Spirituality of a Postgraduate Student With Cancer

大学院に入学したが,まもなく大腸ガンと診断され手術,闘病生活に入った院生がいた｡単身で在宅療養の後,家族による介護を受けた｡ADLが低下して,日常生活が思うように送れないとき,ガンを患うことの苦悩と生活の質(QOL)の低下,院生としての信念の間で悩んだ｡友人にメールや電話で語りかけることで,自分のスピリチュアリティを表現していた｡社会と関わることで,自分の存在を確認し,大学に復帰する希望を持ち続けることができたと思える｡彼女がスピリチュアリティを高く保つことができたのは,家族の支援と友人や保健医療関係者との交流が関係していた｡A postgraduate student who had been diagnosed with large bowel cancer underwent a surgery and spent her days under medical treatment soon after she had entered a postgraduate school. She took care of herself at home for her recovery for a while, but after that she got family nursing care. Deteriorating activities of daily living due to suffering from cancer caused deterioration of quality of life, so she worried about her declining confidence as a graduate student. Then she tried to express her spirituality to friends by talking with them using e-mails and telephone. It was considered that she could keep on having a hope to return to school because she always tried to come in contact with society to realize her situation. Family support and communication with medical staff as well as with friends seemed to have helped encouraging her spirituality during the days of her fighting against disease

The learning of nursing students through on site gerontological nursing practice -The difference in the learning of nursing students between a geriatic hospital and a home for the aged-

当医療技術短期大学部（以下医療短大と略す）の老人看護学実習は，特別養護老人ホーム（以下老人ホームと略す）と老人病棟のどちらかの施設で2週間の実習を行っている。今回は老人看護学実習での学生の学びの内容を把握する目的で，平成10年度のカンファレンスノートの記録を分析した。対象者は医療短大3年生75名のうちカンファレンスの記録が残っていた47名を分析の対象にした。内容分析の手法を用いて研究者2人で分析を行った。その結果，3つのカテゴリー，8つのサブカテゴリーに分類され，以下の2点が示唆 された。①実習の1週目では学生は，実習形態の違いやコミュニケーションがとれないことに戸惑っているが，2週目には日常生活の援助を通して相手を理解しようと努力していた。②老人病棟では治療の必要な患者のケアを通して高齢者の特徴を学び，老人ホームでは，生活の援助を通して個別性の大切さを学んでいた。以上の結果から，2週間の老人看護学実習を通して学生は，高齢者への理解を深めていることが明らかになった。今後は学生の学びと実習目標との関連についても検討が必要である。The purpose of this study was to examine what nursing students had learned through on site gerontological nursing practice for 2 weeks. The data were collected from conference records written by 47 students. And the contents of conference recoeds were analyzed by means of content analysis. The conference records were divided into 3 categories and 8 subcategories. The following results were obtained. ①During the first week, almost all students felt lost concerning the elderly, but　during the next week, students strived to understand them better. ②In the geriatic hospital, the students learned characteristics of the aged by taking care of them. In the home for the aged, the students learned the importance of individual care by helping them. We need to take into more consideration, the relation between what the students learned and the goals of the nursing practice

The grief process of patient's family over the death at hospital against the cancer

近年,在宅で死を迎えたいという人が増えている｡本研究の目的は,終末期を在宅で迎えようとしていた癌患者が,病状の悪化により病院死となった場合の事例を対象に,家族の悲嘆反応の変化を把握し,家族に対しどのような援助が必要なのかを明らかにすることである｡インタビューを患者の夫と娘に行い,A. Deekenによる12の悲嘆のプロセスの概念を基に分析を行った｡その結果,夫はA. Deekenの概念のうち7段階に該当しており,娘は5段階に該当していた｡悲嘆反応に影響を与えた要因としては,急な病変の経験,家族間の協力や仕事,告知に関する心残りがあげられた｡在宅療養継続か入院かを見極めること,キーパーソンをみつけること,家族の仕事をアセスメントすること,家族が告知をどう捉えているかを把握し尊重することなどが,必要な援助であることが示唆された。The aim of this study was to clarify the grief process of patient's family and to know how to support the family when the cancer patient who had been given terminal home care, was forced to die at hospital against the patient's will owing to aggravated condition. We interviewed patient's husband and daughter to analyze the family grief process on the basis of A. Deeken's grief process. The results showed that husband's grade was the 7th and daughter's was the 5th. The factor that caused the grief of the patient's family are listed as follows: the experience of rapidly changing circumstances surrounding them and family's regretting feeling concerning the notification of the cancer

Analysis of Problems in Family Nursing at Intensive Care Unit of O University Hospital

O大学病院のICUにおける家族看護のあり方を検討するため,過去の記録から入室患者の特性と家族の状況を把握し,課題を明らかにした｡128例の看護記録を資料に,患者の入室理由,入室期間,転帰の状況を分類し,入室期間別の家族の言動等から,家族看護の必要性について検討した｡また,家族に対する看護実践を,家族に関する情報の記載の有無から評価した｡その結果,ICU入室患者の9%が死亡退院で,そのうち受け持ち看護師の決まっていない入室後3日以内に死を迎えた患者の家族へのフォローが充分に行えていなかったこと,また,14日以上の長期入室患者の家族には,全事例に家族に関する情報が 記載されており,看護師が家族の気持ちや疲労感,患者への回想などの語りを捉えていたことが明らかとなった｡今後は,短期間で死亡の転帰となった家族へのグリーフケアや,長期入室患者の家族に対する継続看護の評価が必要である。To study family cares at an intensive care unit (ICU) in O University Hospital, we clarified problems existing in the family cares by grasping patients' character and their family conditions in reference to patients' past records. On the basis of the nursing records of 128 patients, the patients were classified according to reasons for their stay in ICU, their staying period, and how they had left ICU to examine the necessity for family cares mainly from the point how families' sentiment and behaviors differed depending on patients' staying period in ICU. Nursing practice for family cares was evaluated in consideration of whether information about patients' families had been recorded or not. As a result, nine percents of the patients studied had left ICU by death and in case patients died within 3 days in ICU, no nurses in charge of them had been assigned to or no sufficient follow-up cares had been given to their families, while families' information of all the patients staying in ICU for more than 14 days was recorded, which indicated that nurses could share the information with patients' families to understand them. This research showed the importance not only of giving grief cares to the families who had lost their important person after a short stay in ICU, but also of evaluating continuous cares for families with patients in ICU for a long time, suggesting the need for some revision of the present care system to give mental as well as physical cares to both patients and their families regardless of staying period in ICU

Investigation about the use of mental illness patients at visiting nursing stations in O prefecture

精神疾患患者への訪問看護における問題を検討する基礎資料とするため,O県の訪問看護ステーションにおける精神疾患患者の利用状況と訪問看護師の利用者への社会資源導入経験の有無を明らかにすることを目的として調査を実施した｡調査は2003年9月に質問紙郵送法により実施した｡対象とした126施設のうち,回答の得られた64施設(回収率50.8%)の1か月間の利用者総数は2,471人であり,そのうち精神疾患患者は743人(30.1%)で,精神疾患のうち痴呆の占める割合は488人(65.7%)であった｡施設単位では精神疾患患者の利用は60施設(93.8%)にあり,疾患の内訳は痴呆が57施設,うつ病が28施設,統合失調症が17施設等であった｡また,訪問看護ステーション開設時からの精神疾患患者への社会資源の導入経験は約半数の34施設(53.1%)にあった｡少数の訪問看護師からは,精神疾患患者への対応の困難さを感じていること,精神科看護に関する情報を求めていることなどの意見があった｡訪問看護における精神科看護のニーズは今後も高まることが予測され,専門的技術の向上や地域における専門施設との連携が求められる｡The family which has a mental illness member is apt to worry about social appearance because of the stigma of the illness. Therefore. it is often difficult to introduce a. social resource to such families. The purpose of this study is to clarify the status of usage of illness patients at visiting nursing stations. and find the problems of family care with such patients. The visiting nurses were surveyed about their experience that introducing social resources to families. Questionnaire survey were administered on the 126 visiting nursing stations of O prefecture, that had an experience to introduce social resources to such families. The valid answers from 64 visiting nursing stations (50.8% of surveyed) were obtained. As a result, 93.8% of visiting nursing stations were utilized by mental illness. The illnesses of patients were dementia, depression and schizophrenia, and had been accepted at 57, 28, and 17 facilities respectively. More than half of facilities had introduced social resources to mental illness patients at first of the service beginning. But some of them feel troublesome to care mental illness patient, and seek for information about psychiatric nursing

Research on satisfaction of elderlies with dementia in health care facilities.

2つの老人保健施設に入所している痴呆老人について,観察者による彼らの満足度とその時に観察された行動の関係を明らかにすることを目的とする｡調査対象者は,2つの老人保健施設に入所中で,本人または家族より調査への了系の得られた,歩行可能な痴呆老人各14名,合計28名である｡観察者は対象者の行動を48時間観察し,どこで誰と何を行っているかとその時の満足度を調査票に記録した｡満足度は対象者の表情や態度から観察者が判断し,大変満足を⑤とし,どちらとも言えないを③,大変不満足を①とした5段階評定で示した｡その結果以下の3点が明らかとなった｡ 1)両施設で満足度の高い時間帯は,レクリエーションが含まれる"午前中の時間"であった｡ 2)満足度が高いのは,居場所では,"レクリエーションルーム･屋外"であった｡ 3)同行者は,"家族","観察者",行動は,"話をする",手伝いをするなど"自発的な行為"が多くみられた｡以上により,2つの施設で満足度ごとの時間帯,居場所,同行者と行動が似通っていたことから,客観的に痴呆老人の満足度を把握することは可能であると考える｡The purpose of this study was to clarify if there is a relationship between the satisfaction of elderlies with dementia in health care facilities by subjective views of the investigator and their actions. The subjects of this investigation were 28 fully functional elderly clients with dementia who were living in 2 health care facilities. They or their family consented to take part in our research. 14 clients were chosen from each facilities. The investigators observed the clients for 48 hours and recorded where they were, with whom they were, what they did, as well as the client's level of satisfaction. The satisfaction levels were judged from the clients' appearances or attitudes by the investigations. There were five satisfaction including from 1 : unsatisfied to 5 : great satisfaction. The following three points were observed both in two facilities in common ; (1) the high satisfaction time period was "morning" when recreation was included. (2) the client received a high level of satisfaction when they were in the "recreation-room" or "outdoors", (3) the client received a high level of satisfaction whom they stayed with "their family" or "observers", when talking to someone or helping someone positively. Analysis of these results demonstrated there was similar pattern between the time of day and place and their companion or their actions among the subjects in two facilities. It can be assumed that it is able to observe elderlies with dementia satisfaction degree objectively

Strategies of community health activities to improve the quality of inhabitants' life

ヘルスプロモーションの理念にそって，住民組織，行政，研究グループが協働して，住民の生活の質の向上をめざした地域保健活動の展開を計画した。まず，休眠状態にあった岡山県M町の健康づくり推進協議会（以下M町協議会と略す）を活性化するため，協議会の委員18人を対象に聴き取り調査を行い，次に，M町協議会でのディスカッションを深めた。1．M町協議会構成団体のうち住民組織は9組織で，このうち6組織は居住地域内の住民の推薦や輪番で代表を選出しており，他の3組織は任意であった。8組織の事務局は行政機関内にあり，活動経費の公費補助率は70％以上であった。2．委員の描く理想の町のイメージとして，福祉の充実した町で老後も安心できるという内容を含んだ回答が多かった。それを実現する為に，住民一人一人が自己管理意識を持つと同時に，協議会が支援的な活動を身近なところで展開することの必要性が挙げられた。3．M町協議会活動への委員の期待は大きく，協議会内での委員間の意思疎通も次第に深められた。事前に聴き取り調査を行ったこと等が効果的に影響したと考えられた。Along with the idea of health promotion, we planned the community health activities to improve the quality of inhabitants' life in cooperation with inhabitants, community organizations, local government and health professionals. In order to revitalize an inactive committee for health promotion of M town hearing surveys were conducted on the members of the committee. 1. Leaders of community organizations occupied 9 of 19 members of the committee. Leaders of 6 organizations out of 9 ones were decided by recommendation or rotation. Eight secretariats of those organizations were located in the governmental office. Seventy percent or more of activity costs of these organizations depends on assistance of local government. 2. Members of the committee imaged the town, which was healthy and filled with mind of welfare as an ideal town. They pointed out that it was required for the committee to perform support activities to realize an ideal town as well as for every inhabitant to have the consciousness of self-management. 3. Activities of the committee were much expected by members of the committee. Communications between members deepened gradually by repeating the meetings. Hearing survey on members also seemed to be much effective for those progress

Support team and its effects on house remodeling for aged and handicapped persons

地域で生活する高齢者･障害者にとって,住宅環境の整備は必須の要件である｡津山市では在宅生活を支援する立場にある保健婦やホームヘルパー,作業療法士等保健･福祉関係者と,建築関係者が共同で支援チームをつくり住宅改造に関わってきた｡本研究では,この支援チームが関わった事例と直接関わらないで当事者と業者のみで改造を実施した事例を比較し,支援チームが関わることの効果をみた｡調査方法は,各事例の家庭を訪問して面接聞き取り調査を行った｡調査内容は調査票を用いて改造箇所,生活空間,介護量,外出の状況について尋ねた｡改造前後の変化を比較して,支援チームの効果について以下のことが明らかになった｡ 1.支援チームの関与による浴室の改造は,入浴が可能となり生活空間が広がるなど改善が認められた｡ 2.離床を目的にした玄関･廊下･居室の改造は,外出などの日常生活行動を広げ,本人のQOLを高めることに役立つ｡以上より住宅の改造が,介護者の介護負担を必ずしも直接軽減するとは限らないが,高齢者･障害者の介護の質に変化を与えることが示唆された。The maintenance and improvement of housing environments are essential for aged and handicapped persons living in a local communities. The support team consists of public health nurses, home helpers, occupational therapists and architects took part in giving an advices for house remodeling in Tsuyama City. We compared the effectiveness of the participation of the team before and after remodeling of housing environment. An interview was conducted at each cases for places of remodeling, living spaces, quantity of care and ease of going. The results are as follows ; 1. The remodeling of bathrooms, participating support team improved the living spaces to be able to take bath. 2. The remodeling of entrances and corridors for leaving beds, improved the living space and the QOL of care recipients. The results suggest that the remodeling of houses dose not always lighten care burdens for caring, but changes the quality of care for aged and handicapped persons

Public transportation and the disabled person

機能訓練事業として実施している「生活リハビリ教室」の教室生208名を対象に，公共交通機関を利用して外出するために障害になっている要因を明らかにする目的で，郵送法による自記式アンケート調査を行った。回答は125名（60.1％）からあった。外出経験がある者は67名（53.6％）で外出経験がない者が58名であった。外出時に付添いが必要と思っている者は，外出経験のない者に多かった。公共交通機関を利用しての外出を阻害している要因には，乗り物の昇降口に段差があることや早く発車して危険である，また周囲の人に介助を依頼しにくいことなどが挙げられている。身体機能障害者が外出できない理由は個人によって異なってはいるが，地域社会に身体機能障害者を受け入れる環境を整えていく必要がある。A survey was distributed by mail to disabled people who received functional training in 1997. Of 208 questionnaires sent, 125 (60.1%) were returned. Sixty-seven (53.6%) of the respondents had experience traveled outside. People who participate in functional trainning for disability hope to have an attendant to accompany them when traveling. One primary factor that hinders traveling outside and using public transportation is that they cannot ask for help because of shyness. Another factor is the construction of entrances (e.g.,bumps) for vehicles which cannot be traversed easily. Reasons differed among those who had traveled outside and those who had not. It is necessary to prepare an environment (e.g., public transportationto) for ease of use for disabled persons in regional communities