アブストラクト
Japanese
| Title | COPD患者の人生の最終段階の過ごし方の意思決定支援における熟練看護師の思考プロセス |
|---|---|
| Subtitle | 原著 |
| Authors | 濱野里香, 辻あさみ |
| Authors (kana) | |
| Organization | 和歌山県立医科大学大学院保健看護学研究科 |
| Journal | 日本医学看護学教育学会誌 |
| Volume | |
| Number | 30-3 |
| Page | 11-22 |
| Year/Month | 2022 / 3 |
| Article | 原著 |
| Publisher | 日本医学看護学教育学会 |
| Abstract | 「概要」「目的」 : 熟練看護師が慢性閉塞性肺疾患患者の人生の最終段階の過ごし方の意思決定支援を実践する思考プロセスを明らかにし, 看護実践の示唆を得ることである. 「方法」 : 研究協力者8名に半構造化面接を行い, SCATを用いて分析しストーリーラインを作成した. 「結果」 : 研究協力者は, 熟練看護師とされる8名であった. 分析結果から9のカテゴリが生成された. 熟練看護師は, 急性増悪を繰り返すCOPD患者を【意思決定支援の介入時期の見極めの困難さの認識】を感じながら, 【生活の延長線上にある終末期をふまえた患者理解】をしていた. そして, 【急性増悪時毎の終末期に至る可能性の認識】をし, 【急性増悪からの回復毎に今後どう過ごしていきたいか考えるきっかけを与える支援】を実施していた. また, 患者や家族の【意思の継続的探索】を実践し続けながら, 【患者の意思が家族の意思に反映していること】や【患者本人のもつ意思の代弁者的役割】, 【治療・看護の方向性の統一と共有】といった支援を【患者に影響される看護師の心理的ジレンマと行動の抑制】といった葛藤を抱えながら実践していることが明らかとなった. 「結論」 : COPD患者の終末期に移行する予測が困難である. そのため熟練看護師は, 患者の意思を探索しながら意思決定支援の介入時期を見極め, 看護師としての役割を自覚しながら自己との内省によってジレンマを乗り越え支援の実践に繋げる思考プロセスを辿っていた. |
| Practice | 看護学 |
| Keywords | COPD (慢性閉塞性肺疾患), 人生の最終段階の過ごし方, 意思決定支援, 熟練看護師, SCAT, COPD (chronic obstructive pulmonary disease), End-of-Life Stage, decision making, expert nurse |
English
| Title | Thought Process of the Expert Nurses for Supporting Decision Making of COPD Patients in the End-of-Life Stage |
|---|---|
| Subtitle | Original Articles |
| Authors | Rika Hamano, Asami Tsuji |
| Authors (kana) | |
| Organization | Postgraduate School of Health and Nursing Science, Wakayama Medical University |
| Journal | Japanese Journal of Medical and Nursing Education |
| Volume | |
| Number | 30-3 |
| Page | 11-22 |
| Year/Month | 2022 / 3 |
| Article | Original article |
| Publisher | The Japanese Association of Medical and Nursing Education |
| Abstract | [Abstract] [Objectives] This study clarified the thinking process of expert nurses to support decision-making of COPD patients at the end-of-life stage and obtained suggestions for better nursing practices. [Method] Semi-structured interviews were conducted from eight subjects, analyzed using SCAT, and a storyline was created. [Results] The subjects were 8 expert nurses. 9 categories were generated from the analysis results : (1) understanding patients at the end of life, seeing it as an extension of their lives. (2) Recognition of difficulty in determining the timing of intervention for decision support. (3) Recognition of the possibility of reaching the terminal stage of each acute exacerbation. (4) Every time a patient recovered from acute exacerbations, the nurse provided support to give the patient an opportunity to think about how he/she would like to spend time in the future. (5) Continuous search for intention. (6) The patient's intention is reflected in the family's intention. (7) The role of the patient as an advocate for his/her own intention. (8) Unification and sharing of the direction of treatment/nursing. (9) Psychological dilemmas of nurses affected by patients and suppression of behavior. [Conclusion] It is difficult to predict the transition to end-of-life in COPD patients. Therefore, expert nurses identify the timing of decision support intervention while exploring the patient's intentions, and while being aware of their role as a nurse, follow a thinking process that overcomes the dilemma and leads to the practice of support through self-reflection. |
| Practice | Nursing |
| Keywords | COPD (chronic obstructive pulmonary disease), End-of-Life Stage, decision making, expert nurse, SCAT |
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