医療観察法の通院処遇対象者への訪問看護師の看護実践内容—デルファイ法による看護実践項目の検討

Nursing Practices of Visiting Nurses for Patients Receiving Forensic Outpatient Treatment under the Medical Treatment and Supervision Act: Investigation of Nursing Practice Items using the Delphi Method

要旨

　目的：医療観察法通院処遇対象者への訪問看護における看護実践項目をデルファイ法によりコンセンサスを求めて，看護実践として活用できる項目を検討する．

　方法：先行研究において明らかになった再他害行為に関連した支援の困難に対する工夫，社会復帰を地域生活において支援をする困難に対する工夫など5領域における42の看護実践項目案に対して，デルファイ法による質問紙調査を2回実施した．医療観察法通院処遇対象者への訪問看護において豊富な経験があると管理者が推薦した訪問看護師54人を対象とした．

　結果：第1回調査は回収数28で，7項目が表現の修正，自由意見で1項目が追加となった．第2回調査は回収数24で，1項目が削除，1項目が表現の修正となった．最終的に42の看護実践項目のコンセンサスを得ることができた．

　結論：訪問看護師がコンセンサスを得た看護実践項目を活用することで，医療観察法通院処遇対象者の訪問看護における困難感を軽減できる可能性につながる．

　Purpose: This study uses the Delphi method to reach consensus and investigate the items that can be used in nursing practices of visiting nurses for patients receiving forensic outpatient treatment under the Medical Treatment and Supervision Act.

　Method: Two questionnaire surveys were conducted using the Delphi method for the proposed 42 nursing practice items in five areas of devising measures to address difficulties in support related to aspects such as repeated harmful behavior and social reintegration into community life, as identified in previous studies. The subjects were 54 visiting nurses who had been recommended by their managers as having extensive visiting nursing experience with patients receiving forensic outpatient treatment under the Medical Treatment and Supervision Act.

　Results: In the first survey, 28 responses were collected, the expressions for seven items were revised, and one item was added based on free opinion. In the second survey, 24 responses were collected, one item was deleted, and the expression for one item was revised. Eventually, consensus was reached for the proposed 42 nursing practice items.

　Conclusion: Utilizing the nursing practice items for which consensus was reached will likely alleviate the perceived difficulties of visiting nurses for patients receiving forensic outpatient treatment under the Medical Treatment and Supervision Act.