重症心不全患者の治療選択におけるシェアード・ディシジョンメイキングへの看護師参画に対する急性・重症患者看護専門看護師の認識

Nurse Participation in The Shared Decision-making Process for Patients with Advanced Heart Failure: Perceptions of The Certified Nurse Specialists in Critical Care Nursing

要旨

　目的：重症心不全患者の治療選択におけるシェアード・ディシジョンメイキング（SDM）への看護師参画の実態に対する急性・重症患者看護専門看護師（CCNS）の認識を明らかにする．

　方法：CCNS10名に半構成的面接を実施し，質的統合法（KJ法）にて分析した．

　結果：【SDMに参画できていない看護師が直面している現状】【多職種からの活動理解に向けたCCNS自らの看護の取り組み】【看護師へのアドバンス・ケア・プランニングやSDM参画に向けた働きかけ】【重症心不全患者の苦悩に向き合う看護師へのSDM参画に向けた働きかけ】【医療チームの意思決定パターン革新に向けた取り組み】【補助人工心臓・移植に進む場合の支援】【移植に進まず緩和を目指す場合の支援】からなる全体像が導き出された．

　結論：CCNSは，看護師参画不十分な現状打開に向け，看護独自の取り組みと医療チームとしての取り組みが必要とされる実態を認識していた．

　Objective: To clarify perceptions of the current situation of the certified nurse specialists in critical care nursing (CCNS) regarding nurse participation in the shared decision-making (SDM) process for patients with advanced heart failure to make treatment choices.

　Methods: Semi-structured interviews were conducted with 10 CCNS, and the obtained data were analyzed adopting a qualitatively and integrative (KJ) method.

　Results: The following categories outlined the status of nurse participation in SDM: [situations faced by nurses with difficulty participating in SDM], [independent nursing approaches adopted by CCNS to promote understanding of their activities among other professionals], [promotion of advance care planning and participation in SDM among nurses], [promotion of participation in SDM among nurses addressing distress in patients with advanced heart failure], [approaches to innovate medical teams' decision-making patterns], [support for patients who choose ventricular assist device/heart transplantation], and [support for patients who choose palliative care, rather than transplantation].

　Conclusion: The CCNS recognized the current situation, where both nursing and medical team approaches are required to resolve insufficient nurse participation in SDM.