訪問看護導入の必要がある外来化学療法を受ける高齢がん患者の特徴

Characteristics of Elderly Cancer Patients Undergoing Outpatient Chemotherapy Requiring Visiting Nursing

要旨

　本研究の目的は，外来看護師と訪問看護師が訪問看護導入を必要と判断する外来化学療法を受ける高齢がん患者の特徴を明らかにすることである．

　外来看護師13名，訪問看護師10名へ，個別の半構造化面接法を実施し，得られた逐語録の質的内容分析を行った．その結果，訪問看護導入が必要と判断される外来化学療法を受ける高齢がん患者の特徴として，「治療決定から外来化学療法を開始するまでの時期」では【自己管理の困難が予測される要因の存在】【家族介護力の危うさ】，「外来化学療法を継続する時期」では【自己管理の困難】【治療方針の再検討の必要性】【治療継続に影響を及ぼすほどの家族介護力の低下】，「外来化学療法の継続が困難になる時期」では【最期の過ごし方に関する決断の不可避】【家族介護の限界】に着眼されていることが導き出された．

　外来看護師と訪問看護師は，高齢がん患者の自己管理と家族の負担を見極め，訪問看護導入の必要な対象を判断していることが明らかになった．また，治療を継続する時期から高齢がん患者に今後の生活や人生を考えてもらい，治療や療養の方向性を高齢がん患者が自身で選択できることに主眼を置きながら，訪問看護の導入が必要な対象を判断していることが示された．

　Individual semi-structured interviews were held with 13 outpatient nurses and 10 visiting nurses to clarify the characteristics outpatient and visiting nurses focus on to determine whether elderly cancer patients undergoing outpatient chemotherapy need visiting nursing. A qualitative content analysis was conducted on the verbatim recordings. Results show the nurses focus on the following characteristics of elderly cancer patients undergoing outpatient chemotherapy deemed to require visiting nursing. In the period from treatment decisions until the outpatient chemotherapy treatment, they are “the existence of factors foreseen to make self-management difficult” and “uncertainty whether family is able to support the elderly cancer patient.” In the period of continued outpatient chemotherapy, characteristics are “difficulty with self-management,” “need to re-examine the direction of treatment and recuperation,” and “a decline in the family's ability to provide nursing care to a degree that impacts the continuation of treatment.” In the period when continuation of outpatient chemotherapy becomes difficult, the characteristics are “unavoidable decisions on how to spend the rest of the patient's life” and “limitations on family alone providing care.” This study clarified that outpatient and visiting nurses ascertain an elderly cancer patient's self-management and the family's burden to determine who needs visiting nursing. It also indicated that the nurses determine the necessity of introducing visiting nursing while asking elderly cancer patients to consider their lifestyle and life going forward from the period of continued therapy, and concentrating on the patient's ability to choose the direction of treatment and recuperation on his or her own.