意味のある支援 : 重度の精神障害者の地域生活を支える看護実践の現象学的研究

臨床実践の現象学研究会

ACT（包括型地域生活支援プログラム）

The purpose of this study is to clarify the structure of a nursing practice that supports community life for people with severe mental illness through a phenomenological method. Individual interviews were conducted with nurses working in an Assertive Community Treatment Program. This study introduces the structure of the practice of Nurse A, who has been involved with Assertive Community Treatment for five years. Nurse A’s practice was developed in an inevitable form, including the norm of "must support" starting from the interest in things that are difficult to grasp on the surface and the feeling of "difficult". Thus, the practice entailed providing support by “increasing what can be done,” by taking “responsibility” through the “troubles” and the “experiences” of the user doing the “thinking” by her/himself. Support that is geared toward the independence of the user was called “meaningful.” “Holding” connects the support activated by the norm to the user who has become independent, while reconnecting relationships with others; inferring the distance and approaching what is behind the user's feelings and living conditions was the basis for directing meaningful support. While Japanese psychiatric policy is shifting from “inpatient medical care centers to community life centers,” it is believed that understanding the method of support like that used by knowing how to provide support like Nurse A is an opportunity to reflect on one's own practice; consequently, this will contribute to the expansion of “community life center” for those with mental illnesses.