熟練看護師が外来で行う肝疾患患者への療養支援のあり様

Expert Nurses' Medical Care Support for Outpatients with Liver Disease

要旨

　目的：熟練看護師が外来で行う肝疾患患者への療養支援のあり様を明らかにする．

　方法：肝疾患外来の経験と実績のある熟練看護師8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：熟練看護師は肝疾患患者に対し，【介入の焦点化と協力体制づくり】を前提条件として，【安心できる丁寧な関わりにより患者を根底から支える】【リスクを予測した受診勧奨と集中支援】【重荷を引き受け患者本来の力を引き出す】ことを行っていた．また，肝炎治療の【副作用減少に伴うケア機会の減少】や，【肝硬変終末期を急性期病院で対応せざるを得ない現状】があるゆえに，患者との関係の形成や悪化の予防を一層重視していた．【社会と向き合う力の獲得】は全ての実践に影響を及ぼしていた．

　結論：肝疾患患者への療養支援のあり様の特徴が明らかになった．肝疾患外来看護は，社会と向き合う力が問われることが示唆された．

　Aim: This study identifies how expert nurses provide medical care support for outpatients with liver disease.

　Method: Semi-structured interviews were conducted with eight expert nurses who have experience in nursing outpatients with liver disease. The interview data were analyzed using a qualitative synthesis method (KJ method).

　Results: Our study extracted seven symbolic marks of medical care support for outpatients with liver disease by expert nurses: focalizing interventions and building a cooperative system; supporting patients from the bottom using a polite and reassuring approach; recommending risk-prediction-based treatments and intensive support; assuming the burden and drawing on the patient's original strength; reduced care opportunities due to the reduced side effects of hepatitis treatment; current situations where end-of-life patients with cirrhosis have to be cared for in acute hospitals; and nurses acquiring the ability to face society.

　Conclusions: The characteristics of medical care support for patients with liver disease were identified. It is suggested that an important factor of outpatient nursing for liver disease is nurses acquiring the ability to face society.