在宅高齢者を看取る家族を支援した訪問看護師の看護観

Nursing Philosophy of Visiting Nurses Who Support Families Caring for Their Dying Elders at Home

要旨

　本研究の目的は，在宅高齢者を看取る家族を支援した訪問看護師が，在宅高齢者を看取る家族への支援について，どのような看護観をもっているのか記述することであった．訪問看護師8名に半構造的インタビューを行った．その結果，訪問看護師は，【高齢者の長い暮らしの終わりを家族とともに支える】【残された家族のそれからの〈生きる糧〉の獲得を支える】ことを目指し，【家族の本当の思いを日々の暮らしの中から探索する】【家族の思いが叶うように日々の介護が続けられる状況に導く】【〈家族の看取り〉ができるように安心を提供する】支援を要と考えていた．その一方で，高齢者と家族の生活の場で継続して支援するには，【人として家族に寄り添いともにある関係性を育む】必要があり，そのことは専門職として【家族により近づく親近感と訪問看護師としてあることの調和をとる】必要性を生じさせていた．これらのことから，家族が後悔を残さない意図的な関わりの重要性，人として，専門職としての家族との距離感をつかむことが家族の主体性への支援となることが示唆された．

Abstract

　The aim of this study was to describe a nursing philosophy based on visiting nurses' reflections on their practice experience supporting family caregivers who lived with their elder until the elders' death at home. The semi-structured interviews with eight visiting nurses provided data for analysis.

　The nurses' intentions were to [work with each family to support the elder until the end of the elder's long life] and to [help the family find its purpose for life after the elder's death]. The nurses believed three types of care were essential: [perceive family's unexpressed needs and desires in their daily lives]; [provide guidance for the family so the family can continue to care for the elder and also meet its desires]; [help the family to become more comfortable and confident living with a dying elder at home]. In providing this care, the nurses expressed the need to [build relationships with the family by being with the family as a person] and to [balance their affinity for a family with their awareness of their professional roles].

　This analysis suggests that nurses' intentional support is important to prevent families from suffering regret associated with the care they provided for their elders and keeping the balance between affinity for the family and one's professional role is a critical dynamic in the nurses' ability to provide nursing care. Maintaining this balance facilitated the family's autonomy.