慢性閉塞性肺疾患療養者の身体活動性を改善した訪問看護師の看護実践

Nursing Practices of Home-visit Nurses that Improve the Physical Activity of Patients with Chronic Obstructive Pulmonary Disease

要旨

　目的：訪問看護師の視点から，COPD療養者の身体活動性を改善した訪問看護師の看護実践を明らかにすること．

　方法：訪問看護師4名にCOPD療養者の身体活動性が改善した1例の経験について半構造化面接を実施した．Steps for Coding and Theorizationを用いて，協働的パートナーシップ螺旋モデルを分析的枠組みに適用し，質的に分析した．

　結果：すべての事例から，COPD療養者と訪問看護師の相互作用を示す62個の理論記述が得られた．さらに，各事例の理論記述の共通性と差異性を検討した結果，【動機付けを高める信頼の獲得】や【安楽な生活動作スキルの協働構築】等，26個の訪問看護師の看護実践が立ち現れた．

　結論：終末期であっても，身体活動や栄養障害の改善に向かう看護の視点が重要であり，特定の訪問看護師によってCOPD療養者の思いが打ち明けられるような関係性を構築しながら，医療的な課題を解決していくことが身体活動性の改善を導くキーポイントであると考えられた．

　Objective: To clarify the nursing practices of home-visit nurses that improve the physical activity of patients with chronic obstructive pulmonary disease (COPD) from the viewpoint of home-visit nurses.

　Methods: Semi-structured interviews were conducted with four home-visit nurses about their experience of one case in which they improved the physical activity of a COPD patient. The interview responses were qualitatively analyzed using the Steps for Coding and Theorization by applying the spiraling model of collaborative partnership to the analytical framework.

　Results: A total of 62 pieces of theory writing showing interactions between COPD patients and home-visit nurses were obtained from all the case examples. Examination of the commonalities and differences between the theory writing of each case example revealed 26 nursing practices of home-visit nurses, including “gaining of trust to improve motivation” and “collaborative building of comfortable activities of daily living skills.”

　Conclusions: The results suggest the importance of a nursing perspective aimed at improving the physical activity and nutritional disorders of patients even at the end of life, and that solving medical problems while building a relationship in which specific visiting nurses can encourage COPD patients to open up about their thoughts is a key element in improving the physical activity of these patients.