日本血液学会研修施設を対象としたがん化学療法を受ける血液・造血器疾患患者への看護師による口腔ケアの実態

Oral Care in Nursing Practice for People with Hematological Malignancies during Chemotherapy in Japan

要旨

　本研究の目的は，日本におけるがん化学療法を受ける血液・造血器疾患患者への看護師による口腔ケアの実態を明らかにすることである．日本血液学会研修施設の当該病棟看護師長と病棟看護師を対象に郵送による横断的・自記式質問紙調査をした．対象看護師長には，施設の概要・標準的口腔ケアなどについて，対象看護師には，看護師の属性・実施している口腔ケアについて調査した．

　対象施設497施設中172施設の協力が得られ1,746部の質問紙が回収できた（回収率30.4％）．そのうち，有効回答は1,735件（99.4％）であった．氷片の含嗽は化学療法による口腔粘膜炎発生予防に効果的だが，実施しているとの回答は13.0％で，効果のないイソジン含嗽は78.6％と非常に高い割合だった．予防目的でのイソジン含嗽使用の割合は，施設内にがん看護専門看護師がいる場合は，いない場合より有意に低かった（χ²＝15.698，df＝1，p＜.05）．口腔内観察開始を口腔粘膜炎発生後に開始すると回答した割合は，院内にがん看護専門看護師，あるいはがん看護領域の認定看護師がいる場合は，いない場合より有意に低かった（χ²＝24.274，df＝1，p＜.05）．

　今回の調査で明らかになった口腔ケア実施状況での問題は，豊富な知識や熟練の技術を必要とするものではなく，まずは，口腔ケアに関する最新の基礎知識を得ることだけでも，大きく改善すると思われる内容であると考える．さらに結果は，口腔ケアの向上を図るうえで，がん看護の専門性の高い看護師の役割が重要であることを示唆していた．

Abstract

　Purpose: To present the findings of a survey that examined oral care in nursing practice for people with hematological malignancies during chemotherapy in Japan.

　METHODS: A cross-sectional designed survey was undertaken. The questionnaires were sent to chief and staff nurses working in hematological units of 497 hospitals certified by The Japanese Society of Hematology. The data collected were from 172 chief nurses and 1,735 staff nurses in the hematological units.

　RESULTS: Of the responding staff nurses(n=1,735), 78.6 % reported using povidone iodine to prevent oral mucositis yet, the Cochrane report says gargling with povidone iodine is not effective. On the other hand, only 13.0 % reported using cryotherapy, which is recommended by the Cochrane reports to prevent oral mucositis. The numbers of the nurses using povidone iodine in the hospitals that have Certified Oncology Nurse Specialists were significantly lower(p＜0.05)than the nurses in the hospitals that did not have Certified Oncology Nurse Specialists/Certified Nurses. Initiating oral observation after the onset(as opposed to prevention)were 7.6 % of the nurses in the hospitals that have Certified Oncology Nurse Specialists, compared with a significant number 16.4 %(p＜0.05)of nurses in the hospitals that did not have Certified Oncology Nurse Specialists/Certified Nurses.

　CONCLUSIONS: According to the results of this research, the latest information on oral care for people with hematological malignancies during chemotherapy is needed in Japan. In addition, this research shows that Certified Oncology Nurse Specialists take on an important role in improving oral care for people.