Framework of subjective cognition in community-dwelling individuals with schizophrenia who experienced long-term hospitalization

フォーマット:

論文

責任表示:

Kawamura, Midori ; Kitaoka, Kazuyo ; 川村, みどり ; 北岡, 和代

言語:

英語

出版情報:

Wellness and Health Care Society — ウェルネス・ヘルスケア学会, 2018-08-01

著者名:

• Kawamura, Midori
• Kitaoka, Kazuyo
• 川村, みどり
• 北岡, 和代

掲載情報:

Journal of wellness and health care = Journal of wellness and health care

ISSN:

2434-1509      

巻:

42

通号:

1

開始ページ:

29

終了ページ:

40

バージョン:

publisher

概要:

This study was performed to elucidate the framework of subjective cognition about themselves and their life to date in individuals with schizophrenia who had experienced long-term hospitalization in a psychiatric hospital and were currently … living in the community to support the life of these individuals in the community. Semi-structured interviews (about ３0 minutes × ３ times per person) were conducted with eight individuals with schizophrenia living in the community for ≥ 1 year after having been hospitalized for ≥ ３ years in total (including one hospitalization period lasting ≥ 1 year). The KJ method, an affinity diagram developed by Kawakita that serves as a tool for organizing ideas and data, was used to divide interview data into 10 groups, or islands: “wanting to escape from the negative situation,” “being admitted to hospital = assurance of security,” and “turning to religion for salvation” indicating hospitalization as an uncontrollable situation with a strong sense of powerlessness, and “not being afraid of the past” and “fighting to avoid re-hospitalization,” showing that after hospital discharge, individuals with schizophrenia looked for a place where they could keep some distance from their past and exert some control over the present. While living in the community, they were secretly “yearning for marriage,” while “keeping an easygoing attitude about their position in society,” “trying to overcome the barriers between themselves and healthy individuals,” and “being encouraged by the realization of being ordinary,” suggesting that they longed for their own place in the community. Finally, “learning from agonizing events to change oneself” suggested that individuals with schizophrenia intend to change themselves through their various experiences during and after hospitalization. Taken together, these findings suggest that to provide adequate care to individuals with schizophrenia living in the community after long-term hospitalization, it is necessary to understand their views about community life, in addition to understanding their past medical history, especially prolonged hospitalization, which constitutes a large part of their outlook on life and the world. It is also important to conform to their pace because individuals with schizophrenia tend to have challenges with voluntary impulse control.<br />本研究は、統合失調症者の地域生活を支援するため、精神科病院で長期入院を経験し現在は地域で暮らす彼らの、今までの自分自身および生活に対する主観的認知の構造を明らかにすることを目的とした。通算 ３ 年以上（継続 1 年以上を含む）入院し、現在は 1年以上の地域生活を送る統合失調症者 8 名に約 ３0 分の半構造化面接を ３ 回ずつ行った。面接内容は、KJ 法により 10 のグループ「島」に統合された。入院とは【理不尽な状態から抜け出したい】【病院＝守られる安心】【信仰に救いを求めて】といった、コントロール不能で無力感の強い状態であった。退院後は【過去に怯えない【】再入院しない闘い】といった、過去と距離を取りつつ、コントロールできる立ち位置を模索していた。地域生活では【結婚生活への憧れ】を秘めつつ、【社会的なポジションにおいて無理しない】【健常者との壁を越えたい】【普通の実感を励みに】といった、自分に合った居場所を希求する意識がみられた。【苦悩からも学び、自分を変えていく】ことで、入院中・退院後のさまざまな体験の意味を考え、自己を変容する姿勢がみられた。長期入院後に地域で暮らす統合失調症者に適切なケアを提供するためには、本人の人生を構成する過去の長期入院を含め、地域生活に関する現在の本人の見解を理解する必要がある。そして、主体的なコントロール感覚の獲得は彼らの課題であるため、統合失調症者本人のペースに合わせることも大切である。 続きを見る

URL:

http://hdl.handle.net/2297/00051942