看護師の暗黙知に基づく看取りケアへの移行を判断する予後予測指標の開発—非がん性呼吸器疾患患者に焦点をあてて—

Development of a prognostic prediction index to determine when to transition to end-of-life care for patients with non-malignant respiratory diseases based on tacit knowledge derived from nurses' experience

　本研究の目的は，非がん性呼吸器疾患患者の看取りケアへの移行を判断するために，看護師の経験知から導かれた暗黙知に基づき作成した予後予測指標原案の内容妥当性と実用性を検証することである．

　予後予測指標原案は，看護師の暗黙知の観点から死期が近いことを予測する手がかりとなる兆候を文献から抽出（小林ら，2022）した28項目で構成されたものである．内容妥当性は，看取りケアの経験のある看護師を対象に質問紙調査を実施し，Lynn（1986）の内容妥当性指数（CVI）を算出した．実用性については，非がん性呼吸器疾患患者の査定に際して，予後予測指標原案を用いて評価を依頼した．

　内容妥当性は15名から有効回答を得て，CVIを算出した結果，0.78以上を示した項目は4項目であった．また症例により指標となる可能性があるCVIが0.67〜0.73を示した10項目を含めた14項目を予後予測指標とした．実用性は，非がん性呼吸器疾患患者37名に予後予測指標を使用した結果，70%が看取りケアへの移行の判断に「大いに参考にできた」「まあまあ参考にできた」と回答した．

　以上から，本研究で開発された看取りケアへの移行を判断するための予後予測指標は内容妥当性と実用性の観点から検証された．

　This study aimed to verify the content validity and practicality of a prognostic prediction index to determine when to transition to end-of-life care for patients with non-malignant respiratory diseases based on tacit knowledge derived from nurses' experience.

　The draft prognostic prediction index consists of 28 items extracted from the literature on nurses' tacit knowledge that contribute to predicting the approach of the end-of-life period. To determine the content validity of this index, a questionnaire survey was conducted on nurses who had experience in end-of-life care and the content validity index (CVI) of Lynn (1986) was calculated for each of the 28 items. To evaluate its practicality, nurses were asked to use the prognostic prediction index when assessing patients with non-malignant respiratory diseases.

　For the content validity analysis, valid responses were obtained from 15 respondents. 4 items showed CVI values of 0.78 or higher. A total of 14 items, including 10 items with a CVI value of 0.67 to 0.73, which could be considered index for some individuals, were used as prognostic prediction index to determine when to transition to end-of-life care. As for the practicality, after using the prognostic prediction index for 37 non-malignant respiratory patients, 70% of nurses answered that the index was “very helpful” or “reasonably helpful” when determining when to transition to end-of-life care.

　These results verified the content validity and practicality of the prognostic prediction index for determining when to transition to end-of-life care.