訪問看護師による心不全患者の生活や身体の“いつもとの違い”からの心不全の増悪の判断

Judgment of Heart Failure Exacerbations by Visiting Nurses Based on "Different Than Usual" Daily Life and Symptoms of Patients

要旨

　目的：訪問看護師による心不全患者の生活や身体の“いつもとの違い”からの心不全の増悪の判断を明らかにする．

　方法：心不全患者の担当経験のある訪問看護師5名に面接し，質的記述的に分析した．

　結果：分析の結果，【患者のいつもの生活をあらかじめ把握して訪問する】【いつもと違う言動や症状から心不全の増悪を疑う】【心不全の病態をふまえ，いつもと違う原因を探求する】【いつもとの違いから活動と心負荷を推し測る】【心不全を裏づけし，いつもとの違いを判断する】の順に5つの判断を導いた．

　結論：“いつもとの違い”とは，いつもの生活との違いであった．訪問看護師は，「いつもの患者の生活や身体の状況を測るものさし」を活用し，心不全患者のいつもを捉えていた．心不全の増悪の判断には，「患者独自の増悪の徴候と判断するものさし」を活用していた．

　Objective: To examine the judgment of visiting nurses with regard to heart failure exacerbations based on "different than usual" daily life and symptoms of patients.

　Methods: Five visiting nurses with experience in treating patients with heart failure were interviewed. The interview contents were analyzed qualitatively and descriptively.

　Results: The results showed that the following five approaches were used in making judgments: "Visiting patients with understanding of their usual daily life", "Suspecting exacerbation of heart failure based on unusual words, behaviors and symptoms", "Searching for unusual causes based on the pathology of heart failure", "Estimating activity and cardiac load that may be different than usual", and "Confirming heart failure and recognizing that this is different than usual".

　Conclusion: "Different than usual" indicates differences from usual daily life. Visiting nurses used the behavior of patients to "evaluate usual daily life and physical conditions", which allowed recognition of a change in the normal situation of a patient with heart failure. These findings suggest that exacerbation of heart failure can be detected using a "patient's own signs of exacerbation".