終末期患者の尊厳を重視する集中治療室看護師の実践知

Practical Wisdom of Intensive Care Unit Nurses Who Respect the Dignity of Patients at End of Life

要旨

　目的：集中治療室（以下，ICU）で終末期患者の尊厳を重視する看護師の実践知を明示すること．

　方法：看護師経験5年以上・ICU経験3年以上の看護師8名に，質問紙調査・半構造化面接を行い，質的帰納的に分析した．

　結果：実践知として【終末期患者自身から情報が得られにくい状況を悟り，知識・経験・獲得した多様な情報を結びつけ，患者の価値観を支援に反映する】，【様々な制約により，共に過ごす時間・空間が不足している終末期患者と家族の状況を察知し，両者の心理的・物理的距離が離れないよう創意工夫する】，【終末期患者と家族への支援の意味を捉え，集中治療領域の終末期看護を探求し続ける】等の5つのカテゴリーを明示した．

　結論：救命が第一義であり患者の尊厳がまもられにくいICUで終末期患者を支援した看護師の実践知は，患者のその人らしさ・看護支援での患者の存在のありようを大切にする看護師の姿を反映していた．

　Objectives: This study aimed to examine the practical wisdom of intensive care unit (ICU) nurses who respect the dignity of patients at end of life.

　Methods: Questionnaire and Semi-structured interviews were conducted with eight nurses who had more than five years of experience and more than three years of ICU experience. The obtained data were qualitatively and inductively analyzed.

　Results: Five categories were extracted as practical wisdom, including “Recognizing that it is difficult to obtain information from patients at end of life, combining knowledge, experience, and various information acquired, and reflecting the patients' sense of value in support”; “Recognizing the situation of patients at end of life and their families who lack the time and space to spend time together owing to various limitations, and making creative efforts to reduce the psychological and physical distance”; and “Continuing to explore end-of-life care in ICUs by grasping the meaning of support for patients at end of life and their families.”

　Conclusions: In ICUs, where the primary focus is on saving lives, and it is difficult to respect the dignity of patients. The practical wisdom of nurses in ICUs who support patients at end of life is reflected in the attitude of nurses who valued the personality of patients and how patients exist in nursing support.