訪問看護師からみた終末期がん患者の在宅療養に関する問題とその解決策

Issues and Solutions with the Care of End-of-Life Cancer Patients at Home from the Perspective of Visiting Nurses

要旨

　本研究の目的は，訪問看護師からみた終末期がん患者の在宅療養に関する問題と，その解決策を明らかにすることである．対象は関東の訪問看護ステーションに常勤勤務する訪問看護師25名で，過去1年間に終末期がん患者を3件以上担当した者とした．調査対象者に，調査目的・方法・調査への参加は自由意思で調査に協力しないことで不利益は生じないことなどを，口頭と文書にて説明した．結果は，約半数が訪問看護師経験10年以上であり，19名が10件以上のがん患者に関わっていた．半構造化面接により終末期がん患者の在宅療養に関する問題が抽出され，【医師に関する問題】【家族に関する問題】【療養環境に関する問題】【看護師に関する問題】【訪問看護師の負担感に関する問題】【他職種に関する問題】【患者に関する問題】【連携に関する問題】【訪問看護ステーションの運営に関する問題】【関係者間の意見調整に関する問題】【利用者の経済的負担に関する問題】の11カテゴリーに分類された．さらにそれぞれの問題に対して，訪問看護師にできる解決策も明らかにした．問題を明確にしその解決策を考えることで，質の高い終末期在宅ケアの提供につながると考える．質の高い終末期在宅ケアが提供できれば，結果として患者・家族の満足につながると考える．

Abstract

　The objective of the study was to clarify the issues related to the care of end-of-life cancer patients at home from the perspective of visiting nurses, as well as to clarify the measures implemented in response to the identified issues. The subjects of this study were 25 visiting nurses working full time at visiting nurse stations in the Kanto region of Japan and who have worked with at least 3 patients with cancer in the last year. About one-half of these nurses have 10 or more years of experience as a visiting nurse, and 19 nurses have been involved with 10 or more cancer patients. The issues related to the care of end-of-life cancer patients at home were identified by a semi-structured interview, and these issues were classified into the following 11 categories: doctors, family, care environment, nurses, feeling of burden experienced by the visiting nurse, workers of other occupations, patient, cooperation, operation of the visiting nurse station, adjustments of opinions between the parties involved, and economic burden of use. Furthermore, measures that can be implemented by the visiting nurses in response were clarified for each of the identified issues. The clarification of issues and the investigation of possible countermeasures will lead to high-quality care of end-of-life cancer patients at home, which then, as a result, will lead to the satisfaction of patients and their families.