進行・再発治療期のがん患者・家族に対する訪問看護師の看護実践上の困難と学習ニーズ

Difficulties and Learning Needs of Home Care Nurses Caring for Advanced-Recurrent Treatment Stage Cancer Patients and Their Families

要旨

　【目的】進行・再発治療期のがん患者・家族を看護するうえで訪問看護師が感じる困難と学習ニーズを明らかにする．

　【研究方法】研究参加者：訪問看護師18名．データ収集：半構成的質問紙による面接法と質問紙調査．分析：進行・再発治療期のがん患者・家族を看護するうえでの困難と学習ニーズについて語られている部分を抽出しカテゴリー化した．

　【結果】進行・再発治療期のがん患者・家族を看護する上での困難は，《治療の継続・中止に関わる介入に思い悩む》《先の見えない不安への対応に悩む》《化学療法に関連した知識がわからない》など9カテゴリー，困難の解決に向けた学習のニーズは，《化学療法に関する基礎知識を得たい》《最新の薬物療法について学びたい》など7カテゴリーが抽出された．

　【考察】進行・再発治療期のがん患者・家族に対する訪問看護師の看護実践上の困難は，倫理的問題，看護を実践するうえでの拠り所となる知識や技術，在宅ケアの提供システムに関することであった．訪問看護師のがん看護実践上の困難を軽減し，地域で患者・家族を支えるためには，看護倫理や最新の知識，コミュニケーション技術や精神面の援助を含めた教育の必要性が示唆された．

　The purpose of this study was to clarify difficulties and learning needs of home care nurses when they are required to provide nursing care for advanced-recurrent treatment stage cancer patients and their families. Data was collected using semi-structured interviews and self-administered questionnaires given to eighteen home care nurses. Collected data was analyzed to extract responses concerning difficulties and learning needs relating to nursing care for advanced-recurrent treatment stage cancer patients and their families, and categorize them according to similarities in semantic content. The difficulties in nursing care for advanced-recurrent treatment stage cancer patients were classified into nine categories including：“Struggling with intervention regarding the continuation and cancellation of treatment”; “Troubled over how to deal with the patient's anxiety regarding an uncertain future”; “A lack of knowledge about chemotherapy”. Learning needs in nursing care for advanced-recurrent treatment stage cancer patients were classified into seven categories including：“Wanting to learn the basics of chemotherapy”, “Wanting to learn the latest chemotherapy treatments”. The difficulties of home care nurses when they are required to provide nursing care for cancer patients and their families relate to ethics, knowledge and the technique to support on their own care, the provided system for the home care. We suggested that it is necessary to educate about nursing ethics, latest treatment, communication skill and psychological care so that home care nurses can reduce difficulties to provide cancer care and support the patients and their family in local area.