著者

橋本 ゆかり 杉本 陽子 Hashimoto Yukari Sugimoto Youko

出版者

三重大学医学部看護学科

雑誌

三重看護学誌 (ISSN:13446983)

巻号頁・発行日

vol.9, pp.31-40, 2007-03-20

被引用文献数

1

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本研究の目的は, 処置前・中・後を通しての他者の関わりによって, 静脈麻酔下で髄腔内注入を受ける小児がんの子どもの認知にどのような変化があったのかを明らかにすることである. 小児がんで小児病棟に入院しており, 髄腔内注入が予定されている 3 ~11 歳の子ども 4 名に対して処置前・中・後を通して介入を行い, 得られたデータを質的に分析し, 以下の結果を得た. 1. 4 事例すべてにおいて, 子どもは眠っている間に何が行われているのかを知らなかったが, 処置前にそのことについての説明を受けたことで, 処置室入室後の麻酔導入までの間, 混乱することなく処置を受け入れていた. また, 処置後の遊ぶ様子や子どもの話から髄注の手順や内容について理解していることがわかった. 2. 4 事例すべてにおいて, 処置中, 子どもは交渉したり好きな遊びに集中したりして自分なりの対処法を選択し, 自分で乗り越えたという気持ちがあった. 3. 幼児 3 例において, 髄注の手順について断片的な理解を示していたが, 処置場面では医療者が助言することで子どもは受けた説明内容を思い出し, 混乱はみられなかった. 4. 3 歳男児は, 処置前や処置中において特に変わった様子はみられなかったが, 処置後の遊びの中で医師役のアンパンマンの手を縛ることで処置を施行できないようにし, 「またされるから」 「怖い」 など, 拒否を示す情緒反応がみられた. We conducted a study with pediatric cancer patients who received intrathecal injection under intravenous anesthesia, with an objective to elucidate how pre-, per-, and post-treatment interventions affect childrens perception of the treatment. Four pediatric cancer patients (age range 3-11 years) who were hospitalized in the pediatric ward and scheduled to receive intrathecal injection underwent pre-, per-, and post-treatment interventions. A qualitative analysis of data revealed the following findings:1. None of the four patients knew what was done to them while they were asleep under anesthesia. Following a pre-treatment intervention that informed them of the treatment, patients showed no sign of confusion in the surgery room before receiving anesthesia. Moreover, post-treatment observation of their activities and conversations suggested their understanding of the treatment and its procedures.2. All four patients chose their own means to cope during the treatment, such as negotiating with the physician or focusing on their favorite activities, and created a feeling that they underwent treatment by themselves.3. Following a pre-treatment intervention that explained procedures, three patients had fragmentary understanding. With help from healthcare professionals during the treatment, these patients were able to recall details of the explanation; they did not show any signs of confusion.4. A three-year-old male patient showed no unusual behavior during pre- or per-treatment observations. During post-treatment playtime, however, he showed emotional responses that suggested refusal of the treatment, such as tying the hands of an Anpanman doll that was in the role of a physician, in order to prevent the toy from giving him the treatment, saying, He will do it again and Im scared.Key Words: childrens perception, pediatric cancer patients, intrathecal injection, intravenous anesthesia