インスリン非使用糖尿病患者に対する外来での看護個別相談・指導の成果についての看護職者の認識に関連する要因

Factors Related to Nurses' Perception of Outcomes of Counseling Services Performed by Nursing Professionals in Japan for Diabetic Outpatients Not on Insulin

　インスリンを使用していない糖尿病患者に対して，看護職者が外来で30分以上かけて個別相談・指導を行っている200床以上の病院を対象に，看護職者による外来での個別相談・指導の成果についての認識とその関連要因を，自己記入式質問紙を用いて郵送法により調査した．有効回答は95施設の看護職者281名（69.9％）から得られた．看護職者が認識する成果（7領域）に関する重回帰分析の結果，糖尿病患者に対する効果的な相談・指導に関連する主な要因として，患者の訴えの確認をすること，身体的なケアを提供することと，個別的な自己管理行動を具体化することという看護行為があがった．一方，施設の体制や相談・指導を実施する環境とはあまり関連が認められなかった．以上のことから，看護職者が認識する効果的な相談・指導には，実施する体制や環境ではなく，どのような看護行為を提供するかが重要であることが示唆された．

　To explore the factors that make nursing professionals regard counseling services, offered by them in Japan for diabetic outpatients not on insulin, as effective, postal surveys were conducted using a self-administered questionnaire. The subjects of the survey consisted of nursing professionals (NPs) working at big hospitals having more than 200 beds, who conducted counseling services at outpatient clinics, and who spent more than 30 minutes with each patient. Two hundred and eighty-one NPs (69.9％) of 95 hospitals sent appropriate responses to the questionnaires. Seven domains of the NPs' perception of counseling were analyzed by multiple regression analysis. It was revealed that the effectiveness of counseling was related to the type of nursing activity provided for the patients (Especially, listening to the patients' complaints), physical care and concrete goal setting for every patient. However, the systems of the hospital and the environment during counseling were associated with a few domains. While the type of nursing activity provided for the patient is importantly related to the effectiveness of counseling, the time and place of counseling are not of great significance.