初期・二次救急外来における入院せず帰宅する患者に対する救急看護認定看護師の看護実践

Nursing Practice of Certified Nurses in Emergency Nursing for Patients Only Required Outpatient Treatment in Primary or Secondary Emergency Care Departments in Japan

要旨

目的：初期・二次救急外来で勤務する救急看護認定看護師の入院せず帰宅する患者に対する看護実践を構造化することである．

方法：近畿圏内の救急看護認定看護師12名に半構造化面接を実施し，質的統合法（KJ法）を用いて分析した．

結果：救急看護認定看護師は入院せず帰宅する患者に対し【医師が診察したあとの看護としての観察とアフターフォロー】，【援助を必要としている患者を見捨てない最後の砦となる】，【入院が必要か否かを探りつつ，帰宅後の生活も想像する】，【救急患者の不安や緊張を思いやり共感しながらも入院不要の納得を得る】，【短時間で帰宅後のリスク回避の方法を説明する】，【重症化の危険に備え，多職種との連携をはかる】，【医療・介護スタッフ，地域住民への救急対応教育】を実践していた．

結論：患者の健康回復のみならず患者を元の生活に戻すことに責任を負う救急看護認定看護師の実践が明らかになった．今後は救急看護師の介入による救急外来再受診や一般外来への定期受診への影響について検討を要する．

Aim: This study aimed to structure the nursing practice of Certified Nurses in Emergency Nursing in regard to patients only required outpatient treatment in primary or secondary emergency care departments in Japan.

Method: Questionnaire data and semi-structured interview data were collected from 12 Certified Nurses in Emergency Nursing in the Kinki region in Japan. All responses were analyzed using the qualitative synthesis method (KJ method).

Results: Our study extracted seven symbolic marks in relation to Certified Nurses in Emergency Nursing practice for patients only required outpatient treatment, as follows:

[Independently observing and following up on patients, with a nursing focus, after doctor examination], [Source of care for patients needing help], [Imagining life after discharge for patients when determining whether hospitalization is necessary], [Receiving confirmation that hospitalization is unnecessary and sympathizing with emergency patients' uneasiness and tension], [Explaining methods of risk aversion when return has taken place after a short period], [Where there is danger of aggravation, cooperating with other professionals], [Educated medical staff, care staff, and local residents who are able to administer first aid].

Conclusion: This paper revealed the nursing practice of Certified Nurses in Emergency Nursing that took responsibility in returning patients to their original life as well as the patients' restoration to health.

Further research is needed to examine the influence of the emergency nurses' intervention on re-consultation to an emergency outpatient and regular consultation to a general outpatient.