前立腺がん治療に伴う性機能障害への支援における看護師の相反する2つの態度とその背景

Two conflicting attitudes of nurses and their backgrounds in support for sexual dysfunction associated with prostate cancer treatment

要旨

　本研究は，前立腺がん治療に伴う性機能障害への看護支援の実情を明らかにすることを目的とし，前立腺がんに関わる部署で3年以上勤務経験をもつ看護師10名に，性機能障害への関わりとその背景について半構成的面接を実施し得たデータを質的帰納的に分析した．

　看護師の関わりは〖性機能障害を抱えた患者を受け容れ問題解決に向かう〗態度と〖前立腺がん患者の性機能障害の支援に踏み込まない〗態度に大別された．｛性機能障害を抱えた患者を受け容れ問題解決に向かわせるもの｝には【看護師自身の志向や都合にかかわらず患者の性機能障害に向き合う姿勢】【関わりの辛さを傾聴・共感する看護師同士の支え合い】が示されていた．一方｛前立腺がん患者の性機能障害の支援に踏み込みにくくさせるもの｝には【性機能障害に対する看護師の思い込みや無関心】などの〖看護師の背景〗，【性機能障害を医療者に発信することへの不安と恐れ】などの〖考えられる患者の背景〗，【性機能障害に関わるための基礎・卒後教育の未整備】などの〖性機能障害に関わるシステムの未整備〗が示されていた．

　支援の促進に向け，性機能障害に関わる専門家の育成とチーム医療体制の構築，性の看護に対する看護師個々の感情に理解を示す職場風土の形成，前立腺がん患者の性機能障害に対応できる教育システムの構築，性機能障害に着目したマニュアル・ツールの作成，性に関わる倫理・行動規範の明示と遵守が必要である．

　This study aimed to reveal the state of nursing support provided for patients with sexual dysfunction associated with prostate cancer treatment. Participants were 10 nurses with ≥3 years of experience working in a department for prostate cancer. Semi-structured interviews were conducted to collect data on the nurses' backgrounds and their involvement in caring for patients with sexual dysfunction. The obtained data were analyzed qualitatively and inductively.

　The nurses' involvement was broadly divided into the following two attitudes: those who accepted patients with sexual dysfunction and worked towards solving the associated problems and those who did not step in to care for sexual dysfunction in patients with prostate cancer.

　The backgrounds of nurses accepting patients with sexual dysfunction and working towards solving their problems included “the attitude of facing a patient's sexual dysfunction regardless of the nurse's own orientation or circumstances,” and “mutual support among nurses who listen to and sympathize with the difficulty of involvement.” Alternatively, the backgrounds of nurses who did not step in to care for sexual dysfunction in patients with prostate cancer were “the nurse's assumption or indifference to sexual dysfunction [background related to nurses],” “anxiety and fear of telling the medical staff about sexual dysfunction [background related to patients],” and “underdeveloped basic and postgraduate education to care for sexual dysfunction of patients [undeveloped systems].”

　To promote adequate nursing support for sexual dysfunction in patients with prostate cancer, several suggestions were provided, such as training experts and establishing a team system to care for patients with sexual dysfunction, creating a workplace culture that considers nurses' feelings about this topic, establishing a systematic education system to address this condition, developing a manual focusing on sexual dysfunction in patients with prostate cancer, and clearly indicating and adhering to ethical and behavioral standards related to sexuality.