二分脊椎症の学童の排尿セルフケアとその関連要因に関する研究

This study examined the action, recognition, feeling, and factors relating to urologic self-care for school children with spina bifida and discussed nursing implications for promoting urologic self-care. Thirteen children (from third to sixth grade) with spina bifida who performed clean intermittent catheterization (CIC) for urination management were selected for this study. The children and their parents were administrated questionnaires as well as semi-structured interviews. Factors that affected recognition and action of urologic self-care thus determining readiness for CIC were: intellectual development, the elaborate nature catheterization procedure, feeling the need to urinate and the stability of seating position. Urologic self-care behavior was found to be affected parental support and parenting attitudes. When parents believed their child was independent, children performed urologic self-care independently. If the child-parent relationship was closed, or a gap in perception of the CIC procedure existed between parents and children, children did not understand CIC appropriately and depended on others for the procedure. Interview and questionnaire data indicated a correlation between the action recognition and feeling of urologic self-care. Children who independently performed clean intermittent self- catheterization (CISC) reported matters that required attention and were necessary to the CIC procedure and tended to have positive feelings about urologic self-care. Children who depended on others for CIC had a low understanding of CIC, and had negative feelings about urologic self-care. These results suggest that in order to promote urologic self-care for school children with spina bifida, nurses must be aware of the correlation between the action, recognition and feeling of urologic self-care, which can be assessed holistically. It is important for nursing staff to consider the relationship between children and parents as well as the child's readiness for CIC.

本研究の目的は,二分脊椎症の学童の排尿セルフケアを,行動,認識,気もちの面から把握し,その関連要因を明らかにして看護援助の示唆を得ることであった。二分脊椎症の小学3から6年生で,排尿管理のために清潔間欠的導尿(CIC)を行っている13組の学童とその親を対象に,質問紙調査と半構成面接を実施した。排尿セルフケアの認識と行動には,「学習レディネス」の,知的発達,巧緻性,尿意の自覚,座位の安定性が影響を与えていた。「親からのサポート・育児方針」では,子どもの自立が育児方針に含まれる者は,学童自身が自分なりの排尿セルフケア行動をとる者が多く,親子関係が密着していたり親子間でニードにずれがある場合には,排尿セルフケアに対する理解が低く,実施を他者に依存している者が多かった。排尿セルフケアの行動,認識,気もちには相互関係がみられた。清潔間欠的自己導尿(CISC)を自分で実施している者は,CICの注意点や必要性を答えており,排尿セルフケアヘ肯定的な気もちをもつ傾向がみられた。CIC実施を他者に依存している者は,CICに対して理解が低く,排尿セルフケアに対して否定的な気もちをもつ傾向がみられた。二分脊椎症の学童の排尿セルフケアを促す看護援助の際には,排尿セルフケアの行動,認識,気もちの相互関係を意識し,多角的なアセスメントに基づき,学童の学習レディネスに合わせて,親子関係を考慮しながらサポートすることが大切である。

source:Journal of Chiba Academy of Nursing Science