産褥期（入院中）の褥婦の排便困難の実態調査

本研究では，正期産で経膣分娩をした褥婦の妊娠末期の排便状態と，産褥期（入院期間）における排便状態を評価し，産褥期における妊産婦の排便困難の実態を明らかにすることを目的とした．排便状態を把握する指標として，日本語版便秘評価尺度（Constipation Assessment Scale：以下CAS）と研究者が作成した質問紙を用い調査した．質問紙は自記式で留め置き法にて回収した．研究に同意が得られた対象者は１３８名（初産婦９７名，経産婦４１名）で，平均年齢は２８．５（SD＝４．９）歳であった． 分娩後の平均初回排便日は２．６（SD＝１．１）日で，産褥期の平均CAS得点は２．３～３．２（SD＝２．４～２．９）点であった．産褥１日目から５日目までの間でCAS得点５点以上の便秘の割合は，産褥３日目が２９．４％，また下剤を服用した時期も１９．１％と最も多かった．産褥期において，３日以上連続して下剤を服用した褥婦は９名いた． 本研究は，産褥期の排便困難の実態を，数値を用いて初めて明らかにした．産褥３日目に便秘の割合が多く，下剤の服用者も多かったことより，産褥早期から自然排便を促す援助の必要があると考える．The aim of this research is an actual condition survey on the difficulty in defecating for pregnant women during the puerperal period. The Japanese version of Constipation Assessment Scale（referred to as CAS）as an indicator and a questionnaire prepared by the researchers were used. The number of the subjects giving their consent for the survey was １３８ （９７ of them were pregnant for the first time and ４１ were parous）. The average days until the first defecation after delivery were ２．６ days （SD＝１．１）. The average CAS points during the puerperal period were between ２．３ （SD＝２．４） and ３．２ （SD＝２．９）. The ratio of developing constipation with ５ or more CAS points reached its highest percentage of ２９．４on the third day of the puerperal period. The ratio of laxative use reached its highest percentage of １９．１ on the third day as well. For the first time, this research has clarified actual conditions of the difficulty in defecating during a puerperal period with the use of numerical values. Natural defecation aid at an early stage of the puerperal period is considered necessary

Illness Experience: Living with Arrhythmia and Implantable Cardioverter Defibrillator

Purpose: To describe the illness experience of patients living with arrhythmia and implantable cardioverter defibrillator (ICD) and evaluate their experience after implantation of the device for gaining insight on care suitable for their condition.Methods: In this qualitative descriptive study, we conducted semi-structured interviews of 22 outpatients who were visiting certified implant facilities.Results: Three categories and seven subcategories emerged from the interviews. The ICD patients were (1) Bewilderment Stemming from Arrhythmia and ICD Implant, (2) Facing the Reality of Arrhythmia, the ICD and Being Able To Continue Life, and (3) Giving Meaning to Living With Arrhythmia and an ICD. The ICD patients first experience bewilderment in the form of [Uncertainty about One’s Own Bodies], [Fear of Arrhythmia Ending My Life], and [Dissatisfaction with Unforeseen Results of the ICD]. After discharge from the hospital following ICD implantation, they slowly resumed their own lifestyles and [Facing the Reality of the ICD and Being Able to Continue Life] and [Confirming and Managing Lifestyle Activities]. As they recognized, objectified, and faced changes in their lifestyles, they began to practically see themselves as living with arrhythmia which required ICD-aided treatment, [Giving Meaning to One’s Illness] and [Recognition of One’s Disease]. And so, they reknit their lives integrated with arrhythmia and an ICD. We expressed these results in a schematic model as “Learning to Live with Arrhythmia and the ICD”.Conclusion: These results can be used to provide a perspective for assessing care to help patients adapt to life after ICD implantation

Time-Dependent Changes in Psychosocial Distress in Japanese Patients with Implantable Cardioverter Defibrillators

This prospective study clarified changes in the mood states of Japanese patients with implantable cardioverter defibrillators as well as factors related to the mood states. Using a longitudinal repeated-measure design, 29 patients with implantable cardioverter defibrillators completed the Profile of Mood States-Short Form Japanese Version questionnaire before discharge and 1, 4, 7, and 13 months after implantation. One month after discharge, the mood states of the patients with implantable cardioverter defibrillators improved. From 7 to 13 months after discharge, moods deteriorated; 13 months after discharge, moods were equivalent to those at the time of discharge. No relationship with defibrillation experience was detected in this study, but employment, age, sex, and lack of experience of syncopal attack were factors related to poor mood states for patients with implantable cardioverter defibrillators. Therefore, Japanese patients with implantable cardioverter defibrillators with any factor deteriorating their mood state should be monitored so that their mood state does not deteriorate again between six months and one year after implantation

タイ語の使役表現 ―hay, thamhayを中心に―

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