体外式膜型人工肺離脱困難患者と家族に対するエンドオブライフケアの構造モデルの開発

The Structural Model of the End-Of-Life Care for Patients With Difficulty Weaning From Extracorporeal Membrane Oxygenation and Their Families

要旨

　目的：ECMO離脱困難患者と家族に対するエンドオブライフケアの構造モデルを開発する．

　方法：ダブルフェーズ探究的デザインの混合研究法．質的に抽出した54項目の質問票調査を455名のエキスパート看護師に実施した．

　結果：【ECMO回路交換にまつわる差し迫った状況下で患者の希望を叶える】を起点に【ICUという限られた環境でECMO継続と患者の安楽について常に自己の実践を問い生を護る】，【ECMO専門の多職種チームで患者の最善を目指す】ことが影響しながら【ECMO離脱困難の逼迫した状況を引き受け患者と家族のそばに居つづける】に集約し，最終的に【家族の心の安寧を追求する】に帰結する5因子から成る構造モデルを導いた．

　結論：エキスパート看護師は不確実で逼迫した状況を引き受け，患者とその家族のそばに居つづけ，ICU環境の中で患者が生ききるためのケアを行っていた．

　Objective: This study aimed to identify and develop a structural model of the end of-life care provided by certified nurse specialists and certified nurses for patients with difficulty weaning from extracorporeal membrane oxygenation [ECMO] and their families.

　Methods: The study design employed a mixed research method with a double-phase exploratory design. A questionnaire survey comprising of 54 qualitatively selected items was conducted with 455 certified nurse specialists and certified nurses. The obtained data were analyzed using structural equation modeling.

　Results: We derived a structural model of the end-of-life care for patients with difficulty weaning from extracorporeal membrane oxygenation and their families, consisting of five factors that culminate in [seek the peace of mind of the family], starting with [respecting and fulfilling the patient's wishes in the imminent situation of ECMO circuit exchange], leading to [being with patients and their families accepting the imminent situation of difficult ECMO withdrawal], while being influenced by [ensuring the patient's life by reflecting one's practice concerning comfort and continuity of ECMO in a limited ICU environment] and [working as a multidisciplinary team specializing in ECMO for patient's best interest and outcomes].

　Conclusion: Expert nurses took care of the uncertain and imminent situation and were close by patients and families, providing care for the patient to live to the fullest in the ICU environment.