緩和ケア病棟の看護師が体験している共感疲労の構成要素と増強要素

Components and Exacerbating Factors of Compassion Fatigue Experienced by Nurses in a Palliative Care Unit

要　旨

　本研究の目的は，緩和ケア病棟の看護師が体験している共感疲労の構成要素と増強要素を明らかにすることである．緩和ケア病棟の看護師10名を対象に半構造化面接を行い，質的帰納的分析を行った．

　緩和ケア病棟の看護師が体験している共感疲労の構成要素として，【勤務外での患者の状態の想起および看護実践の反すう】【共感困難に対する憂鬱】【QOLを重視した看護ができないことの無力感】【自己の看護への自責の念】【患者との関わりへの抵抗】【身体的不調】の6カテゴリが抽出された．共感疲労の増強要素として，【医療者間のケアの方向性の相違による患者の苦痛継続】【患者を尊重した看護実践の苦慮】【過大および過小な共感による患者との適切な心理的距離の維持困難】【緩和ケア病棟の看護実践に対する不全感】【緩和ケア病棟の看護師としての強すぎる使命感】【緩和ケアおよび共感疲労に関連した知識不足】【不十分な人的支援体制】の7カテゴリが抽出された．

　緩和ケア病棟の看護師は，被援助者に共感し苦痛緩和を強く願うことにより，勤務外に患者の状態の想起や自己の看護への自責の念などの共感疲労を体験していた．また，共感疲労の増強要素の1つとして，看護師間の協力不足や相談相手がいないなどの人的支援の不備があげられた．倫理的葛藤や看護のなかで生じた負の感情を話し合える職場環境の整備が共感疲労の予防の1つとして有効である可能性が示唆された．

　The purpose of this study is to clarify the components and exacerbating factors of compassion fatigue experienced by nurses in a palliative care unit. We performed semi-structured interviews with ten nurses working in a palliative care unit and analyzed the content of the obtained data.

　As components of compassion fatigue experienced by nurses in a palliative care unit, six categories were extracted:“recollection of patients' conditions and rumination on nursing practice outside of working hours”,“depression related to difficulty with empathy”,“a sense of powerlessness due to the inability to provide nursing care focused on quality of life”,“self-blame regarding one's nursing care”, “resistance to engaging with patients”, and “physical ailments”. Regarding the exacerbating factors of compassion fatigue, seven categories were identified: “continuation of patient suffering caused by differences in direction among healthcare providers”,“difficulties in implementing nursing care that respects the patient”,“difficulty maintaining appropriate psychological distance from patients due to excessive or insufficient empathy”,“feelings of inadequacy related to nursing practice in a palliative care unit”,“an excessively strong sense of mission as a nurse in a palliative care unit”,“lack of knowledge related to palliative care and compassion fatigue”, and“insufficient human support systems”.

　It was suggested that understanding the characteristics of compassion fatigue in nurses in a palliative care unit, avoiding leaving the ethical dilemma unaddressed, and talking with colleagues about the events that caused compassion fatigue to view the events objectively are effective to prevent and improve compassion fatigue.