急性期慢性閉塞性肺疾患患者の在宅酸素療法導入における作業療法の専門性—クリニカルリーズニングにより分析した事例報告

Occupational therapy expertise in initiating Home Oxygen Therapy for patients with acute exacerbation of Chronic Obstructive Pulmonary Disease: A case report analyzed through clinical reasoning

要旨：本事例では，急性期慢性閉塞性肺疾患患者の在宅酸素療法導入時の作業療法の専門性をClinical Reasoningで分析した．対象は60代女性で，週5日・1日40分で介入した．介入初期は，ADL評価・介入，多職種連携により医学的判断を支えた．導入決定後は，退院後を見据えたADL，セルフマネジメントの支援を実施した．結果，作業療法の専門性として「医療専門職としての治療的役割」と「作業参加に向けた調整的役割」を担い「意味のある作業に結びつけるセルフマネジメント支援」を実施した点が示唆された．

　This case analyzed the professional expertise of occupational therapy during the introduction of Home Oxygen Therapy (HOT) for an acute-phase patient with Chronic Obstructive Pulmonary Disease (COPD) using a clinical reasoning framework. The participant was a woman in her 60s who received occupational therapy five days per week for 40 minutes per session. In the initial phase, occupational therapy focused on ADL assessment and intervention, and it supported medical decision-making through interprofessional collaboration. After the decision to introduce HOT, the intervention emphasized ADL practice and self-management support with a view toward post-discharge life. The findings suggest that the professional expertise of occupational therapy involved two roles: a “therapeutic role as a healthcare professional” and a “coordinative role in promoting occupational participation.” In addition, occupational therapy provided self-management support that enabled the patient to engage in meaningful occupations.