特発性肺線維症療養者の尊厳に着目した看護師育成プログラムの開発と混合研究法ランダム化比較試験による評価

Development and Evaluation of a Nurse Training Program on Dignity-Centered Care for People With Idiopathic Pulmonary Fibrosis: A Randomized Controlled Trial Using Mixed-Methods Study

要旨

　目的：特発性肺線維症療養者の尊厳に着目した看護（Dignity-Centered Care）を基盤に看護師育成プログラムを開発し，混合研究法により評価する．

　方法：混合研究法説明的順次デザインの2要因層化ランダム化比較試験と参加者選定モデルによる質的帰納的研究．受講前後と受講4週後の看護実践項目数と自己効力感を比較しインタビューを行った．

　結果：受講後の看護実践項目数は受講群22.77±7.34，自己学習群22.62±6.06（U＝326.000，p＝0.826），自己効力感は受講群8.19±2.63，自己学習群7.46±1.87（U＝293.000，p＝0.404）で両群に有意な差はなかった．ケアに活用されたが実践の機会に相違がみられた．

　結論：援助行動を促進するも看護実践項目数は増加せず，看護実践は療養者との関わりの頻度に依存するとメタ推論された．

　Purpose: To develop and evaluate a nurse training program based on dignity-centered care for patients with idiopathic pulmonary fibrosis by integrating qualitative and quantitative data regarding changed nursing practice using the participant selection model of an explanatory sequential design of mixed-methods study.

　Methods: This two-armed, two-factor, stratified, randomized controlled trial compared receiving one month of e-learning in nursing practice and self-study. Quantitative data were obtained from two questionnaires.

　Number of nursing practices(34 questions on general items, nursing practice at the time of diagnosis, antifibrotic drugs, home oxygen therapy, and acute exacerbation) from a self-administered questionnaire and General Self-Efficacy Scale. The number of nursing practice items and self-efficacy were compared before, after, and 4 weeks after the program, and interviews with the three nurses provided qualitative data. This program comprises three educational modules: disease overview, illness characteristics, and nursing.

　Results: The number of nursing practice items after the program was 22.77±7.34 for the intervention group and 22.62±6.06 for the control group(U = 326.000, p = 0.826), while self-efficacy was 8.19±2.63 for the intervention group, and 7.46±1.87 for the control group(U = 293.000, p = 0.404), indicating no significant difference between the two groups. Semi-structured interviews yielded three categories.

　Conclusion: The program did not increase self-efficacy or the number of nursing practice items. The meta-inference was that this program deepened knowledge and promoted nursing practice; however, nursing practice depended on the frequency of interactions with patients.