在宅ケア領域における看護診断をめぐる課題

Issues of Nursing Diagnosis in Home Care Nursing

　研究推進委員会では，これからは各専門領域固有の問題について明らかにし，研究推進していくことが重要と考え，在宅ケア領域について第1回看護診断検討会を平成11年度末に開催した．訪問看護婦・保健婦の看護診断用語使用群と未使用群により，この領域独自の問題について自由討議形式で話し合いをしたのちに，研究推進委員が項目別に課題の抽出・整理を行った．概して，介護保険施行にあたってMinimum Data Setが導入され，それに慣れるのに精一杯で，看護診断の意義はわかるが，さらに看護診断用語を取り入れる余裕がない実態が明らかにされた．また，現在の看護診断名が翻訳もので，日本の実情に合いにくい面があることも指摘され，在宅ケア現場で使いやすいものに改定されることが導入を進めるうえでも期待された．平成12年度末に開催した第2回検討会では，クリティカルケア領域検討会で初めて採用したフォーカスグループ面接法（焦点集団面接法）を使うこととし，在宅ケア領域用に設問を一部修正し，ヒアリングにより実情把握を行った．ヒアリングメンバーは，第1回検討会に出席した訪問看護婦半数に，新たに実施している施設1名および大学教師2名を加え，研究推進委員もそれぞれ役割を分担して実施した．設問毎に各メンバーの意見を問い，テープとフィールドノートにより確認した．自由討議と比較し，はるかに深い意見交換がなされ，この領域独特の問題と共通問題が抽出された．

　The purpose of this study is to clarify the specific problems of nursing diagnoses in home care nursing. On March 4, 2000, the research committee had the 1st meeting to discuss freely on the issues of nursing diagnoses in the field of home care nursing. Several home care nurses were invited. It was found that some of them had already started to use NANDA nursing diagnoses in their activities, however, the rest of them who understand the usefulness of NANDA nursing diagnoses, had not introduced them yet. The reason was that MDS had already been introduced as the official tool to describe patient's symptoms in the home care settings. Moreover, because of the troublesome in the use of some of NANDA nursing diagnoses, they wished to have more simple taxonomy that could be used more easily in this field. The 2nd meeting was held on March 3, 2001. Six hearing members and seven committee members were invited as well as one observer. They were composed of three previous participants and a newly invited home care nurse and two professors of the nursing university. Focused Group Interview (FGI) method was used, with some modification from the questions used in the critical care field. Using the tape-recorder and the field notes, the qualitative data were collected. Comparing with the free talking method, FGI was useful in getting more information in detail. Some specific and also common problems were clarified.