Clinical evaluation of the self-monitoring method as nursing support to improve habitual scratching behavior in patients on with adult atopic dermatitis

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  • セルフモニタリング法を使用した成人型アトピー性皮膚炎患者の掻破行動に関する研究
  • セルフ モニタリングホウ オ シヨウ シタ セイジンガタ アトピーセイ ヒフエン カンジャ ノ ソウハコウドウ ニ カンスル ケンキュウ

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成人型アトピー性皮膚炎(以下成人型AD)患者にはかさ〓痒の伴わない嗜癖的掻破行動の存在が指摘され,この皮膚症状は掻破行動によって悪化するためその是正が必要である.そこで成人型AD患者の掻破行動に対し看護援助としてセルフモニタリング法を用いた介入を行ない,その有効性を検討した.2003年6月から9月に外来通院した成人型AD患者52名を,介入群21名,非介入群31名の2群に割り付け,脱落例を除いた9名を介入群,21名が非介入群とした.介入群はセルフモニタリング法(4週間の掻破行動日記(以下日記)の記載反び面接を行なった.非介入群へは面接と4週間後診察を行なった.属性,皮膚症状スコア,無意識の掻破行動の有無,QOLスコア,1日平均軟膏使用量を調査した.介入群9名(男3名,女6名)の平均年齢は27.4±5.45歳,AD発症年齢は11.5±6.96歳であった.非介入群21名(男15名,女6名)の平均年齢は24.7±6.3歳,AD発症年齢は11.6±7.74歳であった.皮膚症状スコアは,介入群における「各部位の合計」,「体幹」,「上肢」が介入初回に比べ4週間後に有意に改善した(p<0.05).1日平均掻破行動では,前半に21.5回,後半では16.8回であり有意差はなかった.1日平均軟膏使用量は,両群ともに介入前半,介入後半で変化はなかった.無意識の掻破行動の有無については,両群ともに介入前半,介入後半で変化はなかった. QOLスコアでは,介入群において「QOL合計」,「皮膚症状の満足」,「生活への支障」が有意に改善した(p<0.05).成人型AD患者の掻破行動に対してセルフモニタリング法を行なった結果,皮膚症状の改善, QOLの向上を認めた.セルフモニタリング法は専門的な面接技法は必要としないが,看護師が主体となり患者の行動変容を促すために適した手法であると示唆された.

It is suggested that patients the with adult atopic dermatitis (ADD) shows habitual scratching behavior even when they do not feel itching. Since scratching behavior aggravates skin symptoms, its cessation is necessary. Therefore, we perfiormed intervention by the self-monitoring method (SMM) and evaluated its effects on the habitual scratching behavior of ADD patients. In this study, between the intervention group (finally 9 patients) required to write a scratching behaviors dairy for weeks and received weekly nurse's interview, and the non-intervention group (finally 21 patients) only received an interview at the start time of this study, patients profile, skin symptom score, unconscious scratching behavior, QOL score, and the mean amount of ointment use per day compared. The 9 patients in the intervention group consisted of 3 males and 6 females aged 27.4 ± 5.45 years (mean). The mean age at the onset of AD was 11.5 ± 6.96 years. The 21 patients in the non-intervention group consisted of 15 males and 6 females aged 24.7 ± 6.3 years (mean). The mean age at the onset of AD was 11.6 ± 7.74 years. In the intervention group, the skin symptom scores for total in all areas, trunk, and upper limbs significantly improved (p < 0.05) after 4 weeks of intervention compared with the first intervention. The frequency of scratching behavior/day did not differ between the former half (21.5 times) and latter half (16.8 times) periods of intervention. The amount of ointment use/day did not differ between the former and latter half periods of intervention in either group. The presence or absence of unconscious scratching behavior did not differ between the former and latter half periods in either group. In the intervention group, the QOL scores for total QOL, satisfaction with skin symptoms, and disturbances in daily living significantly improvedTaking together the fact that SMM could carry out without expert interview skills, it is strongly that SMM is introduced more frequently and actively into the field nursing to promote the patient's behavioral changes.


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