《身体の反応を感じ取り,自分の状況を把握する》《状況理解と対処の体験を積み重ね,その時々の状況にみあう対処法を選択する》《症状を抱え治療を継続しながらもふつうに暮らすことをめざす》《胃切除術や外来化学療法によってもたらされた様々な変化に対して許容範囲が広がる》を含む8カテゴリーに集約された。さらにカテゴリー間の関係を検討した結果,柔軟な対処は4局面からなる構造を呈し,第1局面から第3局面が対処の中核となり,第4局面は他の局面各々を推し進める支持的・促進的機能を果たしていた。また,柔軟な対処を支える看護援助としては,「現状との対峙と自己決定を支える」,「身体感覚をもとにした状況把握と判断,および有効な対処法を選択する力を高める」,「困難や変化に対する認知の広がりを図りながら外来治療の継続を支える」,「情報を獲得する力を高め情緒的安定を図る」が重要であると示唆された。The purpose of this study was to elucidate the structure of flexible coping for postoperative gastric cancer patients receiving ambulatory chemotherapy and to investigate nursing care that supports flexible coping. Subjects were 11 gastric cancer patients receiving ambulatory chemotherapy following gastrectomy. Data were collected using semistructured interviews and participant observation as well as from medical records, and subjected to qualitative inductive analysis. Based on the results, flexible coping for postoperative gastric cancer patients receiving ambulatory chemotherapy was classified into eight categories, including: "facing each other to changes caused by surgery and the need to undergo chemotherapy", "sense the body's responses and understand one's condition", "gain experience in understanding conditions and coping, and select coping methods appropriate for each condition", "aim to return to a daily life despite continuing to have symptoms and receive treatment", and "become more accepting of the various changes caused by gastrectomy and ambulatory chemotherapy". In addition, investigation of relationships between categories showed that flexible coping was composed of four aspects, the first, second and third of which formed the core of coping and the last of which functioned to support and promote each of the other aspects. In addition, the following were considered important for nursing care that supports flexible coping: 1) provide support for patients to facing each other to the present situation and for their self-decision, 2) enhance the patients' ability to understand the condition, make judgments, and to select effective coping methods, 3) support the continuation of treatment at home while broadening the patients' recognition of difficulties and changes, and 4) enhance the patients' ability to acquire information and promote their emotional stability.