重度の障害をもつ乳幼児の睡眠-覚醒パターンのアセスメントと客観的データを用いた援助の有用性

本研究の目的は,重度の障害をもつ乳幼児の睡眠-覚醒パターンをアセスメントする枠組みと子どもの特性に応じた家族によるケアを可能にする看護援助を明らかにし,有用性を検討することである。縦断的デザイン,シングルケースによる援助研究であり,睡眠-覚醒パターンに問題のある在宅中の重度の障害をもつ乳幼児とその家族3例を対象とした。生活日誌,夜間睡眠時ビデオ撮影,必要時夜間酸素飽和度測定,家族の認識を尋ねる半構造化面接からデータを収集した。看護援助は,開発した枠組みにそって睡眠-覚醒パターンを評価したのち,客観的データから睡眠を妨げる要因を説明できる部分を抽出,これを用いて個々の子どもの特性の気づきと理解を促す目的で看護援助を実施した。評価と援助は数回繰り返し,睡眠-覚醒パターンの変化および家族の認識や行動の変化を検討した。全例で子どもの睡眠-覚醒パターンが改善した。中枢神経に起因する症状が基盤にあり,症状による苦痛や不快が高まり,睡眠が妨げられることが特徴であった。家族にこのような要因の認識はなく,睡眠-覚醒パターンの評価に基づいた客観的データを用いた援助は病態理解に直結した効果をもたらした。この結果,症状や苦痛への気づきが増し,疾患による症状と子どもの要求やサインの区別を可能にした。これにより,家族による適切なケアや対応につながったと考えられ,アセスメントおよび援助の有用性が示唆された。

The purpose of this study was to evaluate the usability of an innovative nursing intervention incorporating objective data from sleep-wake behavior assessment in order to improve family members' daily care for infants with severe disability. Using longitudinal and single case experimental designs, we analyzed 3 infants with severe disability and sleep problems in their homes. Data were collected from video recordings, oxygen saturation recordings, sleep diaries, andsemi-structured interviews with family members. Nursing intervention focusing on improving family members' dailycare was provided acording to the following three steps. First, individual sleep problems were assessed using an original sleep-wake behavior assessment tool. Second, characteristic components were extracted from objective data. Finally, nursing intervention sessions explaining the appropriate care for the child's sleep problems using the individual characteristic components were conducted by an Advanced Practice Nurse who was the researcher. Additional assessment and intervention sessions were conducted during the subsequent 6-month period and individual target behaviors were measured longitudinally. As a result of the intervention, all children improved their sleep-wake behavior. Each child had symptoms of central nervous system impairment that disturbed their sleep due to symptom intensification. However, the family members did not realize the actual cause of the sleep problems; therefore, the intervention was important because it gave the family members a deep understanding of the children's needs. We conclude that promoting family awareness of the child's symptoms and distress allowed the family to provide appropriate care for the child. These results demonstrate the usability of this nursing intervention that incorporates objective data from an original sleep-wake behavior assessment.

source:Journal of Chiba Academy of Nursing Science