慢性閉塞性肺疾患療養者に対する訪問看護師のセルフマネジメント教育と困難の実態—訪問看護師の臨床経験に焦点をあてて

Self-Management Education and Difficulties Faced by Home-Visit Nurses for Patients With Chronic Obstructive Pulmonary Disease: Focusing On the Clinical Experiences of Home-Visit Nurses

要旨

　目的：COPD療養者に対する訪問看護師のセルフマネジメント（SM）教育の実施頻度と看護上の課題，他職種との連携頻度，困難に関する実態及び，それらと訪問看護師の臨床経験との関係・特徴を明らかにする．

　方法：全国の訪問看護師3,000人を対象に，郵送法による質問紙調査を実施した．分析は基本統計量を算出後，SM教育の実施頻度と看護上の課題，他職種との連携頻度と臨床経験との差をMann-WhitneyのU検定で解析した．困難に関する自由記述は内容分析によりカテゴリーを抽出した．

　結果：305人を分析対象とした．SM教育の実施頻度では，息切れの評価に関する指導が最も少なく，呼吸器科病棟経験がない群で有意に少なかった．それに加えて，呼吸器科病棟経験がない群はCOPD療養者への訪問看護の困難を感じやすい特徴があった．

　結論：訪問看護師によるSM教育を促進するためには，臨床経験に応じた専門知識の普及と困難感の軽減が求められる．

　Objective: This study aimed to clarify the actual conditions of the frequency of self-management (SM) education, nursing issues, frequency of collaboration with other professionals, difficulties faced by home-visit nurses for patients with chronic obstructive pulmonary disease (COPD), and the relationship between these experiences and home-visit nurses' clinical experiences.

　Methods: A postal questionnaire survey was conducted with 3,000 home-visit nurses nationwide. After calculating the basic statistics, the differences between the frequency of SM education, nursing issues, frequency of collaboration with other professions, and clinical experiences were analyzed using the Mann-Whitney U test. The free-description categories of difficulty were extracted using content analysis.

　Results: The analysis included 305 participants. Regarding the frequency of SM education, instruction on the assessment of shortness of breath was the least common and significantly less common in the group with no experience in respiratory wards. Additionally, the group with no experience in respiratory wards was more likely to experience difficulties in home-visit nursing for patients with COPD.

　Conclusion: To promote SM education among home-visit nurses, there is a need to disseminate expertise and reduce feelings of difficulties.