慢性疾患領域における医師と看護師との役割分担と連携に関する研究

The Division of Roles and Coordination between Doctors and Nurses for the Treatment of Chronic Disease Region Patients

要旨

　目的：慢性疾患領域において医師と看護師間の協働が進んでいる先行事例を調査し，今後の医師・看護師間の役割分担の推進に向けた示唆を得ることを目的とした．

　方法：先行事例を選定し，医師・看護管理者，看護師を対象にヒアリング調査を行った．医師と看護師間の協働の内容や特色，体制の特徴について分析した．

　結果：4事例に調査を行った．役割分担・連携の内容は，（1）看護師による患者把握に基づいた薬剤調整のアセスメントと医師への報告，（2）療養相談や心理的支援，（3）医師による検査や薬剤処方の指示，（4）医師による簡単な治療説明と，看護師による療養生活に即した詳細な説明，（5）看護師による検査や薬剤調整，説明，経過観察，であった．効果は，患者の満足度の向上，医師の本来業務時間の増加等であった．課題は，役割分担に関する取り決めがないことであった．

　結論：慢性疾患領域における医師と看護師の新たな役割分担・連携のあり方が示唆された．今後の実現に向け，院内プロトコールやリスク管理体制の構築，医師・看護師の人材育成が求められる．

Abstract

　Purpose：The purpose of this study is to assess the cases that doctors and nurses work together coordinately for the treatment of chronic disease region patients to find out a desirable division of roles and coordination.

　Method：We selected four cases and interviewed the doctor, nursing administrator, and nurse. We analyzed the features, contents, and characteristics of organization for understanding the coordination between doctors and nurses.

　Results：Four preceding cases were assessed. The contents in the division of roles and the coordination between doctors and nurses were as follows：（1） assessment of dose arrangement by nurses based on the current status of patients and report the same to the doctors；（2） consultation during recuperation and psychological support；（3） receive instructions regarding medical examinations and medical prescription by doctors；（4） receive brief informed consent by doctors and detailed informed consent to adapt each patient's life by nurses；and （5） performance of examination, dose arrangement, informed consent, and observation by nurses. The effects of these aforementioned points were improvement in patient satisfaction and increase in the original business time of the doctors. However, the issue was that there was no agreement regarding the division of roles between doctors and nurses.

　Conclusion：It is suggested that the division of roles and coordination between doctors and nurses in chronic disease region must be renewed. We have realized that it is necessary to structure protocols and risk control systems, and to train doctors and nurses.