フットケア外来における糖尿病看護認定看護師の臨床判断

Clinical Judgment in Foot Care Outpatients by Certified Nurses in Diabetes Nursing

本研究は，フットケア外来における糖尿病看護認定看護師の臨床判断を明らかにし，実践的な支援方法に示唆を得ることを目的とした．糖尿病看護認定看護師7名の語りから質的帰納的に抽出したカテゴリ間の関係を，臨床判断モデルに基づき構造化を試みた．その結果，価値認識：【自律した自己管理行動】【目指すものは希望や生きがいの実現】．背景：【糖尿病足病変の多様なリスクのある生活状況】．気づく・解釈・反応：【服装や歩き方から解釈する生活状況とセルフケア状況】【気づかいのある丁寧な足浴】【自己管理の積極的な意欲に繋がる自覚症状への関心や改善の実感】．省察：【看護師との関係性から自己管理行動に繋げる支援】等が抽出された．

認定看護師の臨床判断には，患者の自律した自己管理行動や生きがいの実現を目指す倫理的認識や価値認識が影響し，患者自身が自己管理行動の内容を語る様子から，教育支援の成功を実感していた．

Purpose：This study aimed to clarify the clinical judgments of certified nurses in diabetes nursing in the foot care outpatient clinics and to obtain suggestions for practical support methods.

Method：An attempt was made to structure the relationship between categories extracted qualitatively and inductivelyfrom the narratives of seven certified diabetes nursing nurses based on a clinical judgment model.

Results：As a result, value recognition：［Autonomous self-management behavior］［The aim is to understand hope andpurpose in life］. Background：［Diverse risk life situations in diabetic foot］. Awareness/Interpretation/Response：［Livingand self-care situations interpreted from clothing and walking］［Careful foot bathing］［Interest in subjective symptomsand realization of improvement leading to positive motivation for self-management］. Reflection：“Support leading toself-management behavior based on the relationship with the nurse” was extracted.

Conclusion：The clinical judgment of certified nurses is influenced by the patient's autonomous self-management behavior,ethical awareness, and value recognition aimed at realizing purpose in life.