日本看護研究学会雑誌

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Factor that complicate or aid substitute voice acquisition in older laryngectomee were investigated. 170 patients from a group of patients who underwent laryngectomy during the last three years in Tokyo served as subjects. The following items were analyzed: age, type of surgery, therapy (outpatient), participation in esophageal speech class, substitute voice acquisition, general health, restricted daily living activity, assistance from patients group, and self-esteem.
Approximately 30% of the patients acquired a substitute voice and were able to use it in their social life, and more than 60% of patients over 70 years-old quit attending classes. These patients experienced difficulty in communicating with their family members. Furthermore, the health of patients over 65 years-old who quit attending classes was poor. The sense of restricted daily living activity was especially high for quit attending classes due to factors such as, limited range of movement and stress from eating. It was thought that these are the factors that determine whether or not older patients attend voice classes.
Results of the present study suggest that it would be necessary to provide a voice rehabilitation program that is based on assessment by a medical team soon after surgery to minimize risks for each patients, and to establish an assistance system in which both medical professionals and patients group work together.

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　本調査では，107症例の摂食障害の患者に対して臨床の看護者が挙げた看護問題を構造的に分析することによって，看護者が何を看護問題と考え，どのような方向性で援助を行っていこうとしているかを検討した。
　その結果，患者と接していく中で，看護者は多くの情報を追加・修正しながらアセスメントを進め，より広範で多岐にわたる問題を看護問題として認識していくことが明らかとなった。
　しかし，看護者の挙げた看護問題の中には，患者の問題というよりは医療者側の治療や管理上の問題が多く含まれており，看護問題の位置づけや方向性に関していくつかの問題点が指摘された。
　また，看護者の挙げた看護問題をみる限り，ボティ・イメージやセルフ・エスティームなどの「自己概念」に関するアセスメントが不足しており，医師との共同の在り方も含めて，要検討課題であると思われた。

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