がん患者の治療法の意思決定に対する看護師のかかわりの程度と看護の実践状況

The Extent of Nurse Involvement in Cancer Patients’ Decision-making about Treatment and the Status of Nursing Practice

要旨

　本研究は，がん患者の治療法の意思決定に対する看護師のかかわりの程度と看護の実践状況を明らかにすることを目的とした．看護師930名を対象に自記式質問紙調査を実施し，767名から回答が得られた．そのうち有効回答数は666部であった．分析は記述統計後，看護師のかかわりの程度と背景との関連について多重ロジスティック回帰分析を行った．意思決定支援に関する看護実践は，一元配置の分散分析を用いて病院種別による差を分析した．すべての分析はSPSS ver15.0を用いて行い，有意水準を5％とした．

　調査の結果，がん患者の治療法の意思決定にかかわることができると回答した看護師は，全体の40.5％であった．そして，意思決定支援に関する自主的な学習をしていることや，先輩看護師による勤務病棟の状況に即した実践的な指導があることが，意思決定支援に対する看護師の意欲の向上や自信につながる可能性が示唆された．看護の実践状況については，患者─看護師間や看護師─看護師間における行動はある程度実施されていたが，医師─看護師間における行動の実施度が低いことが明らかになった．また，都道府県がん診療連携拠点病院は，地域がん診療連携拠点病院や一般病院に比べてほぼすべての項目で看護実践の平均値が有意に高かった．このことから，意思決定支援に対する看護実践の向上には，都道府県がん診療連携拠点病院によるがん医療や看護に関する情報提供や指導，支援が必要であることが示唆された．

Abstract

　The purpose of this study was to clarify the extent of nurse involvement in cancer patients' decision. making about treatment, and the status of nursing practice. A self.administered questionnaire survey was conducted among 930 nurses, with 767 responses and 666 valid responses. After descriptive statistics, a multiple logistic regression analysis was performed to examine the relationship between nurses' involvement and their background. Differences in nursing practice for decision.making support according to the type of hospital were analyzed using a one.way analysis of variance. All analyses were performed using Statistical Package for the Social Sciences(SPSS)ver. 15.0, with a significance level of 5% .

　The survey results showed that 40.5% of nurses answered that they could be involved in decision. making about treatment. The results suggest that voluntary learning on decision.making support and practical guidance by senior nurses according to the status of the hospital wards may lead to improvement of nurses' awareness regarding decision.making support and help to increase their self.confidence. As for the status of nursing practice, it was revealed that patient.nurse and nurse.nurse interactions occurred to some extent, but physician.nurse interactions were recorded less frequently. In addition, the mean scores for almost all items of nursing practice were significantly higher in prefectural core hospitals for cancer care than in regional core hospitals for cancer care and general hospitals, suggesting that the provision of information, guidance and support concerning cancer care and nursing by prefectural core hospitals for cancer care is necessary to improve nursing practice regarding decision.making support in other hospitals.