看護研究論文からみるスピリチュアリティの定義

本論は，看護研究にて関心が高まっている日本と英語圏諸国のスピリチュアリティの定義についての文献による比較検討である．1950年代から1970年代の英語圏諸国において，スピリチュアリティが宗教と同一視されていた背景には，聖職者によるパストラルケアの実践がある．1980年代から1990年代にかけての看護のパラダイムが，宗教的側面の強調から全人的な人間理解に係る概念へと変わった．日本への概念の導入はその後1990年代後半～2000年以降になる．明確な定義は見出されないものの，共通項目は次に示すとおりである．1）人間存在の根源性に関わり，全ての人間が本来持ち合わせている力．2）「自己」「他者」「超越的存在」との関連性において，人生の意味や目的を見出す力．3）危機的状況に直面した時に潜在化する．4）宗教的側面を含めるが，宗教と同一ではない．定義の必要性の一方，英語圏諸国においては，普遍的な定義を求めることに対する非現実性を示す見解も見られる．This paper aims to provide a comparative overview of definitions of spirituality in the nursing literature from Japan and three English-speaking countries (the United Kingdom, the United States and Canada). Much of the nursing literature selected in this paper includes research on definitions of spirituality suggested by individual researchers, review studies on definitions mentioned by previous researchers and researchers' opinions of spirituality. As indicated by one research paper, from the 1950s to the 1970s, spirituality in the target countries was regarded as the same as religion under the influence of pastoral care offered by priests in medical settings. From the 1980s to the 1990s, the paradigm in the nursing field shifted from the religious dimension to the holistic dimension of human beings. The concept of spirituality was introduced in Japan between the late 1990s and the early 2000s. The findings of our research indicate difficulties in conceptualizing spirituality in the nursing field because of its ambiguity and conceptual confusion. Despite the increased interest in spirituality, there has been little agreement over its definition. However, the traits common in definitions of spirituality as suggested by many researchers are as follows: 1) the innate power all individuals possess; 2) an essential, integrative energy which could drive us to search for the meaning or purpose of life in relationships with ‘self,'‘others,' and ‘transcendence;' 3) the potential power we find when people are faced with difficulties or crises; and 4) spirituality has been associated with religion but is not the same as religion. Many nursing researchers have stated it is necessary to define spirituality for better practice in the nursing field while others find it unnecessary to define spirituality due to its uniqueness to individuals.総

日本の児童文学における「死」の表象とスピリチュアリティ―スピリチュアルケアにおける絵本活用の可能性の一考察―

目的：日本の絵本において「死」及び「スピリチュアリティ」はどのように表現され，捉えられているかを分析し，スピリチュアルケアにおける絵本活用の可能性を考察する． 方法：Krippendorff, Kの内容分析の手法を用いて，1967年から2016年に発刊された「死」をテーマとした53冊の絵本における「死」及び「スピリチュアリティ」に関する記述について分析した． 結果：54作品はA「死者との共在感」B「超越的存在の探求」C「輪廻転生」D「死の教育的示唆」の四つに分類された．これらの死をテーマとした絵本の多くは，死は完全な消滅ではなく，亡くなった人との関係性の継続を強調しており，死に逝く人及び死別を経験した人が共に，安心した気持ちで死後の世界へ関心を向け，死を受け入れる一助となっている． 結論：このような絵本を，スピリチュアルケアにおいて活用することは，死に伴う悲しみや苦しみを緩和させ，肯定的に死と生を受け入れるよう促すという点で可能である．Objectives: The objective of this paper is to determine how death and spirituality are represented in death-themed Japanese picture books published between 1967 and 2016, and if these books are potentially utilized in spiritual care to support both children and adults who are faced with their own death or who are grieving loved ones. Methods: We investigated 53 picture books, which were gathered through an Internet search or from local libraries. Krippendorf’s content analysis method was used for the analysis. Results: Descriptive expressions about death and spirituality obtained from 53 picture books were divided into the following four categories showing ways the deceased are depicted: A) existence of being together, B) supernatural existence in another world (i.e., afterlife), C) existence of reincarnation, and D) educational suggestions about death. Data analysis of death-themed picture books showed that most of these books emphasize that death is not complete disappearance of the person and that there is a continued relationship between the deceased and the living. Moreover, such books potentially help both the dying and those grieving loved ones believe that the deceased exist in another world or are near to them even if they are not visible, thus providing relief. Conclusion: These findings indicate that death-themed picture books are possibly effective and powerful tools to help both children and adults alleviate their grief and think positively about life and death as part of spiritual care.報

Effect of Social Service Prenatal Care Utilization on Perinatal Outcomes among Women with Socioeconomic Problems in the Tokyo Metropolitan Area

Background. To investigate the effect of social service prenatal care (PNC) utilization on perinatal outcomes among women with socioeconomic problems in the Tokyo metropolitan area. Methods. Retrospective study. The study enrolled all women at our hospital who either attended PNC utilizing social services (attenders) or who did not attend PNC (nonattenders) between January 1, 2007, and December 31, 2010. We compared the maternal characteristics and perinatal outcome of attenders with those of nonattenders. Results. A total of 83 attenders and 45 nonattenders were enrolled. The mean gestational age at the first PNC visit was 31.1 weeks in the attenders. Attenders were found to have a lower incidence of preterm delivery, pregnancy-induced hypertension, emergency cesarean section, low birth weight, and the NICU admission than nonattenders (P < 0.05). Conclusions. The utilization of social service PNC greatly improved perinatal outcomes among women with socioeconomic problems problems in the Tokyo metropolitan area

近赤外線スベクトロスコピィを用いた小児期自閉スペクトラム症の前頭前野における血液動態反応の低下

Background: Functional neuroimaging studies suggest that prefrontal cortex dysfunction is present in people with autism spectrum disorder (ASD). Near-infrared spectroscopy is a noninvasive optical tool for examining oxygenation and hemodynamic changes in the cerebral cortex by measuring changes in oxygenated hemoglobin. Methods: Twelve drug-naïve male participants, aged 7-15 years and diagnosed with ASD according to DSM-5 criteria, and 12 age- and intelligence quotient (IQ)-matched healthy control males participated in the present study after giving informed consent. Relative concentrations of oxyhemoglobin were measured with frontal probes every 0.1 s during the Stroop color-word task, using 24-channel near-infrared spectroscopy. Results: Oxyhemoglobin changes during the Stroop color-word task in the ASD group were significantly smaller than those in the control group at channels 12 and 13, located over the dorsolateral prefrontal cortex (FDR-corrected P: 0.0021-0.0063). Conclusion: The results suggest that male children with ASD have reduced prefrontal hemodynamic responses, measured with near-infrared spectroscopy.博士（医学）・乙第1442号・令和元年12月5日© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated

脳血管疾患を発症し，緊急入院となった成人期患者の家族の体験―緊急入院時，一般病棟転棟時，急性期病院退院時の三時期に焦点をあてて―

目的：脳血管疾患を発症し，緊急入院となった成人期患者家族の体験を明らかにし，その特徴を踏まえた看護実践への示唆を得る． 方法：脳血管疾患を発症し，緊急入院となった成人期患者家族6名に研究同意を得て面接調査を行った．面接内容を対象者が述べた言葉のみでなく，観察された反応，表情，態度等のメッセージも文字化して，Krippendorff, Kの内容分析法を用いて分析した． 結果・考察：三時期の家族の体験を表す27のカテゴリを形成した．緊急入院時には【配偶者の生命の危機に対する衝撃】，一般病棟転棟時には【配偶者の病状変化に対する継続的懸念】，急性期病院退院時には【退院・転院に向けた心身の準備状態の確立の実感】など，三時期で特有の体験をしていた． 結論：家族の体験の特徴を踏まえ，緊急入院時は家族が過酷な状況を乗り越えられるような支援，一般病棟転棟時には感情の揺れに配慮した支援，急性期病院退院時には発達段階を考慮した具体的支援の必要性が示唆された．Purpose: To elucidate the experiences of family members of adults who were urgently hospitalized due to cerebrovascular disease and to obtain insights into nursing practice based on the characteristics of such experiences. Methods: An interview survey was conducted with six family members who agreed to participate in the research. The data were analyzed using Krippendorff’s method of content analysis. Not only words, but also the observed reactions, expressions and manners expressed by family members during the interviews were analyzed. Results: A total of 27 categories were generated for the following three periods: 1) when patients were urgently hospitalized, 2) when patients were transferred to a general ward, and 3) when patients were discharged after urgent hospitalization. The participants had experiences specific to each period, such as‘ feeling shocked and relieved by the spouse being alive’ upon urgent hospitalization,‘ expectations for recovery and worries for disease progression’ upon transfer to a general ward, and‘ being ready to provide support again’ upon discharge after urgent hospitalization. Conclusions: The characteristics of experiences faced by the participants suggest the necessity of the following support strategies: support for family members to overcome critical situations upon immediate hospitalization, support that considers emotional changes upon transfer to a general ward, and support specific to disease progression level upon discharge after immediate hospitalization.原

The Effect of a Blue Light Filtering Intraocular Lens on Macular Edema

This study sought to compare the effects of either a blue light-filtering intraocular lens (blue-filtering IOL) or an ultraviolet light-filtering intraocular lens (UV-filtering IOL) on the incidence of angiographic macular edema (ME) 3 and 12 months after implantation. A prospective randomized parallel clinical study was performed at Showa University Hospital. Forty-five cataract patients randomly received either a blue-filtering IOL (n = 21) or a UV-filtering IOL (n = 24), and macular leakage was evaluated by fluorescence angiography. At 3 months, ME was 24% in the blue- and 25% in the UV-filtering IOL group. At 12 months, ME was 5% in the blue- and 21% in the UV-filtering IOL group. The recovery rate in the blue-filtering IOL group was higher than in the UV-filtering IOL group at 12 months after surgery (P = 0.0457). These results suggested that an implanted blue-filtering IOL is more effective for recovery of ME than a UV-filtering IOL

Effects of Green Tea Fractions on Oxygen-Induced Retinal Neovascularization in the Neonatal Rat

This study aimed to investigate the preventive effects of green tea fractions (GTFs) on rat model of oxygen-induced retinopathy (OIR). Neonatal Sprague-Dawley rats were exposed to daily cycles of 80% oxygen (20.5 h), ambient air (0.5 h), and progressive return to 80% oxygen (3 h) until postnatal day 12 (P12), then the rats were placed in ambient air until P18. The green tea was fractionated by DM-A50, DM-W, M-B, and M-W. The rats were treated once daily from P6 to P17 by gastric gavage of GTFs (0.05 or 0.01 g/ml) or distilled water (DW) at 50 µl/10 g body weight. On P18, the rats were sacrificed and the retinal samples were collected. The retinal neovascularization (NV) was scored and avascular areas (AVAs) were measured as a % of total retinal area (%AVAs) in ADPase stained retinas. The NV scores in 0.01 g/ml M-W were significantly lower than those in DW. The %AVAs in 0.05 g/ml DM-A50 and in 0.05 g/ml and 0.01 g/ml M-W were significantly lower than those in DW. There were less catechins, and less caffeine in M-W fraction compared with other GTFs, suggesting components of green tea except for catechins and caffeine might suppress the neovascularization in rat model of OIR