成人2型糖尿病患者の抱く健康観・価値観 : 過去10年間の国内文献の検討

成人２型糖尿病患者（以下，患者）の抱く健康観・価値観の動向について，健康観・価値観を「その人らしさを大切にした日々の生活の送り方や行動に対する見方・考え方，判断の基盤となる見方・考え方」と定義して，医学中央雑誌を用いて，過去１０年間の文献検索を行ったところ，患者は，できるだけ身体に不自由や障害がない状態で，生きることを大切と考え，そのために，糖尿病のもたらす怖さを認識し，自己管理行動が大切であると考えていた．また，自己管理行動以外にも，命をはぐくむ食べ物，その人らしい生き方を支える家族や仕事，趣味や嗜好品なども大切であると考えていた．これらは，長年にわたり培われてきたものであり，患者の個別的な生き方を支え，生活の質を潤すものと捉えていた．しかし，同時に，これらは，糖尿病の自己管理行動を促進する場合だけではなく，阻害する場合もあった．また，患者は自己管理行動を身体・心理・社会面での苦痛や負担をもたらすものであると捉えていた．よって，看護介入を行うにあたっては，患者の抱く健康観・価値観の背景や過程を十分に理解した上で，患者の自己管理行動の遂行を援助する必要がある．そして，健康観・価値観の転換が必要な場合には，患者が納得でき，あるいは折り合いが持てるように段階的に進めていく必要がある．今後，患者の抱く健康観・価値観を尊重しながら，いかにして，自己管理行動を促進させる要因を増強させ，阻害する要因の転換を図っていくかということについて研究する必要があると考えられた．

Objectives : The purpose of this study was to review literature published over a １０-year period focusing on the sense of health and values among adults with type ２ diabetes in Japan.
Methods : We used Ichushi-Web（Ver．４）to identify literature published from １９９６ to ２００６. Operationally, we defined the sense of health and values as “ the basic way of thinking and understanding one’ s own life and the behaviors that adults with type ２ diabetes value highly in their individual lives” .
Results :
１．A total of ２３ primary studies were selected.
２．Adults with type２diabetes thought a great deal about living their lives with minimal disorder and inconvenience. Furthermore, they consider self-control to be important for facilitating their understand of the difficulty of managing diabetes and the possible complications.
３．Other important items for adults with type ２ diabetes were diet, family members who tried to support the patients' individuality, hobbies, and their favorite food. These items had developed over a long period of time and are thought to facilitate the individuality of the patients and enrich their lives. However, these items not only helped the patients to perform self-care behaviors（SCB）, but also prevented SCB. The patients considered SCB were their responsibility, but felt they were physically, mentally, and socially painful.
Conclusion : Before helping with SCB through nursing interventions, nurses must recognize the sense of health and values among adults with type ２ diabetes in addition to their backgrounds and self-control processes. If changes to the patients’ sense of health and values are required, nurses should take the necessary steps to ensure that the patient agrees with and accepts the changes. Further research should attempt to identify methods for facilitating SCB. In addition, nursing interventions should also attempt to identify methods of changing the factors that negatively affect SCB while maintaining respect for the patients’ sense of health and values.