糖尿病看護の専門性の高い看護師による糖尿病とがんを併せ持つ患者へのセルフマネジメント支援の実際と困難

Self-management support and its problems in patients with diabetes and cancer from the perspective of nurses specializing in diabetes

【目的】糖尿病看護の専門性の高い看護師による糖尿病とがんを併せ持つ患者へのセルフマネジメント支援の実際と経験している困難について明らかにすることである．

【方法】フォーカスグループインタビューを4回，計16名を対象に実施し，質的帰納的に分析した．

【結果】セルフマネジメント支援の実際は，がん治療の内容や時期をふまえながら専門性を活かして血糖コントロールを軸とした看護が展開されていた．一方，患者の療養内容が複雑であり，がんと糖尿病の両領域からの専門的な知識を要する看護支援が必要なこと，がんと糖尿病の領域間の情報共有や理解不足，患者と関わる時期や場の問題，悪性疾患であることに起因する患者との関わりや血糖コントロールのあり方に対する戸惑いなどから困難を経験していた．

【結論】糖尿病とがんを併せ持つ患者のセルフマネジメント支援において，知識と意識の向上，連携の促進がその困難に対応する上で必要である

[Objective] To clarify the status of self-management support and its problems in patients with diabetes and cancer from the perspective of nurses specializing in diabetes.

[Methods] Focus group interviews were conducted with a total of 16 nurses specializing in diabetes, and the results were analyzed qualitatively and inductively.

[Results] Self-management support for blood glucose control was given to patients in accordance with the content and timing of their cancer treatments and the nurses' expertise. However, the nurses experienced difficulties with self-management support, such as problems with finding a time and place to listen to patients diagnosed with cancer, with constructing a relationship with patients, and with the hesitation of rigorous blood glucose control in relation to malignancy. They felt that informationsharing and understanding between the cancer and diabetes fields were lacking. Because the medical treatment for patients with diabetes and cancer was complicated, self-management support required specialized knowledge from both the cancer field and the diabetes field.

[Conclusion] For nurses to cope with the difficulties in supporting the self-management of patients with diabetes and cancer, we need to improve knowledge and awareness and promote cooperation between the cancer and diabetes fields.