免疫チェックポイント阻害薬治療を受ける肝がん患者に対する外来化学療法室での認定看護師の看護実践：質的記述的研究デザイン

Nursing Practice of Certified Nurses in Outpatient Chemotherapy Unit for Patients With Liver Cancer on Immune Checkpoint Inhibitors: A Qualitative Descriptive Study

要旨

　目的：免疫チェックポイント阻害薬（以下，ICI）治療を受ける肝がん患者に対して外来化学療法室でがん化学療法看護認定看護師（認定看護師）が行う看護実践を明らかにする．

　方法：質的記述的研究デザイン．ICI治療の経験と実績のある認定看護師8名に半構造化面接を実施し，質的統合法（KJ法）にて分析した．

　結果：認定看護師は【病院・地域を巻き込んだ重症化対策】を前提として，【症状の発信と受信の強化】と【信頼し合える診療の保証】を行い，患者の安全と安心を保証していた．また【血管確保の確実性の保証】と【治療による生活のしづらさへの配慮】を行い，患者の治療継続を支援していた．【病院・地域を巻き込んだ重症化対策】の一方で，【患者に深く関わる機会の少なさ】の葛藤も存在した．

　結論：認定看護師には，ICI治療を受ける肝がん患者に対し，症状の発信と受信の強化と信頼し合える診療の保証を図り，心身両面から支える役割が期待されている．

　Objective: To identify nursing practices of certified cancer chemotherapy nurses(hereafter "certified nurses") in the outpatient chemotherapy unit for patients with liver cancer receiving immune checkpoint inhibitor(ICI) therapy.

　Methods: In this qualitative descriptive study, eight certified nurses with experience and performance in ICI treatment were interviewed using a semi-structured format, and the data were analyzed using the qualitative synthesis method(KJ method).

　Results: Certified nurses ensured patient safety and security by "strengthening the transmission and reception of symptoms" and "assuring mutual trust in medical care" based on the premise of "measures to prevent serious illness involving the hospital and community." Moreover, they supported patients in continuing their treatment by "guaranteeing the certainty of securing blood vessels" and "considering the difficulties in living due to treatment." However, a conflict was reported due to "lack of opportunities to be deeply involved with patients."

　Conclusions: Certified nurses are expected to provide physical and mental support to patients with liver cancer undergoing ICI treatment by strengthening the transmission and reception of symptoms and assuring mutual trust in medical care.