著者
百田 武司 西亀 正之
出版者
広島大学大学院保健学研究科
雑誌
広島大学保健学ジャーナル (ISSN:13477323)
巻号頁・発行日
vol.2, no.1, pp.41-50, 2002-09-30

本研究の目的は,脳卒中患者の回復過程における主観的体験を明らかにすることである.Grounded Theory法を参考にした質的帰納的研究を行った.74歳以下の脳卒中発作(初発)で緊急入院した患者のうち,入院直後におけるFIM79点以下,言語コミュニケーション可能で痴呆のない12名を分析対象とした.発症1週間以内から約6ヶ月後まで関わり,継続してインタビューを行った.分析の結果,回復過程に沿って《了解不能》《実感》《喜び》《アンビバレンス》《新たな価値》という意味の変化の局面と,それぞれの局面に一時的に落ち込む《落胆体験》があり,その発生時期と頻度の相違により合計5つの回復のパターンが認められた.従来,《落胆体験》は,リハビリテーションを妨げるマイナス要因とされてきたが,本研究においては《落胆体験》から立ち直った後に元の局面に戻るのでなく新たな局面に移行することが認められた.よって《落胆体験》は,回復を促進する契機と捉え,それを支える看護援助の重要性が示唆された.The purpose of this research is to clarify recovery subjective experiences of stroke patients.Qualitative inductive research was performed using Grounded Theory as a reference. The subjects of the study were twelve patients who were urgently admitted to the hospital for seizures associated with stroke (first incidence) at 74 years of age or younger, who had a score less than FIM79 immediately after being admitted to the hospital, and who were able to verbally communicate without dementia. Interviews were consistently performed from within 1 week of the occurrence of the stroke for approximately 6 months. The results of the study showed that there were a total of 5 patterns of recovery based on changes in the aspects of "lack of comprehension", "actually feeling", "happiness", "ambivalence", and "new values", as well as the timing and frequency of periods of temporary despondency during each of these aspects. Conventionally, bouts of despondency have been considered a negative factor that hinders rehabilitation, but in this study, it was seen that after overcoming a bout of despondency, the patient not only recovered to the original level, but was able to proceed to a new level. Therefore, bouts of despondency can be perceived as an opportunity to promote recovery and suggest the need to support that opportunity with nursing care.
著者
松尾 彰久 清水 一 山崎 郁雄 山下 由美 久野 真矢
出版者
広島大学保健学出版会
雑誌
広島大学保健学ジャーナル (ISSN:13477323)
巻号頁・発行日
vol.3, no.2, pp.10-19, 2004-03

「新聞の記事の中で出現する障害者とインターネットのかかわりは,作業療法における作業の概念でとらえるとどのような特性があるのか」という研究疑問を設定し,障害者のインターネット利用状況に関する枠組み作りを試みた.今回の研究では,全国紙の新聞1紙を対象とし,データとして検出した記事の類似した内容をまとめ,KJ法の考え方を用いて,共通した概念を抽出する方法で行った.この手順は,KJ法を基に開発されたコンピュータープログラムであるISOP-KJ法を補助的に使用した.その分析の結果,6つの大きなカテゴリーを抽出した.インターネットの活用は,作業療法でいう,作業療法として追及していく「作業」を強力に実現していく手段であり,目的にもなり得るという仮説を形成できた.インターネットを利用しての「自己維持活動」,「仕事」,「遊び」,「社会参加」は,「コンピュータによって形成される身体的な接触のない状態で情報伝達が生じる環境」の結果生じる作業といえるので,「バーチャル作業(virtual occupation)」と定義できると考えた. ""The internet can be very helpful if it is fully made use of by the disabled person."This statementmay be true, but the questions arise in what ways, in what fields and to what extent it can be useful.Inorder to obtain answers to those questions, we undertook research through a technique similar to the KJ-method, by collecting related articles from a certain nationally-circulated newspaper as data. Finally, thisdata verified that the internet makes it possible for the disabled to take part in social activities more easilyand willingly and to improve their activities in daily life, both their productive activities and their leisureactivities. We believe that we can define the activities produced by utilizing the internet as a virtualoccupation.
著者
佐藤 美幸 山本 貴志子 百田 武司 三村 聖子 作田 裕美 西亀 正之
出版者
広島大学大学院保健学研究科
雑誌
広島大学保健学ジャーナル (ISSN:13477323)
巻号頁・発行日
vol.2, no.1, pp.51-56, 2002-09

水中毒は精神科のあらゆる障害において見られるが,原因としては未だ明らかになっていない.しかしながら水中毒は重篤な合併症を生じ,生命の危険性も高いことからも,早期に発見し,予防していくことが重要である.本研究では,バイオインピーダンス法を用いて精神障害者の体内水分量を知り,その貯留の程度をアセスメントする事で水中毒の予防に役立てないかと考え,精神分裂病患者と健康な一般女性,病的多飲水患者とそうでない患者のインピーダンス値を比較し,それぞれの間にどのような差が生じているのかを検証した.その結果,精神分裂病患者の細胞内水分量,細胞外水分量の両者とも,一般女性のそれより少なかった.また,病的多飲水患者は細胞外水分量が非多飲水患者に比べて多いが,細胞内水分量は細胞外水分量に比べて増加しておらず,水分量のバランスが悪いといえる.また,精神障害者においてしばしば肥満も問題となるが,今回インピーダンス法を用いて測定した結果,体脂肪率も高値を示していることが明らかになった.まとめ: 1) 精神障害者の体内水分量は健康な人に比べて有意に低い. 2)バイオインピーダンス法は精神障害者の水中毒予防の指標として応用可能である.We find cases of water intoxication among patients of every sort of mental disorder. However, its cause is still unknown. Water intoxication causes serious complications, placing patients' life in danger. It is, therefore, important that its symptoms be identified at its early stage and its occurrence be prevented. In this study, we used the bio-impedance method in order to find out the level of water retained in the schizophrenic patients' body and examined ways to prevent water intoxication. The impedance values were compared between the schizophrenic patients and healthy women as well as between polydipsia and non-polydipsia patients. As a result, we found that both the extra-cellular and the intra-cellular water levels of the schizophrenic patients were significantly less than those of the healthy women. The extra-cellular water level of the polydipsia patients was significantly greater than that of the non-polydipsia patients. On the other hand, the polydipsia patients intra-cellular water level was not as high as their extra-cellular water level, indicating imbalance of water levels within the polydipsia patients body. Obesity is frequently an issue among mental disorder patients : the impedance method showed that body fat rate of these mental disorder patients was rather high. Summary 1)The amount of the body water level of the schizophrenic patients is significantly low compared with the healthy women. 2)The bio-impedance method can be applied as an index of the water intoxication prevention of the schizophrenic patients.
著者
茶圓 智子 横尾 京子 中込 さと子
出版者
広島大学保健学出版会
雑誌
広島大学保健学ジャーナル (ISSN:13477323)
巻号頁・発行日
vol.6, no.2, pp.102-110, 2007-09

本研究は, 予防接種における2歳から3歳の年少幼児の行動を類型化し, 行動の持つ意味を親や医療者の関わりの視点から考察し, 予防接種への対処を助けるために必要とされる看護ケアについて検討することを目的とした. 対象は日本脳炎の予防接種を受けた健康な2歳から3歳の年少幼児とした. データ収集は平成14年7月26日から同年9月12日までの1.5か月に行い, M小児科医院外来で行った. データ収集方法は, ビデオカメラを用いて, 第1回および第2回の日本脳炎予防接種の来院時点から帰院までの幼児の一連の行動と親, 兄弟, 医療者の行動を含めて撮影・録画した. データ分析は, 画像は事例別に全行動を言語で記述し, 予防接種に対する反応に関連する行動を抽出し, 幼児の予防接種に対する反応の出現時期(嫌がる時期, 泣き始める時期, 痛いと言う時期, 泣き止んだ時期), および, 幼児と医療者・親・兄弟との関わりを抽出し, 予防接種を受ける対象の行動の類型化を行った.その結果, 予防接種における年少幼児の行動は, 嫌がり・泣き始め・泣き止みの時期, 痛いという表現, 第1回・第2回の行動の相違点から, 3つに類型化した. タイプⅠの行動は, 第1回・第2回とも注射針刺入までに嫌がり泣き始め, タイプⅡの行動は, 第1回・第2回とも注射終了後に痛いと言って泣き始め, タイプⅢは, 第2回においてのみ注射針刺入時に痛いと言い液注入時に泣き始めるという行動であった. 年少幼児でも, 他者と注射の方法や意義について理解できること, 嫌がり・泣きがあってもがんばろうとしていたこと, 痛みに耐えようとしても耐えられないと泣いてしまうこと, 注射を見ることで不安が増強すること, 反応の内容や強さは個人差があることが考えられた.年少幼児の予防接種におけるケアとしては, 1)がんばるという心構えを支えること, 2)痛み体験を受け止め, がんばったことをほめる, 3)痛みを緩和すること, 4)注射部位の固定・注射の準備の仕方, 5)個別なアセスメントを行うことが示唆された.The purpose of this research is to find patterns in the behavior of infants during immunization injections and to ascertain the care needed when dealing with infants at vaccination. The subjects were five infants (aged from 2 years 11 months to 3 years 8 months old) who received immunization injections for Japanese encephalitis. The data was collected using a video camera of a series of interactions between the subjects, parents, siblings, and the medical treatment staff from their arrival at the clinic to their departure. Semi-structured interviews with the parents were also used to obtain information about the background of the subjects.As a result of inductive and descriptive analysis, the behavior of infants during immunization injections could be classified into three types. Infants of type I showed their dislike of the injection and cried before the prick of the needle at both the first and second injections. Infants of type II complained that it was painful and began to cry after the injection was over at both the first and second injections. Infants of type III said that it was painful at the prick of the needle but cried only during the second injection.Infants could talk with others about the meaning and the method of the vaccination. They tried to bear with the discomfort even though they disliked it and wanted to cry.When they could not endure it, they cried with pain. Seeing the syringe increased their anxiety. There were also individual differences in the strength of their reaction.Based on the infants' backgrounds and their behavior according to type, points relating to the care of infants during vaccination were enumerated as follows: 1) Child's determination to do his/her best. 2) Understand the infant's experience of pain and praise his/her endurance. 3) Consider methods of easing the pain. 4) Devise a method choosing the injection spot and for preparing the materials of the injection. 5) Individual assessment and correspondence.
著者
松原 麻子 車谷 洋 村上 恒二 青山 信一
出版者
広島大学保健学出版会
雑誌
広島大学保健学ジャーナル (ISSN:13477323)
巻号頁・発行日
vol.3, no.2, pp.27-34, 2004-03
被引用文献数
1

頸髄損傷者の食事動作に関して,スプーンの使用方法を替えることにより,上肢各関節(肩・肘・前腕・手関節)の角度と運動の範囲がどのように変化するかを明らかにするために,三次元動作解析を行った.対象はC6レベルの頸髄損傷者5人で,「ヨーグルトを食べる」という課題を2種類の自助具(自助具1:母指側使用,自助具2:手掌側使用)を用い実施した.撮影された画像から時間と上肢各関節角度を求め,自助具1,自助具2使用時で比較検討した.結果,自助具1使用時には自助具2使用時と比べ,1回の食事動作におけるすくう動作が占める割合が多い傾向にあった.また,食物をすくう際に肩関節屈曲,肩関節外転の運動が多く必要とされ,一連の動作を通じて前腕が回内方向に移行し,肩関節が屈曲・外転方向に移行することが明らかとなった.以上より,前腕の回外運動が十分可能である場合には手掌側使用の自助具の導入が望ましく,また母指側使用で食事を行う場合には,食物を口へ運ぶ動作だけでなく,すくう動作においても肩関節の運動が必要になることを十分に考慮した上で,自助具の提供やセッティングを行うことが重要であることが示唆された.The purpose of the present experiment was to examine how the upper limb movements (shoulder, elbow, forearm, wrist) of patients with spinal cord injury (C6 level) were affected while using two types (type 1: pronation type, type 2: supination type) of self-helping device. Five subjects were required to eat 5 spoonfuls of yoghurt. We recorded the position of 11 light reflecting markers attached to the subjects' body with three cameras. We divided the eating action into three phases, the scoop phase, reach-to-mouth phase, and reach-to-plate phase. These kinematic landmarks were used to define the dependent variables. We calculated five joint angles (shoulder flexion, shoulder abduction, elbow flexion, forearm supination, wrist extension) with a three-dimensional video-based motion analysis system (APAS System, Ariel Dynamics), and analyzed how they changed at each phase. We compared them while using type 1 and type 2. While using type 1, the scoop phase played a larger part than other phases, and shoulder flexion, shoulder abduction and elbow flexion angles increased, not only in the reach-to-mouth phase but also in the scoop phase, and the supination angle decreased. This result suggests that patients who can supinate their forearm had better use type 2, and also that it is important to consider upper limb movements in the scoop phase when we provide patients with a self-helping device. In this study, however, we focused only on upper limb movements. We also have to analyze head, neck and trunk movements and examine the relationship among upper limb, head, neck and trunk.
著者
小柴 順子
出版者
広島大学保健学出版会
雑誌
広島大学保健学ジャーナル (ISSN:13477323)
巻号頁・発行日
vol.6, no.2, pp.95-101, 2007-09

Hikikomori (Social withdrawal) has recently been examined as a problem facing Japanese society. Despite the issuance of guidelines by the Japanese government, the creation of parent groups and the availability of support from various government agencies and private organizations, no countermeasure policy has been established. Research on Hikikomori as a problem for the entire family and analysis of functioning in cases of Hikikomori has not been carried out.Hikikomori is seen in the same home and two or more cases are often seen. Then, it thought whether having related to the family function.This study is to find the Hikikomori family's characteristic and make available the clue of the method to it.The present study examines family functioning associated with cases of Hikikomori by assessing 16 families with social withdrawal, 15 families with autism, and 25 control families using the Family Assessment Device (FAD). The seven subcategories of the FAD [Problem Solving (PS), Communication (CM), Roles (RL), Affective Responsiveness (AR), Affective Involvement (AI), Behavior Control (BC) and General Functioning (GF)] were analyzed by a multiple comparison test. Statistical significance was established at p<0.01 or p<0.05.Results demonstrated that families with Hikikomori have higher CM, AR and GF scores than families with autism, and higher PS, CM and GF scores than control families. Furthermore, PS scores for fathers with a family member with Hikikomori scored higher than the control fathers. The PS, CM and GF scored for mothers with a family member with Hikikomori were higher than those of the control mothers, and than mothers with a family member with autism. Also, the AR scores for mothers with a family member with Hikikomori were found to be higher than those of the control mothers. No marked differences were observed between the control and autism groups in any of the scores for the families, fathers, or mothers.While measures and social support are available for autism, the lack of clarification regarding the cause and measurement of Hikikomori appears to have contributed to the observed differences in FAD scores.Mother feels that the family function is the worst in the family, because there are a lot of items with a significant difference of the FAD score.Therefore, appealing to and mother of the solution of "Hikikomori" obtained the suggestion of effective.
著者
森川 千鶴子 梯 正之
出版者
広島大学医学部保健学科
雑誌
広島大学保健学ジャーナル (ISSN:13477323)
巻号頁・発行日
vol.5, no.2, pp.53-61, 2006-03
被引用文献数
2

65歳以上の地域高齢者を対象に質問紙調査法により生活習慣と抑うつ状況・性格傾向について調査を実施した.387人(男性180人,女性207人)から回答を得た.森本の生活習慣スコア,SDS指数(Self-rating Depression Scale),高齢者用簡易性格検査との関連を検討した.生活習慣スコアが良好な高齢者は51人(13.2%),中庸者116人(30.0%),不良者220人(56.8%)であった.男性高齢者は女性高齢者より,生活習慣スコアが高かった(p<0.05).SDS指数の平均値は52.5点(標準偏差12.0点)を示し,女性高齢者の抑うつ傾向が高かった(p<0.05).生活習慣スコアの不良者はSDS指数が高かった.生活習慣スコアと性格3 因子の関連は,社交性・新奇希求性傾向の高い群,神経症性傾向の低い群の男性高齢者の生活習慣スコアが高くなっていた.生活習慣スコアが低い要因は,高齢者の運動・活動に関する習慣が少ないことであった.「健康日本21」の活動の一環として,老人クラブが主体となり,「ウオーキング」を推進している.この活動を継続することが健康づくり対策にとって重要であるとの示唆が得られた.A questionnaire survey on lifestyle, mental health and personality was carried out among the elderly(age 65 or over) in the community, and a total of 387 (180 male and 207 female) responses were obtained.In the survey, Morimoto's scores for lifestyle, Self-rating Depression Scales (SDS) and the SimplePersonality Test for the elderly were used. The scores on lifestyle showed 51 persons (13.2%) to be good,116 (30.0%) to be intermediate and 220 (56.8%) bad. Males had higher scores than females on average(p<0.05). SDS were also calculated to find an average at 52.5 (SD=12.0). Females showed a higher degreeof depression (p<0.05). The results of the Simple Personality Test showed that male elderly with highsociability and/or novelty-seeking or with low neuroticism tended to have a higher score for lifestyle.Low scores for lifestyle were attributable to less frequent physical activities. The importance ofwalking promoted by clubs for the elderly as a response to 'Healthy Japan 21'was confirmed in the healthpromotion.