がん関連領域の専門・認定看護師が捉える認知症を有するがん患者・家族に対する看護上の課題

Nursing Problems Encountered by Certified Nurse Specialists and Certified Nurses in Cancer Nursing While Providing Nursing Care to Patients with Cancer and Dementia and their Families

要旨

　本研究の目的は，がん関連領域の専門・認定看護師が捉える認知症がん患者や家族に対する看護上の課題を明らかにすることである．A県内の8施設11名を対象に半構造化面接を行った．面接内容は，質的記述的研究手法を参考に分析した．

　結果，【認知症がん患者を尊重した治療選択支援の難しさ】【認知症がん患者の安全とQOLを保証したがん治療支援の難しさ】【認知症がん患者に適した生活環境調整の難しさ】【がんと認知症看護を統合した看護職への教育不足】【がんと認知症の専門性を活かした連携不足】【認知症とがんの合併による負担感を軽減するための家族支援の難しさ】の6課題が明らかとなった．

　これらの結果から，専門看護師・認定看護師は，認知症による記銘力・判断能力低下によって患者の意思や意向を十分に理解できず，認知症がん患者に対するがん治療効果やQOLへの影響に関するエビデンスが乏しいことで看護支援に対する確信をもてないと考えられた．安全対策を重視するあまり，認知症がん患者のQOL低下を引き起こしていることに倫理的ジレンマがあった．患者の治療・療養の場移行にともなう病院施設内外の看護師に対する認知症がん看護の質向上の重要性が示唆された．

　The purpose of this study was to clarify the nursing problems encountered by certified nurse specialists (CNS) and certified nurses (CN) in cancer nursing while providing nursing care to patients with cancer and dementia and their families. Semi-structured interviews were conducted of 11 nursing professionals from 8 facilities. Qualitative analysis of the interview contents revealed the following six problems: [Difficulty in decision support that respects patients receiving treatment], [Difficulty in family support to reduce confusion between cancer and dementia], [Difficulty in adjusting the living environment to suit the patient], [Lack of education of nursing staff who provide nursing care for patients with both cancer and dementia], [Lack of collaboration to utilize expertise in cancer and dementia nursing] and [Difficulty in supporting to ensure patient safety and quality of life (QOL) in cancer treatment]. From the results, it appears that CNS and CN cannot fully understand the patients' will or intention due to impaired memory/judgment of the latter associated with dementia, and cannot be confident in providing nursing support due to poor evidence of the efficacy of cancer therapy and effects of treatment on the QOL in cancer patients with dementia. They were faced with an ethical dilemma in that too much emphasis on safety measures led to a decrease in the QOL of cancer patients with dementia. The results suggest the importance of improving the quality of cancer nursing provided by nurses inside and outside hospital facilities for patients who are transferred to another treatment/recuperation facility.