- 著者
-
松井 希代子
柳原 清子
佐藤 正美
能登原 寛子
下 綾華
塚本 愛実
中村 優希
西野 ひかり
東 郁江
兵田 亜未
村田 奈穂
元橋 茉佑
森田 恵里
米澤 智亜紀
- 出版者
- ウェルネス・ヘルスケア学会
- 雑誌
- Journal of wellness and health care (ISSN:24333190)
- 巻号頁・発行日
- vol.41, no.1, pp.125-135, 2017
Cancer medicine is becoming more sophisticated and complex, and therefore it is becoming more difficult to care for people at the end of life. This study was performed to identify the nature of positive attitudes to nursing practice of nurses in general hospitals, and to examine their associations with various different factors. The participants were 683 nurses working in 41 wards in eight regional general hospitals. The survey was carried out as an anonymous self-administered questionnaire. Four factors were identified as constituents of nurses' positive attitudes to nursing practice. These consisted of three factors concerning attitudes and knowledge, comprising [The practice of specialist end-of-life specific care], [Making the best arrangements until the end], and [Spiritual care], and one affirmative sentiment, that of [The confidence to nurse someone at the end of life]. The mean score for factors related to knowledge of nursing practice was > 4 points on a 6-point scale, corresponding to "Somewhat applicable," whereas the mean score for the sentiment [The confidence to nurse someone at the end of life] was > 3 points, corresponding to "Not really applicable." In terms of related factors, for all factors other than spiritual care, positive attitudes to nursing practice increased significantly with increasing experience. There was no association with having cared for a dying family member. Although having experienced an educational opportunity was not associated with the practice of case conferences for deceased patients, it was significantly associated with the experience of having been able to talk at length about the care they had provided and their own thoughts in venues such as case conferences, receiving recognition by colleagues at their own level of seniority or above, and reflection. Improving nurses' positive attitudes to nursing practice in end-of-life care in general hospitals, therefore, depended not on personal characteristics, such as having taken care of a dying family member, but rather on having repeatedly overcome difficulties in the course of nursing experience. Talking at length about care and expressing one's own thoughts, receiving recognition from colleagues at one's own level of seniority or above, and reflection on nursing practice were all important in this process.がん医療が高度・複雑化し、結果、人々が「死」を看取っていくことが難しくなっている。本研究の目的は、総合病院における看護師のがん終末期の実践への肯定感はどのようなものかを明らかにし、要因との関連を見ることとである。対象は地方の 8 つの総合病院 41 病棟683 名の看護師である。自記式質問紙調査を行い、看護師の実践への肯定感は 4 因子の構造として見いだされた。それは【終末期固有の専門的ケア実践】、【最期までの最善の調整】、【スピリティアルなケア】という実践への態度や認識と、【最期を看取っていく自信】という肯定的心情であった。実践への認識の平均値は 6 段階中 4 点台で、「どちらかといえばできる」レベルであり、【最期を看取っていく自信】の心情は 3 点台で「どちらかといえば自信がない」であった。関連要因では、スピリティアルケアを除く全ての因子で、経験年数が増すと実践への肯定感が有意に高まっていた。また、身内の死の看取り経験は関連がなかった。一方、教育的働きかけを受けた経験との関連は、デスカンファレンス実施の有無とは関係がなかったが、自分の行ったケアや思いを十分に語った経験、先輩や同僚に認められた経験、そしてリフレクションが有意に関係していた。つまり、総合病院の終末期ケアにおいて、看護師の実践への肯定感の高まりは、身内の死の看取りなどの個人的特性ではなく、看護経験の中で、困難感からの転換の形で積み重ねられていた。その過程では、ケアや思いを十分に語り、先輩や同僚に認められ、そして実践をリフレクションすることが重要となる。