在宅ターミナル期における癌患者の死別後の家族と看護職による訪問看護の評価

Evaluation of Home Nursing Care for Patients with Terminal Cancer from Perspective of Bereaved Families and Nurses

要旨

　本研究の目的は，家族と看護職による訪問看護の総合満足度に関連する訪問看護ケア内容，および家族と看護職による訪問看護ケア内容に対する評価の相違とその要因を明らかにすることである．調査は，訪問看護を利用して死亡したターミナル期の癌患者の家族48人とその受け持ち看護職21人を対象者として，自記式質問紙により行った．分析対象者は，家族47人（回収率97.9％）と看護職21人である．分析の結果，以下の知見を得た．（1）家族による訪問看護の総合満足度に関連がみられた訪問看護ケア項目は，「インフォームドコンセント」「信頼関係」「安らかな死」「死の受容」「死別後の立ち直り」「安楽」「痛み」「薬剤」「家族の不安」「家族の介護疲労」であった．一方，看護職では，「栄養」「排泄」「清潔」などであった．（2）家族と看護職の評価には差があり（p＜.001），一致率が高かった項目は，「緊急」「死の受容」「医療機関の連携」であった．一方，一致率が低かった項目は，「家族の介護疲労」であった．（3）家族と看護職による訪問看護ケア内容の評価一致が評価不一致に比べ，「死の受容」について，看護歴が有意に長かった．また，「死の受容」「医療機関の連携」について，療養者年齢が有意に高く，「家族の介護疲労」については，家族年齢が有意に高かった．

　以上より，ターミナル期の癌患者への訪問看護を評価する際，注目すべき具体的なケア内容が示唆された．

Abstract

　The purpose of this study was to examine home nursing care services related to satisfaction of family and nurse, differences of results between families and nurses, and factors contributing to these differences. Questionnaires were given to 48 bereaved families of patients with terminal cancer and 21 nurses at visiting nursing stations. The subjects of analysis were 47 families (response rate: 97.9%) and 21 nurses. (1) The following home nursing care services were related to family satisfaction: informed consent, relationship of mutual trust, peace at the time of death, acceptance of death, bereavement support, maintain comfort, pain management, medication, emotional family support, and family support for relief of physical fatigue. Nurses reported other services including nutritional assessment, excretion care, and hygiene support in terms of nurse satisfaction. (2) The results of evaluation were different between families and nurses (p＜.001). Emergency measure, acceptance of death, and collaboration with health care institutions were the top-three services in consistency between families and nurses while family support for relief of physical fatigue was the lowest. (3) Several factors significantly contributed higher consistency in the results between families and nurses: longer nursing career on acceptance of death, older age of patients on acceptance of death and collaboration with health care institutions, and older age of family members on family support for relief of physical fatigue. This study suggests important care services that we need to pay attention in evaluation of home nursing care for patients with terminal cancer.