がんと認知症を併せ持つ高齢患者への老人看護専門看護師による看護実践：質的研究

Nursing Practice for Older Adults with Comorbid Dementia and Cancer by Certified Nurse Specialists in Gerontological Nursing: A Qualitative Study

要　旨

　目的：がんと認知症を併せ持つ高齢患者への老人看護専門看護師による看護実践を明らかにする．

　方法：老人看護専門看護師7名を対象に半構造化面接を実施し，質的記述的研究手法を参考に分析した．

　結果：対象者は急性期病院，特別養護老人ホーム，訪問看護などでのがんと認知症を併せ持つ高齢患者への看護実践を語った．66コード，11サブカテゴリ，3カテゴリ【がんと認知症によって引き起こされる複雑な身体・心理的苦痛の緩和】【がんと認知症の併存を有利にとらえた援助】【がん診断・治療が認知症の人にもたらす意味の検討】が明らかとなった．

　結論：老人看護専門看護師は，がんと認知症による影響を複合的にとらえ，患者の認知症に配慮しながらがんによって生じる身体的・心理的苦痛を緩和していた．また，がんと認知症の併存によって医療・福祉サービスがより多く受けられる，病状の予測がより可能になるなど，認知症とがんの併存を有利にとらえ，支援に活かしていた．認知症によって患者の意向が表面化しづらいため，患者にとってのがん診断・治療の意味を家族・支援者とともに検討していた．

　Objective: The study aimed to identify effective nursing practices of certified nurse specialists in gerontological nursing (GCNS) for older adults with dementia and cancer.

　Methods: Semi-structured interviews were conducted with seven GCNSs, and the data were qualitatively　analyzed.

　Results: The narratives of the subjects were nursing practice in acute care hospitals, special nursing homes　and/or home care nursing. As nursing practice for older adults with both dementia and cancer, 66 codes, 11　subcategories and 3 categories were identified: alleviating complicated physical and psychological pain caused　by cancer and dementia, harnessing the positive aspects of cancer and dementia coexistence and examining　the meaning of cancer diagnosis and treatment for people with dementia.

　Conclusions: The GCNSs alleviated the complicated physical and psychological pain caused by cancer　while taking the patient's dementia into consideration. They provided nursing care that makes the coexistence of dementia and cancer advantageous for patients, such as greater access to medical and welfare services and more predictability of disease status. Because dementia makes it difficult for nurses to understand patients’ intentions, the meaning of cancer diagnosis and treatment for patients was discussed together with their families and support providers.