DEVELOPMENT OF NURSING CARE MODEL FOR DRUG DEPENDENT PATIENTS

在本研究的第一阶段，我们通过对药物依赖患者专用词的实地考察和对5个机构负责药物依赖患者护理的16名护士的访谈，根据日本的临床情况，制定了一套初步的药物依赖患者护理模式，该模式包括按具体3个阶段(戒断阶段、渴求阶段、维持阶段)进行护理的内容和护士对药物依赖患者的护理感受。在研究的第二阶段，我们在本研究第一阶段给出的初步护理模式的基础上编制了一份原始问卷，并对430名护士对药物依赖者的护理行为进行了调查，统计分析结果显示：在关心药物依赖患者的内容上，确定了以下5个因素：(1)尊重患者自身，(2)处理麻烦，(3)与同理心有关，(4)有一致性关系，(5)康复支持。护士对药物依赖患者的护理困扰，确定了以下4个因素。(1)患者的反社会行为，(2)药物依赖患者的护理困难，(3)患者的症状和社会背景，(4)护理系统的问题。“患者的症状和社会环境”与“努力照顾的程度”之间存在显著的关系。护士的职业生活价值总分与护理尝试程度之间存在较强的相关性。根据护士对药物依赖患者的护理感受，发现护士对药物依赖患者的“愤怒”、“负罪感”和“同理心”，综合这些结果，构建了药物依赖患者的护理模式。这些结果表明，无论是本科生还是继续教育，都应重视药物依赖患者的护理特殊教育。

At the first stage of this study, through the field work in the special word for drug dependent patients and interviewing 16 nurses in charge of caring for drug dependent patients from 5 facilities, we developed a tentative nursing model for drug dependent patients based on the clinical situation in Japan, which is consisted of contents of caring according to the specific 3 stages (withdrawal stage, craving stage, maintenance stage) and nurse's feeling on caring for drug dependent patients.At the second stage of the study, we developed an original questionnaire being based on the tentative nursing model given in the first stage of this study, and investigated 430 nurses about their nursing practice for drug dependent patients.As results of statistical analysis, the following matters were revealed.1. As contents of caring for drug dependent patients, the following 5 factors were identified.(1) Respecting patient's own self, (2) dealing with troubles, (3) having relation with empathy, (4) having consistent relation, (5) rehabilitation support.2. As nurses' troubles on caring for drug dependent patients, the following 4 factors were identified. (1) anti-social action of patients, (2) difficulties particular to the nursing of drug dependent patients, (3) patient's symptoms and social context, (4) the problems of nursing system. A significant relationship was found between "patient's symptoms and social context" and "the degree of trying to care".3. A relatively strong correlation was found between the total score of "nurses' professional life worth living" and "the degree of trying to care".4. As the feeling of nurses on caring for drug dependent patients, "anger", "guilty feeling" and "empathy" were founded.Integrating these results, a nursing model for drug dependent patients was demonstrated. These results suggested the importance of special education of nursing for drug dependent patients in both of under graduate program and continuing education program.