看護師が行なう痛みの強さの判断―がん性疼痛のある子どもの痛み緩和ケア実態の把握（第2報）

The Nurse's Judgment of the Degree of Pain: The Nursing Care Situation for the Child with Cancer Pain 2

はじめに

　本稿は文部省科学研究費補助金を得て行なった研究「癌性疼痛のある子どもの痛み緩和ケアの実態の把握」の一部であり，第1報を「痛みの判断プロセスとそれに影響を及ぼす因子」として本号に発表している。近年，がん性疼痛に関する著作物は急激に増加し，医療界におけるがん性疼痛に対する関心の高まり，知識の普及をうかがい知ることができる。しかし，先行研究より小児領域における痛み緩和ケアは，いまだ立ちおくれているといわざるをえない現状にある。がん性疼痛をもつ子どもたちの生活の質を保証するためには，具体的かつ効果的な介入方法を構築することが不可欠と考える。この研究は，がん性疼痛のある子どもへの看護介入方法の構築に向けた前段階として位置づけられる。本稿では，研究結果より得られた仮説のなかでも，看護師が子どものもつ痛みの強さを判断していく際に，子どもが呈している痛みサインをどのように捉え，またそれらをいかに統合しているかという部分に焦点を当てて述べていく。

　The main purpose of this study is to build the integrated nursing care method to relieve the child from cancer pain. In order to understand the nurses' perception and/or attitude of their intervention on children with the cancer pain, interview was conducted with the nurses (N＝17) who had responded to have an experience in caring with the WHO Guidelines on relief of Cancer Pain. Interviews were conducted after obtaining the informed consent from the subject and ethical consideration for privacy and free participation had been taken through the study. This paper will discuss the one part of results on the nurses' process of comparing and integrating the children's pain signs to make judgments on children's status and/or degree of pain. The two patterns were identified when the nurses judge the children's degrees of pain. In the first pattern, the nurses used only two extreme standards in pain continuum : “having pain or not” to judge the existence of pain in one end, “excruciating pain” in the other end. In another pattern, the degree of pain was determined from the effectiveness of analgesics. The nurses used two patterns simultaneously. From these findings ; i.e., using those two patterns, the tendency of nurses to estimate the pain severity less than actual children's pain was discussed.