精神科看護師が用いる統合失調症の「不穏」に関する概念検討

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URI http://shark.lib.kagawa-u.ac.jp/kuir/metadata/28393
Title
精神科看護師が用いる統合失調症の「不穏」に関する概念検討
Title Alternative
A Concept Analysis of Restlessness in Schizophrenia Patients Perceived by Psychiatric Nurses in Literature
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Description

〔総説〕

要旨
 精神科看護の臨床において,“不穏時の頓服” や“不穏時の危険行動への介入” など,「不穏」という専門用語は高頻度に用いられている.しかし,その示す範囲は看護師により差異がみられる現状がある.本研究ではRodgers BL.の概念分析法を参考として,精神科看護師が統合失調症の不穏をどのように捉えているのかを,質的に明らかにした.
 文献は,医学中央雑誌における1987年から2016年までの看護領域の原著論文で,「不穏」と「統合失調症」のキーワードで検索して収集した.このうち,不穏について具体的な記述を読み取ることができるもの,研究筆頭者が精神科看護師である31件を分析対象とした.不穏に関する記載箇所を抽出し,時間軸に沿って比較検討しながら分析した.
 分析の結果を,「先行要件」,「属性」,「帰結」について,臨床的に用い易いものとするため,それぞれ《サイン》,《症状》,《転帰》として記述した.
 《サイン》は,【生理的欲求の未充足】,【状況への不信,不満】,【妄想に支配された訴え】,【対応力の低下】,【看護師が察知する普段との違和感】,【身体的要因の増悪】の6 要素が抽出された.《症状》は,【幻覚・妄想の増悪】,【不意な行動化】,【興奮】,【自己への危害】,【他害行為】の5要素が抽出された.《転帰》は,【行動制限】,【内服薬調整】の2要素が抽出された.
 本研究における,精神科看護師が捉える統合失調症の不穏とは,生理的欲求の未充足,状況への不信や不満,妄想に支配された訴え,対応力の低下,看護師が察知する普段との違和感,身体的要因の増悪などを前兆として,幻覚・妄想の増悪,不意な行動化,興奮,自己への危害,他害行為に至り,行動制限や内服薬調整を必要とする状態と定義された.

キーワード:精神科看護,不穏,看護教育,概念検討

Summary
The term “restlessness” is used in contexts such as “conscription medicine for restlessness” or “intervention to relieve severe behavior under conditions of restlessness” in the clinical setting of psychiatric nursing. However, there are differences in the perception of “restlessness” among nurses even in the same situation.
The purpose of this study was to assess how psychiatric nurses perceive restlessness in schizophrenia patients based on the concept analysis method developed by Rodgers.
The original nursing articles published between 1987 and 2016 by the Japan Medical Abstracts Society were extracted with the following keywords: “restlessness” and “schizophrenia”. From the pool of articles, 31 with clear descriptions of restlessness that were written by psychiatric nurses were selected for the analysis. The descriptions of restlessness were extracted along time axes.
 ‘Antecedent’, ‘attribute’ and ‘consequence’ were paraphrased into the ‘sign’, the ‘symptom’ and the ‘outcome’ for easy use in the clinical setting. The ‘sign’ comprised the following six elements: ‘unsatisfied with the physiological appetite’, ‘distrustful of or dissatisfied with the current situation’, ‘behavior affected by delusions’, ‘limited coping ability’, ‘discomfort sensed by nurses’ and ‘change in the physical condition’. The ‘symptom’ comprised the following five elements: ‘exacerbation of hallucinations and delusions’, ‘unexpected behavior’, ‘psychomotor excitement’, ‘harming themselves’ and ‘harming others’. The ‘outcome’ comprised the following two elements: ‘activity restrictions or confinement in a protected room’ and ‘adjustment of oral medication’.
The concept of restlessness in schizophrenia patients as assessed by psychiatric nurses defined as “showing dissatisfaction with the physiological appetite, being distrustful of and dissatisfied with their situation, showing discomfort,
having their behavior affected by delusions, having a limited coping ability and showing a change in their physical condition, accompanied by the exacerbation of hallucination and delusions, unexpected behavior, excitement and harm to
themselves or others, ultimately requiring activity restrictions or confinement in a protected room and adjustment of oral medication.”

Keywords: psychiatric nursing, restlessness, nursing education, concept analysis

Author
著者 芦沢 直之
著者(ヨミ) アシザワ ナオユキ
著者(別表記) Ashizawa Naoyuki
著者 上野 知恵子
著者(ヨミ) ウエノ チエコ
著者(別表記) Ueno Chieko
著者 渡邉 久美
著者(ヨミ) ワタナベ クミ
著者(別表記) Watanabe Kumi
Publication Title
香川大学看護学雑誌
Publication Title Alternative
Nursing Journal of Kagawa University
Volume
22
Issue
1
Start Page
1
End Page
10
Publisher
香川大学医学部看護学科
Publisher Aalternative
School of Nursing, Faculty of Medicine
Published Date
2018-03-30
ISSN
2189-2970
NCID
AA12029628
Resource Type
Departmental Bulletin Paper
Language
jpn
Text Version
publisher
Set
香川大学
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