慢性閉塞性肺疾患患者の終末期における訪問看護師の支援の構造

The structure of Support by Visiting Nurse for End Stage Patients with Chronic Obstructive Pulmonary Disease

要旨

　目的：COPD患者の終末期における訪問看護師の支援の構造を明らかにする．

　方法：関東圏内の訪問看護師を対象として半構造化面接を行い，グラウンデッド・セオリー・アプローチ（Strauss & Corbin, 1990/1999）を用いて分析した．

　結果：COPD患者の終末期における訪問看護師の支援は，《呼吸が苦しくても生きるために必要な意志を支え抜く》という現象を中核カテゴリーとして，この現象に関連する《呼吸の苦しさと全身症状を照らし合わせて予後を見通す》《身体の衰えに限界を感じる自らを許していく過程を見守る》《自己の存在意義と生きる意味の消滅から生じる苦痛を取り除く》《最期の時まで希望する療養の立て直しを助ける》《呼吸の苦しさと不安を取り除いて静かな命の終焉を目指す》という5つの主要カテゴリーと，13のカテゴリーで構成された．

　結論：COPD患者の終末期における訪問看護師の支援は，死を想定しながらも自立した状態での生活維持を懇望する患者の意志を貫く生き方を実現するプロセスであった．

　Objective: To clarify the structure of the support provided by home-visiting nurses to chronic obstructive pulmonary disease (COPD) patients during the disease's terminal stage.

　Methods: Semi-structured interviews were conducted with home-visiting nurses in the Kanto region and the data analyzed using the grounded theory approach by Strauss & Corbin (1990/1999).

　Results: With “supporting the will needed to live even if breathing is difficult” as the core category, the support provided by the participants during COPD patients' terminal stage was classified into five main categories—“providing a prognosis by comparing breathing difficulty and systemic symptoms,” “watching over the process of forgiving oneself feeling the limitations placed by one's physical decline,” “eliminating the pain arising from the disappearance of the meaning of one's own existence and of life,” “reconstructing the desired medical treatment until the final moments,” and “aiming for a peaceful end by eliminating breathing difficulty and anxiety”—and 13 categories.

　Conclusion: The support provided by the participants was a process of realizing a way of life in accordance with the patient's wish to retain their independence even with death near.