終末期がん患者を抱える家族員の予期悲嘆へのケアに関する一般病棟で勤務する看護師の認識

Recognition by General Ward Nurses Caring for End-of-Life Cancer Patients' Families Suffering Anticipatory Grief

要旨

　本研究の目的は，終末期がん患者を抱える家族員の予期悲嘆へのケアを実践している一般病棟で勤務する看護師の認識を明らかにすることである．

　一般病棟に勤務する看護師12名に半構成的面接を行い，語られた内容を質的帰納的に分析した．その結果，一般病棟で勤務する看護師は，【後悔のない看取りをサポートすること】を重視し，【予期悲嘆へのケアの基盤となる人間関係の大切さ】【予期悲嘆に伴う苦痛・苦悩を抱える家族員の力を高めるケアの大切さ】を認識していた．一方で，【予期悲嘆へのケアの困難さ】【看取り後に残る看護師自身の後悔】を認識しており，コミュニケーション能力などの看護師個人の資質向上だけでなく，予期悲嘆へのケアを組織的に提供する体制づくりや，自らのケアを客観視する力を養っていく必要性が示唆された．また，一般病棟で勤務する看護師が認識していた【看取り経験から得られた看護師としての成長】を促進するために，生と死について考えたり，終末期がん患者とその家族員をケアした体験を意味づけたりできる機会を得ることを支援していく必要性が示唆された．

　The purpose of this study was to clarify the recognition by general ward nurses caring for end-of-life cancer patients' families suffering anticipatory grief. Semi-structured interviews were conducted with a total of 12 nurses working on a general ward, and their accounts were analyzed in a qualitative and inductive manner. These accounts showed that the nurses placed emphasis on “supporting end-of-life cancer patients' families without regret”, and recognized the “importance of interpersonal relationships that become the basis for anticipatory grief care”, and the “importance of care that helps to nurture the strength of families suffering distress associated with anticipatory grief”. On the other hand, nurses recognized the “difficulty of providing anticipatory grief care”, and “nurses' own regret that remains after patients' death”. The results of our study indicate the need not only to improve the skills of nurses, such as their communication skills, but also to help them develop the ability to view their own care objectively, and establish systems for providing anticipatory grief care in an organized manner. In addition, in order to promote “growth as a nurse that can be achieved through end-of-life care experience”, which was noted by general ward nurses, we suggest the need to provide them with opportunities to consider life and death, and recognize the significance of their experience of caring for end-of-life cancer patients and their families.