腹膜透析関連感染症予防のために看護師が患者・家族への指導において重要と考える項目：デルファイ法による検討

Critical components of nurses' instructions to patients and their families in the prevention of peritoneal dialysis-related infections: A Delphi study

【目的】腹膜透析（Peritoneal Dialysis：PD）関連感染症予防のために看護師が患者および家族への指導において重要と考える項目を明らかにすることを目的とした．

【方法】全3ラウンドからなるデルファイ法を用いた質問紙調査を行った．研究者間で協議し計10テーマ，全70項目の調査項目を抽出した．PD患者の指導経験のある医師，看護師計37名を対象に，各項目の重要度を5件法で尋ね，「5：非常に重要である」または「4：それなりに重要である」と回答した者の割合（同意率）を算出した．

【結果】最終ラウンドは対象者34名（回収率91.9％）から回答を得た．同意率60％以上で対象者の合意が得られた項目は，感染リスク，症状観察や清潔に留意したPD手技，療養環境や家族への指導に関する10テーマ66項目であった．

【結論】本研究により，患者の感染リスクを評価すること，清潔に留意したPD手技や症状観察について，改めて指導の重要性が示された．また，本研究で初めて，PD管理における自宅訪問の必要性や家族に対する指導の重要性が示された．国内におけるPD施設と訪問看護等の在宅医療との連携や，PD患者および家族の在宅療養を支える体制の充実が求められる．

【Objective】To identify the critical components of nurses' instructions to patients and their families to prevent peritoneal dialysis (PD)-related infections.

【Methods】A three-round questionnaire survey was conducted using the Delphi method. The questionnaire consisted of 70 items on a total of 10 themes selected following discussions among the researchers. A total of 37 physicians and nurses with experience in instructing patients with PD were asked to rate the importance of each item using a 5-point scale. The percentage of respondents who answered either “5: very important” or “4: moderately important” (the agreement rate)was calculated.

【Results】Responses were obtained from 34 participants in the final round (response rate: 91.9%). Of the 66 items, 60% of participants agreed on at least one item in each of the 10 themes. Agreement was obtained for 66 items on 10 topics related to infection risk, PD techniques with attention to symptom observation and cleanliness, care environment, and instructions for family members.

【Conclusions】This study demonstrated the importance of assessing the patient's risk of infection, and providing instruction on cleanliness-oriented PD techniques and symptom observation. This was also the first study in Japan to demonstrate the necessity of home visits in PD management and the important components of instruction for family members. Cooperation between PD facilities and home care, such as visiting nurse, needs to be improved, as does the system to support home care of patients undergoing PD and their families in Japan.