慢性呼吸器疾患患者の病期移行期のAdvance Care Planningを支援する熟練看護師の実践

Advance Care Planning Support of Experienced Nurses for Patients With Chronic Respiratory Disease in Transitional Stage

要旨

　目的：慢性呼吸器疾患患者の療養支援に関わる熟練看護師が病期移行期においてACPをどのように支援しているのかを明らかにすることを目的とした．

　方法：慢性呼吸器疾患患者を支援している熟練看護師に半構造化インタビューを行い，質的帰納的に分析した．

　結果：【信頼関係を築きながら，日常の生活にこだわって聴く】ことで，途切れない関係性を構築していた．それは【患者や家族が選択できる土台をつくる】支援へとつながっていた．また，【意思決定が求められるタイミングをみはからう】ことができるよう，【変化する状況を見極め（る）】ていた．そして【チームとしての信頼をつなぎ，前に進む】ことができる支援環境を築いていた．

　結論：病期移行期のACPの支援は，安定期から不安定期を行き来する軌跡の中で，生活背景や価値を見据え，患者が選択し，意思決定ができるようサポートし，チームで支えていくため，継続的な支援が行われていた．

　Objective: The purpose of this study was to reveal how expert nurses involved in recuperative assistance for patients with chronic respiratory disease support ACP during the transitional period.

　Method: Semi-structured interviews were conducted with expert nurses who assisted patients with chronic respiratory disease. The interviews were analyzed qualitatively and inductively.

　Results: By "listening particularly to their everyday life while building a relationship of trust," they built an uninterrupted relationship. This led to support for "creating a foundation for patients and their families to choose." Moreover, in order to be able to "know the timing of ACP intervention," nurses "assessed the changing situation and provided support." They built a supportive environment that allowed the "building of trust as a team and making progress."

　Conclusion: In the trajectory of going back and forth from a stable to an unstable period, continuous assistance was provided to support patients as a team, so that they could make choices and decisions based on their lifestyle background and values.