病棟看護師の終末期患者への在宅療養に向けた退院支援に影響する要因

Factors Influencing Discharge Support for Home Care of Terminally Ill Patients Given by Ward Nurses

要旨

　本研究は，病棟看護師の終末期患者への在宅療養に向けた退院支援と，その影響要因を解明することを目的とし，病棟に勤務する看護師428名に対して，自記式質問紙調査を実施した．判別分析の結果，病棟看護師の終末期患者への退院支援に最も影響する要因は，看護師の経験年数や退院調整部署との連携の程度ではなく，患者と死について語ることができる程度であることが明らかとなった．患者と死について語ることができる看護師ほど，終末期患者への退院支援を積極的に実施していた．患者と死について語ることができない看護師が大半であることが明らかとなり，終末期患者への退院支援を推進するために，看護師への死に関する教育支援の必要性を考察した．

　In order to determine the factors that influence the discharge support toward home care provided by ward nurses to their terminally ill patients, as well as to detail the interactions between them, we administered self-reported questionnaires to 428 duty nurses in a hospital ward. Discriminant analysis revealed that the most important factor for terminal patient discharge support was the degree to which nurses could talk with their patients about death, rather than a nurse's years of work experience or the extent of cooperation with the discharge unit. A proactive approach to terminal patient discharge support was implemented, so that more nurses could talk with patients openly about death. The findings also showed that the majority of nurses were not comfortable talking about death with patients; in order to provide discharge support for terminal patients toward home care, we considered providing nurses with better education concerning death.