在宅療養がん患者のターミナル期における訪問看護支援に影響を及ぼす要因の検討

Factors Influencing Home-visit Nursing Services for End-stage Cancer Patients Receiving Home Care

要旨

目的：在宅療養がん患者のターミナル期の訪問看護支援に影響を及ぼす要因の関連性を明らかにする．

方法：訪問看護師を対象に無記名自記式による質問紙調査を実施した．因子分析により得点化したターミナル期の訪問看護支援（22項目，α = 0.96）に影響を及ぼす要因のパスモデルを作成した．

結果：解析対象者は750名であった．ターミナル期の訪問看護支援には，FATCOD-B-Jを介して，［理念に基づいた行動］［組織運営に関する発言の機会］［在宅医との協力関係］［仕事への意欲］［訪問看護師経験年数］が影響を及ぼすモデル（X² = 3.06，p = 0.82，GFI = 0.999，AGFI = 0.994，RMSEA = 0.000）が示された．

結論：在宅療養がん患者のターミナル期の訪問看護支援を促進するには，組織理念に基づき，チーム力を高め，組織にコミットメントできるように取り組む必要性が示唆された．

Objective: To clarify factors influencing home-visit nursing services for end-stage cancer patients receiving home care and their relationships.

Methods: An anonymous, self-administered questionnaire survey was conducted involving visiting nurses. Their responses were scored through factor analysis to create a path model that explains factors influencing home-visit nursing services for end-stage cancer patients receiving home care.

Results: Responses from 750 visiting nurses were analyzed. Based on their FATCOD-B-J scores, a model (X² = 3.06, p = 0.82, GFI = 0.999, AGFI = 0.994, RMSEA = 0.000) explaining the influences of [behavior based on basic principles], [opportunities to offer opinions regarding organizational management], [collaborative relationships with visiting doctors], [motivation to accomplish work-related tasks], and [the length of home-visit nursing experience] on home-visit nursing services for end-stage cancer patients was created.

Conclusion: The necessity of developing mutually supportive relationships among visiting nurses and enabling them to make commitments to their organizations, while emotionally supporting them with appropriate advice in their workplaces, was suggested to promote home-visit nursing support for end-stage cancer patients receiving home care.