病棟看護師が捉える高齢慢性心不全患者が在宅で自己管理を行ううえでの問題とその対応

Issues and Measures Regarding Self-management Practice at Home by Older Adult Patients with Chronic Cardiac Failure Observed from Ward Nurse's Viewpoints

抄録

　本研究の目的は，病棟看護師が捉える高齢慢性心不全患者が在宅で自己管理を行ううえでの問題と，その対応を明らかにすることである．21人の病棟看護師へ半構造化面接を行い，質的記述的に分析した結果，問題として，【長年の生活習慣を変えることは難しい】など7カテゴリー，問題に対する対応として，【患者・家族が理解しやすく管理が容易な方法に変更する】など8カテゴリーを得た．病棟看護師は，心不全に対する正しい知識の獲得を目指し，生活管理の注意点などをわかりやすく説明しており，ときには危機感の薄い患者・家族に対し，生活管理の不徹底が重篤な結果をもたらすと認識させ，心不全の重大性を自覚させる介入をしていた．一方で，残りの人生をどのように生きたいか，アドバンス・ケア・プランニング（ACP）を意識した関わりを行うと同時に，いままでの趣味活動や習慣化している行動は可能な限り継続できるような代替案を提示するなど，成人期の患者とは異なった高齢慢性心不全患者ならではの支援を行っていることが明らかになった．

　This study aimed to identify issues experienced by ward nurses regarding self-management practice performed at home by older adult patients with chronic cardiac failure and clarify effective measures for the problems identified. Semi-structured interview sessions were conducted on 21 ward nurses. The results of qualitative and descriptive analyses of the obtained interview data identified seven categories regarding issues, such as [Having difficulties in changing the lifestyle they followed], and eight categories regarding measures for the issues, including [Changing methods to those easier for the patient and the family to understand and manage]. The ward nurses provided patients and their families with easy-to-understand key points in self-management practices at home so that the patients and their families could obtain correct knowledge about heart failure. For the patients and families with little awareness of the seriousness of their conditions, the ward nurses make necessary interventions to make them understand the severity of heart failure and the possibility that the condition would lead to severe consequences from insufficient lifestyle management. At the same time, the ward nurses also kept in mind to make advanced care planning-oriented interventions, asking older adult patients how they wished to live the rest of their lives and suggesting alternatives in self-management practices that would agree with their customs and activities associated with their hobbies and daily habits. In other words, the study results showed that the ward nurses provided specific support different from the one for patients in their adulthood, mindful of conditions of older adult patients with chronic cardiac failure.