Journal Article 終末期慢性呼吸器疾患患者と看護師の互いの了解を尊重した対人援助実践ガイドの開発
Development of a practical guide for interpersonal support that values mutual agreement for patients with chronic respiratory disease and nurses providing endƒof-life care

高橋, 良幸

23 ( 1 )  , pp.43 - 52 , 2017-08-31 , 千葉看護学会
[抄録] 終末期慢性呼吸器疾患患者と看護師の互いの了解を尊重した対人援助実践ガイドの開発を目的とした。「互いの了解」は「看護師の患者・介護者への関わりに関して,患者・介護者との間に感覚的にあるいは言語的に一致した状態があること」と定義した。研究1では, 慢性呼吸器疾患患者へのケア経験平均9.8年の熟練看護師7名へのインタビューから,「互いの了解」の評価項目,対人援助方法を導き出し,リフレクションのサイクルを参考にガイドを作成した。研究2は,臨床経験平均6.4年の看護師5名に各々の患者に対してガイドを使用してもらった。インタビュー内容,ガイドへの記載内容,患者への「患者のケア知覚尺度」のデータから内容分析,看護過程の分析を行い,ガイドの明確性・実用性・妥当性について質的に検証した。検証結果からガイドは実用性・妥当性があることが判断された。明確性の修正を加え,16項目の「互いの了解」の評価項目,6局面35項目の対人援助方法を含む,5つの質問回答形式で構成されるガイドに修正された。ガイドは,看護師に対人援助の継続と最適化を促すと考えられた。ガイドは対人援助のアイデア創出の実用的側面と実践的知識修得の教育的側面を併せ持ち,ケアの質向上と看護継続教育において有用であると考えられた。
[ABSTRACT] The purpose of this study is to develop a Practical guide for interpersonal support that values mutual agreement for patients with chronic respiratory disease and nurses providing end-of-life care. “Mutual agreement” was defined as “a state in which the nurse and the patient/caregiver have accordance in terms of feelings or speech regarding the involvement of the nurse toward the patient/caregiver” In Study 1, the assessment items “mutual agreement” and “interpersonal support methods” were extracted from interviews of seven expert nurses with a mean of 9.8 years of experience in providing care for patients with chronic respiratory disease, and the guide was created using these items and the reflective cycle. In Study 2, five nurses with a mean of 6.4 years of clinical experience used the guide for five patients. The clarity, practicality, and validity of the guide were verified qualitatively using a content analysis and case studies of nursing process based on interview contents, descriptions of the guide, and the data form the “Client Perception of Caring Scale” completed by patients. Based on the results, the guide was judged to be practical and valid. After making revisions for clarity, I created a revised version of the guide that consisted of five question-and-answer sections that included 16 assessment items for “mutual agreement” as well as six situations and 35 items for interpersonal support methods. The guide was thought to promote the continuation and optimization of interpersonal support by nurses. The guide has both a practical aspect for creating ideas for interpersonal support and an educational aspect for acquisition of practical knowledge, and was considered useful for improvement of the quality of care and the continuing education in nursing.

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