急性期医療後の療養の場を選択する際の脳卒中患者の家族への合意形成支援と影響要因の検討

Supporting Mutual Agreement among Family Members of Stroke Patients on Selecting the Place of Treatment after Acute Care and Related Factors

要旨

　目的：急性期医療後の療養の場の選択における脳卒中患者と家族の合意形成に向けた支援の実態とその影響要因を明らかにする．

　方法：脳卒中看護に携わる看護師を対象に質問紙調査を行った．因子分析にて質問項目の信頼性と妥当性を確認した後，重回帰分析にて影響要因との関連の検討を行った．

　結果：有効回答756名を対象とした因子分析の結果，【最善の決定に向かえるように支える】，【具体策の検討を支える】，【状況の理解や問題意識の整理を支える】，【家族の意向や希望を支える】，【強みを活かした決定になるように支える】の5因子20項目が抽出された．重回帰分析の結果，合意形成支援に最も影響が強い要因は「看護師の自律性」であった．

　結論：家族への合意形成支援には看護師の自律性が関与し，自主的・自立的な判断と適切な看護実践能力を高めていくと同時に，倫理的課題にチームで取り組んでいくことの重要性が示唆された．

　Objective: This study aimed to clarify the actual support situations of mutual agreement among family members of stroke patients on selecting the place of treatment after acute care, and related factors.

　Methods: A questionnaire was administered to nurses working in stroke care. The reliability and validity were examined using factor analysis, and associations with related factors using multiple regression analysis.

　Results: We extracted 20 items and five factors through factor analysis of 756 valid answers. The factors are as follows: “support to move toward to the best decision”, “supporting the thinking of concrete ways”, “support their understanding of the situation and the organization of problem awareness”, “supporting family members' wishes and hopes”, and “supporting decision making based on their strengths”. Multiple regression analysis identified, “professional autonomy in nursing” to be the most influential factor in supporting family members achieve mutual agreement.

　Conclusion: “Professional autonomy in nursing” had greatest impact on supporting family members of stroke patients to achieve mutual agreement on selecting the place of treatment, indicating that it is necessary to improve independent judgment and appropriate nursing practices; these results suggest the importance of a team approach to ethical issues.