救急・集中治療領域における看護師の代理意思決定支援と終末期ケアに対する困難度ならびに態度の関連

Associations of Surrogate Decision-making Support with the Difficulties and Attitudes of Nurses Providing End-of-life Care in Emergency or Intensive Care Settings

要旨

　目的：地域医療支援病院の救急・集中治療領域における看護師の代理意思決定支援と終末期ケアに対する困難度と態度の関連を明らかにする．

　方法：救急・集中治療領域の看護師を対象に無記名自記式質問紙調査を行い，看護師の代理意思決定支援，終末期ケアに対する困難度（DFINE），終末期ケアに対する態度（FATCOD-BJ）を把握した．

　結果：分析対象者120名のうち，代理意思決定支援の高実践群（60名）は低実践群（60名）に比べ，救急・集中治療領域の臨床経験が6年以上の者が多かった．終末期ケアに対する困難度の得点では，代理意思決定支援の高実践群は低実践群より低く，共分散分析においても有意な差がみられた．終末期ケアに対する態度に関しては，代理意思決定支援の高実践群と低実践群では，t検定ならび共分散分析において有意な差はみられなかった．

　結論：救急・集中治療領において代理意思決定支援を積極的に行っている看護師は，終末期ケアに対する困難感が低いことが示された．

　Objective: To clarify the relationship between nurses' surrogate decision-making support and difficulties faced by and attitudes of end-of-life care in emergency or intensive care area of community medical support hospitals.

　Method: A survey was conducted using a self-administered questionnaire, and nurses in emergency or intensive care units responded anonymously to the questionnaire. Nursing practice of surrogate decision-making was assessed using a nursing practice scale for measuring support for surrogate decision-makers of terminal care. Difficulties of nurses providing end-of-life-care were measured using the Scale for DFINE, and attitudes of nurses providing end-of life care were measured using The FATCOD-BJ.

　Results: Of the 120 respondents, 60 nurses practicing surrogate decision-making with more support were more likely to have clinical practice in emergency or intensive care units of over 6 years as compared to the remaining 60 nurses practicing surrogate decision-making with less support. The DFINE scores of nurses practicing surrogate decision-making with more support were significantly lower than those of nurses practicing surrogate decision-making with less support under Student's t-test as well as under analyses of covariance adjusting. The FATCOD-BJ score of nurses practicing surrogate decision-making with more support was almost the same as the score of those of nurses practicing surrogate decision-making with less support under Student's t-test as well as under analyses of covariance adjusting.

　Conclusion: The results suggested that nurses in emergency or intensive care units involved in surrogate decision-making with more support had less difficulty providing end-of-life care as compared to nurses involved in surrogate decision-making with less support.