日本の訪問看護師の行う訪問看護実践における判断の概念分析

Concept Analysis of Nursing Judgment in Home Healthcare Nursing Practice by Home Healthcare Nurses in Japan

要旨

　目的：日本の訪問看護師の行う訪問看護実践における判断について定義することを目的とした．

　方法：日本国内で発表された33文献を対象として，Rodgersの概念分析方法を用い分析を行った．

　結果：4つの属性：【生活者としての対象をよく知る】【先を見通す】【対象者の生活に即したケアを共に考える】【対象者中心思考で熟考する】，3つの先行因子：【生活の場での看護の特徴】【専門職的判断への意志】【看護師個人の能力】，2つの帰結【判断の内容】【対象者に最適なケアの実施】が抽出された．

　結論：日本の訪問看護師の行う訪問看護実践における判断は，対象者中心思考で熟考することを基盤とし，生活者としての対象をよく知り，先を見通しつつ，対象者の生活に即したケアを共に考えるプロセスである，と定義した．このプロセスにより対象者の状態，ケア，関わり方が決定され，対象者に最適なケアの実施に至る．

　Objective: To obtain a definition of nursing judgment in home healthcare nursing practice as performed by home healthcare nurses in Japan.

　Methods: A total of 33 literature references published in Japan were assessed. Rodger's method was employed for concept analysis.

　Results: The following four attributes were extracted: “understanding patients as individuals with their own lifestyles, opinions, and values”, “proactive perspective”, “discussing care for patients to meet their lifestyle needs”, and “careful patient-centered consideration”. In addition, 3 antecedents were extracted: “ characteristics of nursing in daily life”, “intention to exercise professional judgment”, and “ability of each nurse”. Finally, 2 consequences were extracted: “contents of judgment” and “conduct of appropriate care for patients”.

　Conclusion: Nursing judgment in home healthcare nursing practice by home healthcare nurses in Japan was defined as the process of understanding patients as individuals with their own lifestyles, opinions, and values and discussing the care required to meet their lifestyle needs with the patients as well as the people surrounding them. This process should be performed proactively and should be based on careful patient-centered consideration. Through this process, the patient's condition, care, and involvement are determined, so that appropriate care for each patient can be provided in nursing practice.