長期入院統合失調症患者の退院支援に関する熟練看護師の看護実践のプロセス

Process of Nursing Practice among Expert Nurses in Relation to Discharge Support for Long-Term Patients with Schizophrenia

要旨

　目的：本研究では，熟練看護師が長期入院統合失調症患者に対し，退院を意識して患者に関わり始めた時期から退院支援が終了するまでの，看護実践のプロセスを明らかにすることを目的とした．

　方法：研究協力者13名を対象に半構成的面接を行い，質的帰納的分析を行った．

　結果：本研究で見出されたカテゴリーは，《患者を捉え直すことで見えてきた退院可能性》【心の奥底にある退院への希望を引き出す】【退院支援に消極的な主治医との意思統一】【退院に賛同できない家族の心情と背景を理解する】【プライマリーナースが主体となるネットワークの構築】【安心を提供するプライマリーナースの役割遂行】【1対1の関わりから自信を持たせる】の7カテゴリーであった．《患者を捉え直すことで見えてきた退院可能性》は他のすべてのカテゴリーに影響を与える中心的現象と考えられ，本研究のコアカテゴリーに位置づけられた．

　結論：長期入院統合失調症患者の退院支援に関する看護実践のプロセスには，継続的に患者を捉え直しながら可能性を広げる柔軟な臨床判断と，失いつつある希望を引き出し，わずかな変化にも即応できる看護介入が必要である．

Abstract

　Objectives: This study aimed to identify the process of nursing practice among expert nurses in relation to long-term patients with schizophrenia, from the time when the nurses started to consider patient discharge and provide discharge support to the completion of such support.

　Methods: We conducted semi-structured interviews with 13 nurses who consented to participate in the study. The data obtained were analyzed employing a qualitative and inductive approach.

　Results: The following 7 categories were extracted:〈the possibility of discharge presented and facilitated by an ongoing understanding of the patient〉,［bringing out the patient's hope for discharge that lies deep in his/her mind］,［sharing intentions with the primary physician who is reluctant to provide discharge support］,［understanding the feelings and backgrounds of the patient's family members who disagree with discharge］,［developing networks by adopting a primary nurse-centered approach］,［fulfilling the roles of a primary nurse to provide peace of mind］, and［engaging with the patient on a one-on-one level to foster his/her confidence］.〈The possibility of discharge presented and facilitated by an ongoing understanding of the patient〉 was observed to be a central phenomenon affecting all other categories, and, thus, was identified as the core category.

　Conclusion: The process of nursing practice to provide discharge support for long-term patients with schizophrenia should include: flexible clinical judgment to enhance the probability of discharge by performing ongoing assessment of patients; and, the implementation of nursing interventions to help patients restore their hope for discharge that is diminishing, and respond immediately to any slight changes in them.