脳卒中患者の回復過程における主観的体験 : 急性期から回復期にかけて

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.