訪問看護師が捉えた在宅療養を行う薬剤耐性菌検出患者・家族の心理・社会的課題

Psychosocial Issues of Patients with Detected Drug-resistant Bacteria and Their Families who Perform Home-based Medical Treatment, as Reported by Visiting Nurses

要旨

　目的：薬剤耐性菌を有しながら在宅療養を行う薬剤耐性菌検出患者・家族の心理・社会的課題を明らかにすること．

　方法：訪問看護ステーションに勤務する看護師を対象とし，薬剤耐性菌を有し在宅療養を行う患者・家族の心理的反応，社会生活への影響についての認識を半構造化面接により捉え質的記述的内容分析をした．

　結果：心理的課題として，【コントロール困難な状況により引き起こされる感情】，【目に見えないがゆえの楽観視】，【答えが出せない問い】，社会的課題として，【差別されたくないという感覚】，【離れて暮らす家族との心理的距離】，【通所・施設サービス利用の制限】が存在するとの認識が明らかになった．

　結論：薬剤耐性菌検出患者・家族は，コントロール困難な状況において起こる感情や他者から差別をされたくないという感覚を有し，差別や偏見により社会的孤立が懸念され，薬剤耐性菌検出を理由に通所・施設サービス利用が制限されることで，家族の介護負担が増大する状況が示唆された．

　Objective: To clarify the psychological and social issues of patients and families with drug-resistant bacteria who receive home care while having drug-resistant bacteria.

　Methods: Semi-structured interviews were conducted with nurses working at a home health care station to understand the psychological reactions of patients and their families who receive treatment at home with drug-resistant bacteria and their perceptions of the impact on their social lives.

　Results: The following psychological issues were identified: [feelings caused by uncontrollable situations], [optimism due to invisibility], [unanswerable questions], and social issues: [sense of not wanting to be discriminated], [psychological distance from family members who live apart], [limitation of access to day care and facility services]. The results of this study revealed that the following social issues existed in the patients

　Conclusion: Patients and their families who have detected drug-resistant bacteria have feelings that arise in situations that are difficult to control and a sense of not wanting to be discriminated against by others. They are concerned about social isolation due to discrimination and prejudice, and they are concerned that their access to day-care/facility services may be restricted due to the detection of drug-resistant bacteria. The results suggest that the burden of caregiving by family members increases when they are restricted from using day-care and facility services due to the detection of drug-resistant bacteria.