Japanese

Title	自分を伝えないAYA世代終末期患者の残された「今」を支えた看護 - 語りあえない家族をゆさぶる -
Subtitle	事例研究
Authors	土本千春1), 野尻清香2), 柄澤清美3), 柳原清子4), 土山和美2), 白藤恵里子1), 海道智美2), 宇都宮啓子1)
Authors (kana)
Organization	1)金沢大学附属病院, 2)小松市民病院, 3)新潟青陵大学, 4)金沢大学
Journal	家族看護学研究
Volume	26
Number	2
Page	188-200
Year/Month	2021 /
Article	報告
Publisher	日本家族看護学会
Abstract	「要旨」 本研究は, 急性期病院から緩和ケアのある病院に転院となったAYA世代がん患者と家族に対して行われた看護実践を明らかにすることを目的とした事例研究である. 看護実践について2施設の看護師が対話を通して分析し, 実践を, 【関係性をじっくり育て, 今まさにある気持ちを知る】【本人主導を貫き, 自己表現を後押しする】【家族の潜在力を信じて家族をゆさぶり繋ぐ】の3つのカテゴリーと, 11のサブカテゴリーにまとめた. 寡黙な患者に対し《「気になる」「ひっかかる」情報を意識に留めつつ思いを探り続ける》, 《会話できる空気感を作り, 見えない気持ちを日常の中に問う》を行った. そして《「ちゃんと対応するよ」を表明しつつ, 暮らしの中の希望のかけらを拾い集める》, 《先取りしないよう観察と忖度を積み重ね「私が主役」を演出する》, 《生きている実感につながることを探し, したいようにできる舞台を用意する》を行い, 表出の少ない本人の意向を把握した. 家族間調整では《家族の空気温度から家族それぞれに在る思いと交流を見極める》, 《言えない, 聞けない間柄の親子の間に入りこむ》, 《役割を見失った両親に「まだある」と伝えてゆさぶる》で《親子の求めていた最期の時間が持てるよう両親の背中を押す》を行った. 全体として, 語り合えない患者と家族をゆさぶって, 最期に「家族のかたち」を形成した.
Practice	看護学
Keywords	AYA世代がん患者, 終末期, 意思決定, 家族間調整, Adolescent and Young Adult (AYA) cancer patients, Terminal Phase, Decision making, Coordinate between families

English

Title	Ongoing Liaison Between Nurses to Support Terminal-Phase AYA Patients (who cannot express themselves) in the "here and now" ; Jolting Family Members into Talking to Each Other
Subtitle
Authors	Chiharu Tsuchimoto1), Sayaka Nojiri2), Kiyomi Karasawa3), Kiyoko Yanagihara4), Kazumi Tsuchiyama2), Eriko Shirafuji1), Tomomi Kaidou2), Keiko Utsunomiya1)
Authors (kana)
Organization	1)Kanazawa University Hospital, 2)Komatsu Municipal Hospital, 3)Niigata Seiryo University, 4)Kanazawa University
Journal	Japanese Journal of Research in Family Nursing
Volume	26
Number	2
Page	188-200
Year/Month	2021 /
Article	Report
Publisher	Japanese Association for Research in Family Nursing, JARFN
Abstract	This is a nursing case study of adolescent and young adult (AYA) cancer patients and their families who were transferred from an acute care hospital to a palliative care hospital. The purpose is to understand what is going on in the minds of the taciturn patients and clarify the approaches of nursing by coordinating between families. The analysis was conducted through a dialogue between the nurses of two facilities during actual nursing practice. Effective practice was organized into three categories: insisting that "now is the time to know" at a suitable time; making the patient's sense of self into a reliable, quiet one; and jolting his/her family into thinking "we can do this" (from "we want to do this"). These were further organized into 11 sub-categories. The details were as follows: For a patient who was silent, expressing worry that the days are slipping by and that they want to get to know them; capturing their feelings without overlooking their sense of worry or fear; and creating a conversational atmosphere to be able to ask them about their innermost thoughts. Then, while stressing that they would always be available to respond properly, they noted the patient's everyday hopes; created a platform where the patient could aim for a chance to be independent and do as they wished; and supported their initiatives by accumulating observations and conjectures so as not to preempt them. In order to coordinate between families, the following were conducted: Determining ideas and exchanges of each family member within the family atmosphere; intervening between parents and children who cannot communicate with each other; expressing to parents who feel powerless that they still a have a role; and creating a sense of "family" and being together. Nurses at the two facilities sensed a common feeling of discomfort felt by patient and family and harbored a desire to elicit their wishes and make them happen. We worked with patients and their families and were finally able to create a "family-like" situation.
Practice	Nursing
Keywords	Adolescent and Young Adult (AYA) cancer patients, Terminal Phase, Decision making, Coordinate between families

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