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Japanese
Title :
最期の療養場所に関する意向の相違を抱えた家族に対する訪問看護師による意思決定支援
Subtitle :
事例研究
Authors :
大竹泰子1), 野口麻衣子2), 野原良江1), 山本則子2)
Authors (kana) :
Organization :
1)横浜市栄区医師会栄区訪問看護ステーション, 2)東京大学大学院医学系研究科健康科学・看護学専攻 高齢者在宅長期ケア看護学 / 緩和ケア看護学
Journal :
家族看護学研究
Volume :
23
Number :
1
Page :
64-74
Year/Month :
2017 /
Article :
報告
Publisher :
日本家族看護学会
Abstract :
「要旨」本論文は, 訪問看護利用者の最期の療養の場の選択について, 意向の相違を抱えた家族への看護実践に関する事例研究であり, その意向の相違を抱えた家族が合意に至る過程の看護実践を記述することを目的とする. 看護記録や振り返りから文章化したデータを, 看護師と研究者が共同で内容を検討し, 実践の意図に沿ってカテゴリを生成した. 訪問看護利用者は80代男性で肝門部胆管がん末期であった. 主介護者は妻80代で, 介護を誰にも任せられず介護疲労状態にあった. 娘は50代で, 頻回に両親の家に行っていた. 特に主介護者の妻と娘の間で, 病状の進行と共に最期の療養の場の選択についての意向の相違が生じたが, 最終的には相違が解消し最期を迎える場所の合意に至った. 訪問看護の訪問期間は1カ月, 回数は4回であった. 最期の療養の場の選択における意向の相違を抱えた家族への支援のための看護内容は3カテゴリにまとめられた. 1)強い母(妻)に対して娘が意見を言えない時期:家族の介護体制を尊重し, 本人の苦痛症状の軽減を軽減することで在宅療養の安定を図った. 2)母(妻)と娘が膠着状態の時期:家族間の膠着状態を緩めるため, 療養場所のイメージを広げ, 家族員の異なる意見をそれぞれ支持した. 3)母(妻)と娘の膠着状態に風穴が開く時期:家族の衝突を機に切り込むため, 家族の言葉の変化を嗅ぎ取り, アポイントなしの訪問で一気に調整を試みた. このように, 家族の関係性を見極め, まずは在宅療養の安定を図り, 次いで家族間の膠着状態を緩め, 家族の衝突を機に切り込むという支援を速やかに行ったことにより, 入院だけはさせたくないと強い意向を述べていた妻も最期はA氏を後悔なく見送れた.
Practice :
看護学
Keywords :
家族間の意向の相違, 意思決定支援, 訪問看護, 最期の療養場所, 事例研究, family with different views, decision-making support, homecare nursing, place for end-of-life care, case study
  
English
Title :
Decision-Making Support by a Homecare Nurse for a Family with Different Views Regarding the Place for End-of-Life Care
Subtitle :
Authors :
Taiko Ohtake1), Maiko Noguchi-Watanabe2), Yoshie Nohara1), Noriko Yamamoto-Mitani2)
Authors (kana) :
Organization :
1)Yokohama si sakaeku medical association sakae-ku homecare nursing agency, 2)Department of Gerontological Home Care and Long-term Care Nursing / Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
Journal :
Japanese Journal of Research in Family Nursing
Volume :
23
Number :
1
Page :
64-74
Year/Month :
2017 /
Article :
Report
Publisher :
Japanese Association for Research in Family Nursing, JARFN
Abstract :
This case study focuses on elucidating nursing practice that facilitated an agreement between family members who had differing views concerning the appropriate location for the final days of a terminal cancer patient. Information concerning the care process was provided by asking the nurse, and was obtained from the nursing record and a letter provided by the family of the patient. All authors and colleagues of the nurse examined this account, developed categories, and summarized information in a table. The patient was a male (80s) with end-of-life stage biliary cancer. The primary caregiver was the wife of the patient (80s) who exhibited caregiving fatigue. The adult daughter (50s) was involved, often visiting the home of her parents. Initially, different views were expressed between wife and daughter as to the appropriate place for end of life care. However, an agreement was eventually reached after a month while homecare nursing services were provided once a week. Nursing practice that affected the agreement on the place for end of life care was divided into three categories. In the phase "daughter cannot state opinion to mother," the nurse focused on keeping the condition of the patient stable. In the next phase "mother and daughter in deadlock," the nurse tried to repair the relationship between mother and daughter. Through foregoing this nursing practice, the phase progressed to "breaking the deadlock relationship between mother and daughter," in which the nurse promptly responded when family members collided. These strategies by nurses may have assisted patients and families to agree on final location for end of life care and improve the overall care process.
Practice :
Nursing
Keywords :
family with different views, decision-making support, homecare nursing, place for end-of-life care, case study
  

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