医療ニーズの高い小児に対する訪問看護師の在宅ケア実践における困難

The Difficulties Faced by Visiting Nurses Providing Home Care for Children with High Medical Needs

要旨

　本研究は，医療ニーズの高い小児に対する訪問看護師の在宅ケア実践における困難を明らかにし，訪問看護師への支援のあり方について検討することを目的とした．京都府内の小児訪問看護師33名を対象に半構造的面接法を用いて調査した．質的記述的研究の方法を用い，医療ニーズの高い小児に対する訪問看護師の在宅ケア実践における困難として，【単独での看護ケアの実践】【適切な時期の受診の促進】【予測できない急変時の対応】【小児特有の知識やスキルの体得】【母親との関係づくり】【多職種との連携の促進】の6つのカテゴリーが抽出された．

　医療ニーズの高い小児の訪問看護師に対する支援として，在宅ケア実践における判断力，多職種連携に対するコーディネート力，および母親との関係づくりに対する力を身に付けるための教育支援が必要である．

　This study aimed to identify the difficulties faced by visiting nurses providing home care for children with high medical needs, and to examine ways to provide support to visiting nurses. Semistructured interviews were conducted to survey 33 visiting nurses providing services for children in the Kyoto Prefecture. Using qualitative descriptive research methods, six categories of difficulties in home care practice by home care nurses for children with high medical needs were identified: [single-handedly practicing nursing care], [encouraging to seek medical care in an appropriate period], [responding to unpredictable emergencies], [acquiring knowledge and skills specific to pediatric care], [building relationships with the mothers], and [promoting interprofessional collaboration]. As support for visiting nurses of children with high medical needs, educational support is needed to help them acquire judgmental skills in home care practice, coordination skills for interprofessional collaboration, and skills for building relationships with mothers.