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Journal of Iwate Society of Nursing Science. Vol.1, No.1, 2007

Original

ArticleStudy of Nurses

Course of Processing Subjective Data

: A Study of Factors Affecting the Nursing Students Courses of Processing
Subjective Data
Osamu Ito
Iwate Prefectural UniversityAbstract
The objective of this study was to identify factors affecting the nursing students courses ofprocessing subjective data as a first step to analyze the courses of processing subjective data insituations in which nurses detect suicidal signs . Subjects were 32 second-year nursing university
students who had agreed to participate in the study. The data was collected from the words expressedby the students in response to the stated eight situations such as cases of paper patients. From thedata, characteristics of the courses of processing subjective data in the situations were determined.
The contributing factors responsible for these characteristics were then identified. The following
seven factors were identified as the ones contributing to the nursing students courses of processing
subjective data: 1) standpoints that reviews intersubjectivity with patients from a future standpoint,2) attitude that tries to maintain and develop intersubjectivity , 3) characteristic of standpoints
with patients , 4) avoidance of silence, 5) attitude that emphasize on relationships rather thandata, 6) choice between emotional and intellectual approaches, and 7) choice between nursing
expertise and human compassion.In addition, the following three pairs of standpoints, which do notcontradict or conflict with each other, subsist in the nursing students course of processing subjective
data in situations of preventing suicide: non-confrontational vs. confrontational approach,emotional vs. intellectual approach, and nursing expertise vs. human compassion.

Key words:

suicidal signs, course of processing subjective data, contributing factors,
intersubjectivity, case of paper patients- 36 -

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1)

5(1) 59-62 2001.
2)
35 20033)
1778 81 2004
4)

NobukoOkubo:

Improvementin

LevelofConsciousness after Sitting Without Back Support: Case
Study of a Patient in a Persistent Vegetative State UsingKohnan Score and EEG, Proceedings of the 10 th Annual
Meeting of the Society for Treatment of Coma, 10,83-94,2001.
5)
231-462007.

6)49(12) 1139-1145
1997.
7)
10 53-59
1998(20071120071228)

/Journal of Iwate Society of Nursing Science. Vol .1 ,No. 1,2 007<Study Report>

A Case Focusing on Level of Consciousness Before and During
Implementation of a Sitting Position

ithout Back Support to a Patientin the Chronic Stage of Cerebral Vascular Disease
Yuko Hasegawa1) , Nobuko Okubo 2) , Yukami Yamamoto1) ,Iwate Prefectural Ofunato Hospital1) , St. Lukes College of Nursing 2)

Abstract
A sitting position without back support is being introduced to patients in the chronic stage of
cerebral vascular disease as part of patient care targeting improved level of consciousness.
Several studies, particularly those that utilized the Tohoku Ryogo Center Minimally Conscious
State Scale (the Kohnan Score), have reported an improvement in consciousness level byintroducing a sitting position without back support. Studies report no change in the daily
Kohnan scores taken before and during implementation of the sitting position without backsupport, but that improvement was made day by day. However, this research reports findings
different from the aforementioned in a case involving introduction of the sitting position
without back support to a cerebral vascular disease patient.
The patient was a female in her 80s hospitalized for subarachnoid hemorrhaging due to aruptured aneurysm in the left anterior cerebral artery. Neck clipping surgery and ventriculardrainage were carried out, and later surgery for a ventriculoperitoneal shunt was performed.
Three months after onset when the patient was stable, a sitting position without back support
was introduced over a period of 49 days. Consciousness level was measured daily using theKohnan Score before the intervention, 5 minutes into the intervention, and immediately before
the intervention ended, for a total of 3 times. The length of implementation time for the sitting
position without back support ranged from the shortest, 10 minutes, to the longest, 45 minutes,
with an average of 25.9±8.5 minutes.
The average Kohnan score prior to the daily implementation totaled 56.2±3.9, and the score
immediately before ending the implementation averaged 53.5±4.4. The score just before theimplementation ended was significantly lower than the score prior to implementation (pairedt-test, P<0.05). For each of the Kohnan Score elements, improvements are acknowledged
through autonomous movement, eye movement, level of awareness, obeying simple commands,communication, and changes in expression. Because these results differ from previous research,
it is necessary to add to the validity of the results by studying other cases.
In addition, the degree of change in consciousness during the time the sitting position withoutback support was implemented was analyzed. An average score of 53.8±3.8 five minutes intothe implementation and an average score of 53.5±4.4 just prior to ending the intervention
revealed no significant difference. Possibly, no difference was seen because the implementation
time was only 30 minutes. Some believe it is better to include other nursing care in addition tothe sitting position without back support if the implementation is long and consciousness is

/Journal of Iwate Society of Nursing Science. Vol .1 ,No. 1,2 007

reduced. Therefore, cases where the implementation time is long should be analyzed andexamined.
Keywords: sitting position without back support, cerebral vascular disease, chronic stage,Kohnan Score, consciousness level, posture/Journal of Iwate Society of Nursing Science. Vol.1, No.1, 2007

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