集中治療領域での終末期患者とその家族に対するインフォームドコンセントにおける看護実践に関連する要因

Factors of the Nursing Practice Related to Family Conferences for Terminally Ill Patients in Critical Care and Their Families

要旨

　目的：集中治療領域での終末期患者とその家族に対するインフォームドコンセント（Informed Consent：IC）における看護実践の実施程度に関連する要因を明らかにすること．

　方法：集中治療領域で働く看護師（96病院955名）を対象に集中治療領域での終末期患者とその家族に対するICにおける看護実践尺度の得点に関連する要因を重回帰分析にて検討した．

　結果：尺度合計得点が高いことと有意な関連を示したのは，研修参加経験有（β＝.098，p＝.010），学生時の学習歴有（β＝.103，p＝.006），他者への相談頻度が高い（β＝-.214〜-.034，p＜.001），最終学歴（β＝.057〜.063，p＝.010），診療体制：セミクローズド（β＝.093，p＝.023），フリー看護師がいる頻度が高い（β＝-.044〜-.141，p＝.021），看護提供方式：パートナーシップ（β＝.095，p＝.007）であった．

　結論：ICでの看護実践の充実には，問題対処への積極的な姿勢や学習経験，看護提供体制の重要性が示唆された．

　Objective: To clarify the factors of nursing practice related to family conferences (FCs) for terminally ill patients in critical care and their families in Japan.

　Methods: A self-administered questionnaire survey was conducted with 955 nurses working in intensive care units (ICUs) or high care units (HCUs) across 96 hospitals in Japan. Scores on characteristics of the participants were compared with scores on the Nursing Practice Scale for End-of-life Family conferences in critical care (NPSEF), and factors related to nursing practice were examined in the multiple regression analysis. High NPSEF scores indicated high degree of implementation of nursing practice.

　Results: The independent variables were significantly associated with higher total scores on the NPSEF: ethics and end-of-life training experiences (β = .098, p = .010), ethics and end-of-life learning experience as an undergraduate (β = .103, p = .006), higher frequency of consulting others when in ethical trouble (β = -.034~-.214, p < .001), educational background (β = .057~.063, p = .010), medical treatment system: semi-closed (β = .093, p = .023), frequency of working with nurses who do not take charge of patients (β = -.044~-.141, p = .021), and nursing system: partnership nursing system (β = .095, p = .007).

　Conclusion: This study clarifed the nursing practice factors related to the NPSEF scores. It is suggested that a positive attitude toward problem-solving, learning experience, and a nursing provision system is important for enhancing nursing practice in FCs.