@misc{oai:niigata-u.repo.nii.ac.jp:00033876,
 author = {西方, 真弓},
 month = {2020-06-23, 2020-06-23},
 note = {Ⅰ．研究の背景 母体・胎児集中治療室（以下、MFICU）に入院するハイリスク妊婦は、多様な疾患や症状を持ち、自身や胎児の健康に対する不安を抱き、親になる意識や親になるイメージが高まらない傾向にある。MFICUでは、母体や胎児の医学的管理と安全性の確保が最優先とされる。そのため、妊婦は面会や行動が制限され、不自由さや閉塞感を経験するなどの問題が指摘されている。周産期領域のquality of life（以下、QOL）に関する研究について、母親の生活全体を捉えた研究は見当たらない。さらに、MFICU入院妊婦のQOLに関する研究は、標準化されたQOL尺度を用いた調査はあるが極めて少ない。標準化されたQOL尺度は、国民標準値や他の疾患群との比較には適しているが、個々の疾患や特異的な問題点について評価することには適していない。そのため、MFICU入院妊婦のケアの手がかりを得るには、標準化されたQOL尺度では具体的なQOLの項目や内容を把握することは難しい。これらのことから、個人的QOL尺度の1つである個人の生活の質を直接的に重みづけする方法であるSEIQoL-DWを用いることにより、標準化されたQOL尺度より広い視点で、MFICU入院妊婦のQOLの特性を捉えることができると考えた。 Ⅱ．研究目的 本研究の目的は、SEIQoL-DWを用いてMFICUに入院するハイリスク妊婦の個人的QOLの特性を明らかにするとともに、ハイリスク妊婦の医療管理とQOLとの調和を図った個人的なケア計画立案と療養環境の改善に向け必要な視点を示唆することである。 Ⅲ．研究方法 本研究が用いるSEIQoL-DW は、個人の生活の中で重要な領域を示す“cue”と選択理由を把握するための質的データ収集、“cue”に対する各満足度や重みづけした数値、更に全般的主観的QOL（以下、SEIQoL index score）の量的データ収集を同一段階で並行して行い、分析の段階で統合する並行的トライアンギュレーションデザインを採用した。また、MFICUに入院妊婦の個人的QOLの特性を描写するため、横断的デザインで行った。個人的QOLを調査するために、総合周産期母子医療センターのMFICU入院妊婦20名を対象に属性の聴取と、SEIQoL-DWを用いて半構造化面接を実施した。分析の第1段階として、MFICU入院妊婦のcueの傾向を把握するために、対象者が挙げた各cueを名義的に分類し、カテゴリ化した。各カテゴリに分類されたcueの総数と対象者数を集計し、level、weightの平均を算出した。各カテゴリに分類されたcue のインタビューデータから、彼女たちのQOL として、どのような意味合いや機能があるのかを質的に分析した。第2段階として、SEIQoL index score の四分位が75％（高群）と25％（低群）の2群間で、入院時妊娠週数、面接時妊娠週数、入院から面接までの期間、SEIQoL index score の差を検定した（ｐ＜.05）。本研究は、新潟大学医学部の研究倫理審査委員会の承認を得た（承認番号：1545）。また、対象者に研究の主旨、調査概要について口頭および書面にて説明を行い、同意を得て実施した。 Ⅳ．結果 対象者が挙げたcue の総数は95 で、SEIQoL index score の平均値は62.0だった。対象者が挙げたcue をカテゴリ化し、13のカテゴリを生成した。最もcueの数が多かったカテゴリは、〈家族との関係〉であった。2群間の入院時の診断、点滴治療や安静度による大きな違いは見られなかった。SEIQoL index score の平均値を比較した結果、有意差がみられた。医療従事者が考えるよりも広範囲の家族が対象者の重要なQOL構成要素となっていたが、一時的にでも、その人達の世話をできないことがQOLにネガティブな影響を及ぼしていた。入院によって胎児の健康状態が維持されていると認識している対象の場合、そのことが彼女たちの主要なQOL構成要素になっていたが、低群では、QOLの構成要素として〈胎児の成長・健康〉を挙げない傾向にあった。病院の制約の中で自分を清潔に保つことについてはある程度の満足が得られており、ベッド上で過ごす多くの時間の使い途を見つけられた場合は、それらが満足度の高いQOL構成要素となっていた。その一方で、食事、自由に動けることへの対象者の欲求は、MFICUの入院生活においては充分に満たされていなかった。 Ⅴ．考察 SEIQoL-DWを用いて評価したMFICU入院妊婦の個人的QOLは、必ずしも高いとはいえず、その原因としてresponse shiftの起こりにくさが考えられる。面会制限の緩和や、家族とのプライベートな時間を過ごせる面会スペースの確保などを検討すべきである。医療者から胎児の健康状態や日々の変化に関する詳細な情報と、彼女たちがMFICUに入院していることの意味を実感できるような肯定的なフィードバックを提供することの重要性が示唆された。また、食事や自由に動けることに関するサービスを改善することでMFICU入院妊婦のQOLの向上が図れる可能性がある。, Background: Because women with high-risk pregnancies in the maternal–fetal intensive care unit (MFICU) have various diseases and symptoms and feel anxiety regarding their health and that of their fetus, they tend to have poor awareness about becoming a parent and a poor image of parenting. Medical management and maintenance of the safety of both the mother and fetus are priorities in the MFICU; therefore, outside visits and movements of pregnant women are restricted. This has been identified as problematic because it results in a lack of freedom and a sense of being trapped in the MFICU for the pregnant women. To the best of my knowledge, no study on perinatal quality of life (QoL) has attempted to ascertain the daily life of mothers in the MFICU. Furthermore, very few studies on the QoL of pregnant women in the MFICU have used standardized QoL measurements. Standardized QoL measurements are suited for use in comparison to the national standard value and other diseases; however, they are unsuitable for assessing individual diseases or specific problems. Therefore, when using standardized QoL measurements, it is difficult to identify specific QoL items and contents that can provide clues that can be used for the care of pregnant women in the MFICU. Therefore, this study hypothesized that the use of the Schedule for the Evaluation of Individual QoL-Direct Weighting (SEIQoL-DW), which is an individual QoL scale, may allow to determine the QoL characteristics of pregnant women in the MFICU because it provides a broader perspective than that provided by standardized QoL measurements. Objective: This study aimed to use the SEIQoL-DW to elucidate the individual QoL characteristics of women with high-risk pregnancies in the MFICU; this may provide the perspective required for the medical management of high-risk pregnancies and personalized care planning designed to improve the QoL of pregnant women as well as the treatment environment. Methods: The SEIQoL-DW scale used in this study uses a concurrent triangulation design to integrate the analytical stages. It accumulates qualitative data to identify the “cues” that indicate the areas of individual QoL that are affected and the reasons for selecting these; further, the scale simultaneously provides information about the satisfaction level of these “cues,” weighted scores, and quantitative data on the overall subjective QoL (SEIQoL index score) at the same stage. This study uses a cross-sectional design to describe the personal QoL characteristics of pregnant women in the MFICU. To survey individual QoL, this study conducted interviews to accumulate data regarding the attributes of 20 pregnant women in the MFICU of a general perinatal medical center and semi-structured interviews using the SEIQoL-DW scale. The first stage of analyses involved the nominally categorization of the cues that the subjects indicated to understand trends in the cues of pregnant women in the MFICU. Subsequently, we calculated the total number of the cues that were placed in each category and the number of subjects as well as the mean level and weight. From the interview data of cue classified into each category, there analyzed qualitatively what kind of meaning and function. In the second stage, there compared differences in the gestational age at admission, gestational age at the time of the interview, period of time between admission and interview, and SEIQoL index scores between the following two groups based on the quartile of the SEIQoL index score: 75% (high group) and 25% (low group) (p < .05). The research ethics committee of the Niigata University School of Medicine approved the study (No. 1545). All participants were provided with verbal and written explanations of the study, and their written informed consent was obtained prior to study initiation. Results: The total number of cues identified by the subjects was 95, and the mean SEIQoL index score was 62.0. There generated 13 categories from the cues and interview data. The category with the highest number of cues was “relationship with family. “There found no significant differences in the diagnoses made upon hospitalization between the patients in the high and low groups or in terms of the number of participants undergoing intravenous therapy or the degree of bed rest required. The results of the intergroup comparisons of the mean SEIQoL index scores indicated a significant. The pregnant women in the MFICU identified their extended families a constituent of their QoL to an extent greater than that anticipated by the care providers. Furthermore, although temporary, the fact that the women could not care for their family members negatively impacted their evaluation of the QoL.The perception that hospitalization in the MFICU allows pregnant women to maintain the health of their fetuses was a major constituent in the QoL. In the low group, there was a tendency not to indicate “growth and health of the fetus” as a constituent of QoL. Satisfaction, to a certain degree, with their ability to maintain cleanliness while complying with the restrictions placed on them in the hospital and the ability to gainfully utilize the long periods of time they spent in bed were factors that were linked to a high degree of satisfaction. However, their desire to have their meals and move around freely was not sufficiently met during their time in the MFICU. However, their desire to have their meals and move around freely was not sufficiently met during their time in the MFICU. Discussion: The individual QOL of pregnant women hospitalized in an MFICU, as assessed using the SEIQoL-DW, is not necessarily high, perhaps because of difficulties related to experiencing a response shift. There is a need to investigate ways to alleviate the restrictions on pregnant women in the MFICU receiving visitors and ensure that they have a private space where they can spend time with family members. The study findings suggest that it is important for care providers to provide detailed information regarding the health of the fetus as well as daily changes in their health status; moreover, it is important for care providers to provide positive feedback that reinforces the sense that the time pregnant women spend in MFICU is meaningful. Finally, the QoL of pregnant women in the MFICU can be improved by improving the services related to their meals and their ability to move around freely., 新大院博(保)甲第33号},
 title = {当事者視点に基づく母体・胎児集中治療室入院妊婦の個人的QOL},
 year = {}
}