Family Caregiving in Japan: The Influence of Cultural Constructs in the Care of Adults with Cancer

Caring culture is a concept embodying the perceptions and caring practices of caregivers, acknowledging the unique role of cultural beliefs in shaping behavior. A qualitative descriptive study with 13 caregivers of adult family members with a cancer diagnosis in Japan was conducted to gain insight into perceptions and experiences surrounding caregiving. Several major categories were identified, representing rarely reported cultural constructs of high cultural value for the Japanese: On—repayment for what the patient has given, Caregiving as performing a socially expected role, Enryo/meiwaku—restraint in asking for help, Family decision making reflecting strong bonds, Omoiyari—empathizing with the patient’s feelings, and Inori—praying to myriad gods and ancestors. The Japanese cultural construct of ie (the strong relationship to family lineage and spiritual connection to past and future generations) is helpful in understanding these categories. Invisible yet powerful cultural constructs permeated caregiving practices. Insights from Japanese cultural concepts and beliefs may foster sensitivity and individualized care in diverse settings, cultures, and societies

Function of the Family Networks and its Problems with the Elderly Care in the Nearby Islands of Okinawa

平成13年度～平成15年度科学研究費補助金(基盤研究(C)(2))研究成果報告書研究概要：離島における介護をめぐる親族ネットワーク機能と課題を明らかにするすることを目的に、沖縄本島周辺の5離島において要介護高齢者の生活史や親族の介護支援状況等を調査し分析を行った。また火葬場のない島の葬法の現状と葬法に対する住民の関心や高齢者の入院状況を調査し、住み慣れた島での終末期ケアについて検討を加えた。調査対象と方法は、親族ネットワークに関し要介護高齢者72人及び介護者15人に半構造化面接調査を行い、また終末期ケアについては火葬場のない2離島の住民376人に質問紙調査を、さらに4病院に入院した離島の高齢者91人の入院状況調査等を行った。調査の結果、各島の介護サービスには差があり、福祉基盤が整備され豊富なサービス提供がある島と、介護が必要になると高齢者が本島に移動している島があった。介護をめぐる親族ネットワーク機能は、高齢者と親族や地域との人間関係、子供がUターンできる地場産業の発展、高齢者自身の積極的な地域への関わり等の要因が関連し8タイプに分類された。これらをさらに親族支援の多寡で3つ(親族支援が豊富、子供家族だけが支援、親族支援が乏しい)に類別し離島間比較を行うと、これらは行政のサービス整備と関連し親族支援が豊富な島はサービスも充実していた。また、火葬場がなく埋葬・洗骨の伝統的習俗を継続している島では、洗骨を避けたい住民の葬法に対する関心が、入院、入所、死亡、火葬の一連のパターンを辿らせていると推測され、火葬場の有無は高齢者の島での終末に影響を及ぼしていた。他方、高齢者自身の期待する終末は住み慣れた島であれ施設であれ、親族支援の多寡でなく親族に依存しない自立した終末をサービス提供機関に期待する傾向が認められた。以上の結果から、親族支援が乏しくサービス提供が少ない島の高齢者ケア向上のために、地域の支援体制づくりや施策化への支援が早急な課題であると示唆された。要約（欧文）:To find function of the family networks and its problems with the elderly care in small islands, we surveyed on the health care support for the elderly in 5 nearby islands of Okinawa, and analyzed the family networks, and its type and background in the elderly care, and the terminal care. In this research we had semi-structured interviews with 72 elderly who needed care and 15 caregivers, and cast a questionnaire on the funeral practices to 376 inhabitants in 2 islands with no crematorium, and also surveyed on the hospitalization and its related events for 91 elderly patients in 4 hospitals in Okinawa, the mainland. The type of the family networks was classified into 3 ; the abundant support from the family, the support from their sons or daughters, and the poor support from the family. The islands with the abundant support from the family had enough public services. In the islands where the people were succeeding in a traditional custom of interment and born washing as no crematorium was provided, it was suggested that the people took a series of hospitalization, death, and cremation because they wished avoid born washing. It showed that the presence of crematorium or no in the island gave a great effect to the elderly for their terminal in the island. Notwithstanding the abundant or poor family support, it was clear that the elderly wished to face their own terminal in the island where they used to live, with expecting the public care facilities for their terminal care. The result above showed that the community activation with the nursing professionals and the support in its administrative actualization seemed to be of urgent theme to improve the elderly care in the island with low family networks and poor services.未公開：P.13以降（別刷論文のため