Japanese

Title	救急・集中治療領域における終末期患者の家族支援の充実に向けた看護管理者の働きかけ - 看護師の困難感を有する状況に着目して -
Subtitle	原著
Authors	西開地由美, 吉本照子
Authors (kana)
Organization	千葉大学大学院看護学研究科博士後期課程, 千葉大学大学院看護学研究科
Journal	千葉看護学会会誌
Volume	25
Number	1
Page	107-116
Year/Month	2019 / 8
Article	原著
Publisher	千葉看護学会
Abstract	本研究の目的は, 救急・集中治療領域の終末期患者の家族支援に困難感を有する看護師を支援し, 家族支援を充実させるための看護管理者の働きかけを明らかにすることである. 急性・重症患者看護専門看護師資格を有し, 救急・集中治療領域の終末期患者の家族支援の充実に向けた看護管理実践を語れる看護管理経験者8名に半構造化個人面接調査を行い, 質的帰納的に分析し, 看護師が家族支援に困難感を有する状況に対する看護管理者の意図と行動を抽出した. 看護師が困難感を有する状況として【医師・看護師・家族間で治療方針を合意形成できない状況】【終末期患者及びその家族へ看護を提供する意味が見出せない状況】【家族支援に関して支援環境が整っていない状況】等7項目, サブカテゴリー21項目を抽出した. 看護管理者は各状況に対し <医師と看護師が患者と家族にとって最善な治療や支援について考える機会をつくる><看護師自身の価値観に目を向け, 家族支援における使命や役割を看護として意味づける><看護師が患者や家族のケアに専念できるようにする> 等30の働きかけを行っていた. 救命を使命とする治療・ケアの場では, 医療者と家族の合意形成が困難, 終末期ケアに意味を見出せない, ケア環境が不適切等の状況があり, 看護師が困難感を有すると考えられる. 看護管理者は, こうした状況に対し, 患者と家族にとって最善の治療方針を決めるように, 医師と看護師, 家族間の合意形成や救命と共に終末期患者の家族支援に関する看護師の役割遂行を促し, ケア環境を調整していたと考える.
Practice	看護学
Keywords	emergency care or intensive care units field, terminal care nursing, family support, approach of nursing administrators

English

Title	APPROACH OF NURSING ADMINISTRATORS TO IMPROVE SUPPORT FOR FAMILIES WITH TERMINAL PATIENTS IN EMERGENCY AND INTENSIVE CARE : FOCUSING ON SITUATIONS WHERE NURSES FACE DIFFICULTY
Subtitle	Original Articles
Authors	Yumi Nishikaichi*1, Teruko Yoshimoto*2
Authors (kana)
Organization	*1Department of Doctoral, Graduate School of Nursing, Chiba University, *2Graduate School of Nursing, Chiba University
Journal	Journal of Chiba Academy of Nursing Science
Volume	25
Number	1
Page	107-116
Year/Month	2019 / 8
Article	Original article
Publisher	Chiba Academy of Nursing Science
Abstract	To identify how skilled nursing administrators approach to nurses who have difficulties in family support for families with terminal patients in emergency and intensive care. We conducted semi-structured one-on-one interviews with eight experienced skilled nursing administrators. The participants were critical care nursing specialist and were encouraged to talk about nursing management practices for the enhancement of family support for end-of-life patients in emergency and intensive care areas. We conducted a qualitative inductive analysis and extracted the nurse manager's intentions and behavior for situations where the nurse faced difficulties. Seven items were identified for situations where nurses faced difficulty, including situations where the doctor, nurse, and family cannot reach a consensus on treatment strategy; situations where the nurse cannot find meaning in providing nursing care for the terminal patient and their family; and situations where a supportive environment is not prepared to support the family. These situations included 21 subcategory items, and 30 were identified as objectives for approaches taken by nursing administrators in response to each situation, including creating a venue for doctors and nurses to cooperatively consider the best options for the patient and family; having nurses reflect on their own values and find purpose in their mission and role of providing family support; and forming groups within hospital wards where nurses can focus on patient and family care for family support for terminal patients. In situations where it is difficult for nurses to provide family support to end-of-life patients, the nursing team makes the best decisions for the medical team and the family for the patient and creates consensus among doctors, nurses and families aim to promote role recognition among nurses with diverse values and prepare an environment for terminal care. Nursing managers have to take an approach according to the actual situation.
Practice	Nursing
Keywords	emergency care or intensive care units field, terminal care nursing, family support, approach of nursing administrators

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