村上 礼子

Aims and objectives To understand the psychological aspects in patients undergoing post-operative wound care and to gain insights for improving nursing practice. Background Very few studies have examined education on or practice of wound care with a view towards the patient's psychology. Design Descriptive exploratory qualitative study. Methods Four patients who had undergone open surgery of the upper gastrointestinal tract were interviewed using a semi-structured format to gain an understanding of their feelings and opinions with regard to wound care. Interview transcripts were analysed using an inductive coding approach. Results Fifteen categories of responses were finally identified from the data. Patients wanted nursing staff to observe their wound more often so that patients could recognise improvement, to have better knowledge of the patient's disease and condition, to explain the patient's situation more completely and to appropriately answer questions. Patients also said that they felt more comfortable in posing questions or concerns regarding their condition to nursing staff than to their surgeons and did so while the wounds were being taken care of by nurses. Conclusions These findings suggested the importance of nursing staff to fully understand and to be ready to share feelings regarding a patient's postoperative condition and to have skills in properly explaining the importance of each procedure or steps in treatments that a patient must undergo. The present study also indicates that it is imperative for nursing staff to learn methods to build relationships with patients so that they can express their feelings of fear or anxiety freely to nurses. Relevance to clinical practice It is not possible to develop nursing practice without understanding psychological aspects of patients undergoing postoperative wound care.

本研究は,ペースメーカー埋め込み術後の日常生活への病棟看護師による看護支援の実施状況を明らかにし,今後の看護支援の課題の検討を目的とした。先行研究に基づいた質問紙により調査を実施し,看護支援の実施状況を分析した。その結果,大多数の看護師が何らかの方法で実施している看護支援があり,これらは術後の埋め込み患者に必須で,その認識も浸透していると考えられた。また,看護師によって実施にばらつきがある看護支援があり,この背景には,看護師の判断の思考プロセスにおいて「認識不足」あるいは「経済面や個人情報保護への配慮」などの要因が影響していると考えられた。退院後予測される困難を含め,看護師が患者および家族をアセスメントのうえ,具体的な看護支援を行えば,困難への遭遇の予防が可能性であると示唆された。今後の課題は,設問文の妥当性・信頼性について洗練し,そのうえで他施設でも調査することである。(著者抄録)

Aim: To clarify the effects on the cardiovascular system and autonomic nervous system of activities simulating washing of the lower limbs in subjects with different body types (underweight body mass index [BMI] < 18.5, normal weight BMI 18.524.9, overweight BMI = 25). Methods: Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), skin blood flow (BF), and HR variability were measured in 15 healthy adults while performing movements similar to washing the lower limbs. Changes in SBP, DBP, HR, BF, double product (DP), low-frequency values (LF), high-frequency values (HF) and the ratio between the powers of LF and HF (LF/HF) during activities performed from the supine position (?SBP, ?DBP, ?HR, ?BF, ?DP, ?LF, ?HF and ?LF/HF) were compared among subjects grouped according to body type. Results: ?HR and ?DP in the overweight group were significantly lower than in underweight and normal weight groups (?HR, underweight P < 0.05 and normal weight P < 0.05; ?DP, underweight P < 0.05 and normal weight P < 0.001). Moreover, ?DP in the underweight group was significantly lower than in the normal weight group (normal weight P < 0.05). ?BF and ?LF/HF in the normal weight group were significantly lower than in underweight and overweight groups (?BF, underweight P < 0.05 and overweight group P < 0.05; ?LF/HF, underweight P < 0.05 and overweight P < 0.01). ?HF in the overweight group was significantly lower than in the normal weight group (normal weight P < 0.05). Conclusion: The effect on the cardiovascular and autonomic nervous systems by movements simulating washing of the lower limbs differed according to body type.

本研究では，健康人な17名を対象に清拭時の体位変換と膝立て等の活動と上半身挙上角度の違いが循環機能に及ぼす影響について検討した。実験は，ベット頭側を無作為に０度，30度，45度，60度，90度に挙上して体位変換と膝立て等の活動を行った。活動前，中，後の循環機能の影響の測定は，血圧（収縮期および拡張期），心拍数，心拍変動解析指標（LF成分，HF成分，LF/HF比），心筋の酸素消費量を用いた。その結果，45度以上での体位変換と膝立て等の活動では，動的と静的運動の両方の影響が加わり心拍数や血圧の上昇につながること，60度以上では交感神経活動の亢進が生じることが明らかになった。さらに，上半身挙上角度の上昇に伴い体位変換等の活動での循環機能への負荷は増大することが推察された。