熟練看護師が実践する大腿骨頚部骨折を発症した超高齢者への周手術期の看護

Perioperative Nursing Care Provided by Experienced Nurses to Oldest-old Patients with Femoral Head Fractures

要旨

　目的：熟練看護師が実践する大腿骨頚部骨折を発症した超高齢者への周手術期の看護を明らかにする．

　方法：熟練看護師12名に半構成的面接を行い，修正版グラウンデッド・セオリー・アプローチを用いて分析した．

　結果：熟練看護師は超高齢者にとって【安心して入院生活を過ごすための意図的な関わり】【身体機能の低下を防ぐための意図的な関わり】【認知機能の低下を防ぐための意図的な関わり】に基づき，【超高齢者が無事に手術を受けるための術前のケア】と【超高齢者が順調な回復に向うための術後のケア】を行っていた．また早期から【超高齢者の状況に応じた家族や多職種との情報共有】を行い【超高齢者を介護する家族の負担を考慮した退院支援】につなげていた．これらの看護実践の基盤は【超高齢者が無理をしないための配慮】であり，不可欠な支援であった．

　結論：これらの知見に基づく看護の実践は超高齢者のQOLの向上に寄与することが示唆された．

　Objectives: To elucidate perioperative nursing care provided to oldest-old patients with femoral head fractures by experienced nurses.

　Methods: Semi-structured interviews were conducted with 12 experienced nurses and analyzed the data using the modified grounded theory approach.

　Results: Experienced nurses provided oldest-old patients with [preoperative care so that the oldest-old patient can undergo surgery without incident] and [postoperative care for the oldest-old patient to recover smoothly], which were based on [intentional involvement for oldest-old patients to pass their hospital stay with ease], [intentional involvement to prevent decline in physical functioning], and [intentional involvement to prevent decline in cognitive functioning]. Furthermore, from the early stage, [sharing of information among multi-disciplines and with the family according to the status of the oldest-old patient] led to [discharge support, taking into consideration the burden on the family members who will provide care for the oldest-old patient]. The basis of these nursing duties lies in [the consideration of preventing the elderly individual from exertion] and providing indispensable support to the oldest-old patient.

　Conclusion: On the basis of these findings, it was suggested that nursing duties contribute to improving the quality of life of oldest-old patients.