糖尿病看護における熟練看護師のケアの分析

Nursing Care Performed by Expert Nurses in Diabetes Nursing

　本研究は，糖尿病看護において熟練看護師が行う患者の生活に沿って自己管理行動を組み込むケアはどのようなケアであるのかを明らかにすることを目的とした帰納的記述的研究である．調査対象は2名の熟練看護師と17名の糖尿病患者であり，熟練看護師の行う看護面接を参加観察し，分析結果を例題として示した．熟練看護師は「患者の生活を理解し血糖値と生活の関係を見通す」，「患者の感情を支え自己効力感を引き出す」，「患者と合意できるように駆け引きをする」，「存在を認め合い共同責任としての空間を創出する」のケアを行っていた．熟練看護師は患者との相互関係において患者の生活に注目し，何が患者にとって望ましい行動であるのかを判断する一方で，患者には療法を実行できる限界があることを理解し，生活との兼ね合いをはかりながら患者の選択を支えていた．その際，患者の否定的感情に注目し，患者が自信を高めることができるアプローチを意図的に行い，患者が肯定的になったときを見極めて具体的な調整点をアプローチしていた．熟練看護師は，患者と信頼関係を築き，患者が実行可能だと思えるケアを行っており，糖尿病患者へのアプローチの手がかりになることが示唆された．

　This inductive/descriptive study is performed to clear what care the care, which incorporates regimen along with a life of the patient in diabetes nursing, is. For this purpose, the analysis results obtained from participation an interview with two expert nurses and seventeen diabetic patients are shown as an exemplar. They were taking care of by being caution of following points; “to incorporate a regimen into living”, “to support the emotion of patient and pull out the self efficacy”, “to diplomatize that it can agree with a patient”, “to create the atmosphere of mutual responsibility and accepted each other”. Through the correlation with patients, the nurses judged what a desirable way was for and understood that the patient had which could perform, furthermore, supported a patient's selection in the adjustment between living and limit. At that time, they paid attention to the negative emotion of patients, and performed intentionally approach which could raise confidence to the patient, after then, they approached the concrete adjusting point when a patient becoming affirmative has been discerned. An expert nurse built a confidential relation with a patient, and was performing the care that a patient could perform, and it was suggested that this became the key of the approach to patients with diabetes.