࣭࣭࢞࣠ࢺࠈ㧏㱃㏩ᯊᝀ⩽㸡㏩ᯊ┫㆜㸡⒢㣬ᣞᑙࠈ
Key Words elderly dialysis patients㸡dialysis nursing㸡medical-treatment instruction
抄 録
⫴ᬊࠈ㎾ᖳ㸡㏩ᯊ⒢ࡡ㐅Ṅ࡞ࡻࡾ⏍Ꮛᑋࡡ㛏࡛ᑙථࡡ㧏㱃࡞ࡻࡽ㸡㧏㱃㏩ᯊᝀ⩽ᖳࠍቌຊࡊ࡙࠷ࡾ㸣㏩ ᯊ⒢ࡡུᐖ࡞ࡢ㸡ヾ▩ᶭ⬗ᙫ㡢ࡌࡾࡆ࡛࠾ࡼ㸡ᖳ㱃㧏ࡂࡾ㏩ᯊ⒢ࡡུᐖࡢᝇ࠷ࡆ࡛ᣞᦤࡈࡿ࡙࠷ࡾ㸣 ࡊ࠾ࡊ㸡㧏㱃㏩ᯊᝀ⩽ࡡኣࡂࡢ㸡㏩ᯊ⒢ࢅఆࡳࡆ࡛ࡷᨲᲘࡌࡾࡆ࡛ࡂ⒢ࢅ⤽⤾ࡊ࡙࠽ࡽ㸡ࡐࡆ࡞ࡢ㏩ᯊࡡུᐖ ࡛ࡢ␏ࡾ⒢㣬⏍Ὡ࡞࠽ࡄࡾమ㥺ࡡណࡘࡄ࠵ࡾ࡛⩻࠻ࡼࡿࡾ㸣 ┘Ⓩࠈᮇ◂✪ࡢ㸡㧏㱃㏩ᯊᝀ⩽ࡡ⒢㣬⏍Ὡ࡞࠽ࡄࡾమ㥺ࡡណࡘࡄ࡞ࡗ࠷࡙᪺ࡼ࠾࡞ࡌࡾࡆ࡛ࢅ┘Ⓩ࡛ࡊࡒ㸣 ᪁Ἢࠈṋ௧୕ࡡ㧏㱃㏩ᯊᝀ⩽ྞࢅᑊ㇗࡞㸡༖ᵋᠺⓏ㈹ၡ⣤࡞ࡻࡽࣤࢰࣄ࣭ࣖࢅ⾔ࡖࡒ㸣㟻හᐖࡢ㸡㸞◂✪༝ງ⩽ ࡡᇱᮇⓏᒌᛮ㸡㸞⾉ᾦ㏩ᯊ⒢Ἢࢅࡊ࡙࠷ࡾ⏍Ὡ࡞ࡗ࠷࡙㸡㸞㏩ᯊ㸡㟸㏩ᯊࡡ㐛ࡇࡊ᪁࡞ࡗ࠷࡙㸡㸞⒢㣬୕ࡡᕝኰ ࡞ࡗ࠷࡙㸡㸞⒢㣬⏍Ὡࡡ୯࡚ずฝࡊ࡙࠷ࡾ⏍ࡀࡾណ㸡౮ೋ㸡┘Ⓩ㸡ᚨࡡᨥ࠻➴࡚㸡◂✪༝ງ⩽࡞⮤⏜࡞ㄊࡖ࡙ࡵࡼࡖࡒ㸣 㟻හᐖࡡ㏪ㄊ㘋ࢅషᠺࡊ⢥ㄖࡊࡒ㸣㧏㱃㏩ᯊᝀ⩽ࡡ⒢㣬⏍Ὡ࡞࠽ࡄࡾమ㥺࡞㛭㏻ࡊ࡙࠷ࡾ࡛ᛦࢂࡿࡾᩝ⬞ࡡࡗࡡ༇ว ࡽࡇ࡛࡞ࢤ࣭ࢺࢅషᠺࡊ㸡ฦ㢦ᩒ⌦ࡊ㸡ୖన࢜ࢷࢥࣛࢅฝࡊࡒ㸣ࡐࡊ࡙㸡ୖన࢜ࢷࢥࣛࢅẒ㍉᳠ゞࡊ㸡୯న࢜ࢷࢥࣛࢅ ฝࡊࡒ㸣୯న࢜ࢷࢥࣛࢅẒ㍉᳠ゞࡊ㸡୕న࢜ࢷࢥࣛࢅฝࡊ㸡୕న࢜ࢷࢥࣛࡡ㛭㏻ࢅ᳠ゞࡊࡒ㸣 ⤎ᯕཀྵࡦ⩻ᐳࠈ࠘⏍࠵ࡾ⩽࡛ࡊ࡙⏍ࡀᢜࡂጶເ࠙㸡࠘ළ⁝࡞㐛ࡇࡌࡒࡴࡡຑງ࠙㸡࠘ᬧ⃢࡛ࡊ࡙ࡷࡾࡎ࠷࠙㸡࠘ࡷࡾࡎ ࡈ࡛ࡡᢙࡽྙ࠷࠙㸡࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾㆉ࠙㸡࠘⒢㣬⏍Ὡ࡞࠽ࡄࡾᙽ࠙ࡡࡡ࢜ࢷࢥࣛࢅฝࡊࡒ㸣㧏㱃㏩ᯊᝀ⩽ࡢ㸡 ⒢㣬⏍Ὡ࡞࠽࠷࡙⏍ࡡᕵị࡞ᇱࡘ࠷ࡒ࠘⏍࠵ࡾ⩽࡛ࡊ࡙⏍ࡀᢜࡂጶເ࠙ࢅᣚࡔ㸡ᖏ⏍Ὡࢅ⮤❟ࡊ࡙㐛ࡇࡎࡾࡻ࠹ ࡞⒢㣬⏍Ὡࢅ࠘ළ⁝࡞㐛ࡇࡌࡒࡴࡡຑງ࠙ࢅࡊ࡙࠷ࡒ㸣ࡐࡡୌ᪁࡚㸡㧏㱃㏩ᯊᝀ⩽ࡢ㸡⒢㣬⏍Ὡ࡞࠘ᬧ⃢࡛ࡊ࡙ࡷࡾ ࡎ࠷࠙మ㥺ࢅࡊࡼࡵ࠘ࡷࡾࡎࡈ࡛ᢙࡽྙ࠹࠙ࡆ࡛࡚㏩ᯊࡡ⒢㣬⏍Ὡࢅུᐖࡊ࡙࠷ࡒ㸣㧏㱃㏩ᯊᝀ⩽ࡢ㸡⒢㣬 ⏍Ὡ࡞࠽ࡄࡾெ㛣㛭౿ࢅ㏳ࡊ࡙࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾㆉ࠙ࢅࡌࡾమ㥺࡞ࡻࡽ࠘⒢㣬⏍Ὡ࡞࠽ࡄࡾᙽ࠙ࢅずฝࡊ㸡⒢ 㣬⏍Ὡ࡞࠽ࡄࡾ㎖ࡈ࠾ࡼࡡゆᨲࡷᚨࡡᏭᏽࢅវࡋࡾమ㥺ࢅࡊ࡙࠷ࡒ㸣 ࠈ㧏㱃㏩ᯊᝀ⩽⒢㣬⏍Ὡࢅࡻࡽඖᐁࡊ࡙㐛ࡇࡎࡾࡻ࠹࡞㸡ᐓ᪐࡛㏻ᦘࡊ࡙ᝀ⩽ࡡヾ▩ᶭ⬗ࡷ⌦ゆງ࡞ྙࢂࡎࡒㄕ᪺ ࢅ⾔࠷㸡ᆀᇡ࡛ࡵ㏻ᦘࡊ࡙ᨥᥴࡌࡾᚪこ࡚࠵ࡾ࡛⩻࠻ࡾ㸣 ⤎ㄵࠈ┫㆜ᖅ࡞ࡢ㸡㧏㱃㏩ᯊᝀ⩽ࡻࡽඖᐁࡊࡒ⒢㣬⏍Ὡࢅ㏞ࡾࡆ࡛࡚ࡀࡾࡻ࠹࡞㸡⒢㣬⏍Ὡ࡞࠽ࡄࡾమ㥺ࡡណ ࡘࡄࢅ⌦ゆࡊ㸡ᐓ᪐ࡷᆀᇡ࡛ࡡ㏻ᦘࢅࡴ㸡ࡻࡽࡻ࠷ெ㛣㛭౿ࢅᵋ⠇ࡊ㸡㐲วᨥᥴࢅᚋࡾࡆ࡛࡚ࡀࡾࡻ࠹࡞ᨥᥴ ࡌࡾࡆ࡛㔔こ࡚࠵ࡾࡆ࡛♟ြࡈࡿࡒ㸣Abstract
BackgroundࠈIt has been pointed out that the older the patients are㸡the more poorly they accept dialysis
treatment because of a decline in cognitive function㸣I consider that they implicate their medical treatment lives as matters different from acceptance of dialysis㸣
ObjectiveࠈThe present study aimed to clarify the experiences of elderly patients with dialysis receiving medical
treatmet㸣
MethodsࠈI conducted a semi-structured interview with eight elderly patients with dialysis aged over 65
years㸣The topics in the interview included 㸝1㸞 basic attributes of the participants㸡㸝2㸞 living with hem dialysis treatment㸡㸝3㸞 days spent with and without dialysis㸡㸝4㸞 devices used in medical treatment㸡and 㸝5㸞 the significance㸡value㸡purpose㸡and mental support received during medical treatment㸣
Results/discussionࠈSix categories㸡that is㸡“attitudes to survive as those with life,” “efforts to spend life smoothly,”
“being depressed and disconsolate,” “compromising melancholia,” “recognition of the value of their own existence,” and “expectations of living with medical treatment life,” were extracted㸣When living with medical treatment㸡elderly patients wih dialysis were motivated to live and made efforts to live with medical treatment as best as they could㸣They were interpreting these as due to having higher expectations of living with medical treatment and using these experiences 㸝recognizing the values of their own existence㸞 to improve their human relationships while living with medical treatment.
ConclusionࠈIt is important for nurses to empathize with elderly patients with dialysis receiving medical
treatment and to deepen the cooperation with the patients’ families and regions in supporting them㸣
高齢透析患者の療養生活における体験の意味づけ
What the Elderly Patients with Dialysis Receiving Medical Treatment Experiences
⏛୯ࠈ⣎Ꮔ
㸞㸟㸡ཋ⏛ࠈᑚእ
㸞㸡ኯ⏛ࠈ⟿Ꮔ
㸞Michiko Tanaka㸡Sayo Harada㸡Setsuko Oota
㸞ㄌකఌⲙ⥪ྙ㝌ࠈKusatsu General Hospital
㸞⪯ἠኬᏕ┫㆜Ꮥ㒂ࠈSchool of Nursing㸡Seisen University ＊E-mail：[email protected]
⪯ἠ┫㆜Ꮥ◂✪ࠈ㸧ᕬ㸝㸞
Ϩ㸣⥬ࠈゕ
ࠈ㎾ᖳ㸡㏩ᯊ⒢ࡡ㐅Ṅ࡞ࡻࡾ⏍Ꮛᑋࡡ㛏 ࡛ᑙථࡡ㧏㱃㐅ࡲ㸡⾉ᾦ㏩ᯊࢅུࡄࡾ㧏 㱃㏩ᯊᝀ⩽ᖳࠍቌຊࡊ࡙࠷ࡾ㸝ᮇ㏩ᯊ༈Ꮥ ఌ㸡 㸞㸣㏩ᯊ⒢Ἢࡢ㸡⭀ධ࡞ࡻࡽࢂࡿࡒ ⭀ᶭ⬗ࡡ᭨⒢Ἢ࡛ࡊ࡙⾉ᾦὯࢅ┘Ⓩ࡛ࡊࡒ⏍ ⥌ᣚࡡࡒࡴࡡ༖ỄⓏ⒢࡚࠵ࡾ㸣ᅹᏩ⏍Ὡࢅ ㏞ࡾ⾉ᾦ㏩ᯊᝀ⩽࡞ࡢ㸡㣏โ㝀ࡷమ㔔⟮⌦㸡ࢨ ࣔࣤࢹࡡ⟮⌦㸡᭱ⷾ⟮⌦➴ࡡࢬࣜࣆࢢᚪこ࡛ ࡾ㸣㧏㱃⩽࡚ࡢ㸡ຊ㱃࡞ఔ࠹ヾ▩ࡷ⢥♼㟻ࡡᶭ ⬗ୖ࡞ࡻࡾࢬࣜࣆࢢ⬗ງࡡୖ࡛⮤ᚂ♼⤊ᶭ ⬗ࡡୖࢅᮮࡊ᪾ࡂ㸡ࡐࡿࡼࡢ㸡㧏㱃㏩ᯊᝀ⩽ࡡ Quality of life㸝௧ୖQOL࡛ࡌࡾ㸞࡞ᙫ㡢ࢅ࠻ ࡾ㸣㏩ᯊུᐖ࡞⮫ࡾࠖᝊびࡡࣈࣞࢬࢪࠗࡢ㸡ࡡ ᖳ࡞࠽࠷࡙ࡵ㸡ྜྷᵕࡡࣈࣞࢬࢪࢅࡒࡾ㸝⏛ ୯㸡 㸞㸣㏩ᯊᝀ⩽ࡡᚨ⌦Ⓩ㐲ᚺࡷ⒢ࡡུᐖ ࡢ㸡ᖳ㱃㧏࠷ᝇࡂ㸝ࢨ࢘ࣛࣆኣ⏛㔕㸡ኯ⏛㸡 㸰Keogh㸡 㸞㸡㧏㱃㏩ᯊᝀ⩽ࡡ㏩ᯊུᐖ ࡛QOL࡞ࡢ㸡ヾ▩ᶭ⬗᭩ࡵᙫ㡢ࡌࡾこᅄ࡚࠵ ࡾ࡛ࡈࡿ࡙࠷ࡾ㸝ኬಲ㸡ᮟ⏛㸡㸞㸣ࡐࡡࡒࡴ㸡 ヾ▩ᶭ⬗ࡡୖࢅᮮࡊ᪾࠷㧏㱃㏩ᯊᝀ⩽ࡢ㏩ᯊུ ᐖ࡞ᨥ㝸ࢅᮮࡒࡊ᪾࠷㸣 ࠈኬኣᩐࡡ㏩ᯊᝀ⩽ࡢ㸡㏩ᯊུᐖࡡࣈࣞࢬࢪ࡚㸡 ᖏ࡞ࠔ㏩ᯊᢼྫྷࡡᚨ⌦ࠕࢅᣚࡔࡗࡗ㏩ᯊࢅུࡄ࡙ ࠽ࡽ㸡ࠔᶭ࡞ᨥ࠻ࡼࡿࡒ⏍ࠕ࡛ࡊ࡙⏍ࡀ࡙ࡹ ࠾ࡂ࡙ࡢࡼࡍ㸝᫋ᮄ㸡 㸞㸡㌗మࡢṒ්࡛ ⏍ࡡ⧖ࡽ㏁ࡊ࡞ୌ⏍├㟻ࡊ⤾ࡄ㸡⤧࠻ࡍṒࢅ├ち ࡎࡉࡾࢅᚋ࠷࡛࠷࠹ኣኬࢪࢹࣝࢪࡡ୯࡚⮤ฦ ࢅᏬࡾࡒࡴ࡞ᚨⓏវつ㯖⑯࡞㝏ࡾ༱㝜ᛮ࠵ࡾ 㸝ᗀ℡㸡㸞㸣 ࠈࡊ࠾ࡊ㸡㧏㱃㏩ᯊᝀ⩽ࡡኣࡂࡢ㸡㏩ᯊ⒢ࢅఆ ࡳࡆ࡛ࡷᨲᲘࡌࡾࡆ࡛ࡂ㸡Ὲࠍ࡛⒢ࢅ⤽⤾ࡊ ࡙࠷ࡾ㸣㧏㱃㏩ᯊᝀ⩽⒢ࢅ⤽⤾ࡊ࡙࠷ࡾ≟ឺ ࡞ࡢ㸡㏩ᯊུᐖ࡛ࡢ␏ࡾ⒢㣬⏍Ὡࡡណࡘࡄ ࠵ࡾ࡛⩻࠻ࡼࡿࡾ㸣ᮇ◂✪ࡢ㸡㧏㱃㏩ᯊᝀ⩽ࡡ⒢ 㣬⏍Ὡ࡞࠽ࡄࡾమ㥺ࡡណࡘࡄ࡞ࡗ࠷࡙᪺ࡼ࠾࡞ ࡌࡾࡆ࡛ࢅ┘Ⓩ࡛ࡊࡒ㸣ϩ㸣᪁ࠈἪ
㸦㸣◂✪ࢸࢧࣤࡢ㈹Ⓩエ㏑Ⓩ◂✪࡛ࡊࡒ㸣
㸧㸣◂✪༝ງ⩽
ࠈA┬Bᕰහ࡚◂✪༝ງࢅᚋࡼࡿࡒC㏩ᯊࢬࣤࢰ ࣭ࡡ┫㆜⟮⌦⩽࡞◂✪ࡡ㉻᪠㸡┘Ⓩ㸡᪁Ἢ➴ࢅㄕ ᪺ࡊ㸡㏳㝌ࡊ࡙⾉ᾦ㏩ᯊ⒢ࢅུࡄ࡙࠷ࡾゕㄊⓏ ࢤ࣐ࣖࢼࢢ࣭ࢨࣘࣤྊ⬗ṋ௧୕ࡡ㧏㱃⩽ 㸝ヾ▩ࡡ࠵ࡾ⩽ࡢ㝎ࡂ㸞ྞࡡ⣺ࢅᚋࡒ㸣 ྞ࡞ᑊࡊ㸡◂✪⩽ࡻࡽ㸡ᮇ◂✪ࡡ㉻᪠㸡┘Ⓩ㸡᪁ Ἢ➴࡞ࡗ࠷࡙ᨭࡴ࡙ㄕ᪺ࡊ㸡◂✪༝ງᚋࡼࡿࡒ ྞࢅᑊ㇗࡛ࡊࡒ㸣㸝⾪㸞 ࠈᮇ◂✪࡚ࡢ㸡㧏㱃㏩ᯊᝀ⩽ࡡ⒢㣬⏍Ὡ࡞࠽ࡄࡾ మ㥺ࡡណࡘࡄࡡධమࢅ᪺ࡼ࠾࡞ࡌࡾࡆ࡛ࢅ┘Ⓩ ࡛ࡊ㸡ཋ⑄ᝀࡷ㏩ᯊṌ㸡ᐓ᪐⫴ᬊࡡ㐢࠷࡞ࡻࡾ⤘ ㎰ࡲࡢ⾔ࢂࡍ㸡ᵕࠍࢢ࣭ࢪΊᅹࡌࡾࡻ࠹࡞㐽 ᏽࡊࡒ㸣 ⾪ࠈ◂✪༝ງ⩽ࡡᖳ㱃ࠉᛮืࠉ㏩ᯊ᮪௲ࠉཋ⑄ᝀࠉᐓ᪐ᙟឺ ᕈ ᐕ㦂 ∔ᖚ ㅘᨆᱧ ㅘᨆ࿁ᢙ ㅘᨆᤨ㑆࿁ ኅᣖ᭴ᚑ C ↵ ᘟᕈ♻⣢Ἳ ᐕ ࡩ ㅳ ࿁ ᤨ㑆 Ꮺቛ D ᅚ ♧ዩ∛ᕈ⣢∝ ᐕ ㅳ㑆 ㅳ ࿁ ᤨ㑆 ᄦߣੑੱ E ↵ ♧ዩ∛ᕈ⣢∝ ⣾⢲≸⣢≸ ࡩ ㅳ ࿁ ᤨ㑆 ⁛ዬ F ↵ ♧ዩ∛ᕈ⣢∝ ᐕ ࡩ ㅳ ࿁ ᤨ㑆 㐳↵Ꮺߣหዬ G ↵ ᘟᕈ♻⣢Ἳ ᐕ ࡩ ㅳ ࿁ ᤨ㑆 ᆄߣ㐳↵ H ᅚ ᘟᕈ♻⣢Ἳ ࡩ ㅳ ࿁ ᤨ㑆 Ꮺቛ I ᅚ ♧ዩ∛ᕈ⣢∝ ᐕ ࡩ ㅳ ࿁ ᤨ㑆 ᄦߣ㐳ᅚ J ↵ ♧ዩ∛ᕈ⣢∝ ᐕ ࡩ ㅳ ࿁ ᤨ㑆 ᆄߣ㐳↵Seisen J. Nurs. Stud., Vol. 2. 2013
㸨㸣ࢸ࣭ࢰ㞗᪁Ἢ
ࠈ༖ᵋᠺⓏ㈹ၡ⣤࡞ࡻࡾெ㟻Ἢ࡛ࡊࡒ㸣ࢸ࣭ ࢰ㞗㛣ࡢ㸡ᖲᠺᖳ᭮㹳 ࡚᭮࠵ ࡾ㸣㟻හᐖࡢ㸡㸞◂✪༝ງ⩽ࡡᇱᮇⓏᒌᛮ㸡㸞 ⾉ᾦ㏩ᯊ⒢Ἢࢅࡊ࡙࠷ࡾ⏍Ὡࡡ୯࡚㸡ࡡࡻ࠹ ࡆ࡛ࢅវࡋࡒࡽ㸡ᛦࡖࡒࡽࡊ࡙㐛ࡇࡊ࡙࠷ࡾ࠾㸡 㸞㏩ᯊ࡛㟸㏩ᯊࡢࡡࡻ࠹࡞㐛ࡇࡊ࡙࠷ࡾ ࠾㸡㸞⒢㣬୕ࡡᕝኰࡢࡡࡻ࠹ࡆ࡛ࢅࡊ࡙࠷ ࡾ࠾㸡㸞㏩ᯊ⒢ࢅ⤽⤾ࡊ࡙࠷ࡾ⒢㣬⏍Ὡࡡ୯ ࡚㸡⏍ࡀࡾណ࣬౮ೋ࣬⏍ࡀࡾ┘Ⓩ࣬ᚨࡡᨥ࠻➴ ࡢ㸡ࡡࡻ࠹ࡵࡡ࠵ࡾࡡ࠾࡛ࡊ㸡◂✪༝ງ⩽ ࡞⮤⏜࡞ㄊࡖ࡙ࡵࡼࡖࡒ㸣㟻㸡ሔᡜࡢ㸡◂ ✪༝ງ⩽ࡡᕵ᭻ࢅඁࡊ㸡㟻㛣ࡢ㸡◂✪༝ງ ⩽㧏㱃ࡡ㏩ᯊᝀ⩽࡚࠵ࡾࡆ࡛ࢅ⩻៎ࡊ࡙㸡ᅂ ฦ࠾ࡼฦ࡛ࡊࡒ㸣ᅂࡡ㟻࡚༎ฦࣤࢰ ࣄ࣭࡚ࣖࡀ࠾ࡖࡒྞ࡞ᑊࡊ࡙ࡢ㸡ᅂᐁ᪃ࡊ ࡒ㸣ᅂࡡ㟻ࡢ 㹳 ฦ࡚ᖲᆍ㟻㛣ࡢ㸡 ฦ࡚࠵ࡖࡒ㸣㟻හᐖࡢ㸡ྞ࡞ࡗ࠷࡙ࡢスྊࢅ ᚋ࡙㘋㡚ࡊ㸡ྞࡢ㸡エ㘋ࡡスྊࢅᚋ࡙㸡ࣆ࣭ ࣜࢺࢿ࣭ࢵ࡞エ㘋ࡊࡒ㸣㸩㸣ࢸ࣭ࢰฦᯊ᪁Ἢ
ࠈ㟻හᐖࡡ㏪ㄊ㘋ࢅషᠺࡊ⢥ㄖࡊࡒ㸣㧏㱃㏩ᯊ ᝀ⩽ࡡណࡘࡄ࡞㛭㏻ࡊ࡙࠷ࡾ࡛ᛦࢂࡿࡾᩝ⬞ ࡡࡗࡡ༇วࡽࡇ࡛࡞ࢤ࣭ࢺࢅషᠺࡊ㸡ฦ㢦ᩒ⌦ ࡊ㸡ୖన࢜ࢷࢥࣛࢅฝࡊࡒ㸣ࡐࡊ࡙㸡ୖన࢜ࢷ ࢥࣛࡡẒ㍉᳠ゞࢅ⧖ࡽ㏁ࡊ㸡୯న࢜ࢷࢥࣛࢅฝ ࡊࡒ㸣୯న࢜ࢷࢥࣛࢅẒ㍉᳠ゞࡊ㸡୕న࢜ࢷࢥࣛ ࢅฝࡊ㸡୕న࢜ࢷࢥࣛࡡ㛭㏻ࢅ᳠ゞࡊࡒ㸣ฦᯊ 㐛⛤࡞࠽࠷࡙㸡◂✪༝ງ⩽࡞㟻ࡡこ⣑࡛㏪ㄊ㘋 ࢅᥞ♟ࡊ㸡☔ヾࢅ⾔࠷ࡼಘ㢏ᛮࡡ☔ಕ࡞ຑࡴ ࡒ㸣ࡱࡒ㸡࢜ࢷࢥࣛࡡฝ㸡࢜ࢷࢥࣛྞࡡỬᏽ࡞ ࠷ࡒࡾධฦᯊ㐛⛤ࡢ㸡◂✪⩽࡛㈹Ⓩ◂✪⩽࡞⢥㏳ ࡊࡒ┫㆜◂✪⩽࡛⾔࠷㸡ゆ㔐ࡡጂᙔᛮࡡྡྷ୕࡞ຑ ࡴࡒ㸣୕న࢜ࢷࢥࣛࡢ࠘ࠈࠈ࠙୯న࢜ࢷࢥࣛࡢࠒࠈ ࠈࠓୖన࢜ࢷࢥࣛࡢ㹐ࠈࠈ㹒࡚♟ࡊ㸡࢜ࢷࢥࣛ ࡡහᐖࢅ◂✪༝ງ⩽ࡡࢤ࣭ࢺࢾ࣭࣑ࢅエࡊ㸡㏪ㄊ 㘋࠾ࡼࠔࠈࠈࠕ࡚ᘤ⏕ࡊㄕ᪺ࡌࡾ㸣 ⌦Ⓩ㒼៎㸯ᑊ㇗⩽࡞ࡢ㸡ཾ㢄࡛ᩝ᭡࡞ࡻࡽ㸡༌ྞ ᛮࡡ☔ಕ㸡◂✪ཤຊࡡ௴ណᛮ㸡ᕵ᭻࡞ࡻࡽ࠷ࡗ࡚ࡵ ୯Ḿ࡚ࡀࡾࡆ࡛㸡◂✪┘Ⓩ௧አ࡞ප⾪ࡊ࠷➴ࡡᚪ こㄕ᪺ࢅ⾔࠷㸡ᩝ᭡࡞ࡻࡾᢆㅑࢅᚋࡒ㸣⁘㈙༈⛁ ኬᏕ㸝ᖲᠺᖳ᭮ 㸡ᢆヾ␊ྒ 㸞࡛ⲙ⥪ ྙ㝌㏩ᯊࢬࣤࢰ࣭㸝ᖲᠺᖳ᭮㸡スྊ␊ྒ 㸞ࡡ⌦ጟဤఌࡡᢆヾࢅᚋ࡙࠷ࡾ㸣Ϫ㸣⤎ࠈᯕ
ࠈ㟻හᐖࢅฦᯊࡊࡒ⤎ᯕ㸡ࡡࢤ࣭ࢺ ฝࡈࡿࡒ㸣ࡐࡿࡼࡡࢤ࣭ࢺࢅ┞ப࡞Ẓ㍉᳠ゞࢅ⾔ ࠷㸡㢦జࡊࡒᒌᛮࡡࡵࡡࢅ㞗ࡴฦ㢦ࡊࡒ⤎ᯕ㸡 ࡡୖన࢜ࢷࢥࣛᑙࡀฝࡈࡿࡒ㸣ࡐࡿࡼࢅẒ㍉ ᳠ゞࡊ㸡ฦ㢦ࢅ㔔ࡠࡒ⤎ᯕ㸡ࡡ୯న࢜ࢷࢥࣛ ࡛࠘⏍࠵ࡾ⩽࡛ࡊ࡙⏍ࡀᢜࡂጶເ࠙㸡࠘ළ⁝࡞ 㐛ࡇࡌࡒࡴࡡຑງ࠙㸡࠘ᬧ⃢࡛ࡊ࡙ࡷࡾࡎ࠷࠙㸡࠘ࡷ ࡾࡎࡈ࡛ࡡᢙࡽྙ࠷࠙㸡࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾ ㆉ࠙㸡࠘⒢㣬⏍Ὡ࡞࠽ࡄࡾᙽ࠙ࡡ୕న࢜ࢷࢥࣛ ฝࡈࡿࡒ㸣㸝⾪㸞㸦㸣
࠘⏍࠵ࡾ⩽࡛ࡊ࡙⏍ࡀᢜࡂጶເ࠙࡞ࡗ࠷࡙
ࠈ➠ࡡ୕న࢜ࢷࢥࣛࡢ㸡࠘⏍࠵ࡾ⩽࡛ࡊ࡙⏍ࡀᢜ ࡂጶເ࡛࠙ྞࡊࡒ㸣Ṓࡡᜅᛟࡷ⏍ࡡᕵị࡞ᇱ ࡘ࠷ࡒ㏩ᯊᝀ⩽ࡡ⒢㣬⏍Ὡ࡞࠽ࡄࡾጶເ࡚㸡 ࡡ୯న࢜ࢷࢥࣛࠒṒࡢᜅᛟ࡚࠵ࡽᩓ࡚࠵ࡾࠓ㸡ࠒ⏍ ࡀࡾࡒࡴ࡞⒢࡞ཱིࡽ⤄ࡳࠓ㸡ࠒᐓ᪐ࡡࡒࡴ࡞㛏⏍ ࡀࡌࡾࠓ࡚ᵋᠺࡈࡿࡒ㸣୯న࢜ࢷࢥࣛࠒṒࡢᜅᛟ ࡚࠵ࡽ㸡ᩓ࡚࠵ࡾࠓࡢ㸡㹐⏍ࢅᣚࡖࡒ⩽࡞࡛ࡖ࡙㸡 Ṓࡢᜅᛟ࡚࠵ࡽᩓ࡚࠵ࡾ㹒ࡡࡡୖన࢜ࢷࢥࣛ ࡚ᵋᠺࡈࡿࡒ㸣ࠔ⏍ࢅᣚࡖࡒ⩽ࡢࡷ㸡ࡷࡖࡤࡽ Ṓࡡࡢୌ␊ࡡᜅᛟࡷࡊᩓࡷࡊࠕ㸝a㸞ࡷ㸡ࠔࡵ ࠹㛏࠷ࡆ࡛ࡵ࡙ࢆࡡ㐢࠹࠾ࡖ࡙㸝ࡵ࠹㸡⮤ฦࡡ 㛏ࡂ࠷ࡡ࡚ࡢ࠷࠾࡛㸞Ꮽࡷࡖࡒࡠࠕ㸝e㸞 ࡛㸡㏩ᯊᑙථ࡞ఔࡖࡒṒࡡᜅᛟ㸡⏍ࡡᕵị࠵ ࡾࡆ࡛ࢅㄊࡖࡒ㸣ࡱࡒ㸡୯న࢜ࢷࢥࣛࠒ⏍ࡀࡾࡒ ࡴ࡞⒢࡞ཱིࡽ⤄ࡳࠓࡢ㸡㹐ࡡࡒࡴࡡ⒢ࢅࡀ ࡔࢆུ࡛ࡄࡾࡒࡴ࡞㡱ᘿࡖཱི࡙ࡽ⤄ࡳ㹒㸡㹐⏍ࡀࡾ ࡒࡴ࡞㏩ᯊࢅࡌࡾ㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺ ࡈࡿࡒ㸣ࠔࡀࡔࢆ࡛⒢ࢅུࡄࡾࡒࡴ࡞㸡⮤ฦࡵ ࡀࡔࢆ࡛㡱ᘿࡾࠕ㸝a㸞࡛㸡㐲ว⒢ࡡࡒࡴ࡞ ⮤ฦ⮤㌗ࡵཱིࡽ⤄ࡳ࡛࠷࠹ጶເࡷࠔ⏍ࡀࡾࡒࡴࡡ 㐠රࡷ࡛ᛦࡖ࡙ࡾࠕ㸝c㸞ࡡࡻ࠹࡞㸡⏍ࡀࡾࡒࡴ࡛ ࠷࠹ጶເࢅㄊࡖࡒ㸣୯న࢜ࢷࢥࣛࠒᐓ᪐ࡡࡒࡴ࡞ 㛏⏍ࡀࡌࡾࠓࡢ㸡㹐࡚ࡀࡾࡓࡄᐓ᪐ࡡࡒࡴ࡞㛏⏍ ࡀࡊࡒ࠷㹒㸡㹐ஷࡀẍࡡṋࡱ࡚⏍ࡀ࡙のᏏ⾔ࡊࡒ࠷㹒 ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔࡷࡖࡤࡽ㸡 ࡞㸝ᘽ㸞ெࢅず㏞ࡖ࡙࠵ࡅ࡙࠾ࡼ࡚࠷ ࡛㏵ࡄࢆ㸝㏵ࡄ࠷㸞࡛ᛦࡖ࡙ࡾࠕ㸝g㸞ࡡࡻ࠹࡞㸡 ࠽ப࠷㧏㱃࡛ࡖࡒኰࢅず㏞ࡾࡆ࡛⮤ฦࡡᙲ ࡚࠵ࡽ㸡㈈௴࡚࠵ࡾ࡛࠷࠹ᛦ࠷ࢅㄊࡖࡒ㸣ࡱࡒ㸡ࠔの Ꮟ⾔࡙࠵ࢆࡱࡽ࡚ࡀࢆ࠾ࡖࡒࡊ㸡ஷࡂࡖࡒẍ ࡡṋ㸝 ṋ㸞ࡱ࡚⏍ࡀࡾࡡ㸡ࡎࡴ࡙ࡵࡡのᏏ⾔⪯ἠ┫㆜Ꮥ◂✪ࠈ㸧ᕬ㸝㸞 ⾪ࠈ㧏㱃㏩ᯊᝀ⩽ࡡᚨ⌦Ⓩమ㥺 ࠞ࠹ࠧ ਛࠞ࠹ࠧ ਅࠞ࠹ࠧ 1㧚↢ࠆ⠪ߣߒߡ↢߈ᛮߊᆫ ᱫߪᕟᔺߢࠅᢜߢࠆ ↢ࠍᜬߞߚ⠪ߦߣߞߡޔᱫߪᕟᔺߢࠅᢜߢࠆ ↢߈ࠆߚߦᴦ≮ߦขࠅ⚵ ߩߚߩᴦ≮ࠍ߈ߜࠎߣฃߌࠆߚߦ㗎ᒛߞߡข ࠅ⚵ ↢߈ࠆߚߦㅘᨆࠍߔࠆ ኅᣖߩߚߦ㐳↢߈ߔࠆ ߢ߈ࠆߛߌኅᣖߩߚߦ㐳↢߈ߒߚ ߈Უߩᱦ߹ߢ↢߈ߡⷫቁⴕߒߚ 2㧚Ṗߦㆊߏߔߚߩദജ ࡞ࡈࠤࠕࠍ⛮⛯ߔࠆദജ ߢ߈ࠆߎߣߢ㒢ߦขࠅ⚵ ࿐ߩੱߦᛂߜߌߡදജࠍᓧࠆ 㘩߿᳓ಽ㒢ߦኻߒߡޔ⚻⾰ߦߥࠄߥ ⺞▤ℂߩߚߦ⸥㍳ࠍߟߌࠆ ⁁⛽ᜬߩദജࠍ⛯ߌࠆ ㆡᐲߦભᕷࠍߣࠆ ឃଢࠦࡦ࠻ࡠ࡞ߩ੍ቯࠍ⚵ ᐕ㦂ࠍታᗵߒෂ㒾࿁ㆱߩߚߩ⥄ⴡ ᐕ㦂ࠍታᗵߒෂ㒾࿁ㆱߩߚߦⴕേ▸࿐ࠍ⁜ޔ⥄⊒ ⊛ߦ⥄ⴡߔࠆ ኅᣖ߿ઁ⠪ߦ߆ߌࠆㅅᖺ߳ߩ㈩ᘦ ࿐ߩㅅᖺߦߥࠄߥࠃ߁⥄┙ߔࠆ ⥄ಽߩᖱ߿⸒േߦ᳇ࠍߟߌࠆ ኅᣖߦㅅᖺࠍ߆ߌߥࠃ߁୫㊄ߩᷣࠍ⛯ߌࠆ 3㧚ᥧổߣߒߡ߿ࠆߖߥ ㅘᨆ≮ᴺߦ߁り⊛⧰∩ ⸃ᶖߢ߈ߥ⓫ೝߩ∩ߺߣᔺߐ ㅘᨆਛߩ᜔᧤ᤨ㑆߇㐳ߊ⧰∩ ᔃ߇ࠄ߇ߕᘷ㝠 2 ᣣߦ 1 ᐲ߿ࠅ⛯ߌߥߊߡߪߥࠄߕᕷߟߊ㑆߇ή ᧪ࠆߛߌߢ♖৻᧰ߢᲤᣣ߇ᘷ㝠 ⥄↱߇ᅓࠊࠇߚߒߐ߇ࠅޔή᳇ജߢᭉߒߺ߇ή ㅘᨆࠍߔࠆ⠪ߦߒ߆⸃ࠄߥㄆߐ߇ࠆ 㘩ߩ㒢ߪㄆߊᭉߒߺ߇ή 㒢߇ࠇߥᒁߌ⋡ 㘩㒢߿᳓ಽ㒢߇ᚻߊⴕ߆ߕ⥄ା߇߽ߡߥ ㅘᨆߦⴕߊߩ߇ంധߦߥࠆ ੱߦㅅᖺࠍ߆ߌࠆᒁߌ⋡ ੱߩㅅᖺߦߥࠆ↢ᵴߦᄌࠊߞߚߩߢᣧߊᱫࠎߢߒ߹ ߚ వ߇ᝪ߃ࠄࠇߥਇ ᐕ㦂߿∛⁁߆ࠄߩਇߢవ߇ᝪ߃ࠄࠇߥ ㅘᨆࠍߟ߹ߢߔࠆߩ߆ਇߢߚ߹ࠄߥ ㅘᨆߪ৻↢߿ࠅ⛯ߌߥߊߡߪߥࠄߕᦨᖡ ৻↢߿ࠅ⛯ߌߥߊߡߪߥࠄߕᦨᖡߛ ㅘᨆ≮ᴺߘߩ߽ߩߦᛶ᛫߇ࠆ ߿ߡ߽߆ߣ᳇ᜬߜ߇ߋࠄߟߊ ᐕ㦂⊛ߦ߿ߡ߽߆ߣ᳇ᜬߜ߇ߋࠄߟߊ
Seisen J. Nurs. Stud., Vol. 2. 2013 ࡛ᛦࡖ࡙ࡾ࠾ࡼࠕ㸝c㸞ࡡࡻ࠹࡞㸡ẍஷࡂࡖࡒ ṋࡱ࡚ࡢ⏍ࡀࡾࡆ࡛㸡⮤ฦ࡞࡚ࡀࡾẍࡡのᏏ ⾔࡚࠵ࡾ࡛࠷࠹ᛦ࠷ࢅㄊࡖࡒ㸣
㸧㸣
࠘ළ⁝࡞㐛ࡇࡌࡒࡴࡡຑງ࠙࡞ࡗ࠷࡙
ࠈ➠ࡡ୕న࢜ࢷࢥࣛࡢ㸡࠘ළ⁝࡞㐛ࡇࡌࡒࡴࡡຑ ງ࡛࠙ྞࡊࡒ㸣ࢬࣜࣆࢢࡡ⤽⤾ࡷຊ㱃࡞ఔ࠹ ᶭ⬗ୖ࠾ࡼវࡋࡾ༱㝜ࢅᅂ㑂ࡊ㸡ெ㛣㛭౿ࢅⰃ ይ࡞ಕࡗࡆ࡛࡚ළ⁝⒢㣬⏍Ὡࢅ㐛ࡇࡌࡒࡴࡡຑ ງ࡚࠵ࡽ㸡ࠒࢬࣜࣆࢢࢅ⤽⤾ࡌࡾຑງࠓ㸡ࠒᖳ㱃 ࢅᐁវࡊ༱㝜ᅂ㑂ࡡࡒࡴࡡ⮤⾠ࠓ㸡ࠒᐓ᪐ࡷ⩽࡞ ࠾ࡄࡾ㏖ᝠࡡ㒼៎ࠓࡡࡡ୯న࢜ࢷࢥ࡚ࣛᵋ ᠺࡈࡿࡒ㸣୯న࢜ࢷࢥࣛࠒࢬࣜࣆࢢࢅ⤽⤾ࡌࡾ ຑງࠓࡢ㸡㹐࡚ࡀࡾࡆ࡛࡚โ㝀࡞ཱིࡽ⤄ࡳ㹒㸡㹐࿔ ࠞ࠹ࠧ ਛࠞ࠹ࠧ ਅࠞ࠹ࠧ 4㧚߿ࠆߖߥߐߣߩ᛬ࠅว ⥄ಽߩߖߣᚓࠆ ߎ߁ߥߞߚߩ߽⥄ಽߩߖߛߣᕁ߁ ᣧߊᛮߌߒߚ ᣧߊㅘᨆ߆ࠄᛮߌߔߎߣ߫߆ࠅ⠨߃ߡࠆ ߈ࠄࠆ ㆇߛߣ߈ࠄࠆ ᣇߥߣ߈ࠄࠆ ߊࠃߊࠃߖߕ㐿߈⋥ࠆ 㐿߈⋥ߞߡ⿰ࠍᭉߒࠃ߁ߦᔃ߇ߌࠆ ߊࠃߊࠃߖߕߦᭉߒߊࠄߔ ߣᕁߞߡഀࠅಾࠆ ᱦࠍߣߞߡ߆ࠄߩߣᕁഀࠅಾࠆ ⽶ߌߥࠃ߁ߦ♖ജࠍߟ ⥄ಽߦ⽶ߌߥࠃ߁ߦ৻↢ ദജߔࠆ කᏧߩᔘ๔߿ઁߩᖚ⠪ߩ㛎ࠍബߺߦߔࠆ ା㗬ߒߡߚකᏧߩᔘ๔ࠍᚻᒁ߈ߦߔࠆ 㛎⺣ࠍ⺒ࠎߢബߺߦߔࠆ 1 ᣣ 1 ᣣࠍήߦㆊߏߖࠆߎߣߦᗵ⻢ߔࠆ 1 ᣣ 1 ᣣࠍήߦㆊߏߖࠆߎߣߦᗵ⻢ߔࠆ ⧰∩߇ߞߡ߽ㅘᨆߩ߅⬺ߣᗵ⻢ߔࠆ ㅘᨆߩ߅⬺ߢ↢߈ߡࠄࠇࠆ ᯏ᪾ߩㅴᱠ߇ࠅ߇ߚ 5㧚⥄Ꮖߩሽଔ୯ߩ⼂ ࿐ߩੱߩᥦ߆ߐ߇ࠅ߇ߚ ኅᣖߩᥦ߆ߐߦᗵ⻢ߒߡࠆ ࿐ߩੱߩᅢᗧ߇ࠅ߇ߚ කᏧ߿ࠬ࠲࠶ࡈߩℂ⸃߿ബ߹ߒࠍታᗵ ∛㒮ߩㅍㄫࠨࡆࠬ߇ࠅ߇ߚ කᏧ߿⋴⼔Ꮷߦℂ⸃ߒޔബ߹ߐࠇߡࠆߣታᗵߔࠆ ➅ࠅߐࠇࠆᵈᗧߪ⥄ಽߩߚߣᕁ߁ ኅᣖߣߡ߽⇹ᄖᗵࠍᗵߓࠆ ኅᣖߦჿࠍ߆ߌߡ߽ขࠅวߞߡߊࠇߥ ኅᣖߩఝߒᔃ㈩ࠅ߇ᗵߓࠄࠇߥ ߊߥߞߚᄦࠍᕁߒߡㆊߏߔ ߊߥߞߚᄦߣߩᕁࠍᕁߒߡㆊߏߔ ක≮⠪ߣߩ㑐ଥߦᔃᗵࠍᓧߚ એߦකᏧ߿ࠬ࠲࠶ࡈߣߩኒߥ㑐ଥࠍᜬߜޔᔃ ᔃᗵࠍᓧߚ 6㧚≮㙃↢ᵴߦ߅ߌࠆᦼᓙ ⥄ಽߩ᧪ߦኻߔࠆᦼᓙ ర᳇ߦߥߞߡੱߦ༑ࠎߢ߽ࠄߚ ᆷࠍᇾ߇ߖߡቊߩሶ߇ߒߚ ᣣᏱߩਛߦࠆᭉߒߺ ାઔᔃߦ༑߮ࠍߔ ࠺ࠖࠨࡆࠬߦⴕߊ ࠬࡐ࠷ⷰᚢ߿⿰ࠍᭉߒ ቊߣߩ߰ࠇࠍᭉߒ කቇߩㅴᱠߦኻߔࠆᦼᓙ ㅘᨆߩᤨ㑆߿⓫ೝߩ∩ߺ߇シᷫߔࠆ⎇ⓥߦᦼᓙߔࠆ ⣢⤳ࠍౣ↢ߔࠆࠃ߁ߥ⎇ⓥ߇ㅴߥࠄߘࠇ߹ߢ↢߈ ߡߚ⪯ἠ┫㆜Ꮥ◂✪ࠈ㸧ᕬ㸝㸞 ᅑࡡெ࡞ᡬࡔ᪺ࡄ࡙༝ງࢅᚋࡾ㹒㸡㹐㣏ࡷỀฦโ 㝀࡞ᑊࡊ࡙♼⤊㈹࡞ࡼ࠷㹒㸡㹐మㄢ⟮⌦ࡡࡒࡴ ࡞エ㘋ࢅࡗࡄࡾ㹒㸡㹐⌟≟⥌ᣚࡡຑງࢅ⤾ࡄࡾ㹒㸡㹐㐲 ᗐ࡞ఆࢅ࡛ࡾ㹒㸡㹐ᤴ౼ࢤࣤࢹ࣭ࣞࣜࡡᏽࢅ⤄ ࡳ㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔࢸ࡞ ࡢ㸡࠽Ⲍࢅ㔖ࡖ࡙ᣚࡖ࡙⾔ࡖ࡙ࡾࠕ㸝b㸞࡛㸡⮤ ฦ࡚ฝᮮࡾཱིࡽ⤄ࡲࡷ㸡ࠔẴᝇ࠷ࡈࡄ㸝┞ᡥ࡞ᝇ ࠷ࡡ࡚㸞㸡Ẵࡡࡆ࡛㝻ࡈࢆ࡛ゕ࠹࡙㸡㸝㣟ࡲ∸➴ ࢅ㸞ฝࡈࢆࡻ࠹࡞㸝ฝࡈ࠷ࡻ࠹࡞㸞ࡊ࡙ࡵࢀ࡙ ࡾࠕ㸝a㸞ࡡࡻ࠹࡞㸡▩ࡽྙ࠷࡞ࡢᡬࡔ᪺ࡄ࡙༝ ງࢅᚋ࡙࠷ࡾࡆ࡛➴ࢅㄊࡖࡒ㸣ࡱࡒ㸡ࠔ㸝โ㝀࡞ᑊ ࡊ࡙㸞࠵ࢆࡱࡽ♼⤊㈹࡞ࡼࢆ࡛㸝♼⤊㈹࡞ࡼ ࠷࡚㸞㸡ᬉ㏳ࡡẴᣚࡔ࡚࠷ࡾࡡ㸡⚶ࡢ࠷࠷࡛ ᛦࡖ࡙ࠕ㸝d㸞࡛㸡⮤ᕤ⟮⌦ࡡ⤽⤾ࡡࡒࡴ࡞♼⤊ ㈹࡞ࡽࡌࡁ࠷ࡆ࡛ࢅㄊࡖࡒ㸣ࠔమ㔔ࡢẎᅂ㢴 ࿁࡞ථࡾᗐ㸝エ㘋ࢿ࣭ࢹ࡞㸞ࡗࡄ࡙ࡾࠕ㸝a㸞ࡷ㸡 ࠔ⾉ᅸࡢᚪࡍ㸝エ㘋ࢿ࣭ࢹ࡞㸞ࡗࡄ࡙ࡾ㸡మ㔔࡛ࠕ 㸝e㸞ࡡࡻ࠹࡞㸡మ㔔ࡷ⾉ᅸࡡエ㘋ࡡ⩞ៈࡷ㸡㹷㏩ ᯊ࠷ࡢ㸡㎾ࡂࡡࢪ࣭ࣂ࣭࡚㸡㈑࠷∸࡙ࡼṄ ࠷࡙ࡾ㹸㸝a㸞ࡷ㸡ࠔࡷࡖ࡙ࡾ㸡୦ᡥࡡమ᧧ࡵ࣬࣬㸣 ࡐࡿ࡛㸡࡚ࡀࡾࡓࡄአṄ࠷࡙ࡾࠕ㸝e㸞࡛㸡మງࡷ ࢨࣔࣤࢹࡡ⥌ᣚࡡࡒࡴࡡຑງࢅㄊࡖࡒ㸣ࠔᚪࡍ ᐱࡌࡾࡻ࠹࡞ࡊ࡙ࡾࠕ㸝e㸞࡛㸡మࢅ༎ฦ࡞ఆࡴࡾ ຑງࡷ㸡ࠔ౼ฝ࠷ࡊⷾ㣟ࡳ࡛㸡ḗࡡࡢአ࡞ ฝࡿࢆ㸝ฝࡿ࠷㸞࠾ࡼ㸡ᚪࡍỀ᭑ࡢࡐࡡ 㸝ᤴ౼ࢤࣤࢹ࣭ࣞࣜࡡ㸞࡙Ửࡴ࡙ࡾ࠾ࡼࠕ㸝g㸞࡛㸡 ᤴ౼ࢤࣤࢹ࣭ࣞࣜࡡᏽࡵ⤄ࢆ࡚࠷ࡒ㸣୯న࢜ࢷ ࢥࣛࠒᖳ㱃ࢅᐁវࡊ༱㝜ᅂ㑂ࡡࡒࡴࡡ⮤⾠ࠓࡢ㸡㹐ᖳ 㱃ࢅᐁវࡊ༱㝜ᅂ㑂ࡡࡒࡴ࡞⾔ິ⠂ᅑࢅ≻ࡴ㸡⮤ ⓆⓏ࡞⮤⾠ࡌࡾ㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈ ࡿࡒ㸣ࡆࡿࡢ㸡ࠔṋ࠷ࡂ࡛㸡Ꮔ࠾ࡄࡒࡽ㞹⌣ ࢅን࠻ࡒࡽ㸡ࣁࣚࣤࢪཱིࡿࢆ㸣Ꮔ࠾ࡼⴘ ࡔ࡙࠾ࡼࡢ㸡Ꮔ࡞ࡊ࡙ࡵࢀ࡙ࡾ㸝Ꮔ࡞ࡊ࡙ࡵ ࡼࡖ࡙࠷ࡾ㸞ࠕ㸝a㸞࡛㸡༱㝜ࢅវࡋ࡙࠾ࡼࡢ㸡⮤ ࡼ༱㝜ࢅᅂ㑂ࡊ࡙࠷ࡾࡆ࡛ࢅㄊࡖࡒ㸣୯న࢜ࢷࢥ ࣛࠒᐓ᪐ࡷ⩽࡞࠾ࡄࡾ㏖ᝠࡡ㒼៎ࠓࡢ㸡㹐࿔ ᅑࡡ㏖ᝠ࡞ࡼ࠷ࡻ࠹⮤❟ࡌࡾ㹒㸡㹐⮤ฦࡡ⾪ ࡷゕິ࡞Ẵࢅࡗࡄࡾ㹒㸡㹐ᐓ᪐࡞㏖ᝠࢅ࠾ࡄ࠷ࡻ ࠹ೇ㔘ࡡ㏁ῥࢅ⤾ࡄࡾ㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛ ᵋᠺࡈࡿࡒ㸣ࠔࡇ㣜ࡢ㸡ࢪࢴࢲථࡿࡒࡼ⅍ࡄࡾ ࡊ㸡Ꮨ࡞ὑᶭࡡ࠷᪁ࡵ⩞࡙㸡ࡐࡊࡒࡼᐓࡡ⩽ ࡞ࡵ㏖ᝠ࠾ࡄࢆ࡚ࡌࡳࡈࡄ㸝㏖ᝠ࠾ࡄ࠷࡚ࡌࡳ ࡡ࡚㸞ࠕ㸝a㸞ࡷ㸡ࠔ⮤ฦ᎒ࠍ㸝㏩ᯊ࡞㸞⾔ࡂࡐ ࡩࡽずࡎࡒࡽ㸡ᬧ࠷㢞ࡊ࡙ࡒࡼᚨ㒼࠾ࡄࡾࡷࢀ㸴 ࡐࡷ࠾ࡼẴࢅࡗࡄ࡙ࡾࡻࠕ㸝e㸞࡛㸡⮤❟ࡡຑງࡷ ᐓ᪐ࡡ㒼៎࡛㸡ࠔࡵ࠹ࡔࡺࡖ࡛⏍ࡀ࡙ࡒ࠷㸣㸝 ᴏ࡞ᩃࡊࡒೇ㔘ࢅ㸞⏍ࡀ࡙ࡔࡺࡖ࡛࡚ࡵ㏁ࡎࡒ ࡼ㸡ᚃࡡ㸝ᏄࡷᏘࡡ㸞ㇿᢰᴞ࡞ࡾࡈࡄ㸝ᴞ ࡞ࡾࡡ࡚㸞ࠕ㸝a㸞࡛㸡⮤ฦṒࢆࡓᚃ࡞⮤ฦࡡ ࡆ࡛ཋᅄ࡚࠾ࡄࡾࡆ࡛࡞ࡾ㏖ᝠࢅ㸡ᑛࡊ࡚ࡵ ΅ࡼࡊࡒ࠷࡛࠷࠹ᛦ࠷ࢅㄊࡖࡒ㸣
㸨㸣
࠘ᬧ⃢࡛ࡊ࡙ࡷࡾࡎ࠷࠙࡞ࡗ࠷࡙
ࠈ➠ࡡ୕న࢜ࢷࢥࣛࡢ㸡࠘ᬧ⃢࡛ࡊ࡙ࡷࡾࡎ ࠷࡛࠙ྞࡊࡒ㸣ࡆࡿࡢ㸡⒢㣬⏍Ὡ࡞࠽ࡄࡾ⢥♼ Ⓩ㸡♣ఌⓏ㸡㌗మⓏ㎖ࡈࡷⱖ㸡ୌゕ࡚ࡢ ⾪⌟ࡊࡀࡿ࠷々㞟మ㥺ࢅࡊ࡙࠷ࡾࡆ࡛࡚࠵ࡾ㸣 ࠒ㏩ᯊ⒢Ἢ࡞ఔ࠹㌗మⓏⱖࠓ㸡ࠒᚨᏭࡼࡍ 㨒ࠓ㸡ࠒโ㝀Ꮼࡿ࠷ᘤࡄ┘ࠓ㸡ࠒெ࡞㏖ᝠࢅ࠾ࡄ ࡾᘤࡄ┘ࠓ㸡ࠒずᤛ࠻ࡼࡿ࠷Ꮽࠓ㸡ࠒ㏩ᯊࡢ ୌ⏍ࡷࡽ⤾ࡄࡂ࡙ࡢࡼࡍ᭩ᝇࠓ㸡ࠒࡷࡴ࡙ࡵ࠷ ࠷࠾࡛Ẵᣚࡔࡃࡼࡗࡂࠓࡡࡡ୯న࢜ࢷࢥࣛ ࡚ᵋᠺࡈࡿࡒ㸣୯న࢜ࢷࢥࣛࠒ㏩ᯊ⒢Ἢ࡞ఔ࠹㌗ మⓏⱖࠓࡢ㸡㹐ゆᾐ࡚ࡀ࠷✰ๆࡡࡲ࡛ᛟࡈ㹒㸡 㹐㏩ᯊ୯ࡡᣂᮨ㛣㛏ࡂⱖ㹒ࡡࡡୖన࢜ࢷ ࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔ㔢ๆࡈࡿࡒࡼࡵࡡࡌࡇ㸝ࡵ ࡡࡌࡇࡂ㸞࠷ࢆ࡚ࡌࠕ㸝h㸞ࡷ㸡ࠔࡼ㸝㔢ࢅๆ ࡌ㸞ᛟࡈࡵ࠵ࡾ㸣ࡐࡼ㸡ゆᾐࡢ࡚ࡀࢆࢂ㸝࡚ࡀ ࠷ࡻࡠ㸞ࠕ㸝a㸞࡛㹐ゆᾐ࡚ࡀ࠷✰ๆࡡࡲ࡛ ᛟࡈ㹒࡛㸡ࠔ┫㆜ᖅ࠾ࡼずࡾ࡛㸡ࡒࡓ㛣ᐱ࡙ࡒ ࡼ࠻࠻࡞ࡶࢀ㸝ᐱ࡙࠷ࡒࡼ࠷࠷ࡡࡓࢀ㸞࡛ᛦ࠹࠾ ࡵ▩ࡿࢆࡄ㸡ኬᴣ㎖࠷ࢂࠕ㸝a㸞࡛㸡㹐㏩ᯊ୯ࡡ ᣂᮨ㛣㛏ࡂⱖ㹒࡛࠷࠹మ㥺ࢅㄊࡖࡒ㸣୯న ࢜ࢷࢥࣛࠒᚨᏭࡼࡍ㨒ࠓࡢ㸡㹐࡞ᗐࡷ ࡽ⤾ࡄࡂ࡙ࡢࡼࡍࡗࡂ㛣↋࠷㹒㸡㹐ᮮࡾࡓ ࡄ࡚⢥ୌ᮴࡚Ẏ㨒㹒㸡㹐⮤⏜ዞࢂࡿࡒᐜࡊ ࡈ࠵ࡽ㸡↋Ẵງ࡚ᴞࡊࡲ↋࠷㹒㸡㹐㏩ᯊࢅࡌࡾ ⩽࡞ࡊ࠾ࢂ࠾ࡼ࠷㎖ࡈ࠵ࡾ㹒㸡㹐㣏ࡡโ㝀ࡢ ㎖ࡂᴞࡊࡲ↋࠷㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺ ࡈࡿࡒ㸣ࠔኬమ㸡࡞ࢆࡡࡵࢆࡷࢀ㸡ⱖࡡ ⧖ࡽ㏁ࡊ࡚㸡ࡗࡂ㛣↋࠷ࢂࠕ㸝a㸞ࡷ㸡ࠔࡵ ࠹ᮮࡾࡓࡄ࡚⢥ୌ᮴㸡ర࠾ࡊࡻ࠹ᛦࡒࡼ㸝ర࠾ࡊ ࡻ࠹࡛ᛦࡖࡒࡼ㸞㸡మງࡵ㛣ࡵ࠷ࡾࡊ㸡㨒࡞ ࡖ࡙ࡂࡾࠕ㸝e㸞࡛㸡మງࡡୖࢅវࡋ࡙࠷ࡾࡆ ࡛ࡷ㏩ᯊ࡞ࡻࡾࠍࡡẴᚹࡊࡈ㸡㨒ࡈࢅㄊࡖࡒ㸣 ࠔ㏩ᯊࡊ࡙ࡾ࡛ࡆ࡞ࡵ⾔ࡄ࠷ࡊ㸡⮤⏜ዞࢂ ࡿࡒࡻ࠹វࡋࠕ㸝f㸞࡛⮤⏜࡞ࡼ࠷㎖ࡈࡷ㸡ࠔẎ ⱖࡊ࠷࡚ࡌ㸣㏩ᯊࢅࡊ࡙ࡾ⩽࡞ࡊ࠾ࢂ࠾ࡼࢆ࠻ ࡼࡈ࠵ࡽࡱࡌ㸝㏩ᯊࡊ࡙ࡾ⩽࡞ࡊ࠾ࢂ࠾ࡼ࠷ ㌗మⓏⱖ࠵ࡾ㸞ࠕ㸝d㸞࡛ெ࡞⌦ゆࡊ࡙ࡵࡼSeisen J. Nurs. Stud., Vol. 2. 2013 ర࡚ࡆࢆࡆ࡛ࡎࢆࢆ࡞ࡶ㸝㏩ᯊࢅࡊࡂ࡙ࡢ ࡼ࠷ࡡ࠾㸞ࠕ㸝a㸞ࡷ㸡ࠔ㸝㏩ᯊ࡞ࡖࡒࡆ࡛ࡢ㸞 㟸ᖏ࡞ṟᛍࡆ࡛࡚ࡌࠕ㸝d㸞࡛㸡ᚨࡡ୯࡞ࡢࡷ ࡢࡽ㏩ᯊ⒢ࡌࡾࡆ࡛࡞ᢤᢘ࠵ࡾࡆ࡛ࢅㄊࡖࡒ㸣 ࠈ୯న࢜ࢷࢥࣛࠒࡷࡴ࡙ࡵ࠷࠷࠾࡛Ẵᣚࡔࡃࡼ ࡗࡂࠓࡢ㸡㹐ᖳ㱃Ⓩ࡞ࡷࡴ࡙ࡵ࠷࠷࠾࡛Ẵᣚࡔ ࡃࡼࡗࡂ㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔᖳ ࡵṋ࡞ࡾࡊ㸡ࡵ࠹࠻࠻ࡷ࠷࠾࡛ࡆ࠹࠷࠹វ ࡋࡵ㸡ࡷࡷࡵࡌࡾ࡛ࡽࡔࡷࢂࠕ㸝a㸞ࡡࡻ࠹࡞㸡 ᖳ㱃ࢅᛦ࠹࡛㸡ࡗ࠷ᢖࡅࡷࡽ࡞ࡽࡐ࠹ᘽࡈ ฝ࡙ࡂࡾࡆ࡛ࢅㄊࡖࡒ㸣
㸩㸣
࠘ࡷࡾࡎࡈ࡛ࡡᢙࡽྙ࠷࠙࡞ࡗ࠷࡙
ࠈ➠ࡡ୕న࢜ࢷࢥࣛࡢ㸡࠘ࡷࡾࡎࡈ࡛ࡡᢙࡽྙ ࠷࡛࠙ྞࡊࡒ㸣ࡆࡿࡢ㸡⒢㣬⏍Ὡࡡࡷࡾࡎ࠷ Ẵᣚࡔ࡛ᢙࡽྙ࠹ࡆ࡛࡚࠵ࡾ㸣ࠒ⮤ฦࡡࡎ࠷࡛ᠼ ࡴࡾࠓ㸡ࠒ᪡ࡂᢜࡄฝࡊࡒ࠷ࠓ㸡ࠒ࠵ࡀࡼࡴࡾࠓ㸡ࠒࡂ ࡻࡂࡻࡎࡍ㛜ࡀ├ࡾࠓ㸡ࠒ࡛ᛦࡖ࡙ࡽวࡾࠓ㸡 ࠒㇿࡄ࠷ࡻ࠹࡞⢥♼ງࢅಕࡗࠓ㸡ࠒ༈ᖅࡡᚽ࿈ࡷ ࡡᝀ⩽ࡡమ㥺ࢅທࡲ࡞ࡌࡾࠓ㸡ࠒࢅ↋࡞ 㐛ࡇࡎࡾࡆ࡛࡞វㅨࡌࡾࠓ㸡ࠒⱖ࠵ࡖ࡙ࡵ㏩ᯊ ࡡ࠽ⶩ࡛វㅨࡌࡾࠓࡡ ࡡ୯న࢜ࢷࢥ࡚ࣛᵋᠺ ࡈࡿࡒ㸣୯న࢜ࢷࢥࣛࠒ⮤ฦࡡࡎ࠷࡛ᠼࡴࡾࠓࡢ㸡 㹐ࡆ࠹ࡖࡒࡡࡵ⮤ฦࡡࡎ࠷ࡓ࡛ᛦ࠹㹒ࡡࡡୖ న࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿ㸡ࠔ⮤ฦᝇ࠷࠾ࡼࡊࡺ࠹ ࠷࡛ᛦࡖ࡙ࡱࡌࠕ㸝h㸞࡛㸡㏩ᯊ⒢ࢅᚪこ ࡛ࡌࡾ≟࡞ࡖࡒࡡࡢ㸡⮤ฦࡡࡎ࠷ࡓ࡛⮤ฦࢅ ㈈ࡴࡾࡆ࡛࡚⣙ᚋࡊࡻ࠹࡛ࡊ࡙࠷ࡾࡆ࡛ࢅㄊࡖࡒ㸣 ୯న࢜ࢷࢥࣛࠒ᪡ࡂᢜࡄฝࡊࡒ࠷ࠓࡢ㸡㹐᪡ࡂ㏩ ᯊ࠾ࡼᢜࡄฝࡌࡆ࡛ࡣ࠾ࡽ⩻࠻࡙࠷ࡾ㹒ࡡࡡ ୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿ㸡ࠔ࠹࡞࠾㸡᪡ࡂ㏩ᯊ ࠾ࡼᢜࡄฝࡎࡒࡼ࡛ࡐࡿࡣࡖ࠾ࡽ࡚࣬࣬ࠕ㸝f㸞࡛㸡 ᪡ࡂ㏩ᯊࢅ⤽⤾ࡌࡾ⏍Ὡ࠾ࡼᢜࡄฝࡊࡒ࠷ᛦ࠷࡚ 㐛ࡇࡊ࡙࠷ࡾࡆ࡛ࢅㄊࡖࡒ㸣୯న࢜ࢷࢥࣛࠒ࠵ࡀ ࡼࡴࡾࠓࡢ㸡㹐㐘ࡓ࡛࠵ࡀࡼࡴࡾ㹒㸡㹐᪁࠷ ࡛࠵ࡀࡼࡴࡾ㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿ ࡒ㸣ࠔࡵ࠹ࡆ࠹ࡖࡒࢆࡷࡊ㸡㐘࠾࡛࠵ࡀࡼ ࡴ࡙ࡾࠕ㸝c㸞㸡ࠔࡵ࠹᪁࠷࡛ᛦࡖ࡙ࡾ㸡࠵ࡀࡼ ࡴ࡙ࡾࠕ㸝e㸞࡛㸡࠵ࡀࡼࡴ࡙ᢙࡽྙࡖ࡙࠷ࡾࡆ࡛ ࢅㄊࡖࡒ㸣୯న࢜ࢷࢥࣛࠒࡂࡻࡂࡻࡎࡍ㛜ࡀ├ࡾࠓ ࡢ㸡㹐㛜ࡀ├ࡖ࡙㉻ࢅᴞࡊࡳࡻ࠹࡞ᚨࡄࡾ㹒㸡 㹐ࡂࡻࡂࡻࡎࡍ࡞ᴞࡊࡂᬵࡼࡌ㹒ࡡࡡୖన࢜ࢷ ࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔ㸝ᐓ࡚㸞ࡋࡖ࡛ࡊ࡙ࢆࢆࡆ ࡛࠷ࡊ㸝ࡋࡖ࡛ࡊ࡙࠷ࡂ࡙ࡢࡼ࠷ࢂࡄ࡚ ࡢ࠷ࡊ㸞㸡㛜ࡀ├ࡖ࡙࣏࣭ࢩࣔࣤࡷࡼ㉻ࢅᴞ ࠻࠷㎖ࡈࡷ㸡ࠔࢤࢴࣈࢅᣚࡗࡓࡄ࡚ࣈࣝࢴࢨࣔ ࣭ࡢវࡋࡾࠕ㸝a㸞㸡ࠔࡢ㸡ࡵ࠹ይࡀࡵࢆ㸝ይ ࡀࡵࡡ㸞ࡵ㣏ࡿࢆࡊ㸡㣏ࡿࡒࡼᎪࡊ࠷ࡄ ࠕ㸝e㸞ࡡࡻ࠹࡞㸡㣏ࡷỀฦโ㝀ࡡ㎖ࡈࢅ ㄊࡖࡒ㸣୯న࢜ࢷࢥࣛࠒโ㝀Ꮼࡿ࠷ᘤࡄ┘ࠓ ࡢ㸡㹐㣏โ㝀ࡷỀฦโ㝀୕ᡥࡂ⾔࠾ࡍ⮤ಘᣚ ࡙࠷㹒㸡㹐㏩ᯊ࡞⾔ࡂࡡ൦ຒ࡞ࡾ㹒ࡡࡡ ୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔ㸝㣏ᣞᑙ㸞⩞࠹࡙ ࡾࡡ࡞㸝⩞ࡖ࡙࠷ࡾࡡ࡞㸞㸡ᐁ⾔࡚ࡀ࠷ࢆ࡚ࡌ ࡻࠕ㸝b㸞࡛㸡㣏⟮⌦ࡡᚪこᛮࡢ⌦ゆ࡚ࡀࡾ ୕ᡥࡂ࡚ࡀ࠷ࡆ࡛ࢅㄊࡖࡒ㸣ࠔ᭽㉫ࡀ࡙మ㔔゛ ࡖ࡙㸡ቌ࠻࡛ࡖࡒࡼࡠ㸝ቌ࠻࡙࠷ࡒࡼ㸞㸡ࡆࡆ ㊂㐘ࡩࡡ㸡㔔࠷࠾ࡖࡒ㸝㔔࠾ࡖࡒ㸞࡚ࡌࢂࠕ㸝b㸞 ࡛㸡โ㝀ࢅᏬࡿ࠷ࡡࡣࡗࡡᝇࡈ࡞ࡗ࠷࡙ㄊࡖ ࡒ㸣୯న࢜ࢷࢥࣛࠒெ࡞㏖ᝠࢅ࠾ࡄࡾᘤࡄ┘ࠓࡢ㸡 㹐ெࡡ㏖ᝠ࡞ࡾ⏍Ὡ࡞ንࢂࡖࡒࡡ࡚᪡ࡂṒࢆ࡚ࡊ ࡱ࠷ࡒ࠷㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔெ ࡡᙲ࡞❟ࡗ㸝ᾐ㜭ኃ㸞ࡊ࡙ࡒࡡ࡞㸡ெ࡞㏖ᝠ ࡞ࡾ㸝⢶ᑺࡡᝇ࡚㏩ᯊ࡛᪺㸞❟ሔ࡞ንࢂ ࡖࡒ࠾ࡼࡠ㸡᪡ࡻṒࢆ࡚ࡊࡱ࠷ࡒ࠷࡚ࡌࢂࠕ㸝h㸞 ࡛Ẵ࡚ெࡡຐࡄࢅᚪこ࡛ࡌࡾ❟ሔ࡞ࡽ㸡ࡐࡿ ࢅெ࡞㏖ᝠࢅ࠾ࡄࡾ㎖ࡈ࡛ࡊ࡙វࡋ࡙࠷ࡾࡆ࡛ࢅ ㄊࡖࡒ㸣୯న࢜ࢷࢥࣛࠒずᤛ࠻ࡼࡿ࠷ Ꮽࠓࡢ㸡㹐ᖳ㱃ࡷ≟࠾ࡼࡡᏭ࡚ずᤛ࠻ࡼ ࡿ࠷㹒㸡㹐㏩ᯊࢅ࠷ࡗࡱ࡚ࡌࡾࡡ࠾Ꮽ࡚ࡒࡱࡼ ࠷㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔᖳ㱃 ࡡ࡞㸡㊂ࡢࡱࡓࡐࡆࡐࡆ㸝ኬኰ㸞࡛ᛦࡖ࡙ࡾ ࡄ㸡࠷ࡗࡱ࡚ࡵࡗ࠾㸝࠷ࡗࡱ࡚ࡡ≟ឺಕ࡙ ࡾ࠾㸞㸡మງಕ࡙ࡾࡷ▩ࡼࢆ࡚㸝మງಕ࡙ ࡾ࠾ฦ࠾ࡼ࠷㸞ࠕ㸝a㸞ࡷ㸡ࠔཪ㐡࡞⬳ᱶራࡡᚃ 㐿᳔࡚∸≟ឺࡡ⩽ࡷࡼ㸡⑭࿄࡚࿄ࡄ࡙ࡾ⩽ࡷࡼ ࡠ㸡⚶ࡵ࠷ࡗࡱ࡚⮤ฦ࡚ᛦ࠹ࡻ࠹࡞ࡷࡖ࡙ࡼࡿࡾ ࢆ࠾࣬࣬ࡠࠕ㸝d㸞࡛㸡మງⓏᏭࡷ㸡࠷ࡗࡱ ࡚⮤ฦࡡណᚷ࡚⒢㣬⏍Ὡࢅ⤾ࡄࡼࡿࡾ࠾࡛࠷࠹ Ꮽࢅㄊࡖࡒ㸣ࠔᏄࡢ᫋࡞ࡖࡒࡼࡾ࠾ࡼࡖ࡙ ゕࡖࡒࡡ࡞㸡࠾࠾ࡲ࠻ࡱࡎࢆࡠࠕ㸝f㸞࡛㸡 ᫋࡞ࡢࡾ࡛ಘࡋ࡙㏩ᯊࢅࡊ࡙࠷ࡾ㸡᫋ࢅ㐛ࡁ ࡙ࡵ⤂ࢂࡼ࠷ࡆ࡛࡚₅↓࡛ࡊࡒᏭ࠵ࡾࡆ࡛ ࢅㄊࡖࡒ㸣୯న࢜ࢷࢥࣛࠒ㏩ᯊࡢୌ⏍ࡷࡽ⤾ࡄ ࡂ࡙ࡢࡼࡍ᭩ᝇࠓࡢ㸡㹐ୌ⏍ࡷࡽ⤾ࡄࡂ࡙ࡢ ࡼࡍ᭩ᝇࡓ㹒㸡㹐㏩ᯊ⒢Ἢࡐࡡࡵࡡ࡞ᢤᢘ࠵ࡾ㹒 ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔୌ⏍ࡀྙ ࢂࢆࡼࢆ㸡ᖳࡼᖳ㸡ᖳࡼᖳᠻះࡊࡒࡼ ࡾࡵࢆ࡛ࡔ࠹㸣᭩ᝇẴࡷࠕ㸝a㸞࡛㸡ୌ ⏍⤾࠷࡙࠷ࡂ㎖ࡈࡷ㸡ࠔ࣏ࢻࢪᛦ⩻࡞⩻࠻ࡾ࡛⪯ἠ┫㆜Ꮥ◂✪ࠈ㸧ᕬ㸝㸞 ࡊࢆ࡚ࡾࠕ㸝d㸞㸡ࠔ⮤ฦࡂࡻࡂࡻࡎࢆ࡛ࡠ㸡Ẏ ᴞࡊࡂᬵࡼࡌ࠷࠹ࡠ㸝ᴞࡊࡂᬵࡼࡌࡆ࡛ࢅࡠ㸞ࠕ 㸝g㸞࡛㸡⒢㣬⏍Ὡࡡࡷࡾࡎ࠷ᛦ࠷࡞㛜ࡀ├ࡾࡆ ࡛࡚ᢙࡽྙࡖ࡙࠷ࡾࡆ࡛ࢅㄊࡖࡒ㸣୯న࢜ࢷࢥࣛ ࠒ࡛ᛦࡖ࡙ࡽวࡾࠓࡢ㸡㹐ṋࢅ࡛ࡖ࡙࠾ࡼࡡ ࡛ᛦ࠷ࡽวࡾ㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋ ᠺࡈࡿ㸡ࠔṋ࠷ࡖ࡙࠾ࡼࡵࡼࡖࡒࡷ࡛ᛦࡖ࡙㸡 ࠵ࡾ⛤ᗐࡽวࡼࢆ࡛ࠕ㸝a㸞࡛ㄊࡖࡒ㸣୯న࢜ࢷ ࢥࣛࠒㇿࡄ࠷ࡻ࠹࡞⢥♼ງࢅಕࡗࠓࡢ㸡㹐⮤ฦ ࡞ㇿࡄ࠷ࡻ࠹࡞ୌ⏍ᠩຑງࡌࡾ㹒ࡡࡡୖ న࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿ㸡ࠔୌ⏍ࡀྙࢂࢆࡼࢆ ࢂ㸡⮤ฦࢅࡊࡖ࠾ࡽᣚࡖ࡙㸡ᚨᚋ࡛࠾ࢆ࡛ࡻ㸝ᚨ ᚋ࡙࠽࠾࠷࡛㸞㸡ࡷࡵࡌࡾ࡛ㇿࡄ࡙ࡊࡱ࠷ࡐ࠹ ࡞ࡾࡷࢀ࣬࣬㸴ࡐࡷ࠾ࡼୌ⏍ᠩຑງࡌࡾࠕ㸝a㸞 ࡛㸡ୌ⏍ᠩ⮤ฦࡡ⢥♼Ⓩᘽࡈ࡞ㇿࡄ࠷ຑງ ࢅࡊ࡙࠷ࡾࡆ࡛ࢅㄊࡖࡒ㸣୯న࢜ࢷࢥࣛࠒ༈ᖅࡡ ᚽ࿈ࡷࡡᝀ⩽ࡡమ㥺ࢅທࡲ࡞ࡌࡾࠓࡢ㸡㹐ಘ㢏 ࡊ࡙࠷ࡒ༈ᖅࡡᚽ࿈ࢅᡥᘤࡀ࡞ࡌࡾ㹒㸡㹐మ㥺ㄧࢅ ㄖࢆ࡚ທࡲ࡞ࡌࡾ㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺ ࡈࡿࡒ㸣ࠔ⚶ࡇཀ࡞ࡖࡒ⏍ࡡࡠ㸡ゕࢂࡿ ࡒࡆ࡛ࢅẎᛦ࠷ฝࡊ࡙㸡ᚽᐁ࡞Ꮼࡖ࡙វㅨࡊ࡙ 㐛ࡇࡊ࡙ࡾࠕ㸝d㸞ࡷ㸡ࠔࡢࡋࡴࡢ㸡ࡵ࠹㸝㏩ᯊ㸞 ᎒࡚᎒࡚ᐓ᪐࡞ࡵࡍ࠷ࡩࢆ㎖ࡂ࠵ࡒࡖࡒࡻ㸣ࡄ 㸡ெࡡమ㥺ㄧ࡛࠾ㄖࢆ࡚ࡠ㸡⮤ฦࡓࡄࡷ࠷ ࠵࡛ᛦࡖ࡙ࡠ㸡ࡐ࠹࠷࠹ࢆ࡞ທࡱࡈࡿࡒࡠࠕ㸝e㸞 ࡛㸡ྜྷࡋᛦ࠷ࢅࡊ࡙࠷ࡾࡡ㏩ᯊᝀ⩽ࡡ⤊㥺ࢅ▩ ࡽ㸡⮤ฦࡓࡄ࡚ࡢ࠷࡛ᛦ࠻ࡒࡆ࡛࡚㏩ᯊࡡ⒢㣬 ⏍Ὡࢅུࡄථࡿ࡙ࡀࡒࡆ࡛ࢅㄊࡖࡒ㸣୯న࢜ࢷࢥ ࣛࠒࢅ↋࡞㐛ࡇࡎࡾࡆ࡛࡞វㅨࡌࡾࠓࡢ㸡 㹐ࢅ↋࡞㐛ࡇࡎࡾࡆ࡛࡞វㅨࡌࡾ㹒ࡡ ࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔ↋࡚ᬵࡿ࡙ ࡂࡿࡒࡼ࠷࠷㸡ࢆ࡚ࡵ࠹༎ฦ࠾࡛ᛦ࠹ࠕ㸝c㸞 ࡷ㸡ࠔࡢ㸡ࡐࡡࡐࡡ↋࡞ᬵࡼࡎࡒࡼ࠷࠷㸡 ࡵ࠹ࡐࡿវㅨࡷࠕ㸝e㸞࡛㸡ࠍ↋࡚࠷ࡼࡿ ࡾࡆ࡛࡞វㅨࡌࡾࡆ࡛࡚ࡷࡾࡎࡈ࡛ᢙࡽྙࡖ࡙ ࠷ࡾࡆ࡛ࢅㄊࡖࡒ㸣୯న࢜ࢷࢥࣛࠒⱖ࠵ࡖ࡙ ࡵ㏩ᯊࡡ࠽ⶩ࡛វㅨࡌࡾࠓࡢ㸡㹐㏩ᯊࡡ࠽ⶩ࡚⏍ ࡀ࡙࠷ࡼࡿࡾ㹒㸡㹐ᶭࡡ㐅Ṅ࠵ࡽࡒ࠷㹒ࡡ ࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔⱖࡊ࠷ᛦ࠷ࡵ ࡌࡾࡄ㸡㏩ᯊࡡ࠽ⶩ࡚⏍ࡀỄࡼ࠻࡙ࡾࡡࡷ࡛ ᛦ࠷ࡱࡌࠕ㸝d㸞ࡷ㸡ࠔ࠵ࡽࡒ࠷࡛ᛦࡖ࡙ࡾࡻ㸡 ᪿࡷࡖࡒࡼ࠾ࡖࡒࡼࡊ࠷ࡊ㸡ᶭࡻࡂ ࡖࡒࡼࡊ࠷ࡻࡖ࡙ࡠࠕ㸝e㸞ࡡࡻ࠹࡞㸡㏩ᯊ⒢ࡢ ⱖ࡚࠵ࡾ㸡⏍ࡀ࡙࠷ࡼࡿࡾࡡࡢ㏩ᯊࡡ࠽ⶩ࡚ ࠵ࡾ࡛ᛦ࠹ࡆ࡛࡚ᢙࡽྙࡖ࡙࠷ࡾࡆ࡛ࢅㄊࡖࡒ㸣
㸪㸣
࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾㆉ࠙࡞ࡗ࠷࡙
ࠈ➠ࡡ୕న࢜ࢷࢥࣛࡢ㸡࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾㆉ࠙ ࡛ྞࡊ㸡ࠒ࿔ᅑࡡெࡡᬦ࠾ࡈ࠵ࡽࡒ࠷ࠓ㸡ࠒ༈ ᖅࡷࢪࢰࢴࣆࡡ⌦ゆࡷທࡱࡊࢅᐁវࠓ㸡ࠒᐓ᪐࡛࠷ ࡙ࡵአវࢅវࡋࡾࠓ㸡ࠒஷࡂࡖࡒኰࢅᛦ࠷ฝࡊ ࡙㐛ࡇࡌࠓ㸡ࠒ༈⒢⩽࡛ࡡ㛭౿࡞Ꮽᚨវࢅᚋࡒ࠷ࠓ ࡡࡡ୯న࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿ㸡࿔ᅑ࡛ࡡெ㛣 㛭౿ࡡ୯࡞⮤ᕤࡡᏋᅹ౮ೋࢅヾㆉࡌࡾమ㥺ࢅࡊ࡙ ࠷ࡾࡆ࡛࡚࠵ࡾ㸣୯న࢜ࢷࢥࣛࠒ࿔ᅑࡡெࡡᬦ࠾ ࡈ࠵ࡽࡒ࠷ࠓࡢ㸡㹐ᐓ᪐ࡡᬦ࠾ࡈ࡞វㅨࡊ࡙ ࠷ࡾ㹒㸡㹐࿔ᅑࡡெࡡይណ࠵ࡽࡒ࠷㹒ࡡࡡ ୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔெ㸡ࡔࡶࢆ࡛ ฝ࡙ࡀ࡙㸡㸝㏞㎼ࡡࢪࢰࢴࣆ࡞㸞ୌ⥬࡞࠽♡ゕ࠹ ࡙ࡂࡿࡱࡌࡊࡠ㸡࠵ࡽࡒ࠷࡛ᛦࡖ࡙ࠕ㸝b㸞ࡷ㸡 ࠔ⚶㸡ࡔࡺࡖ࡛㸝࣏࣭ࢩࣔࣤ㸞ఆࢆ࡚ࡊࡣࡼࡂ ⾔ࡄࢆ࡛ࡠ㸡ࡌࡃ㞹ヨ࡚ࡠ㸡࠷ࡗ࡚ࡵᖆ✭ࡄ࡙ ᙽࡖ࡙ࡾ࡚ࡖ࡙ທࡱࡊ࡙ࡂࡿ࡙ࡠ㸡ᛦࢂࡍᾞฝ ࡾ࡛ࡀ࠵ࡽࡱࡌࠕ㸝d㸞࡛㸡࿔ᅑ࠾ࡼ⮤ฦࡡࡒࡴ ࡞ᬦ࠾࠷ᨥᥴࢅུࡄ࡙࠷ࡾ࡛វࡋ࡙࠷ࡾࡆ࡛ࢅㄊ ࡖࡒ㸣୯న࢜ࢷࢥࣛࠒ༈ᖅࡷࢪࢰࢴࣆࡡ⌦ゆࡷທ ࡱࡊࢅᐁវࡌࡾࠓࡢ㸡㹐㝌ࡡ㏞㎼ࢦ࣭ࣄࢪ࠵ ࡽࡒ࠷㹒㸡㹐༈ᖅࡷ┫㆜ᖅ࡞⌦ゆࡊ㸡ທࡱࡈࡿ࡙ ࠷ࡾࡆ࡛ࢅᐁវࡌࡾ㹒㸡㹐⧖ࡽ㏁ࡈࡿࡾἸណࡢ⮤ฦ ࡡࡒࡴ࡛ᛦ࠹㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿ ࡒ㸣ࠔࡆࡆ㸝㝌㸞ࡢ㸡㌬࡚㏞ࡽ㎼࠻ࡊ࡙ࡵࡼ࠻ ࡾࡡ࠵ࡽࡒ࠷ࠕ㸝b㸞ࡷ㸡ࠔ⏍ࡷࡼ┫㆜ᖅࡈ ࢆࡢ㸡ൃ᪉⾔ይࡀࡆ࡛ࢅ▩ࡖ࡙ࡂࡿ࡙ࡢࡖ ࡙ࡠ㸡᪉⾔࡞⾔ࡄࡾࡻ࠹࡞㸡㸝᪉⾔㸞ࡡ㝌ࢅ ᥀ࡊ࡙ࡂࡿࡢࡖࡒࡽࡠࠕ㸝d㸞㸡ࠔమ㔔ቌ࠻࡙ࡂ ࡾ࡛ࡠ㸡ࡀࡗ࠹㸝ࡀࡗࡂ㸞Ἰណࡈࡿࡾࡵ࠵ࡽࡱ ࡌ࡞ࡶࡄ㸝࠵ࡽࡱࡌࡄࡿ㸞㸡ࡐࡿࡵ⮤ฦࡡࡆ ࡛ࢅᛦࡖ࡙ゕ࠹࡙ࡂࡿࡢࡾࢆࡷ࡛ᛦࡖ࡙ࡠࠕ㸝g㸞 ࡛㸡༈ᖅࡷࢪࢰࢴࣆࡼ࡛ࡡ㛭౿ࢅ㏳ࡊ࡙㸡⮤ฦࡡ Ꮛᅹ౮ೋࢅヾࡴࡼࡿ࡙࠷ࡾ࡛ヾㆉࢅࡊ࡙࠷ࡾࡆ࡛ ࢅㄊࡖࡒ㸣୯న࢜ࢷࢥࣛࠒᐓ᪐࡛࠷࡙ࡵአវࢅ វࡋࡾࠓࡢ㸡㹐ᐓ᪐࡞ኇࢅ࠾ࡄ࡙ࡵཱིࡽྙࡖ࡙ࡂ ࡿ࠷㹒㸡㹐ᐓ᪐࠾ࡼඁࡊ࠷ᚨ㒼ࡽវࡋࡼࡿ࠷㹒 ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔࡇࡲᤖ࡙࡙ ࠷࠹࡙ࡵ㸡ࠖ㸡ࡊ࠵࠾ࢆࡆ࡛࠷ࡷࢀࠗ࠷࠹ ࡙࣬࣬㸡⮤ฦࡢ㛏࠷ࡆ࡛㞹ヨ࡚ヨࡊ࡛ࡾࢆ࡚ࡌࠕ㸝h㸞 ࡷ㸡ࠔ㸝ጏ㸞ᖉࡖ࡙ࡀ࡙ࡵ㸡ൃࡡ㒂ᒁࡱ࡚ᮮ࡙ㄢ Ꮔ࠻࠻࠾㸝ㄢᏄࡢ࠷࠷࠾㸞࡛࠾ࡢ⪲࠷࡙ࡂࡿ ࠷ࠕ㸝h㸞࡛㸡ᐓ᪐ࡡᑊᚺ࡞አវࢅវࡋ࡙࠷ࡾ ࡆ࡛ࢅㄊࡖࡒ㸣୯న࢜ࢷࢥࣛࠒஷࡂࡖࡒኰࢅᛦ ࠷ฝࡊ࡙㐛ࡇࡌࠓࡢ㸡㹐ஷࡂࡖࡒኰ࡛ࡡ࠷࠷ᛦSeisen J. Nurs. Stud., Vol. 2. 2013 ࡚ࡵ▯࠷㛣࡚ࡌࡳ࡛࠾㸡ࡐࢆ◂✪ࡵࡊ࡙ࡊ ࠷ࠕ㸝a㸞࡛ㄊࡼࡿ㸡ࠔ⭀⮒ࢅᡘࡌ⣵⬂ฝᮮࡾ࡛ ࠾ࡠ࣬࣬㸣⭀⮒ࡊ࡙ࡵࡼ࠻ࡾࡡࡼ㸡ࡐࡿࡱ࡚⏍ ࡀ࡙࠷ࡒ࠷࡛ᛦ࠷ࡱࡌࠕ㸝h㸞࡛ㄊࡽ㸡⒢㣬⏍Ὡ ࡡ㎖ࡈ࠾ࡼࡡゆᨲࡷ㸡ࡈࡼࡾ༈⒢ࡡ㐅Ṅ࡛ࡐࡡ ᜠ࡞࠵ࡍ࠾ࡽࡒ࠷࡛࠷࠹ᙽㄊࡼࡿࡒ㸣
ϫ㸣⩻ࠈᐳ
ࠈ㧏㱃㏩ᯊᝀ⩽ࡡ⒢㣬⏍Ὡ࡞࠽ࡄࡾమ㥺ࡡណࡘ ࡄ࡛ࡊ࡙ฝࡈࡿࡒ࢜ࢷࢥ࡛ࣛ࢜ࢷࢥࣛࡡ㛭㏻ࢅ ᳠ゞࡊ㸡㧏㱃㏩ᯊᝀ⩽ࡡ⒢㣬⏍Ὡ࡞࠽ࡄࡾమ㥺ࡡ ណࡘࡄ࡞ࡗ࠷࡙⩻ᐳࡌࡾ㸣㸦㸣୕న࢜ࢷࢥࣛ㛣ࡡ㛭㏻࡞ࡗ࠷࡙
ࠈ㧏㱃㏩ᯊᝀ⩽ࡢ㸡࠘⏍࠵ࡾ⩽࡛ࡊ࡙⏍ࡀᢜࡂጶ ເ࠙ࢅᙁࡂᣚࡗࡆ࡛࡞ࡻࡖ࡙㸡⒢㣬⏍Ὡࢅ࠘ළ⁝ ࡞㐛ࡇࡎࡾຑງ࠙ࢅࡊ࡙࠷ࡒ㸣ࡊ࠾ࡊ㸡ࡐࡡୌ᪁ ࡚㸡࠘ᬧ⃢࡛ࡊ࡙ࡷࡾࡎ࠷࠙Ẵᣚࡔࢅᣚࡗ㸣㧏 㱃㏩ᯊᝀ⩽࡞࡛ࡖ࡙㸡㏩ᯊࡡ⒢㣬⏍Ὡࡡུᐖ࡛ࡢ㸡 ࠘ᬧ⃢࡛ࡊ࡙ࡷࡾࡎ࠷࠙మ㥺࡚࠵ࡽ㸡࠘ළ⁝࡞㐛 ࡇࡌຑງ࡛࠙࠘ᬧ⃢࡛ࡊ࡙ࡷࡾࡎ࠷࠙మ㥺࡛ࡡ 㛣࡚⏍ࡋࡒࡿິࡂẴᣚࡔࡡ୯࠾ࡼ㉫ࡀࡒ࠘ࡷࡾ ࡎࡈ࡛ࡡᢙࡽྙ࠷࡚࠙࠵ࡖࡒ㸣ࡈࡼ࡞㸡࠘⏍࠵ ࡾ⩽࡛ࡊ࡙⏍ࡀᢜࡂጶເ࠙ࡡ⏍ࡡᕵịࡢ㸡࠘ࡷ ࡾࡎࡈ࡛ࡡᢙࡽྙ࠷࠙ࢅࡗࡄࡾࡆ࡛࡞⦽ࡖ࡙ ࠷ࡒ㸣ࡱࡒ㸡࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾㆉ࠙࡞ࡻࡖ࡙㸡 ࠘⒢㣬⏍Ὡ࡞࠽ࡄࡾᙽ࠙⏍ࡱࡿ㸡࠘ළ⁝࡞㐛ࡇ ࡌຑງ࠙࡞⦽ࡖ࡙࠷ࡒ࡛⩻࠻ࡼࡿࡾ㸣㸧㸣
࠘⏍࠵ࡾ⩽࡛ࡊ࡙⏍ࡀᢜࡂጶເ࠙࠾ࡼ⏍ࡱࡿࡒ
ࠈ
࠘ළ⁝࡞㐛ࡇࡌࡒࡴࡡຑງ࠙ࡡమ㥺࡞ࡗ࠷࡙
ࠈ㔔ష㸝㸞ࡢ㸡㏩ᯊᝀ⩽ࡢṒࡡᜅᛟ㸡⏍ ࡡᕵịࢅᣚࡗࡆ࡛ࢅᣞᦤࡊ࡙࠷ࡾ㸣ᮇ◂✪࡚ࡢ㸡 ࠘⏍࠵ࡾ⩽࡛ࡊ࡙⏍ࡀᢜࡂጶເ࡛࠙ࡊ࡙㸡ࠒṒࡢᜅ ᛟ࡚࠵ࡽ㸡ᩓ࡚࠵ࡾࠓ㸡ࠒ⏍ࡀࡾࡒࡴ࡞⒢࡞ཱིࡽ ⤄ࡳࠓ࡛ࠒᐓ᪐ࡡࡒࡴ࡞㛏⏍ࡀࡌࡾࠓ࠾ࡼᵋᠺࡈ ࡿࡒ㸣ࠒṒࡢᜅᛟ࡚࠵ࡽ㸡ᩓ࡚࠵ࡾࠓࡢ㸡⭀ධ ࡢ⒭ࡎࡍ㸡ᖏ࡞Ṓࢅណㆉࡎࡉࡾࢅ࠻࠷ࡆ࡛ࢅ ណࡌࡾ㸣ࡐࡡࡒࡴ㸡㐲ว⒢ࢅུࡄࡒ࠷࡛࠷ ࠹ᛦ࠷࡚࠵ࡾࠒ⏍ࡀࡾࡒࡴ࡞⒢࡞ཱིࡽ⤄ࡳࠓ࡛ ࠷࠹ጶເ࡛ࡊ࡙ណࡘࡄࡼࡿࡒ㸣ࡱࡒ㸡ᑚᒜහࡼ 㸝 㸞ࡢ㸡ṋ௧୕ࡡ㏩ᯊᝀ⩽࡚ࡢ㸡ᐓ᪐ࢅ⏍ ࡀ࠷࡛ࡊ࡙ᣪࡅࡾ⩽᭩ኣ࡚࠵ࡾࡆ࡛ࢅᣞᦤࡊ ࡙࠷ࡾ㸣◂✪༝ງ⩽ࡢ㸡භ࡞㧏㱃࡛ࡖࡒኰࢅず ࠷ฝࢅᛦ࠷ฝࡊ࡙㐛ࡇࡌ㹒ࡡࡡୖన࢜ࢷࢥࣛ ࡚ᵋᠺࡈࡿࡒ㸣㹷ெ㏵ࡖ࡙ࡔࡺ࠹ᖳఴࡽ࡚ ࡌ㸣᪉⾔࡞⾔ࡖࡒࡆ࡛࡛࠾㸡࠷࠷ᛦ࠷ฝࢅࡠ࣬࣬㸡 ᠔࠾ࡊࢆ࡚ࡾ㹸㸝f㸞࡛㸡ୌெ࡞ࡖࡒᏓ≺វࢅវ ࡋ࡙࠷ࡾమ㥺ࡵ࠵ࡖࡒ㸣୯న࢜ࢷࢥࣛࠒ༈⒢⩽࡛ࡡ 㛭౿࡞Ꮽᚨវࢅᚋࡒ࠷ࠓࡢ㸡㹐௧୕࡞༈ᖅࡷࢪࢰ ࢴࣆ࡛ࡡᐠ㛭౿ࢅᣚࡔ㸡ᚨࡳᏭᚨវࢅᚋࡒ࠷㹒 ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣ࠔᝀ⩽ࡢ㸡⢥ ♼Ⓩ࡞ࡵ㸡ṋ࠷ࡖ࡙మງⓏ࡞ࡵࡱ࠷ࡖ࡙ࡾࢂ㸡ࡵ ࡖ࡛௧୕࡞┫㆜ࡌࡾ࠹࡛ࡡᐠᚨࡳ㛭౿ ࡊ࠷ࢂࠕ㸝a㸞࡛㸡ࢪࢰࢴࣆ࡛ࡡ㛭౿࡞࠽ࡄࡾ វࢅវࡋ࡙࠷ࡾࡆ࡛ࡵㄊࡖࡒ㸣㸫㸣
࠘⒢㣬⏍Ὡ࡞࠽ࡄࡾᙽ࠙࡞ࡗ࠷࡙
ࠈ➠ࡡ୕న࢜ࢷࢥࣛࡢ࠘⒢㣬⏍Ὡ࡞࠽ࡄࡾᙽ࠙ ࡛ྞࡊࡒ㸣ࡆࡿࡢ㸡㧏㱃㏩ᯊᝀ⩽ࡡ⒢㣬⏍Ὡ࡞ ࠽ࡄࡾᙽ࡚࠵ࡽ㸡ࠒ⮤ฦࡡᑑᮮ࡞ᑊࡌࡾᙽࠓ㸡 ࠒᖏࡡ୯࡞࠵ࡾᴞࡊࡲࠓ㸡ࠒ༈⒢ࡡ㐅Ṅ࡞ᑊࡌࡾ ᙽࠓࡡࡡ୯న࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣୯న ࢜ࢷࢥࣛࠒ⮤ฦࡡᑑᮮ࡞ᑊࡌࡾᙽࠓࡢ㸡㹐ඔẴ ࡞ࡖ࡙ெ࡞ႌࢆ࡚ࡵࡼ࠷ࡒ࠷㹒㸡㹐ፃࢅᎋࡎ࡙ ᏘࡡᏄᏬࡊࡒ࠷㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺ ࡈࡿࡒ㸣ࠔ᪡ࡂඔẴ࡞ࡖ࡙ࡠ㸡∳㣨ࡆࡊࡼ࠻ ࡙㸡ࡲࢆ࡞ࡵࡼࡖ࡙ࡵࢀ࡙㸝ࡵࡼࡖ࡙࠷ࡒࡓ࠷ ࡙㸞ႌࢆ࡚ࡵࡼ࠷ࡒ࠷ࠕ㸝b㸞ࡷ㸡ࠔፃᎋࡎ࡙㸡 Ꮨࡡࡵࡽ㸝ᏄᏬ㸞ࡊࡒ࠷ࠕ㸝g㸞࡛㏩ᯊࢅࡊ࡙ඔ Ẵ࡞㐛ࡇࡊ㸡ࡵ࠹ୌᗐெࡡᙲ࡞❟ࡔࡒ࠷࡛࠷࠹ᛦ ࠷ㄊࡼࡿࡒ㸣୯న࢜ࢷࢥࣛࠒᖏ࡞࠵ࡾᴞࡊࡲࠓ ࡢ㸡㹐ಘ௭ᚨ࡞ႌࡦࢅずฝࡌ㹒㸡㹐ࢸࢦ࣭ࣄࢪ࡞ ⾔ࡂ㹒㸡㹐ࢪ࣭࣎ࢵびᡋࡷ㉻ࢅᴞࡊࡳ㹒㸡㹐Ꮨ࡛ࡡ ࡨࡿ࠵࠷ࢅᴞࡊࡳ㹒ࡡࡡୖన࢜ࢷࢥࣛ࠾ࡼᵋ ᠺࡈࡿࡒ㸣ࠔᪿ࠾ࡼቨ࡞ᡥࢅྙࢂࡊ࡙ࡱࡌ㸡ᚨ ⴘࡔ╌ࡂࡊ㸣࡛ࠖࢀࡀࠗ࠷࠹ᮇᮮࡾࡡᴞ ࡊࡲ࡚ࡌࠕ㸝b㸞ࡷ㸡㹷ࢸࢦ࣭ࣄࢪ࡞⾔ࡂ࡛㸡ࡲ ࢆ࡞ඔẴࡵࡼ࠷ࡱࡌࢂ㹸㸝b㸞㸡㹷࣏࣭ࢩࣔࣤ⾔ ࡖ࡙ࡾ࡛ࡠ㸡ࡐࡡࡓࡄࡢ㏩ᯊࡡࡆ࡛ᚸࡿࡱࡌࡊ ࡠ㹸㸝d㸞ࡷ㸡㹷Ꮨࡡࡔ࠷ࡔࡶ࠷ᡥ࡚ࡠ㸡ࣃࣚࣃࣚ ࡛࣬࣬㸡ࡐࡡᑑᮮࢅ⩻࠻ࡾ࡛ᴞࡊࡲ࡚ࡠ㹸㸝h㸞࡛㸡 ᖏࡡࡈࡈࡷ࠾ႌࡦࡡ୯࡞㸡⒢㣬⏍Ὡࡡ㎖ࡈ࠾ ࡼゆᨲࡈࡿࡾ█㛣࠵ࡾࡆ࡛ㄊࡼࡿࡒ㸣୯న ࢜ࢷࢥࣛࠒ༈⒢ࡡ㐅Ṅ࡞ᑊࡌࡾᙽࠓࡢ㸡㹐㏩ᯊ ࡡ㛣ࡷ✰ๆࡡࡲ㍅΅ࡌࡾ◂✪࡞ᙽࡌࡾ㹒㸡 㹐⭀⮒ࢅ්⏍ࡌࡾࡻ࠹◂✪㐅ࡳࡼࡐࡿࡱ࡚ ⏍ࡀ࡙࠷ࡒ࠷㹒ࡡࡡୖన࢜ࢷࢥ࡚ࣛᵋᠺࡈࡿࡒ㸣 ࠔ㔢࡚ࡵ㸡ࡵ࠹ࡔࡺࡖ࡛ࡂ࠷㸡㛣ࡔࡺࡖ࡛⪯ἠ┫㆜Ꮥ◂✪ࠈ㸧ᕬ㸝㸞 ࡛Ẵᣚࡔࡃࡼࡗࡂࠓ࡛࠷࠹࠘ᬧ⃢࡛ࡊ࡙ࡷࡾࡎ ࠷࠙మ㥺࡛ណࡘࡄࡼࡿࡒ㸣ࠒ㏩ᯊ⒢Ἢ࡞ఔ࠹ ㌗మⓏⱖࠓࡢ㸡㹐ゆᾐ࡚ࡀ࠷✰ๆࡡࡲ࡛ᛟ ࡈ㹒࡛㹐㏩ᯊ୯ࡡᣂᮨ㛣㛏ࡂⱖ㹒࡛࠷࠹ࡆ ࡛࡚࠵ࡖࡒ㸣㏩ᯊᝀ⩽࡞࡛ࡖ࡙⒢㛣ࡡ㛏ࡈ ࡢ㸡㏩ᯊࡡུᐖ࡞ᙫ㡢ࢅ࠻㸝ࢨ࢘ࣛࣆኣ⏛㔕㸡 ኬ⏛㸡㸰ኬಲ㸡ᮟ⏛㸡㸞㸡ࢪࢹࣝࢪࡡこ ᅄ࡞ࡾ㸝ḿᮄ㸡 㸞㸣㧏㱃㏩ᯊᝀ⩽ࡢ㸡ᚨᶭ ⬗㸡ᚘ⎌ჹᶭ⬗ࡡୖ࠾ࡼ㏩ᯊ୯ࡷ㏩ᯊᚃ࡞⾉ᅸ ୖࢅࡀࡒࡊࡷࡌࡂ㸡మ㔔ቌຊࡡ≟Ἓ࡞ࡻࡽ ㏩ᯊ㛣ࡡᘇ㛏ᚪこ࡛ࡽ㸡㌗మⓏⱖࡷᙁ ࠷ࢪࢹࣝࢪࢅវࡋ࡙࠷ࡾࡆ࡛᥆ᐳࡈࡿࡾ㸣㹐㏩ ᯊ୯ࡡᣂᮨ㛣㛏ࡂⱖ㹒࡚࠵ࡾ࡛࠷࠹మ㥺ࡢ㸡 ࠒ㏩ᯊ⒢Ἢ࡞ఔ࠹㌗మⓏⱖࠓ࡛ࡊ࡙⧖ࡽ㏁ࡈࡿ ࡾ㸣࡞ᗐࡡ㏳㝌㏩ᯊ࡛࠷࠹Ẵࡏࢂࡊࡈ࡞ࡻࡖ ࡙㸡⮤⏜ࢅዞࢂࡿࡒ㎖ࡈࡢ㸡㏩ᯊࢅࡊ࡙࠷ࡾ⩽࡞ ࡊ࠾ࢂ࠾ࡼ࠷㎖ࡈ࡛ࡽ㸡ࠒᚨᏭࡼࡍ㨒ࠓ మ㥺࡛ࡊ࡙ណࡘࡄࡼࡿ㸡㏩ᯊࡡུᐖ࡞ࡵᙫ㡢 ࡊ࡙࠷ࡒ㸣 ࠈࡈࡼ࡞㸡㏩ᯊ㛣ࡡᘇ㛏࡛࠷࠹⌟㇗ࡢ㸡ࠒโ㝀 Ꮼࡿ࠷ᘤࡄ┘ࠓ࡛ࡊ࡙ណࡘࡄࡼࡿ㸡㣟Ềโ 㝀Ꮼࡿ࠾ࡖࡒࡆ࡛࡞ᑊࡌࡾ༈⒢⫃ࡡビ౮ࢅណ ㆉࡌࡾࡆ࡛࡞ࡻࡖ࡙⏍ࡋ࡙࠷ࡒ㸣㏩ᯊᝀ⩽ࡡࢪࢹ ࣝࢪࡡ୕న࡞࠵ࡾ㣟Ềโ㝀ࡢ㸡⏍⌦Ⓩḟịࡡโ㝀 ࡞ᑊࡌࡾ㎖ࡈ࡛ࡊ࡙ヾㆉࡈࡿࡾ㸝ࢨ࢘ࣛࣆኣ⏛㔕㸡 ኬ⏛㸡㸰ḿᮄࡼ㸡 㸞㸡ᮇ◂✪࡚ࡢ㸡㣟 Ềโ㝀ࢅᏬࡾ㎖ࡈ࡚ࡢࡂ㸡㣟Ềโ㝀୕ᡥࡂ࡚ ࡀ࠾ࡖࡒ⤎ᯕ࡛ࡊ࡙⌟ࡿࡒమ㔔ቌຊ࡞ᑊࡌࡾ༈ ⒢⫃ࡡビ౮࡞ᘤࡄ┘ࢅវࡋࡾ⮤ᕤຝງវࡡୖ࡛ ࡊ࡙ណࡘࡄࡼࡿࡒ㸣 ࠈḿᮄ㸝 㸞㸡㏩ᯊᝀ⩽ࡡࢪࢹࣝࢪࡡ୕న࡞ ࠵ࡾᑑᮮ࡞ᑊࡌࡾᏭࡢ㸡Ṓ࡛ࡡ├㟻࣬Ẵࡷ⏍ ᚃ㸡⮤ฦࡡᑑᮮാࡡᏭ࡚࠵ࡾ࡛ᣞᦤࡊ࡙࠷ ࡾ㸣ᮇ◂✪࡞࠽࠷࡙ࡵ㸡◂✪༝ງ⩽ࡢ㸡⒢㣬⏍Ὡ ࡞࠽ࡄࡾᑑᮮ࡞ᑊࡌࡾᏭࢅమ㥺ࡊ࡙࠷ࡒ㸡ᠺ ெࡡ㏩ᯊᝀ⩽࡛ࡢ␏ࡾࡵࡡ࡚࠵ࡖࡒ㸣◂✪༝ ງ⩽ࡢ㸡ᖳ࡛࡛ࡵ࡞⬳⾉⟮⑄ᝀࡷヾ▩ࢅᝀࡖࡒ ㌗㎾ཪெࡼࢅ┘ࡡᙔࡒࡽ࡞ࡌࡾࡆ࡛࡚㸡࠷ࡗࡱ ࡚⮤ฦࡡ᪺☔ណᚷ࡞ࡻࡖ࡙㏩ᯊ⒢ࢅ⤽⤾࡚ ࡀࡾ࠾ྫྷ࠾࡛࠷࠹⮤ᕤࡡᑕཚ࡞㛭ࡾណࡵྱࢆ ࡓࠒずᤛ࠻ࡼࡿ࠷Ꮽࠓ࡛ࡊ࡙ណࡘࡄ࡙ ࠷ࡒ㸣ࡈࡼ࡞㸡✲↓ࡡ㏩ᯊᑙථࡡ㝷࡞༎ฦㄕ᪺ ࢅུࡄ࡙࠷࠾ࡖࡒሔྙࡢ㸡㏩ᯊ⒢ࡡ⤂ࢅ ᙽࡊ㸡ず࠻࠷₅↓࡛ࡊࡒᏭࢅᢢ࠷࡙࠷ࡒ㸣 ༈⒢୕ࡡ⮤ᕤỬᏽࡢ㸡ᖳ㱃㧏ࡂࡾᾐᴗ ㏞ࡾࡆ࡛ࢅጏࡡᙲࡷ㈈௴࡚࠵ࡾ࡛ᤂ࠻ࡒࡽ㸡ẍ ஷࡂࡖࡒṋࢅ┘ᵾ࡞㛏⏍ࡀࡌࡾࡆ࡛Ꮔࡡ ᙲ࡚࠵ࡾ࡛ᤂ࠻ࡾ㸡ࠒᐓ᪐ࡡࡒࡴ࡞㛏⏍ࡀ ࡌࡾࠓࡆ࡛ࢅ⏍ࡀࡾ┘Ⓩࡷ⏍ࡀ࠷࡛ࡊ࡙ណࡘ ࡄ࡙࠷ࡒ㸣 ࠈ࠘ළ⁝࡞㐛ࡇࡌࡒࡴࡡຑງ࡛࠙ࡊ࡙㸡ࠒࢬࣜࣆࢢ ࢅ⤽⤾ࡌࡾຑງࠓ㸡ࠒᖳ㱃ࢅᐁវࡊ㸡༱㝜ᅂ㑂ࡡ ࡒࡴࡡ⮤⾠ࠓࢅࡊ࡙࠷ࡒ㸣ࠒࢬࣜࣆࢢࢅ⤽⤾ࡌ ࡾຑງࠓ࡚ࡢ㸡Ềฦࡷ㣏ࡡ⟮⌦࡞ࡢ≁࡞Ἰណࢅ ᡮ࠷㸡࿔ᅑ࠾ࡼࡡ༝ງࢅ✒ᴗⓏ࡞ུࡄථࡿࡾୌ᪁ ࡚㸡࠵ࡱࡽ♼⤊㈹࡞ࡼ࠷ࡻ࠹࡞ᚨࡄ࡙࠷ࡒ㸣 మ㔔ࡷ⾉ᅸࡡエ㘋ࢅࡊ㸡ᤴ౼ࡡࢤࣤࢹ࣭ࣞࣜࢅ㐄 ࡡᏽ࡞⤄ࡲ㎰ࡳࢬࣜࣆࢢࡡ⤽⤾ࡡࡒࡴ࡞ ⮤ฦ࡚ࡀࡾࡆ࡛ࢅమⓏ࡞⩻࠻࡙⾔ິࡊ࡙࠷ࡒ㸣 ࡱࡒ㸡◂✪༝ງ⩽ࡢ㸡㌷ⴘࡷᖏ⏍Ὡ୕ࡡຊ㱃࡞ ࡻࡾᶭ⬗ୖࢅᐁវࡊࡒࡆ࡛ࢅࡀࡖ࠾ࡄ࡞㸡ࠒᖳ 㱃ࢅᐁវࡊ㸡༱㝜ᅂ㑂ࡡࡒࡴࡡ⮤⾠ࠓࢅណㆉࡊ࡙ ࠷ࡒ㸣ฦᮄ㸝㸞ࡢ㸡㌷ࡷᨶ࡞ࡻࡾᛱᠻࡷ 㝸ᐐࢅㇿ࠹ࡆ࡛ࡢ㸡ᐱࡒࡀࡽࡡᏭ࡞⦽ࡾࡆ ࡛ࢅᣞᦤࡊ࡙࠷ࡾ㸣◂✪༝ງ⩽ࡢ㸡㊂⭔ᘽࡾࡆ ࡛࡞ࡻࡖ࡙㸡⮤❟Ṅ⾔㞬ࡊࡂࡾࡆ࡛㸡⮤❟ࡊ ࡒ⾔ິ࡞ᨥ㝸⏍ࡋࡾࡆ࡛ࡡᜅࡿࡷᏭࢅវࡋ ࡙࠷ࡒ㸣㧏㱃㏩ᯊᝀ⩽࡞࡛ࡖ࡙㸡㌷ࡷᨶ࡞ࡻ ࡾṄ⾔ᶭ⬗ࡡୖࡢ㸡㏳㝌࡞ࡻࡾ㏩ᯊ⒢ࡡ⤽⤾ ࡞ᨥ㝸ࢅᮮࡌࡆ࡛࡞├⤎ࡦࡂวᐁᏭ࡛ࡊ ࡙ណㆉࡈࡿࡾࡒࡴ㸡༱㝜ࢅᅂ㑂ࡊ㸡ᖏ⏍ὩࢅᏭ ධ࡞㐛ࡇࡌࡆ࡛ࢅណㆉࡊ࡙࠷ࡒ࡛⩻࠻ࡼࡿࡾ㸣ࡱ ࡒ㸡ࡆ࠹ࡊࡒណㆉࡢ㸡ࠒᐓ᪐ࡷ⩽࡞࠾ࡄࡾ㏖ᝠ ࡡ㒼៎ࠓ࡞ࡵ㛭㏻ࡊ࡙࠷ࡾ㸣◂✪༝ງ⩽ࡢ㸡 ᖏ⏍Ὡࢅ㸡ฝᮮࡾࡓࡄ⮤❟ࡊ࡙㐛ࡇࡌࡻ࠹࡞ຑງ ࢅࡊ㸡ᐓ᪐࡞ᚨ㒼ࢅ࠾ࡄ࠷ࡻ࠹࡞ゕິ࡞Ẵࢅࡗ ࡄ࡙㐛ࡇࡊ࡙࠷ࡒ㸣ࠒᐓ᪐ࡷ⩽࡞࠾ࡄࡾ㏖ᝠ ࡡ㒼៎ࠓ࡞ࡻࡖ࡙㸡ᖏ⏍Ὡ୕࡚ࡡ⮤❟ࢅណㆉࡌ ࡾࡆ࡛㸡࠘ළ⁝࡞㐛ࡇࡌࡒࡴࡡຑງ࡛࠙ࡊ࡙ណ ࡘࡄࡼࡿࡒ㸣
㸨㸣
࠘ᬧ⃢࡛ࡊ࡙ࡷࡾࡎ࠷࡛࠙࠷࠹మ㥺࡞ࡗ࠷࡙
ࠈ◂✪༝ງ⩽ࡢ㸡⒢㣬⏍Ὡ࡚ຑງࡌࡾୌ᪁㸡࠘ᬧ ⃢࡛ࡊ࡙ࡷࡾࡎ࠷࠙మ㥺ࢅࡊ㸡ࡿິࡂẴᣚࡔ ࢅమ㥺ࡊ࡙࠷ࡒ㸣 ࠈ㧏㱃㏩ᯊᝀ⩽ࡢ㸡ຊ㱃࡞ࡻࡾ㌗మⓏ㸡⢥♼Ⓩᶭ ⬗ࡡୖࡷྙె➴࡞ࡻࡽ⒢㣬⏍Ὡ࡞ຐᚪこ ࡚࠵ࡾ㸣◂✪༝ງ⩽࡞࡛ࡖ࡙⒢㣬⏍Ὡࡢ㸡ࠒெ࡞ ㏖ᝠࢅ࠾ࡄࡾᘤࡄ┘ࠓࢅវࡋ㸡ࠒ㏩ᯊࡢୌ⏍ࡷࡽ ⤾ࡄࡂ࡙ࡢࡼࡍ᭩ᝇࠓ࡚㸡ࠒࡷࡴ࡙ࡵ࠷࠷࠾Seisen J. Nurs. Stud., Vol. 2. 2013 ㆉ࡛࠙࠷࠹ណࡘࡄࢅࡊ࡙࠷ࡒ㸣⮤ᕤࡡᏋᅹ౮ೋ ࢅណㆉࡌࡾࡆ࡛࡚㸡⮤ᕤུᐖࡷ⮤ᑕវ㧏ࡱ ࡽ㸡⩽ࢅུᐖࡊ㸡⌦ゆࡌࡾጶເ࡞⦽ࡖࡒ㸣㧏 㸝㸞ࡢ㸡⩽ུᐖࡢណᚷྡྷⓏጶເࡷ㸡 ⮤ᕤㄚ㢗Ⓩጶເ࡞㛭㏻ࡌࡾࡆ࡛ࢅ㏑࡙࠷ ࡾ㸣◂✪༝ງ⩽ࡢࠒ࿔ᅑࡡெࡡᬦ࠾ࡈ࠵ࡽࡒ ࠷ࠓ࡛࠷࠹Ẵᣚࡔ࠾ࡼ㸡༈⒢⩽࠾ࡼࡡ⒢㣬⏍Ὡࡡ ᵕࠍ⟮⌦࡞࠽ࡄࡾᣞ♟ࢅࡵ㸡㹐⧖ࡽ㏁ࡈࡿࡾἸ ណࡢ⮤ฦࡡࡒࡴ࡛ᛦ࠹㹒࡛๑ྡྷࡀ࡞ᤂ࠻࡙࠷ࡒ㸣 㣟Ềโ㝀ࡡཚࡊ࠷ᣞ♟ࢅ⧖ࡽ㏁ࡊུࡄࡾ㎖ࡈ ࡵ㸡⮤ฦ࡞࡛ࡖ࡙ណࡡ࠵ࡾࡆ࡛࡛ᤂ࠻ࡾࡆ࡛࡚㸡 ࠒ༈ᖅࡷࢪࢰࢴࣆࡡ⌦ゆࡷທࡱࡊࢅᐁវࡌࡾࠓమ 㥺࡛ࡖࡒ㸣࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾㆉ࠙ࢅࡌࡾࡆ ࡛࡞ࡻࡖ࡙㸡⮤ᕤུᐖࡷ⮤ᑕវ㧏ࡱࡽ㸡⩽ ࢅུᐖࡊ㸡⩽ࢅ⌦ゆࡌࡾጶເ࡞⦽ࡖࡒ㸣ࡱࡒ㸡 ◂✪༝ງ⩽ࡢ㸡ࠒᐓ᪐࡛࠷࡙ࡵአវࢅវࡋࠓࡒ ࡽ㸡ࠒஷࡂࡖࡒኰࢅᛦ࠷ฝࡊ࡙㐛ࡇࡌࠓ࡛࠷࠹ Ꮣ≺វ࠾ࡼ㸡ࠒ༈⒢⩽࡛ࡡ㛭౿࡞Ꮽᚨវࢅᚋࡒ࠷ࠓ ࡛វࡋ࡙࠷ࡒ㸡࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾㆉ࠙࡞ࡻ ࡖ࡙㸡㹐ඔẴ࡞ࡖ࡙ெ࡞ႌࢆ࡚ࡵࡼ࠷ࡒ࠷㹒 㸡ࠒ⮤ฦࡡᑑᮮ࡞ᑊࡌࡾᙽࠓࢅᣚࡔ㸡ಘ௭ࡷ Ꮨ࡛ࡡࡨࡿ࠵࠷㸡㌗㎾ࠒᖏࡡ୯࡞࠵ࡾᴞ ࡊࡲࠓࢅずࡗࡄࡾࡆ࡛࡚㸡⒢㣬⏍Ὡࡡ㎖ࡈࢅ⒭ࡊ㸡 ᚨࡡᏭᏽࢅវࡋ࡙࠷ࡒ㸣◂✪༝ງ⩽ࡢ㸡࠘⒢㣬⏍ Ὡ࡞࠽ࡄࡾᙽ࡛࠙ࡊ࡙㸡⒢㣬⏍Ὡࡡ୯්࡚⏍༈ ⒢ࡡᐁ⌟ࡡ㸡ࠒ༈⒢ࡡ㐅Ṅ࡞ᑊࡌࡾᙽࠓࢅࡊ㸡 ㏩ᯊ⒢࡞ఔ࠹ⱖࡷṒࢅណㆉࡎࡉࡾࢅᚋ࠷≟ Ἓ࠾ࡼゆᨲࡈࡿࡒ⏍Ὡࢅ㢢ࡖ࡙࠷ࡒ㸣㐲วࢮ࣭ ࢨࣔࣜࢦ࣭࣎ࢹࡢ⾢ᦹⓏฝᮮ࡞⪇࠻ࡾງࡷၡ 㢗ゆỬ⬗ງࢅ㧏ࡴ㸝ᑚᓞ㸡㸞㸡ᑑᮮ࡞ᕵ᭻ࢅ ᣚࡗࡆ࡛ࡢ⮤ᕤຝງវ࡞ይᙫ㡢ࢅࡵࡒࡼࡊ㸝⸠㸡 㸞㸡ᚨࡡఴࡷ㇇࠾ࡈ࡛࠷ࡖࡒ⢥♼≟ឺࡢ㏩ ᯊུᐖࡡᙫ㡢こᅄ࡞⦽ࡾ㸝ኬಲ㸡ᮟ⏛㸡㸞㸣 ᮇ◂✪࡞࠽࠷࡙ࡵ㸡࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾㆉ࠙㸡 ࠘⒢㣬⏍Ὡ࡞࠽ࡄࡾᙽ࠙࡞ᙫ㡢ࢅ࠻ࡾࡆ࡛ ⩻࠻ࡼࡿࡒ㸣㧏㱃㏩ᯊᝀ⩽㸡⒢㣬⏍Ὡ࡞࠽࠷࡙ ᴞࡊࡲࢅずࡗࡄ㸡⮤ฦࡡᑑᮮ࡞ᕵ᭻ࢅᣚࡖ࡙㐛ࡇ ࡌࡆ࡛࡚ࡀࡾࡻ࠹࡞㸡ᐓ᪐ࡷᆀᇡ࡛ࡵ㏻ᦘࢅ࡛ ࡽᨥᥴࡊ࡙࠷ࡂᚪこ࠵ࡾ࡛⩻࠻ࡾ㸣
Ϭ㸣⤎ࠈㄊ
ࠈᮇ◂✪ࡡ⤎ᯕ㸡㧏㱃㏩ᯊᝀ⩽ࡡ⒢㣬⏍Ὡࡡమ㥺 ࡡណࡘࡄ࡛ࡊ࡙ࡡ࢜ࢷࢥࣛ࠘⏍࠵ࡾ⩽࡛ࡊ ࡙⏍ࡀᢜࡂጶເ࠙㸡࠘ළ⁝࡞㐛ࡇࡌࡒࡴࡡຑງ࠙㸡࠘ᬧ Ⓩ࡞ࡽ㸝ᖏ┑㸡㸞㸡㧏㱃⩽ࡢུ㌗࡚࠵ࡾࡆ ࡛ࢅይࡳ㸝Kaplan㸡 㸞ࠈ࡛ࡊ࡙࠷ࡾ㸣ࡊ࠾ࡊ㸡 ㏩ᯊᝀ⩽ࡡᚨ⌦Ⓩ㐲ᚺ࡞ࡢ㸡㏩ᯊࡡ࠵ࡾ⛤ᗐࡡ ῼ࡛༎ฦㄕ᪺㔔こ࡚࠵ࡽ㸝ࢨ࢘ࣛࣆኣ⏛㔕㸡 ኬ⏛㸡㸞㸡⮤ᕤỬᏽࡢ⒢㣬⏍Ὡ࡞࠽ࡄࡾᝀ⩽ ࡡమᛮࡷQOL࡞ࡵ㛭ࢂࡾ㸝▴ᕖ㸡㸞㸣ᚉࡖ࡙㸡 ㏩ᯊᑙථῼࡈࡿࡾ㧏㱃⩽ࡡሔྙ࡞ࡢ㸡ಕᏋ ࠾ࡼᝀ⩽㸡ᐓ᪐࡞ᑊࡌࡾ㏩ᯊᑙථ࡞㛭ࡌࡾㄕ᪺ࡷ ሒᥞ౩ࠈ㸝⏛୯ࡼ㸡㸞࡞ࡻࡖ࡙ࠒずᤛ ࠻ࡼࡿ࠷Ꮽࠓࢅ㍅΅ࡌࡾࡆ࡛㔔こ࡚࠵ࡾ㸣㸩㸣
࠘ࡷࡾࡎࡈ࡛ࡡᢙࡽྙ࠷࠙ࡡమ㥺࡛ࡊ࡙ណ
ࠈࡘࡄࡼࡿࡒ㏩ᯊ⒢㣬⏍Ὡࡡུᐖ
ࠈ㧏㱃㏩ᯊᝀ⩽ࡡ㸡㏩ᯊ⒢㣬⏍Ὡࡡུᐖࡢ㸡࠘ᬧ ⃢࡛ࡊ࡙ࡷࡾࡎ࠷࡛࠙࠷࠹మ㥺࡞ᑊࡌࡾ㸡࠘ࡷ ࡾࡎࡈ࡛ࡡᢙࡽྙ࠷࡛࠙ណࡘࡄࡼࡿࡒ㸣 ࠈ࠘ࡷࡾࡎࡈ࡛ࡡᢙࡽྙ࠷࡚࠙ࡢ㸡◂✪༝ງ⩽ࡢ㸡 ㏩ᯊ⒢ᚪこ࡞ࡖࡒࡡࡢࠒ⮤ฦࡡࡎ࠷࡛ᠼࡴࠓ ࡒࡽ㸡㏩ᯊ⒢ࢅࠒ᪡ࡂᢜࡄฝࡊࡒ࠷ࠓ࡛ᛦ࠷ ࡼ㸡㏩ᯊ⒢ࢅ⤽⤾ࡊ࡙࠷ࡒ㸣㏩ᯊᑙථ࡛ࡖ ࡒࡆ࡛ࢅࠒ࠵ࡀࡼࡴࠓ㸡ࠒࡂࡻࡂࡻࡎࡍ㛜ࡀ├ࡽࠓ㸡 ㏩ᯊ⒢ࢅ᩺ࡒ࡛ᤂ࠻࠽ࡊ㸡⮤ฦ࡞࠻ ࡼࡿࡒࠒ࡛ᛦࡖ࡙ࡽวࡾࠓࡆ࡛࡚㸡⒢㣬⏍ Ὡ୕ࡡโ㝀ࡷㇿᢰវ࡛ᢙࡽྙࡖ࡙࠷ࡒ㸣㏩ᯊ⒢ ࢅᢖࡅฝࡊ࡙ࡊࡱ࠷ࡒࡂࡾẴᣚࡔࡡᘽࡈ࡞ᑊࡊ㸡 ࠒㇿࡄ࠷ࡻ࠹࡞⢥♼ງࢅಕࡗࠓࡆ࡛࡛ࡊ࡙ណ ࡘࡄ㸡ࡻࡽࡻ࠷⒢㣬⏍Ὡࢅ㏞ࡾࡒࡴ࡞㸡ࠒ༈ᖅࡡ ᚽ࿈ࡷࡡᝀ⩽ࡡమ㥺ࢅທࡲ࡞ࠓࡊ㸡ࠒⱖ࠵ ࡖ࡙ࡵ㏩ᯊࡡ࠽ⶩ࡛វㅨࡌࡾࠓࡆ࡛࡚㸡㏩ᯊࡡ⒢ 㣬⏍Ὡࢅུᐖࡊ࡙࠷ࡒ࡛⩻࠻ࡼࡿࡾ㸣ࡱࡒ㸡◂✪ ༝ງ⩽ࡢ㸡ࠒࢅ↋࡞㐛ࡇࡎࡾࡆ࡛࡞វㅨ ࡌࡾࠓࡆ࡛ࢅ⏍Ὡࡡ┘ᵾ࡛ࡊ࡙࠷ࡒ㸣㧏㱃㏩ᯊᝀ ⩽࡞࡛ࡖ࡙㸡ࡐࡡࡐࡡࢅᏭධ࡞ᬵࡼࡌࡆ࡛ ⒢㣬⏍Ὡࡡ┘ᵾ࡛ࡊ࡙ᤂ࠻ࡼࡿ࡙࠷ࡒ࡛⩻࠻ࡼࡿ ࡾ㸣┫㆜⫃ࡢ㸡㧏㱃㏩ᯊᝀ⩽ࡐࡿࡑࡿࡡ࠘ࡷࡾࡎ ࡈ࡛ࡡᢙࡽྙ࠷࠙ࡡమ㥺࡞ࡗ࠷࡙⌦ゆࡊ㸡⒢㣬 ⏍Ὡࡡུᐖಀࡈࡿࡾࡻ࠹࡞ࡡ༈⒢⫃ࡷᐓ᪐࡛ ㏻ᦘࡊ㸡ᨥᥴࡌࡾᚪこ࠵ࡾ㸣㸪㸣⒢㣬⏍Ὡࢅᨥ࠻ࡾ࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾㆉ࠙
ࠈ࡛࠘⒢㣬⏍Ὡ࡞࠽ࡄࡾᙽ࠙࡞ࡗ࠷࡙
ࠈ㧏㱃㏩ᯊᝀ⩽ࡢ㸡⒢㣬⏍Ὡࡡ⮤ฦࢅཱིࡽᕬࡂெ 㛣㛭౿ࡡ୯࡞ࠒ࿔ᅑࡡெࡡᬦ࠾ࡈ࠵ࡽࡒ࠷ࠓ ࡛វࡋ㸡ࠒ༈ᖅࡷࢪࢰࢴࣆࡡ⌦ゆࡷທࡱࡊࢅᐁវࠓ ࡌࡾࡡమ㥺ࢅ㏳ࡊ࡙㸡࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾ⪯ἠ┫㆜Ꮥ◂✪ࠈ㸧ᕬ㸝㸞
ϭ㸣◂✪ࡡ㝀⏲࡛ᚃࡡㄚ㢗
ࠈᮇ◂✪࡚ࡢ㸡㧏㱃㏩ᯊᝀ⩽ࡡཋ⑄ᝀࡷ㏩ᯊṌ➴ ࢅ㝀ᏽࡊ࠾ࡖࡒࡆ࡛࡚㸡ᖳࠍቌຊࡊ࡙࠷ࡾ㧏㱃 ㏩ᯊᝀ⩽ࡡ⒢㣬⏍Ὡ࡞࠽ࡄࡾమ㥺ࡡណࡘࡄࡡධ మ᪺ࡼ࠾࡛ࡖࡒࡆ࡛ࡢណ⩇࠵ࡾ࡛࠷࠻ࡾ㸣 ࡊ࠾ࡊ㸡ᑊ㇗⩽ࡡཋ⑄ᝀࡷ㏩ᯊṌ➴࡞ࡻࡾ⒢㣬⏍ Ὡࡡమ㥺ࡡណࡘࡄࡡ㐢࠷࡞ࡗ࠷࡙ࡢ᪺ࡼ࠾࡞࡚ ࡀ࠷ࡆ࡛ᮇ◂✪ࡡ㝀⏲࡚࠵ࡾ㸣ࡊࡒࡖ࡙㸡 ᑊ㇗⩽ࢅཋ⑄ᝀࡷ㏩ᯊṌ➴࡚㝀ᏽࡊ㸡ࡐࡿࡑࡿࡡ ណࡘࡄ࡞ࡗ࠷࡙㈹Ⓩ࡞◂✪ࢅ㔔ࡠ㸡ࡈࡼ▩ずࢅ ࡴ࡙࠷ࡂࡆ࡛ࢅᚃࡡㄚ㢗࡛ࡌࡾ㸣Ϯ㸣ㅨࠈ㎙
ࠈ࠽ᚹࡊ࠷୯㸡ᮇ◂✪ࡡ㉻᪠ࢅỦࡲ㸡㟻ㄢᰕ࡞ ࡇ༝ງ࠷ࡒࡓࡀࡱࡊࡒ㏩ᯊᝀ⩽ࡡⓑᵕ㸡ࡱࡒ㸡ᮇ◂ ✪ࡡ┘Ⓩࢅࡇ⌦ゆ࠷ࡒࡓࡀ㸡ࡇ༝ງࡂࡓࡈ࠷ࡱࡊࡒ &㏩ᯊࢬࣤࢰ࣭ࡡⓑᵕ࡞ᚨࡻࡽវㅨ࠷ࡒࡊࡱࡌ㸣ᩝࠈ⊡
Anne M Keogh,John Freehally, Marta Taylor 㸝1999㸞㸯A Quantitative Study Comparing
Adjustment and Acceptance of Illness in Adults on Renal Replacement, Therapy, ANNA jounal㸡26㸝5㸞㸡471-478. 㔔షΰᏄ㸝㸞㸯⾉ᾦ㏩ᯊᝀ⩽ࡡẴࡡమ㥺 ࡞࠽ࡄࡾᚨ⌦ؐẴࡡུᐖᙫ㡢ࡌࡾこᅄࡡゆ ᪺㸡⚗ᒱኬᏕኬᏕ㝌ㄵ㞗㸡㸝㸞㸡 ⃢࡛ࡊ࡙ࡷࡾࡎ࠷࠙㸡࠘ࡷࡾࡎࡈ࡛ࡡᢙࡽྙ ࠷࠙㸡࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾㆉ࠙㸡࠘⒢㣬⏍Ὡ࡞࠽ࡄ ࡾᙽ࠙ฝࡈࡿࡒ㸣 㸣㧏㱃㏩ᯊᝀ⩽ࡢ㸡⒢㣬⏍ὩࢅṒࡡᜅᛟ㸡⏍ ࡡᕵị࡞ᇱࡘ࠷ࡒ࠘⏍࠵ࡾ⩽࡛ࡊ࡙⏍ࡀᢜࡂጶ ເ࠙ࢅᣚࡗ࡛࠷࠹మ㥺ࢅࡊ࡙࠽ࡽ㸡㐲ว⒢ࢅ ུࡄࡾࡒࡴ࡞ཱིࡽ⤄ࡳጶເࡷᐓ᪐⏍ࡀࡾ┘Ⓩ࡛ ࡖ࡙࠷ࡒ㸣ࡐࡡ┘Ⓩࡡࡒࡴ࡞㸡㧏㱃㏩ᯊᝀ⩽ࡢ㸡 ࢬࣜࣆࢢࢅ⤽⤾ࡊ㸡✒ᴗⓏ࡞༱㝜ᅂ㑂ࡌࡾࡆ࡛ ࡞ࡻࡖ࡙㸡ᖏ⏍Ὡࢅ⮤❟ࡊ࡙㐛ࡇࡎࡾࡻ࠹࡞࠘ළ ⁝࡞㐛ࡇࡌࡒࡴࡡຑງ࠙ࢅమ㥺ࡊ࡙࠷ࡒ㸣 㸣㧏㱃㏩ᯊᝀ⩽ࡢ㸡⒢㣬⏍Ὡ࡞࠽ࡄࡾຑງࡡୌ ᪁࡚㸡㏩ᯊ⒢࡞ఔ࠹ⱖࡓࡄ࡚ࡂ㸡࠷ࡗࡱ࡚ ⮤ฦࡡ᪺☔ណᚷ࡚㏩ᯊ⒢ࢅ⤾ࡄࡼࡿࡾ࠾࡛࠷ ࠹Ꮽࡷᘤࡄ┘㸡Ẵᣚࡔࡡࡹࡿࢅវࡋ㸡⒢㣬⏍Ὡ ࡢ࠘ᬧ⃢࡛ࡊ࡙ࡷࡾࡎ࠷࡛࠙࠷࠹మ㥺࡛ࡊ࡙ណ ࡘࡄ࡙࠷ࡒ㸣ࡊ࠾ࡊ㸡㧏㱃㏩ᯊᝀ⩽ࡢ㸡࠘ࡷࡾ ࡎࡈ࡛ࡡᢙࡽྙ࠷࡛࠙࠷࠹మ㥺࡞ࡻࡽ㏩ᯊࡡ⒢ 㣬⏍Ὡࢅུᐖࡊ࡙࠷ࡒ㸣 㸣㧏㱃㏩ᯊᝀ⩽ࡢ㸡⒢㣬⏍Ὡ࡞࠽ࡄࡾெ㛣㛭౿ ࢅ㏳ࡊ࡙࠘⮤ᕤࡡᏋᅹ౮ೋࡡヾㆉ࠙ࢅࡌࡾమ㥺࡞ ࡻࡽ࠘⒢㣬⏍Ὡ࡞࠽ࡄࡾᙽ࠙ࢅずฝࡊ㸡⒢㣬⏍ Ὡ࡞࠽ࡄࡾ㎖ࡈ࠾ࡼゆᨲࡈࡿࡾ█㛣ࡷᚨࡡᏭᏽࢅ វࡋࡾమ㥺ࢅࡊ࡙࠷ࡒ㸣 ࠈ┫㆜ᖅ࡞ࡢ㸡㧏㱃㏩ᯊᝀ⩽ࡡమ㥺ࡡណࡘࡄࢅ ⌦ゆࡊ㸡㧏㱃㏩ᯊᝀ⩽మⓏ࡞ࡻࡽඖᐁࡊ࡙⒢ 㣬⏍Ὡࢅ㏞ࡾࡆ࡛ฝᮮࡾࡻ࠹࡞㸡ᐓ᪐ࡷᆀᇡ࡛ ࡡ㏻ᦘࢅࡴᨥᥴࡊ࡙࠷ࡂ㛭ࢂࡽịࡴࡼࡿࡾ࡛ ⩻࠻ࡾ㸣 ᅒࠈ㧏㱃㏩ᯊᝀ⩽ࡡ⒢㣬⏍Ὡ࡞࠽ࡄࡾమ㥺ࡡណࡘࡄ หᤨߦሽߒߡࠆ㑐ଥࠍ␜ߔ ߪฦࠞ࠹ࠧ㑆ߩߟߥ߇ࠅߩᣇะࠍߔ ޣ≮㙃↢ᵴߦ߅ߌࠆᦼᓙޤ ޣ⥄Ꮖߩሽଔ୯ߩ⼂ޤ ޣṖߦㆊߏߔദജޤ ޣᥧổߣ߿ࠆߖߥޤ ޣ↢ࠆ⠪ߣߒߡ↢߈ᛮߊᆫޤ ޣ߿ࠆߖߥߐߣߩ᛬ࠅวޤ
ࢨ࢘ࣛࣆኣ⏛㔕ீᏄ㸡ኬ⏛᪺ⱝ㸝㸞㸯⾉ᾦ㏩ ᯊᝀ⩽ࡡᚨ⌦Ⓩ㐲ᚺ㸝㏩ᯊུᐖ㸞࡞ᙫ㡢ࢅ࠻ ࡾこᅄ࡞ࡗ࠷࡙㸡ᮇ┫㆜⛁Ꮥఌヽ㸡㸝㸞㸡
Sherrie H Kaplan㸡PHD㸝1995㸞㸯Patient and Visit Characteriatics Related to Physicians’ Participatory Dicision-Making Style㸡 Results from the medical Outcomes Study㸡 Lippincotto-Raven Publishers㸡33㸝12㸞㸡 1176-1187. 㧏 ⠂ Ꮔ㸝 㸞㸯 ᑊ ெ 㛭 ౿ ᛮ ࡡ ち Ⅴ ࡞ࡻࡾ ⏍ ࡀ᪁ឺᗐࡡⓆ㐡Ⓩ◂✪㸡⮣ᗃᚨ⌦Ꮥ◂✪㸡㸡 ⏛୯㡨Ꮔ㸝 㸞㸯㧏㱃⩽ࡡᑙථࡡᚨࡡၡ㢗㸡 ㏩ᯊࢢ㸡Ꮢቌษ㸡㸣 ⏛୯⣎Ꮔ㸡ኯ⏛⟿Ꮔ㸡ཋ⏛ᑚእ㸝㸞㸯㏩ᯊ⒢ Ἢ࡞ࡗ࠷࡙ࡡ༎ฦㄕ᪺࠾ࡖࡒౚࡡᚨ⌦ Ⓩమ㥺ࡡฦᯊ㸡➠ᅂᮇ┫㆜Ꮥఌㄵᩝ㞗㸡ᆀ ᇡ┫㆜㸡 ᖏ┑ᩝᯖ㸝㸞㸯ះᛮ⩽ࡡ༈⒢ࢢ୕࡞࠽ࡄ ࡾ⮤ᕤỬᏽ࡞㛭ࡌࡾヾㆉ࡛⾔ິ࠽ࡻࡦᙫ㡢こᅄ ࡡ᳠ゞ㸡ᮇ┫㆜⛁Ꮥఌヽ㸡㸝㸞㸡 ฦᮄࡥ࡛ࡲ㸝㸞㸯㧏㱃⩽ࡡ㌷Ꮽ࡛ࡐࡡこᅄ㸡 మງ⛁Ꮥ㸡㸝㸞㸡 ᫋ᮄ⦶ୌ㸝 㸞㸯㏩ᯊᝀ⩽ࡡᚨ⌦࡛⢥♼≟㸡㸡 ୯አ༈Ꮥ♣㸡᮶ா㸡 ᗀ℡ᐰᏄ㸝㸞㸯㏩ᯊ⒢Ἢࡡ⌦ゆ࡛ࢢ㸡ᒷ Ꮔ⥽㸡➠ϯ❮㏩ᯊᝀ⩽ࡡ⢥♼Ⓩᨥᥴ㸡Ꮥ◂㸡 ▴ᕖᘧᏄ㸝㸞㸯㧏㱃⩽ࡡ⭀ධ⒢Ἢ㐽ᢝ ࡡ┫㆜㸡⮣ᗃ㏩ᯊ㸝㸞㸡ᮇ࣒ࢸ࢜ࣜࢬ ࣤࢰ࣭㸡᮶ா㸡 ᑚᓞ᧧Ꮔ㸝㸞㸯┫㆜࡞࠽ࡄࡾ༱ᶭ⌦ㄵ࣬༱ᶭ ථࣆࣤࢠࢤ࣭ࣤࢡ࣑࣭ࣝࣚࢪࡡ༱ᶭ ࣓ࢸࣜ࠾ࡼᏕࡩ㸝➠∟㸞㸡㔘ⰶᇸ㸡ா㒌 ḿᮄᜠ㸡㔕ཾ⨶Ꮔ㸡ᮇ⨶ఫᏄ㸝 㸞㸯ះ ᛮ⾉ᾦ㏩ᯊࡡ㏩ᯊࢪࢹࣝࢴࢦ࣭࡛ࢤ࣭ࣅࣤࢡ⾔ ິ࡞ࡗ࠷࡙㸡༐ⴝኬᏕ┫㆜Ꮥ㒂⣎こ㸡㸡 ᮇ ㏩ ᯊ ༈ Ꮥ ఌ ⤣ ゛ ㄢ ᰕ ጟ ဤ ఌ㸝 㸞㸯 ࢂ ᅗࡡះᛮ㏩ᯊ⒢Ἢࡡ⌟Ἓᖳ᭮⌟ᅹ㸡 ኬಲ⨶㭧㸡ᮟ⏛ఘ㸝㸞㸯㧏㱃㏩ᯊᝀ⩽ࡡ㏩ᯊ ུᐖ࡛QOL࡛ࡡ㛭౿㸡ᮇᅹᏩࢢᏕఌヽ㸡 㸝㸞 ᑚᒜහᖶ㸡᳔ᮿᐓ㸡ᮇᮟᩝୌ㸝 㸞㸯㏩ᯊ ᝀ⩽ࡡᖳื࡞ࡲࡒ⏍ࡀ࠷ࡡ⩻ᐳ㸡㏩ᯊఌヽ㸡 㸝 㸞㸡 ⸠⨶⳱㸝㸞㸯㧏㱃㏩ᯊᝀ⩽ࡡᖏ⏍Ὡࡡඖ ᐁវ࡛⮤ᕤຝງវཀྵࡦ㏩ᯊࢤࣤࢹ࣭ࣞࣜ≟Ἓ࡞ 㛭ࡌࡾ◂✪㸡᮶ኬᏕ༈Ꮥ㒂ಕᏕ⛁⣎こ㸡 㸝㸞㸡
