Japanese

Title	集中治療室において侵襲的陽圧換気法による人工呼吸器の早期離脱に関わる熟練看護師の判断
Subtitle	研究報告
Authors	堀江純子1), 城丸瑞恵2)
Authors (kana)
Organization	1)SOMPOケア札幌星置訪問看護, 2)札幌医科大学保健医療学部看護学科
Journal	札幌医科大学札幌保健科学雑誌
Volume
Number	11
Page	61-67
Year/Month	2022 / 3
Article	報告
Publisher	札幌医科大学保健医療学部
Abstract	本研究は, 集中治療室において熟練看護師が侵襲的陽圧換気法による人工呼吸器の早期離脱に向けてどのような判断を行っているのか, その実際を明らかにすることを目的として, 侵襲的人工呼吸器装着患者の援助を行っている看護師6名に, 半構造化面接を行った. その結果, 早期離脱に向けた判断として4カテゴリ, 12サブカテゴリが生成された. 【離脱を推進する身体的準備状況】では, 数値的データや原疾患の改善状況などから判断し, 【離脱に向けた阻害要因の有無】では, 特にせん妄や抑制状況から判断を行っていた. 【離脱に向けた患者の意識・意欲の高まり】では, 患者の離脱への意識・意欲から, 【経験知を活かした抜管成功についての可能性】では, 熟練看護師がこれまで離脱した患者の言動を踏まえて判断していた. 熟練看護師は, これまでの経験を活用しながら, 患者の身体面・心理面の状況を見極め人工呼吸器離脱の判断を行っていたことが示唆された.
Practice	医療技術
Keywords	人工呼吸器, 早期離脱, 判断, 熟練看護師, intensive care unit, mechanical ventilation, early weaning, judgments, expert nurses

English

Title	Judgments made by expert nurses involved in early weaning from mechanical ventilation of invasive positive pressure ventilators in intensive care units
Subtitle	RESEARCH REPORTS
Authors	Junko HORIE1), Mizue SHIROMARU2)
Authors (kana)
Organization	1)sompocare sapporohosioki home visit nursing care, 2)Department of Nursing, School of Health Sciences, Sapporo Medical University
Journal	Sapporo Medical University Sapporo Journal of Health Sciences
Volume
Number	11
Page	61-67
Year/Month	2022 / 3
Article	Report
Publisher	School of Health Sciences Sapporo Medical University
Abstract	In this study, six nurses who attend patients on invasive mechanical ventilators were given semi-structured interviews, for the purpose of elucidating the state of judgment-making by expert nurses in the ICU regarding early weaning from respiratory apparatus of invasive positive pressure ventilation (IPPV) utilized in patients. The results yielded a total of four categories and twelve subcategories concerning judgments leading to early weaning. In "Physical Preparedness for Weaning," judgments were made by considering numerical data and improvements in underlying illnesses, and in "Presence of Hindrances Toward Weaning," judgments were made especially by considering delirium and physical constraints. For "Increase in Patient's Awareness and Will Toward Weaning," the patients' awareness and will toward weaning were considered, and for "Probability of Successful Extubation Based on Experience," the expert nurses based their judgments on the words and actions of patients they had previously extubated. Results of the study suggest that expert nurses make their judgments concerning weaning of mechanical ventilation by examining the patients' physical and mental conditions while applying knowledge from previous experiences.
Practice	Medical technology
Keywords	intensive care unit, mechanical ventilation, early weaning, judgments, expert nurses

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