Japanese

Title	超急性期脳卒中患者家族への認定看護師による代理意思決定支援
Subtitle	研究報告
Authors	犬飼智子1), 渡邉久美2)
Authors (kana)
Organization	1)岡山県立大学保健福祉学部, 2)香川大学医学部看護学科
Journal	家族看護学研究
Volume	26
Number	2
Page	119-130
Year/Month	2021 /
Article	報告
Publisher	日本家族看護学会
Abstract	「要旨」 目的:超急性期脳卒中患者の家族が行う代理意思決定において, 認定看護師が行っている看護実践を明らかにする. 方法:超急性期脳卒中治療を行う部署に勤務する救急看護, 集中ケア, 脳卒中リハビリテーション認定看護師5名に, 家族の代理意思決定場面を想起してもらい半構造化面接を行った. 録音した面接内容から逐語録を作成し, 質的内容分析を行った. 結果:5カテゴリが生成された. まず認定看護師は【家族の心情の受け止めと緩和】を行い, 精神的支援をしていた. 同時に家族のアセスメントを行い, 治療への同意ができるように家族の来院を促す等【代理意思決定に関わる家族状況の確認と調整】を行っていた. 家族への病状説明は医師のみで実施されることがほとんどであったが, 家族の言動を見逃さず注意を払いながら, 病状説明後には【代理意思決定に伴う疑問や不安の表出】を促し, 理解の程度の確認や情報提供により【病状・治療の理解の促進】を図っていた. これらの支援は患者の治療の合間を縫って行われていた. また【家族支援の継続と調整】がなされ, スタッフへロールモデルとしての関わりによる家族支援の調整, 医療者間の情報共有によって家族支援が継続されるよう管理を行っていた. 考察:認定看護師らは, 治療開始のための初回病状説明における家族の言動を最も重視し, 表情や言動を見逃さず, 家族と接する僅かな時間を見出していた. 精神的支援, 家族システムへの介入, 情報提供が行われており, まずは「家族の安定」, そして「病状・治療等の理解」の支援が重要であると考えられた.
Practice	看護学
Keywords	代理人, 意思決定, 認定看護師, 超急性期脳卒中, Surrogate, Decision-making, Certified Nurses, Hyper acute Stroke

English

Title	Surrogate Decision-making Support for Families of Hyperacute Stroke Patients Provided by Certified Nurses
Subtitle
Authors	Tomoko Inukai1), Kumi Watanabe2)
Authors (kana)
Organization	1)Okayama Prefectural University, Faculty of Health and Welfare Science, Department of nursing Science, 2)Kagawa University, Faculty of Medicine, School of Nursing, Mental Health and Psychiatric Nursing
Journal	Japanese Journal of Research in Family Nursing
Volume	26
Number	2
Page	119-130
Year/Month	2021 /
Article	Report
Publisher	Japanese Association for Research in Family Nursing, JARFN
Abstract	Objective: To clarify the details of surrogate decision-making support for families of hyperacute stroke patients provided by certified nurses. Methods: Semi-structured interviews were conducted with 5 nurses certified in emergency nursing, intensive care, and post-stroke rehabilitation who worked in departments providing hyperacute stroke treatment, asking them to describe the surrogate decision-making support for families that they had provided. Narratives were created from their statements recorded during the interviews to perform qualitative content analysis. Results: Five categories, explaining surrogate decision-making support for families of stroke patients provided by certified nurses, were established. [Accepting the emotions of families and alleviating their distress] and providing mental support for them were their first approaches. At the same time, they conducted family assessment, and encouraged families to participate in the informed consent and decision-making processes for treatment, with a view to [confirming and coordinating family matters for surrogate decision-making]. To promptly provide treatment and care, patients' pathological conditions were explained to families only by doctors. However, the nurses provided their own approaches, such as paying careful attention to families' statements and behaviors during the explanation, and [listening to their doubts and anxiety], confirming their levels of understanding, and providing them with information after it, with the aim of [promoting understanding of the pathological condition and treatment] among them. These support approaches were performed within limited time frames in between the duties of treating and caring for patients. [Continued family support and related coordination] was another approach adopted by the nurses. As a role model, they helped staff, and performed management to ensure continued family support through coordination for family support and information-sharing among medical professionals. Discussion: The nurses placed the utmost importance on families' statements during the initial explanation of the patient's pathological condition on initiating treatment, carefully observed their facial expressions, statements and behaviors, and actively communicated with them within limited time frames. As part of surrogate decision-making support for families, the nurses provided mental support, intervened in family systems, and offered information. The results suggest the importance of helping families maintain their mental stability first, and then understand patients' pathological conditions and treatment.
Practice	Nursing
Keywords	Surrogate, Decision-making, Certified Nurses, Hyper acute Stroke

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