老人看護専門看護師が非がん疾患高齢者・家族とのACPを躊躇したときの実践

Initiation of ACP for Older Non-cancer Patients and Their Families by Certified Nurse Specialists in Gerontological Nursing Despite the Nurses' Initial Hesitation

抄録

　本研究の目的は，非がん疾患高齢者・家族とアドバンス・ケア・プランニング（以下，ACP）を行うにあたり，老人看護専門看護師が躊躇したとき，どのようにACPを実践したのかを明らかにすることである．

　老人看護専門看護師を対象に，郵送法による質問紙調査を実施した．調査内容は，ACPを躊躇する理由や，躊躇しつつもACPが行えた経験等であった．ACPを躊躇する理由として「よくある」「何度かある」の頻度で回答が得られたものは〈患者が落ち込んだり，傷ついたりしてしまうのではないかと思う〉で，次いで〈患者が真実を伝えられていない〉〈ゆっくり関わる時間がない〉であった．老人看護専門看護師は，ACPを躊躇したとき，患者や家族からの発言がみられたときをタイミングと判断し，本人の負担にならないように話す工夫を行っていた．また，患者の性格や生活歴などの情報を得たり，日常のケアの対話のなかから本人の価値観を聴いていた．

　This study aimed to reveal how certified nurse specialists in gerontological nursing initiated advance care planning (ACP) for older non-cancer patients and their families despite their initial hesitation. 　A mail-in questionnaire survey of certified nurse specialists in gerontological nursing was conducted. The questionnaire items included reasons for their hesitation in initiating ACP and their experiences in which ACP could be initiated. The most common reason for hesitation in initiating ACP experienced “frequently” or “several times” by respondents was <I thought that the patient might get depressed or hurt>, followed by <the patient could not tell the truth>, <I don't have time to get involved slowly>. To initiate ACP, the respondents considered it a chance when the patients or their family members spoke up and tried to talk to the patients in a manner that would not make them feel burdened. The nurses also collected information about the patients, such as personality and life history, and found out the patients' values in conversations during daily care.