緊急手術とともに初めてがんと診断される患者へのがん看護専門看護師による支援の実際

Supporting Patients First Diagnosed with Cancer along with Emergency Surgery: The Role of Certified Nurse Specialists in Cancer Nursing

要　旨

　目的：緊急手術とともに初めてがんと診断される成人患者に対するがん看護専門看護師による入院中からの支援の実際を明らかにすることである．

　方法：がん看護専門看護師7 名を対象に半構造化面接を行い，質的帰納的に分析した．

　結果：【置き去りになった患者・家族の心情を汲み取る】【病状から今後の展開を予測し，支援のスピード感をつかむ】【患者・家族，医療者間のこじれた状況を紐解きチームの力を見極める】【過酷な境遇を乗り越えるための患者・家族の良き理解者となる】【突然変化した身体とがん治療が加わる新たな日常への手助けをする】【患者・家族から足が遠のく病棟看護師・医師を後押しする】【専門性を生かして協働し，複雑な状況にあるがん患者のケアに参入する】【急性期医療に埋もれたがん患者と繋がるために，がん看護専門看護師の存在を組織に浸透させていく】の8カテゴリが抽出された．

　考察：がん看護専門看護師は，術後の回復過程，がんの予後という2つの時間軸を意識しながら，急性期医療の体制，そこに従事する医療者のなかで置き去りになる患者・家族を多角的・俯瞰的視点でとらえ，情報提供の専門性によりがん告知にともなう衝撃の軽減と受容の促進を意図し，意思決定を支援していた．

　結論：がん看護専門看護師は，患者が新たな日常を取り戻す支援を行いながら，急性期医療に埋もれやすい，緊急手術とともにがんと診断される患者と繋がる方法を模索していた．

　Purpose: This study aimed to examine the role of Certified Nurse Specialists (CNSs) in Cancer Nursing in providing support to adult patients undergoing emergency surgery following their initial cancer diagnosis, from the time of admission.

　Methods: Semi-structured interviews were conducted to collect data from experienced CNSs who provided support to cancer patients undergoing emergency surgery. The collected data were analyzed using qualitative and inductive methods.

　Results: A total of seven CNSs were included in this study. The data analysis resulted in the identification of eight categories: “capturing the overlooked emotions of patients and their families”,“predicting future developments based on medical conditions and ensuring timely support”,“unraveling the complicated situations between patients, their families, and healthcare providers to ascertain the team strength”,“advocating for patients and their families to help them overcome challenging circumstances”,“helping patients adjust to a new normal after experiencing sudden changes to their body and undergoing cancer treatments”, “supporting hesitant ward nurses and doctors in engaging with patients and their families”,“utilizing their expertise to care for cancer patients in complex situations and collaborating with other medical professionals”, and “promoting the presence of CNSs in the organization to better serve cancer patients in acute care settings”.

　Discussion: The CNSs interviewed recognized two important time frames: the postoperative recovery process and cancer prognosis. Notably, they adopted a holistic approach to address the needs of patients and their families who were overlooked by the acute care system and the medical personnel engaged in it. They assisted in decision-making by providing information to reduce the shock associated with cancer diagnosis and to promote acceptance of the disease.

　Conclusions: The CNSs advocated for the provision of support to cancer patients in acute care settings through routine appeals to organizations while helping patients establish a new normal.